CERVICAL RADICULOPATHY

WHAT IS IT?

Pain that is coming from a pinched or irritated nerve in your neck can refer down into your shoulder, arm, hands or fingers, and even into the middle of back (shoulder blade region).

HOW CAN PAIN IN MY ARM BE COMING FROM MY NECK?

Structurally speaking, our nerves originate from our spinal cord and travel from this central location outwards to different parts of our body to perform different functions. At times, on their journey they can be pinched, irritated or damaged due to the small passages they need to pass through. This can result in pain, decreased or altered sensation, and muscle weakness. When explaining this to patients I often use the analogy of a garden hose – if there’s a kink the hose, some flow of water still gets through, however the flow isn’t quite as strong. This is representative of the signal travelling along the nerve pathway being ‘kinked’ or ‘pinched’ resulting in less flow and is expressed as a change in the neurological symptoms outlined below.

HOW DOES THIS GET DIAGNOSED?

Your physiotherapist will complete a series of tests including Cervical, thoracic and upper limb range of motion, joint palpation, muscle strength testing of the upper limb, and depending on symptoms may look at upper limb reflexes and neural tensioning tests to develop a well-rounded picture of your symptoms. Finally, if you have previously had relevant imaging, then physiotherapists will also review these as part of the overall clinical assessment.

WHAT TREATMENT IS INVOLVED?

From here, depending on your symptoms, consultations will include a degree of manual therapy, exercise prescription and education to form a structured home exercise program, provide education on any task modification (whether that be for work or home), as well pain-relieving techniques and general management strategies.

If you feel you have these symptoms the team at Select Physiotherapy and Pilates would love to help you become symptom free!

SYNDESMOSIS INJURY

In recent times with the return to football, we are noticing an increased incidence of syndesmosis injuries (sometimes referred to as a “high ankle sprain”).

Today I’m going to break down what the syndesmosis is, how it’s impacted when we roll our ankle, and some strategies and management tips for overcoming and preventing syndesmosis injuries.

WHAT IS IT?

The syndesmosis in the lower leg serves is part of a mesh known as the interosseus membrane which helps to both hold the tibia (shin bone) and fibula (bone on the outside of the lower leg) together as well as serve as a pathway for neurovascular structures.

WHAT DOES IT DO?

Functionally, the role of the syndesmosis is to provide stability during rotational movements when the foot is planted and loading occurs through the ankle. During weightbearing activities, there will be a natural small amount of movement that occurs between the bones of the lower leg. The syndesmosis prevents these two bones from widening too far. In a syndesmosis injury, there is a disruption of the lower  attachment between these bones causing issues with stability and pain.

HOW COMMON IS IT?

Syndesmosis injury is relatively common reportedly occurring in up to 18% of all ankle sprains to varying degrees. Easily missed, these injuries can lead to chronic ankle instability, ongoing pain, poor balance as well as a longer recovery to return to sport/physical activity.

HOW WILL A PHYSIOTHERAPIST HELP?

A physiotherapist will perform a detailed assessment on both the ankle and syndesmosis to determine the nature of your injury. This will be a combination of both a subjective and objective assessment. From here, immobilisation of the joint will be required either with taping or a moon boot as deemed necessary based on the severity. Manual therapy may also be used for pain relief of surrounding muscles. Following this, education on appropriateness of current activities is offered, with a graduated return to exercise through a structured rehabilitation program.

STRENGTH TRAINING FOR OLDER ADULTS

As we naturally age we will often notice a decline in our muscle mass and bone density. This can lead to issues with strength, balance and confidence completing daily tasks, as well as an increase in the need for support both from family and community services. Although these challenges are becoming progressively more apparent, there are still many things we can do to slow our functional decline and maintain independence for as long as possible – strength training is one such way.

Strength training not only improves the strength of the muscles surrounding joints to reduce wear and tear, but also facilitates an improved capacity to complete daily activities such as standing up and sitting down, walking, climbing stairs, gardening and even swimming to name a few. Further to this, the flow on effect of being generally more active is improved cardiovascular health (heart and lungs), improved ability to burn energy (weight management), as well as facilitate increased opportunities to participate independently in social events assisting with the individual’s mental health and sense of self efficacy.

Strength training can come in many forms – and is not unique to simply the ‘gym’ or ‘Pilates’ – although these do serve as excellent options in their own right. Strength training can occur in the individual’s home – either on the floor, or on the bed if mobility/safety is limiting. It can occur in the loungeroom using a couch, or even outside on the back deck with a TheraBand and a step. If water is more your thing, hydrotherapy has excellent evidence for maintaining and improving overall musculoskeletal function in older adults in a low impact, often pain-relieving social environment.

As physiotherapists we utilise functional patient specific home exercises to facilitate both the rehabilitation of a given injury, as well as the provide education to minimise the likelihood of any ongoing associated concerns. We provide information relating to how and where to access community exercise groups, as well as facilitate linking in to health provider networks. In the private setting, we also offer structured clinical exercise (Pilates) sessions tailored to your needs.

Should you wish to discuss how strength training may help you live a more independent lifestyle, then please do not hesitate to reach out. Here at Select Physio and Pilates we offer both 1-1 and group clinical exercise (Pilates), as well as regular physiotherapy sessions should you be in need. We work with Private Health Funds, Medicare, DVA and compensable (TAC/WorkSafe) patients alike.

A 2 minute read – Hydrotherapy and Arthritic Pain

Who May Benefit From Hydrotherapy?

• Those with varying types of arthritis – OA, RA and JA
• Those who are experiencing symptoms in their feet, knees, hips and back
• As preparation and recovery for hip and knee replacements
• For those who find on-land exercises challenging or painful

How Does Hydrotherapy Help Arthritis?

• The temperature of the water allows your muscles to relax and in turn eases the pain in your joints allowing freer, less painful movement
• The water supports your weight, which helps to reduce compressive pain as well as increase your functional joint range of motion
• The water can be used to provide both resistance to build strength and endurance, as well as challenge your balance, improving your safety and capacity for your activities of daily living.
• By finding a way to exercise relatively pain free, not only will your strength and confidence improve, but you will be able to better manage your weight through a structured and progressive program
• Exercise can be completed in a group for those who want a social experience, or solo for those who would like to tackle pool independently.

Here at Select Physiotherapy and Pilates we can write you a personalised hydrotherapy exercises program fit for your individual needs and goals to help moderate your arthritic pain.

Note: For Safety reasons (e.g. Unstable BP or a history of heat sensitivity) patients may require a GP’s medical clearance prior to completing hydrotherapy based exercises.

For more information, please see Arthritis Australia’s summary on the positive effects of hydrotherapy.

Link: https://arthritisaustralia.com.au/managing-arthritis/living-with-arthritis/physical-activity-and-exercise/water-exercise/

Tennis Elbow

WHAT IS IT?

Tennis elbow is pain in the outside of the elbow, often localised to the outermost part of the bone (lateral epicondyle). This is caused by the tension from the common attachment of the forearm extensor muscles (the ones that allow you to open your hand). These muscles connect to the bone via a tendon. When the muscles are tight, this causes pulling and irritation to the tendon which in turn can cause irritation to attachment of the tendon to the bone – hence the focal soreness and tenderness on palpation. Notably, often patients will report some radiating symptoms into the forearm, particularly in parts of those muscles which are closest to the outside of the elbow.

WHY “TENNIS” ELBOW?
The nature of the extensors muscles is that they are involved in both grip, and extension of the wrist. The most common way to represent these combined movements is if you were holding a racquet (or perhaps even riding a motorcycle).

OTHER COMMON NAMES:
Lateral epicondylitis and extensor tendinopathy
** Note “golfers elbow” is essentially the same pathology, but on the inside of the elbow, rather than the outside **

WHAT DO WE DO ABOUT IT?
As discussed in previous posts, load is the biggest consideration. Has there been a spike (increase) in load? Perhaps you’ve been inspired by the Australian Open and taken up tennis, or perhaps you’ve been spending more time in the gym or painting around home, or even more time on the computer– whatever the reason, a sudden increase in gripping and extending activity can result in a flare up of tennis elbow.

PHYSIOTHERAPY TREATMENT
Physiotherapy treatment will begin with taking a detailed history to determine where your spike in load has come from. From here, a combination of a structured progressive home exercise program as well as manual therapy will be utilised to provide pain relief, coupled with a discussion of your individual risk management strategies to facilitate pain relief and the maintenance of function.

Blog post 2022- Shin Splints

With Covid still ripe in the community, I have seen an influx of patients who are transitioning their exercise space to being either at home or outdoors rather than in large public gymnasiums.  Consequentially, (and perhaps in part due to a few new pairs of Nike’s under the Christmas tree), I have been seeing a sharp increase in the number of patients experiencing ‘shin splints’. This blog post will focus on how and why you get shin splints, as well as some general advice in the management and prevention of this often niggling injury.

WHAT IS IT?
Shin splits aka ‘Medial Tibial Stress Syndrome’ is when additional stress is placed on the front inside part of the shin for extended periods of time and often will involve a degree of increased impact. The most important thing to acknowledge with shin splints is load management – it is often this load that has recently been sharply spiked which has caused the shin splints in the first place. A change in load can come from a few commonly overlooked sources – for example recent increase in running/walking either recreationally or post-surgery, a change in walking surface (footpath to sand), new shoes (different sole density, style, support levels), the change from runners to sport specific footwear (runners to footy/soccer boots with studs) or even repetitive trauma from impact (for example shin strikes in hockey).

HOW DO WE MANAGE IT?
The first step is to take a detailed history and determine where the change in load has come from as outlined above. From here, we will look at any additional biomechanical components that may be contributing (e.g. tight hip flexors effecting gait when walking or running), and then utilise a combination of manual therapy and corrective exercises to get you back on track. In certain situations medication may also be required at which point we would liaise with your GP, however this is not always the case.
Note: very rarely would we ever consider a complete rest from exercises (we do not want to de-condition the entire limb!) – normally you will be safe to continue some gym based strength training, walking within reason, as well as low impact cycling or swimming – this is of course person dependent however.

WHAT CAN I DO TO STOP SHIN SPLINTS OCCURRING?
– If you are going to change footwear, then mix in your new and old footwear. Trial one day old, one day new for the first week or so whilst you ‘wear in’ your new shoes.

– Similarly, when it comes time to pull on the studded shoes for sport, you may consider one night a week still wearing runners for the first couple of weeks.
– Consider a general mobility/recovery routine that includes stretching out the calves, hip flexors and lower back. Suggestions of exercises can be found by viewing our previous blog posts below.
– Complete strength training unilaterally (one sided) – this will help address natural imbalances (although these are still expected to a degree), it will limit ‘favouring’ especially when under fatigue.
– If you are unsure on your technique (whether that be running, cycling, lifting weights), spend the time to train with someone who has the experience to talk you through your specific task. They will be able to pick of on technical errors and steer you in the right direction, improving both performance and decreasing your risk of injury simultaneously– a small investment up front will save you a lot of time and energy down the track!

Finally, if you do find that your shins are sore, you’re limping, you’ve tried resting but whenever you increase the load your symptoms return, then book in to see your local physiotherapist – your load management expert!

Senior Physiotherapist Daniel Browne

HEADACHES

A headache is one of the most uncomfortable sensations a person can experience. Headaches can vary from a transient ache to  perceivably crushing unrelenting pressure. When treating a headache, physiotherapists must first establish whether or not we are dealing with a primary or secondary headache.

Primary headaches can include migraines which can be described as episodic (i.e. they periodically come and go) lasting anywhere from a few hours to a few days, ‘tension type headaches’ (the most common type of primary headache) which can also be considered episodic and have a more chronic (long term) nature to it, as well as the subcategory of ‘cold’ headaches relating to a sensitivity of being outside in colder temperatures (think from the exposure to direct cold (ice pack) or experienced in the consumption of cold –  like a brain freeze when eating an icy pole!).

Secondary headaches on the other hand are generally more common and are a result of either too much or too little load on the musculoskeletal system (particularly the head, neck, shoulders, and thoracic spine) coming from prolonged poor ergonomics (work postures), an injury playing sport or in the community (such as whiplash), as well as neural referral from issues such as pain in the jaw (TMJ, teeth clenching or grinding at night) or inner ear pathologies (vestibular headaches) – not to mention the age old situation of not wearing your glasses when you should!

As you can see, there can be many contributors to a headache. Often, unfortunately, the longer the headache is left to brew – the worse it gets. A physiotherapist will firstly  gather a detailed history to help ascertain the contributing factors. From here, a combination of manual therapy, individualised exercises, as well as ergonomic advice and pain-relieving strategies will comprise the first session.

Everyone’s headache experience is different and here at Select Physiotherapy and Pilates we pride ourselves on offering each of our clients a tailored and evidence-based solution fit to their situation.

We look forward to helping you soon!

By Daniel Browne

Senior Physiotherapist

1) FIND A WARM UP THAT WORKS FOR YOU

You will hear different schools of thought ranging from static stretching all the way to a more dynamic warm up and perhaps even no warm up at all! Ultimately you need to figure out what’s best for you – more often than not, what we recommend is that when in doubt begin by completing the movements that you will be about to do but at a much lower intensity to prepare your body for a more intense effort. For example, if you were to play football, then you would have a ‘kick to kick’, tennis – a light hit, and basketball – you could do some light shooting.

2) STAY HYDRATED

A simple and effective strategy for not only keeping you out on the court/pitch longer but also significantly reducing your risk of injury related to cramping and fatigue. Moving into the warmer weather you want to assure that you are firstly drinking that little bit more due to the hotter days, but then also acknowledge that your body is perhaps not up to the same vigour of exercise as last time you hit/kick. Sipping water throughout the session rather than waiting until you are dying for a gulp is generally a better strategy. Likewise, having a glass of water before you head off can be a nice way to increase your chances of being adequately hydrated.

3) SOMETIMES LESS IS MORE

I think it’s fair to say we perhaps have all had an extended ‘off season’. The first session back is always going to be a little rough! As a general rule, you want to walk about from the exercise effort thinking “I could have done a little more’ rather than “I did too much!!”. Not only will this allow you to then turn up again shortly for another round of your desired activity, but it will be more likely to facilitate the building of an exercise routine – which as we know, will have many long-lasting positive health benefits.

The above advice is general in nature and if you have any more specific questions, please do not hesitate to contact us here at Select Physiotherapy and Pilates.

1) MOBILITY
– Spend some time working on the controlled movements of your limbs – particularly those that may be of heavy focus in your sport i.e. shoulders for throwing sports, hips for running sports. What is old is new again, and “CAR’s” or “Controlled Articular Rotations” are making a comeback in the vernacular of sporting clinician. A CAR, as the name suggests, involves taking your limbs through slow and controlled range of motions or movements representative of your sport so as to develop a smoother more refined quality of movement.
A gentle CAR’s routine can be found via the link below:
https://www.youtube.com/watch?v=AyJ3omVBIho

2) SOFT TISSUE EXTENSIBILITY
– Depending who you talk to they will either swear by or swear against things like foam rollers, massage balls and the new(er) Thera guns – you name it, there’s a passionate camp either side. Does it really change ‘fascial length’, does it really ‘break up scar tissue’ or ‘adhesion’ – it remains to be seen. What I can see from both anecdotal patient experience as well as my personal experience, is that I have seen promising results relating to recovery – especially if you have had either a large training session or conversely you haven’t moved around a great deal for the day – perhaps shackled to the couch watching Netflix. Foam rollers and massage balls in particular are a cheap and non-invasive method used by athletes around the world. I think it’s worth giving it a go!
An example of a foam rolling routine can be found below:
https://www.youtube.com/watch?v=aTcRYJsuhkI

3) BODY WEIGHT EXERCISES
– The beauty of body weight exercises is that you don’t need any equipment (other than perhaps a bar overhead if you want to do some pullups), you don’t need a lot of room, they can be done indoors or outdoors (great for winter), they can be grouped together for a high intensity interval session if that’s your thing and they are easily scalable (progressions/regressions).

Below I’ve outlined a couple of pathways of progressions and regressions to keep your exercises interesting.

LOWER BODY
Double leg bridge à Offset bridge à Single leg bridge
Double leg hip thrust à offset hip thrust à single leg hip thrust
Sit to stand à Offset sit to stand à Single leg sit to stand
Offset Romanian deadlift à single leg Romanian deadlift
Double leg calf raise à single leg calf raise

UPPER BODY
Incline push up à kneeling push up à push up on toes à decline push up
Let me up/inverted row à chin up à parallel grip pull up à regular pull up

Daniel Browne – Commonwealth Games Physiotherapist.

From the 4^th to the 15^th April in 2018 Select Physiotherapy and Pilates Senior Physiotherapist Daniel Browne worked at the XXI Commonwealth Games held on the Gold Coast. Below Daniel reflects on some of his experiences working with elite athletes.

During Autumn of 2018 I was fortunate enough to be afforded a position at the 2018 Gold Coast Commonwealth Games as a Physiotherapist at Carra Sports and Leisure Centre. Within this role I formed part of the medical team which included fellow international physiotherapists, sports doctors and emergency medicine physicians, myotherapists and strength and conditioning coaches. Our role in essence was to provide care both before, during and after competition to optimise athletic performance. My direct role had me working both on the field of play and in the warm up area for wrestling, weight lifting, badminton, para weightlifting and athletics.

Having experience myself as an athlete at an international level, I had always felt I had a good understanding of what would be expected and appreciated from the medical team. What is unique about the Commonwealth Games however, is the level of competitiveness seen between athletes despite notably disparities in socioeconomic status. This became clearly evident in even the warm up area with large nations bringing an army of medical personnel to support their athletes, with others being seldom able to afford to bring a coach. It was these athletes, the ones who didn’t have access to elite sports performance facilities, 24 hour rehabilitation monitoring programs or 5 star hotels when travelling abroad, that I really enjoyed working with the most.

For many of these athletes, sport provides a means of focus and hope for a better life. One such instance of the games remains clear in my mind – I was treating a young athlete from Uganda. It was his first time overseas, and the first time he had spent more than a week away from his family. During the warm up he had rolled his ankle badly and was scheduled to compete the following afternoon. I had managed him acutely, spoken to the general access sports doctor and discussed a plan of management. We had decided to re assess the following morning and see where the athlete was at. The next morning he presented to me and immediately broke down into tears. He was from a small rural village, that had needed to fund raise for 2 years to assist with paying for a plane ticket and accommodation and now he may not even get his chance to compete. I am pleased to say this story had a happy ending all things considered, the athlete was successful through the first round and then lost the second – but in his own words ‘ I made my country proud’, and he did. Walking away from this I felt good knowing that I had assisted in some way to help this young man live out his dream, and make his community proud.

That night reflecting I felt a little disappointed that I hadn’t taken a photo or something to remember him by. The next day when I turned up for my shift one of the staff members approached me and handed me an envelope. The young man had left his countries pin for me in a way to say thanks. For those who don’t know. There is a currency at the commonwealth and Olympic games of ‘pins’. Each athlete gets a set amount that they then trade and barter with other athletes the idea being you try and collect a set. I received a couple during my time on the Gold Coast, but this one was particularly special.

Daniel is available for appointments as follows:
Tuesday- 10:30am-7:00pm
Thursday- 11:00am-6:30pm