Get your two strength sessions in per week

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physio newcastle university callaghan

Callaghan provides a community who strive to produce and utilise research to better ourselves and our university.

There is a single research driven intervention that increases concentration, mood, mental health, metabolic health and overall well-being. Yet most of us struggle to maintain a routine that includes it. Exercise is that intervention and it is well known that achieving the National health and WHO recommendations of 150-300 mins of exercise per week including two strength sessions provides many benefits.

So, what are the side-effects or negative consequences of achieving this? If you find the right exercise for you and use simple exercise guidelines there are minimal risks. Here are some of those recommendations:

  • If over 50 get a medical check from your GP before starting a new routine, especially if its going to be high intensity exercise.
  • Don’t go too hard at the start. Its a common source of injury when the body is not conditioned to a new activity or exercise program.
  • If you are going to lift weights, then make sure your technique is correct. A personal trainer or exercise physiologist at NU Sport can provide this advice and education.
  • Strength classes don’t have to involve weights. You can use body weight in multiple ways to achieve your two strength sessions. Learn more about strength in small group pilates style classes designed for uni staff on campus.
  • If you feel pain associated with exercise that doesn’t ease of quickly then get some advice from the uni physio clinic on campus. Don’t let pain stop you participating in activity and exercise. Early advice and management is the key.

Go to the gym and get your 2 recommended strength sessions per week! You will feel better and live healthier if you can achieve what research has clearly proven.

If you want to read more here is a summary of a research article on strength exercise.

10 things NOT to do with tendon pain

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1. Rest completely

Tendon pain stems from the tendon not coping with a given load. Complete rest will only decrease the tendon’s capacity to tolerate load even further. Rather than completely resting, you should continue to place the tendon under a small amount of load that you know it will tolerate, and then slowly and progressively increase it over time.

2. Have ongoing passive treatments

Passive treatment such as massage, dry needling, ice, heat, TENS, ultrasound and interferential do not improve the tendon’s capacity to tolerate load, and therefore will usually not provide long lasting benefit. Some of these treatments can be helpful in the short term for pain relief if you aren’t coping, however it is understood that these treatments aren’t curative.

Tendon Pain

Passive Tr

3. Have injection therapies

Injections directly into tendon tissues has not been shown to be effective in good clinical trials. In some cases, particular injections can actually have a detrimental effect to the tendon’s health long term. They should only be considered if the tendon has not responded to a well designed and implemented exercise-based program.

4. Ignore your pain

Once you have tendon pain, it is normal to expect some pain when you place load on the tendon. Just as you shouldn’t rest completely, you also shouldn’t push through large amounts of pain. A general guide is that pain more than 4/10 pain might indicate that the tendon isn’t coping with the load and it may make the condition worse over time. If pain is kept below a 4/10 during and after exercises and the pain is allowed to settle between bouts of exercise, the tendon will likely adapt, get stronger and tolerate more activity with less pain in the future.

5. Stretch your tendon

Stretching your tendon places it under high compressive load. We now know that compressive load can be harmful to a painful tendon and may slow down its recovery. There is also no published evidence to support stretching as a useful intervention in tendon pain.

6. Massage your tendon

An overloaded and irritated tendon is often further aggravated by the compressive load of massage. Massage, like other passive therapies is not usually helpful in the long term, though may provide short term pain relief.

7. Be worried about the images of your tendon

Tendon imaging (ultrasound or MRI) and medical terms such as ‘degeneration’ and ‘tear’ can create some fear around loading a tendon. The concern is that loading may make the tear worse and cause further degeneration. There is actually evidence demonstrating that problematic tendons can eventually tolerate quite significant load without pain, especially when load is incrementally increased. Interestingly, the amount of changes identified on imaging is actually poorly associated with the load capacity in a tendon.

8. Be worried about rupture

Pain is a protective mechanism that makes you unload a tendon – therefore you are actually less likely to rupture a tendon which is painful. Most tendons that rupture are pain-free, despite having substantial pathology when subjected to medical imaging (see point 7 – imaging is not a reliable indicator of a tendons capacity!)

9.  Take short cuts with rehabilitation

Time is required to develop strength and increase a tendon’s capacity. Although this time can seem long (sometimes 3-6 months or longer), the long-term outcomes are good if rehabilitation is completed. Things that are often promised as immediate fixes (see points 2 and 3) may provide short term pain improvements with no positive effect on long term tendon loading capacity and function.

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10. Not understand tasks requiring high tendon loads

As a general rule, painful tendons hate being compressed and contracted forcefully from a stretched position. For the achilles and patella tendon, this involves spring like tasks, such as jumping, sprinting and changing direction. Early tendon rehab involves slow resistance exercises with gradual increases in load. As your tendon adapts to rehab, you should progress towards faster, spring like actions to prepare you for the functional demands of the muscle-tendon unit.

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So what does this mean for you?

The current best evidence for rehabilitating painful tendons is an exercise-based program which is progressive and guided by a physiotherapist with an understanding of these tendon loading principles. An individual’s pain and function need to be considered, and loads adjusted accordingly to ensure that tendons are being appropriately challenged.

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This blog is an adaptation of the work of Professor Jill Cook – a world leader in tendon pain management – and you can find her original article, along with an accompanying video at http://semrc.blogs.latrobe.edu.au/10-things-not-to-do-if-you-have-lower-limb-tendon-pain/.

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Stay tuned for more information about tendinopathy in our upcoming tendon series.

If you or someone you know is suffering from tendon pain, contact us:

Ph: (02) 49216879

E: admin@numovesphysiotherapy.com.au

Staying active on Callaghan campus

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Staying active on Callaghan Campus Physio Newcastle

Its winter but your body still needs a regular dose of activity. Staying active is harder when the days get shorter but it’s still just as important and beneficial to our health. The good news is that inactivity is reversible.

The research still tells us that better cardiovascular fitness is associated with healthier living and 2 strength sessions per week can make a difference to your health in many ways. We’ve summarised the evidence of staying active via strength exercise previously. Click here to read more. There are plenty of good activity options on Callaghan campus.

  • Walking on campus – it’s the quickest and easiest option and much better than having lunch at your desk each day
  • Outdoor equipment surrounding the oval 2 and 3 outside The Forum is free and easy to use. Another great lunchtime session combined with walking between them.
  • Group fitness classes at The Forum – either before work or after or even at lunchtime, the group fitness classes
  • NU Strength classes – If you like small group, mat based pilates style exercise then NU Moves Physio provides a range of early morning, lunchtime and evening workouts to help the body and back.
  • The newly refurbished gym at The Forum is an excellent way to combine cardio exercise with some stretching and strength exercise for an overall feel better workout that you are in control of.
  • Have a swim at The Forum – its particularly quiet and calm around lunchtime for a peaceful exercise session that will make you feel great.

Feel better & get active. Its worth doing.

Pre-operative & non-operative ACL physiotherapy

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ACL physiotherapy

 

The benefits of a high-quality individualised rehabilitation program after having ACL surgery are clear, but what should individuals be doing immediately after their ACL injury? Well, current best practice guidelines1 advise gentle pain-free range of motion exercises within the first few days, followed by commencement of early ACL physiotherapy. The physiotherapist will take some measurements of swelling and range of movement as well as strength on the un-injured side. Early goals of physio are to reduce pain and swelling and restore normal range of movement. Following a significant knee injury it is common to experience poor activation and wasting of the muscles in the thigh, particularly the quadriceps. A large component of physio following knee injury is to get these muscles firing again and rebuild strength back up towards normal.

Together with an orthopaedic surgeon or sports physician, the physiotherapist can help guide the decision when to have the ACL reconstructed. It is generally accepted that patients should have their ACL reconstructed as soon as possible following injury. However, if the knee is still significantly swollen, painful and has poor function, it is likely to be in a worse state following surgery and take longer to return to normal. Ideally, before having surgery, the knee should have minimal swelling, good range of movement, muscle strength and balance. Studies have identified that pre-operative quads strength predicts outcome 2 years after surgery. This means that if someone doesn’t regain good quads strength before surgery, they have to work very hard for a longer time after surgery to get their strength back.

Depending on the type of injury, how an athlete is progressing with their rehab, and their sporting or functional goals, surgical intervention might not be necessary at this point. Regardless of whether an individual has surgery – undergoing a physiotherapist guided rehabilitation program immediately following ACL injury has been found to improve outcomes both pre- and post- surgery3.

One study found 50% of patients who delayed their operation and underwent rehabilitation avoided the need for surgery at all. Interestingly, over the following 6 years there was no negative consequences of delaying surgery. In fact, early surgery, and delayed (optional) surgical groups had no significant difference in the following outcomes:

  • Participation in sport
  • Quality of life scores
  • Evidence of arthritis on scans
  • Future surgery

If you’re interested in finding out more about ACL rehabilitation or seeking guidance regarding the best time to have your ACL reconstructed, contact us on 49216879.

  1. https://bestpractice.bmj.com/topics/en-gb/589/management-approach BMJ Best practice guidelines
  2. https://www.bmj.com/content/bmj/346/bmj.f232.full.pdf 2013 Study
  3. https://www.ncbi.nlm.nih.gov/pubmed/26879746 2017 Systematic review

 

Optimising outcomes after ACL surgery

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ACL surgery rehab physiotherapy newcastle australia

As discussed in our previous post, the rate of ACL surgery in Australia are on the rise. We are also performing the most ACL reconstructions per person than any other country in the world. Alarmingly though, the incidence of secondary ACL repairs is rising at a greater rate than primary repairs! Why is this so? Part of the reason may be due to the quality of rehabilitation and/or the decision-making process regarding return to sport (RTS).

So, what does a high-quality rehabilitation program comprise of, and what needs to be considered when making a return to sport?

An ACL rehabilitation program should be individualised. The stage of healing, current impairments and the individual’s goals must be considered. A quality program should be broken into phases with the athlete working towards specific goals within each phase before progressing to the next phase. The athlete should be guided by their physiotherapist to restore normal joint range of motion, muscle strength, balance and proprioception (awareness), landing mechanics, speed, power and agility. Then, the athlete must prepare for returning to sport. During this last phase of rehab, it is very important that the athlete attempts progressively harder sport-specific exercise and develops confidence in the tasks they will be required to do in their particular sport. This process should be guided by a physiotherapist who can take specific measurements to determine progression of rehab through the various phases.

Deciding when to return to sport can be difficult. In 2016, a meeting of world experts in injury management developed a consensus statement on returning to sport. One of the key findings from this conference was that the time to RTS varies among individuals, unrelated to the type and severity of injury. While time alone is not a reliable indicator of readiness to return to sport, it has been found that the likelihood of re-injury is reduced by 51% for each month a return to sport is delayed from 6 months until 9 months post-surgery (Grindem 2016).

So while delaying a RTS until at least 9 months following surgery is wise, decisions should be made based on information from a battery of tests. These tests should include not only physical tests such as strength, power and agility, but also assessment of psychological readiness and confidence. One particular study found that individuals who did not successfully complete the outcome measure at the end of their rehabilitation before returning to sport were 4x more likely to re-rupture their ACL (Kyritsis 2016).

If you’ve injured your knee and want help to ensure you optimise your recovery and avoid reinjury, contact us on 02 49216879 or admin@numovesphysiotherapy.com.au.

Please find the articles referred to in this post below:

  1. Likelihood of ACL graft rupture: not meeting six clinical discharge criteria before return to sport is associated with a four times greater risk of rupture (Kyritsis, 2016)
  2. 2016 Consensus statement on return to sport from the First World Congress in Sports Physical Therapy, Bern (Griffin, 2016)
  3. Simple decision rules can reduce reinjury risk by 84% after ACL reconstruction: The Delaware-Oslo ACL cohort study (Grindem, 2016)

ACL reconstruction on the rise in Australia

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Newcastle football physiotherapy

 

News reports of high-profile athletes being sidelined due to ACL injuries seems to be becoming more and more common in Australia – and a recent study suggests that this isn’t just a coincidence. Research published last year has found the incidence of knee reconstructions performed in Australia to be on the rise, with Australia now performing more of these surgeries than any other country in the world!

From 2000 to 2015, the annual incidence of this surgery increased by 43%, and by a staggering 74% among those under 25 years of age. Those most likely were men aged 20- 24 years, and women aged 15 – 19 years. It is suspected that this is a result of greater participation in these age groups in high risk sports which involve pivoting, jumping and rapid deceleration. It is estimated that 72% of ACL reconstructions in Australia are sport-related, with sports such AFL, rugby, netball, basketball, soccer and skiing the most frequent culprits.

Perhaps even more alarmingly, the percentage of people undergoing revision ACL reconstructions was found to be increasing more rapidly than those undergoing their first reconstruction! This suggests that not enough people are completing high-quality rehabilitation, or perhaps are returning to high-risk activities too soon.

In the following weeks we’ll discuss how to most effectively prevent ACL injuries, and the evidence behind making a safe return to sport after undergoing surgery. If you’ve injured your knee and are considering surgery, or if you’ve already had knee surgery and want to ensure you optimise your recovery and avoid reinjury, contact us on 02 49216879 or admin@numovesphysiotherapy.com.au.

To read more on this topic go to: https://www.mja.com.au/journal/2018/208/8/increasing-rates-anterior-cruciate-ligament-reconstruction-young-australians

Bending the back

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Back pain physio newcastle australiaWe all know the old posters showing correct lifting technique. An ominous red cross stamped atop a person bending the back to pick up a box. The message was clear “keep the spine straight and move through the hips and knees when lifting”.  After all, many back injuries result from lifting with a rounded spine. However, what if there is no load or you are not lifting? Is it unsafe to tie our shoes, or play with the kids? This message has been misinterpreted somewhat. Fearing bending the back (spinal flexion) when it is not under load in some cases can lead to persisting back pain. The problem is that if we don’t move and stretch our spine, it can become inflexible and tight, possibly leading to further injury. Maintaining flexibility and stability throughout our spine is optimal to allow us to perform everyday tasks and reduce back pain.

If you have recurrent back pain and don’t stretch contact us on 4921 6879 and we can develop a suitable program of movement to reduce pain.

NU Pilates is also a great way to introduce safe spinal flexibility and core stability for those who want general body conditioning for back pain. A physiotherapist supervises our small group classes, so your exercises are modified appropriately to suit your body.

To bend or not to bend – the choice is yours.

Shoulder posture and movement

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Physiotherapy shoulder newcastle

The shoulder blade is an attachment point which the rotator cuff muscles of the shoulder operate from. Its only bony connection to the body is via the collar bone which in turn connects to the sternum. Otherwise it is incredibly moved and controlled by muscles connecting from the trunk and neck.

The muscles that hold the shoulder blade in position are often affected by pain in the region and what is normally a coordinated movement becomes the opposite. Because it sits over the back where you cant see it you often don’t know its moving poorly but this is sometimes what can lead to persisting shoulder pain. If assistance to correct the movement improves pain then you need to start with scapula rehabilitation.

The very old fashioned advice of shoulders “back and down” is not good advice. In fact the starting posture for a lot of us needs to be more “up, back and hold” but that also depends on your posture. The most common movement dysfunction is when the shoulder drops forwards and down and the shoulder blade wings or lifts away from the body nearest to the spine.

There are good and bad ways to correct posture of the shoulder blade. We use a combination of key verbal instructions, hands on facilitation of position and movement, mirrors for visual feedback, and sometimes tape to assist the process. Static posture holds are the starting point with correcting poor movement of the shoulder blade but it also needs to be progressed to functional movements like reaching overhead to a cupboard in front.

Some people are able to get the shoulder blade posture and movement better quite quickly but others take some time and repeated practice to move better and reduce pain. If you aren’t sure of how to correct your shoulder posture or if you have shoulder pain then we would be happy to help you. If you have shoulder pain a carefully prescribed exercise program can help.

Physiotherapy gym exercise shoulder

Read more about movement control problems in the shoulder (dyskinesia).

Spinal pain treatment – move more often

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Back and neck pain treatment

NU Moves Physio leads the way in evidence based treatment. We are constantly looking to the latest evidence to help our clients move better and feel well. Being located at The University of Newcastle means a lot of our clients are academics, students and staff. A few areas we commonly treat are back and neck pain, which many people attribute to postural or sitting loads at work or while studying.

The scientific understanding of this problem has definitely evolved over the last few decades and has now changed significantly from the old adage of ‘sit up straight and don’t slouch’ to the ‘move more often’ advice. Move more means varying your postures and positions rather than having to sit up straight all the time. It might be that you need slouch a little if you have been upright for a while or sit back in your chair and use your backrest to sit up tall if you have been slouching. Stand desks are great to get you out of your chair but not for standing all day. A mixture of sitting and standing changes your posture which is best.

This is notably advice based on research for lower back pain. A common mistake leading to neck pain is reaching too far whilst at a computer.  Neck pain is often also related to the stress and tension that we carry in our shoulders. Again the best advice is often to get up and move more – go for a walk or do some exercise for 30 mins aiming for a daily basis. If you are too busy to walk that is often the problem that needs to be managed.

Professor Peter O’Sullivan leads the way in back pain research and advises ‘your best posture is your next posture’. Simple spinal pain treatment – move more often!

If you have neck pain or back pain at work or study, get moving and if pain holds you back then contact us on 0249216879 or admin@numovesphysiotherapy.com.au

Stress Fractures In Football

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Football Physio Newcastle

Stress Fractures In Football

As we move towards selection for next year’s club football sides there is a tendency for players to push harder to prove themselves. More training, higher intensity, less rest / recovery time plus there can be school soccer games added in there, not to mention lunchtime playground fun. One consequence of an imbalance in load versus rest time is stress fractures. The earlier the problem is diagnosed the better the outcome and given that stress fractures can unfortunately lead to prolonged periods of lost game time, it is an important topic in football health and wellbeing. We have previously published a blog regarding stress fractures in runners, which includes a detailed explanation of the cause, biological process, diagnosis and management which you can read about here.

This blog will focus on some common causative factors and the division of the “high risk” versus “low risk” types of stress fractures, as these are managed very differently. The risk relates to the specific location within a given bone rather than the likelihood of developing that type of stress fracture.

Stress fractures almost always occur in one of the following scenarios, or a combination of these.

  1. Increase in load on a region of the body in a given (often too short) time period
  2. Decrease in recovery time relative to loading time
  3. Decrease in the bone’s ability to repair / remodel following exposure to load.

Therefore, when volume of load increases the risk is higher, such as progressing to a higher competitive level of play, a busy period in the season with extra games and training sessions, an increase in training load such as during pre-season fitness training or even a change in training surface or footwear relative to the amount of loading. Conversely if the athlete’s load remains unchanged but they have a change in diet, energy input, illness or nutritional balance this can lead to an increased risk of injury.

High risk stress fractures generally involve a bony area where there is critical blood supply or an ossification centre (where the bone grows from). An example of these are the Femoral neck (hip), Navicular bone (midfoot), base of the 5th metatarsal (outside of foot) and the medial malleolus (inside of the ankle). These are considered high risk due to the possibility of a full fracture disrupting the only blood supply to this part of the bone, which can lead to ongoing problems. The high risk stress fractures are often managed initially with complete unloading / non-weight bearing and then closely monitored during the periods of activity reduction / relative rest including repeated imaging studies to track bony healing. In more severe cases these can require surgical management. High risk stress fractures often require orthopaedic specialist involvement in early management. Regardless of severity if a stress fracture is diagnosed we recommend assessment and advice regarding management with a sports physician specialist.

Low risk stress fractures are located in areas with good blood supply which are known to heal well with relative rest and progressive rehabilitation. These are more common in soccer and mostly found in the postero-medial tibia (lower inside of the shin) and in the metatarsals (the forefoot). This type of stress fracture can usually be diagnosed clinically but usually require imaging (MRI / Xray) to confirm type and severity.

Effective management of these injuries in soccer players requires good communication between the physiotherapist, sports physician, coaches and player, especially given the potentially longer period of recovery than most soft tissue injuries. It is important not to continue to play if a stress fracture is a possibility.

If you have any questions on the information in this blog or need assistance in diagnosis or rehab relating to soccer injuries, contact us on admin@numovesphysiotherapy.com.au or 49216879.