Small Group Exercise Classes

Comment

Small Group Exercise Classes

PhysioStrong - Circuit Training focusing on strength, flexibility, balance and cardiovascular system

  • 45-minute sessions combining functional upper and lower body plus core exercises.

  • Exercises performed using body weight, dumbbells, resistance bands, pulley cables, exercise balls, and more.

  • Different exercises every week to keep the sessions challenging and fun!

When are PhysioStrong classes?

  • Every Tuesday 6.30 PM

  • Every Thursday 7.00 AM

  • Every Thursday 9.30 AM

Body Tension - A gymnastics inspired Pilates experience

  • 45-minute sessions focusing on abdominal and back muscles strength, as well as spine and shoulder stability.

  • Exercises performed using body weight, exercise balls, and other small equipment.

  • Different exercises every week to keep the sessions challenging and fun!

When is Body Tension class? 

  • Every Wednesday 9.30 AM

Terms and Conditions for group classes PhysioStong and Body Tension

1.       Casual entry and pack options – Both PhysioStrong and Body Tension classes are available casually or in pack of 10. Packages for classes attract a discount rate and expire 12 weeks from the commencement of the first class.  Clients are responsible for making sure all their sessions are completed before the expiry date.

2.       24 hours cancellation policy – If you cannot attend a class, more than 24 hours notice is required to be able to reschedule. If you cancel your class less than 24 hours before it starts or are absent for your class you will forfeit your session.

3.       Bookings – Bookings are currently made through reception by:

  • Calling the clinic on 02 8411 2050 (if it is outside our operating hours please leave a message and we will get back to you on the next business day)

  • Emailing us at info@thornleighphysio.com.au

  • In person

4.       Priority – Please be aware classes are booked on a first come first serve basis. We do however give preference to clients in existing classes to continue on at their existing time before it is opened up to others. To avoid disappointment, please let us know your preference or your intentions to continue before your pack expires so we can make the required arrangements.

5.       Securing your spot – Your place in classes is only secured once payment is received. If payment is not received your spot will become available for those on the wait list.

6.       Rescheduling – Rescheduling classes is your responsibility, you may reschedule missed classes once. If you are unable to attend your rescheduled class you will forfeit that credit.

7.       Waiting list – If a class you particularly want is fully booked you may put your name on a waiting list. However, we would also suggest you book into another class just in case that one does not become available.

8.       Initial assessment – PhysioStrong and Body Tension sessions require an initial assessment to be performed so the physiotherapist can custom design your program and familiarise you with the equipment.

9.       Number of participants – Each class is limited to 4 participants.

10.    Non-refundable and non-transferable – Casual classes and packs are non-refundable and non-transferable.

11.    Class modification – Instructors and classes are subject to change without notice. Thornleigh Performance Physiotherapy reserves the right to cancel classes if necessary.

12.    What to bring – A clean towel and a water bottle are required for all classes. Please wear comfortable clothing that you can move freely in. Close fitting clothes are preferable as dangling or loose-fitting clothing, hair or jewellery may get caught in the equipment.

13.    Start and finish time – Sessions start and finish at the time indicated in the booking – all classes are 45 minutes

14.    Payment – Payment methods include:

  • EFTPOS

  • Credit Card

  • Cash

15.    Health Fund – All PhysioStrong and Body Tension classes are claimable under your private health insurance. Contact your Health Fund for more information about your own available rebates. The tax invoice for each session will be provided by email by the day after the class.

16.    Cancellation policy – Both PhysioStrong and Body Tension class sizes are small and fill up quickly, so clients must adhere to our cancellation policy. Cancellations will need to be made 24 hours prior to your class beginning at the latest in order to be able to reschedule your session.

17.    Payment policy – Payment needs to be made upon booking. To book into a class you must either have credits in your account or pay at the time of booking. By booking into a class you automatically agree to the above terms and conditions.

Comment

Blood Flow Restriction Training

Comment

Blood Flow Restriction Training

What is blood flow restriction training?

Blood flow restriction training (BFRT) refers to resistance training performed with a reduction of blood flow in the exercising muscles with the use of a compression device. The compression device used can either be a belt, an inflated air cuff (pneumatic cuff), a sleeve (elastic wrap) or a specific tape. Contrary to common resistance training routines, the intensity of BFRT is very low, performed with a load between 20 to 40% of an individual’s 1-RM [5].

The compression device reduces the level of oxygen circulating through the exercising muscles, and in doing so, muscle adaptation occurring after working at low intensity is greater than the benefits of low intensity with a normal level of oxygen in the working muscle [5]. However, it is unclear whether low load BFRT reaches the same benefits as high load training or not [1,3].

BFRT is a relatively new type of resistance training, inspired from KAATSU, a Japanese strengthening method invented in 1966. Over the last years, studies have been conducted to understand the benefits of BFRT, how it is best to be implemented for different conditions and its safety [4].

Benefits of BFRT

Most studies found that BFRT brings physiological and functional benefits for the general population as well as people with various conditions, such as knee osteoarthritis, tendon injuries and ACL reconstruction. Physiologically, BFRT has been found to increase muscle size (hypertrophy) and muscle strength in the general population. Functionally, the use of BFRT may reduce pain and recovery time in people with specific conditions [1,2,3].

The authors of a systematic review compared low load BFRT to low and high load training without BFR, for population presenting with various musculoskeletal conditions (ACL reconstruction, knee osteoarthritis, and older adults at risk of sarcopenia). Low load BFRT showed a greater increase in strength compared to low load training without BFR, whereas it was found to be less effective than heavy-load training [3]. However, another study focusing on women with knee osteoarthritis found that low load BFRT provided the same increase in lower limb strength than high load training [1]. This study also looked at muscle size, function and pain. The authors found that (1) low load BFRT and high load training provided a greater increase in lower limb muscle size compared to low load training; (2) low load BFRT and high load training led a greater improvement in function compared to low load training; (3) low load BFRT and low load training provided a greater reduction in pain compared to high load training [1].

People with patellofemoral pain may also benefit from BFRT. Compared to standard rehabilitation, the use of BFRT provided a greater increase in knee extensors strength and a greater reduction in pain in daily activities [2].

Safety, precautions, contra-indications

The safety of BFRT is a common and legitimate question as blood flow is voluntarily restricted within the exercising muscles. A study conducted in Japan in 2006 indicated that KAATSU training  (original name given to BFRT) is a safe method for training athletes and healthy persons, and it can also be applied to persons with various physical conditions [4]. The most common side effects are subcutaneous hemorrhage (13.1%) and temporary numbness (1.3%), while serious complications are rare (venous thrombus (0.055%), pulmonary embolism (0.008%) and rhabdomyolysis (0.008%)) [4].

Take home message

BFRT is an effective way to increase strength and muscle size while only working at low intensity. Thus, it appears to be a good clinical rehabilitation tool, especially for people suffering from knee osteoarthritis, tendon injuries, and ligament injuries (such as ACL reconstruction). During rehabilitation, the use of BFRT provides greater gain in muscle strength and muscle size than low load training, while avoiding pain caused by high load training.

Due to the potential side effects of BFRT, we recommend you to use this method in the presence of health professionals. They will set it up safely for you and will monitor throughout your training in order to minimise the risks of side effects.

If you have any questions regarding whether you think you could benefit from doing some supervised blood flow restricction training, please give us a call at (02) 8411 2050. At Thornleigh Performance Physiotherapy, we can give you an accurate diagnosis and treatment, to help you get back in action as soon as possible. We are conveniently located near Beecroft, Cherrybrook, Hornsby, Normanhurst, Pennant Hills, Waitara, Wahroonga, Westleigh, West Pennant Hills, and West Pymble.

References

1. Ferraz RB, Gualano B, Rodrigues R, et al. (2017). Benefits of Resistance Training with Blood Flow Restriction in Knee Osteoarthritis. Medicine & Science in Sports & Exercise, 897-905. DOI: 10.1249/MSS.0000000000001530

2. Giles L, Webster KE, McClelland J, et al. (2017). Quadriceps strengthening with and without blood flow restriction in the treatment of patellofemoral pain: a double-blind randomised trial. Br J Sports Med, 51, 1688–1694.

3. Hughes L, Paton B, Rosenblatt B, et al. (2017). Blood flow restriction training in clinical musculoskeletal rehabilitation: a systematic review and meta-analysis. Br J Sports Med, 51, 1003–1011.

4. Nakajima T, Kurano M, Iida H, et al. (2006). Use and safety of KAATSU training: Results of a national survey. Int. J. KAATSU Training Res., 2, 5-13

5. British Journal of Sport Medicine (blog) (2018). Bood flow restriction: miracle return to play adjunct or therapy fad? Retrieved on 18/01/2018 from https://blogs.bmj.com/bjsm/2018/11/07/blood-flow-restriction-miracle-return-to-play-adjunct-or-therapy-fad/?utm_source=hootsuite&utm_medium=social&utm_term=&utm_content=&utm_campaign=

Comment

What the Cup?

Comment

What the Cup?

What is cupping?

Cupping has been used since 3000 BCE, it originated in ancient Egypt where it was used to remove toxins from the body [1]. Since then cupping has spread throughout the world and been used in many cultures as a treatment for a variety diseases. Today cupping is mostly seen in traditional eastern medicine, where it is used to correct blockages and help the flow of Qi throughout the body [2]. It involves suctioning special cups to the skin of a patient, in the form of wet cupping or dry cupping. Wet Cupping is invasive and involves suctioning small amounts of blood through minor incisions made in the skin, this means it is usually not performed by physiotherapists in western practices [3].

What is dry cupping?

Dry cupping is non-invasive, as it doesn’t involve exposure to blood. It is mostly used to treat musculoskeletal pain in the chest, stomach, back and buttocks [4]. Smaller cups can also be used to treat regions on the arms and legs.

Cups vary from 38-50mm in diameter and are generally made of plastic or glass [3].

The cup is suctioned and held in place by heating the air in the cup then placing the rim of the cup on the skin so it is air tight, or by suctioning air out of the cup using an air pump after placing it on the skin [3]. This negative pressure inside the cup suctions the skin and feels like your skin and soft tissue underneath is being pulled or stretched. Then it is generally left in place for 5-20 minutes or can be moved around to cover a larger area using lubricant so that it can slide without interrupting the vacuum seal made between the skin and the cup [5].

 

How does dry cupping work?

The vacuum inside the cup creates a tensile force that stretches the skin, subcutaneous tissue and fascia lying beneath [2]. This also causes the small blood vessels in that area to expand. The larger the cup and more suction created the stronger it stretches the soft body tissues underneath, and the longer it is left in place the more blood that is drawn to that area [2].  

This means dry cupping has the potential to be used for a number of benefits such as:

  1.  Relieving muscle and surrounding fascia tightness [3]

  2. Aiding muscle and soft tissue healing [6]

  3. Increase blood circulation and aid removal of toxins from muscles [4]

  4. Improve immune function by aiding flow of lymph [6]

  5. Provide pain relief through stimulating pain inhibiting nerves [7]

  6. Promoting deep relaxation [7]

 

Is it safe?

Yes, provided it is performed by a suitably trained therapist. Patients may feel warmer and may sweat during a cupping treatment, this is just a result of blood vessels expanding and drawing more blood and heat to the skin [3]. Patients may also experience redness, swelling and bruising of areas of skin that have been cupped after a treatment, this is normal and should go away within a few days or weeks [4]. You should not having cupping therapy if you are pregnant, menstruating, have metastatic cancer or have cupping therapy over an area with a bone fracture, deep vein thrombosis, palpable pulse or skin irritation [8]. 

Complications to cupping are very rare and usually due to a lack of therapist training and incorrect practice, which have lead to only a few reports of skin burns, contamination and pressure wounds [9].

 

What does research say about the effectiveness of dry cupping?

There have been several studies investigating the treatment effects of dry cupping on a variety of musculoskeletal conditions. The findings of these studies are:

  • 2 weeks of cupping treatment significantly reduced chronic neck pain [10]

  • 2 weeks of pulsating cupping effectively relieved pain, improved function and quality of life in patients with chronic neck pain [11]

  • Cupping and exercise together is effective in improving neck pain and neck function, and better at improving pain than using a heating pack [12]

  • Patients with sub acute and chronic lower back pain felt less pain and improved flexibility in their lower back after 1 treatment [13]

  • Pulsating dry cupping is effective at relieving symptoms of knee osteoarthritis [14]

There is however a need for future studies to focus on confirming comparing these effects to standard treatments as well as understanding long lasting effects of dry cupping.

 

If you have any questions regarding treating your aches and pains or cupping therapy, please give us a call at (02) 8411 2050. At Thornleigh Performance Physiotherapy, we can give you an accurate diagnosis and treatment, to help you get back in action as soon as possible. We are conveniently located near Beecroft, Cherrybrook, Hornsby, Normanhurst, Pennant Hills, Waitara, Wahroonga, Westleigh, West Pennant Hills, and West Pymble.

 

References

  1. Nickel, J.C., Management of urinary tract infections: historical perspective and current strategies: part 1—before antibiotics. The Journal of urology, 2005. 173(1): p. 21-26.

  2. Tham, L., H. Lee, and C. Lu, Cupping: from a biomechanical perspective. Journal of biomechanics, 2006. 39(12): p. 2183-2193.

  3. Rozenfeld, E. and L. Kalichman, New is the well-forgotten old: The use of dry cupping in musculoskeletal medicine. Journal of bodywork and movement therapies, 2016. 20(1): p. 173-178.

  4. Yoo, S.S. and F. Tausk, Cupping: east meets west. International journal of dermatology, 2004. 43(9): p. 664-665.

  5. Turk, J. and E. Allen, Bleeding and cupping. Annals of the Royal College of Surgeons of England, 1983. 65(2): p. 128.

  6. Ahmadi, A., D.C. Schwebel, and M. Rezaei, The efficacy of wet-cupping in the treatment of tension and migraine headache. The American journal of Chinese medicine, 2008. 36(01): p. 37-44.

  7. Musial, F., D. Spohn, and R. Rolke, Naturopathic reflex therapies for the treatment of chronic back and neck pain-part 1: neurobiological foundations. Complementary Medicine Research, 2013. 20(3): p. 219-224.

  8. Chirali, I.Z., Traditional Chinese medicine: cupping therapy. 1999: Elsevier Health Sciences.

  9. Cao, H., X. Li, and J. Liu, An updated review of the efficacy of cupping therapy. PloS one, 2012. 7(2): p. e31793.

  10. Lauche, R., et al., The influence of a series of five dry cupping treatments on pain and mechanical thresholds in patients with chronic non-specific neck pain-a randomised controlled pilot study. BMC complementary and alternative medicine, 2011. 11(1): p. 63.

  11. Cramer, H., et al., Randomized controlled trial of pulsating cupping (pneumatic pulsation therapy) for chronic neck pain. Complementary Medicine Research, 2011. 18(6): p. 327-334.

  12. Kim, T.-H., et al., Cupping for treating neck pain in video display terminal (VDT) users: a randomized controlled pilot trial. Journal of occupational health, 2012. 54(6): p. 416-426.

  13. Markowski, A., et al., A pilot study analyzing the effects of Chinese cupping as an adjunct treatment for patients with subacute low back pain on relieving pain, improving range of motion, and improving function. The Journal of Alternative and Complementary Medicine, 2014. 20(2): p. 113-117.

  14. Teut, M., et al., Pulsatile dry cupping in patients with osteoarthritis of the knee–a randomized controlled exploratory trial. BMC complementary and alternative medicine, 2012. 12(1): p. 184.

Comment

Don’t run from the P.O.L.I.C.E.

Comment

Don’t run from the P.O.L.I.C.E.

So, you rolled your ankle, you're thinking it will be fine, I’ll just walk it off. Little did you know as you continued to play the last 10 minutes of the game, the phases of healing have already begun. As you continue to run, your ankle throbs and feels unstable beneath your body. You feel sick as the pain won’t go away but continues to get worse. Thoughts race through your mind, what have I done? Should I see someone? Finally, you make the decision to come off the court, but what do you do now?

In the past, the process to assist with recovery was known as R.I.C.E.R. (Rest, Ice, Compression, Elevation and Referral). This has been proven to be effective, however, methods of management have changed to the P.O.L.I.C.E. protocol [1] :

P – Protection: this reminds individuals that a little bit of pain is okay but if the injury causes severe pain then the ankle should be protected using bandages, taping or crutches to off-load the ankle.

O – Optimal: the right amount of pain/discomfort (not too much but tolerable).

L – Loading: placing weight on the ankle (optimal-loading is advised).

I – Ice*: applied for 8-10 minutes at a time [2,3] alternating between 10 minutes on then 10 minutes off. This should be done as often as possible in the first 48 hours.

C – Compression: apply a compression bandage around the ankle, ensuring it is firm enough without cutting off circulation to the foot (Pinch test: squeeze toe, it should turn white then red again).

E – Elevation: raise leg above heart height to prevent pool of blood around the ankle due to gravity.

* Warning: any burning sensations in the region REMOVE the ice. Do not place ice directly on skin (apply a 1-2 cm cloth in between ice and skin). Never place ankle on top of the ice but rather the ice on top of the ankle.

 

Why this protocol?

Recent studies have shown that protecting the joint should be only as required as resting or offloading the joint could be detrimental causing changes as to how the tissue recovers [1, 4, 5]. These studies therefore promote optimal loading, where an individual can start placing body weight onto the ankle, as tolerable. This encourages correct fiber type and alignment to develop, early mobilisation and can facilitate accelerated recovery times [1, 4]. Further benefits of optimal loading are positive as changes to mechanical properties regarding load alter sensory feedback. This informs the brain that this painful feedback, which it was experiencing earlier on, is no long dangerous thus de-sensitizing the injury and reducing pain levels [4]. Previously the R.I.C.E. [6] method did not consider optimal loading and referral but rather focused on resting and went straight into management. Though icing is effective, studies have shown this has a limited effect depending on the duration and severity of the injury and should only be utilised in the acute phases [3]. Benefits of using ice should still be utilised as icing reduces the analgesic (pain) response and facilitates optimal healing by reducing swelling that would otherwise delay an individual’s rehabilitation process [7, 8].

So, when in doubt, don’t run, follow the P.O.L.I.C.E. protocol. If pain persists or worsens or you are unable to weight bare, contact your local physiotherapist and book an appointment.

 

What would a Physiotherapist do to help?

  • Perform a thorough movement examination of the lower body to provide education and understanding of the condition.
  • Provide tailored strategies and modifications to correct improper biomechanics of the ankle, i.e., taping, ergonomic assessment.
  • Design a personalised exercise program tailored to resolving muscle imbalances that would otherwise cause ankle instability.
  • Assist with improving range of movement and pain management strategies.
  • Provide education on self-management techniques.
  • Improve balance and retrain an individual back to pre-injury status.

 

If you have any questions regarding your acute injury, please give us a call at (02) 8411 2050. At Thornleigh Performance Physiotherapy, we can give you an accurate diagnosis and treatment, to help you get back in action as soon as possible. We are conveniently located near Beecroft, Cherrybrook, Hornsby, Normanhurst, Pennant Hills, Waitara, Wahroonga, Westleigh, West Pennant Hills, and West Pymble.

 

References

  1. Bleakley CM, Glasgow P, MacAuley DC. PRICE needs updating, should we call the POLICE?. British Journal of Sports Medicine. 2011 Sep 7:bjsports-2011.
  2. Adie, Naylor, & Harris. (2010). Cryotherapy After Total Knee Arthroplasty: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. The Journal of Arthroplasty,25(5), 709-715.
  3. Prins, J., Stubbe, J., Van Meeteren, N., Scheffers, F., & Van Dongen, M. (2011). Feasibility and preliminary effectiveness of ice therapy in patients with an acute tear in the gastrocnemius muscle: A pilot randomized controlled trial. Clinical Rehabilitation, 25(5), 433-41.
  4. Glasgow, P., Phillips, N., & Bleakley, C. (2015). Optimal loading: Key variables and mechanisms. British Journal of Sports Medicine, 49(5), 278-279.
  5. Bleakley, C., Dischiavi, S., Taylor, J., Doherty, C., & Delahunt, E. (2017). Rehabilitation reduces re-injury risk post ankle sprain, but there is no consensus on optimal exercise dose or content: A systematic review and meta-analysis. British Journal of Sports Medicine, 51(20), British Journal of Sports Medicine, Oct 15, 2017, Vol.51(20).
  6. Hing, Wayne, Lopes, Justin, Hume, Patria A., & Reid, Duncan A. (2011). Comparison of multimodal physiotherapy and "R.I.C.E." self-treatment for early management of ankle sprains. (RESEARCH REPORT)(Report). New Zealand Journal of Physiotherapy, 39(1), 13-19.
  7. MacAuley, D. (2010). Effect of accelerated rehabilitation on function after ankle sprain: Randomised controlled trial. BMJ. British Medical Journal (Clinical Research Ed.), 340(10), 1122.
  8. Bleakley CM, O'Connor SR, Tully MA, et al. Effect of accelerated rehabilitation on function after ankle sprain: randomised controlled trial. BMJ. 2010; 340:1964.

Comment

Patello-Femoral Pain Syndrome

Comment

Patello-Femoral Pain Syndrome

What is PFPS?

Patellofemoral pain syndrome (PFPS) is prevalent in approximately 25% of the athletic population and most commonly affects young adult females [1].  PFPS is characterised by anterior knee pain in and around the patella [2,3]. When bending at the knee joint, the patella should normally track in a lateral to medial direction before moving laterally again at full knee flexion. This motion is controlled by the quadriceps muscle group, particularly the vastus medialis oblique and vastus lateralis components. Poor coordination or weakness of these muscles can lead to inflammation of soft tissues (lateral retinaculum, infrapatellar synovium and fat pad) in addition to stress on cartilage and bone causing pain [3].

Presentation

  • Acute or gradual onset
  • Aggravated by increased on unaccustomed loads on the patellofemoral joint (e.g. higher training volume, increased running speed, hill/stair running and bounding)
  • Varied presentations including achy/sharp pain, poorly localised under or around the patella
  • Knee/s may feel like it is gives way or buckles [2,3]
  • Pain during squatting [4]
patellofemoral-pain-syndrome.jpg

Aetiology

  • Inadequate neuromuscular control or weakness of quadriceps muscles
  • Patella position (tilt/rotation)
  • Pronated foot type [1,2]
  • Increased knee valgus or femoral internal rotation
  • Reduced strength, coordination or range of motion of hip abductors causing increased stress on frontal and transverse forced around the knee [3]

Complications

May predispose to the development of patellofemoral osteoarthritis.

How can Physiotherapy help?

  • Provide education and advice about your condition and promote strategies to reduce your pain and symptoms
  • Provide an accurate and comprehensive assessment of your condition and address any underlying biomechanical factors contributing to your pain
  • Provide condition specific treatment including manual therapy, massage and stretches
  • Create an individualised exercise program to target muscular imbalances in the hip and/or knee and improve coordination of quadriceps muscles
  • Taping to correct abnormal positioning of the patella [2,5]

 

If you have any questions regarding your knee pain, please give us a call at (02) 8411 2050. At Thornleigh Performance Physiotherapy, we can give you an accurate diagnosis and treatment, to help you get back in action as soon as possible. We are conveniently located near Beecroft, Cherrybrook, Hornsby, Normanhurst, Pennant Hills, Waitara, Wahroonga, Westleigh, West Pennant Hills, and West Pymble.

 

References

  1. Nunes, G. S., Stapait, E. L., Kirsten, M. H., De Noronha, M., & Santos, G. M. (2013). Clinical test for diagnosis of patellofemoral pain syndrome: Systematic review with meta-analysis. Physical Therapy in Sport, 14(1), 54-59.
  2. Brukner, P. (2012). Brukner & Khan's clinical sports medicine. North Ryde: McGraw-Hill. 4th Edition, 87. 725-726.
  3. Panken, A., Heymans, M., Van Oort, L., & Verhagen, A. (2015). Clinical prognostic factors for atients with aterior knee pain in physical therapy: A systematic review. International journal of sports physical therapy, 10(7), 929.
  4. Collado, H., & Fredericson, M. (2010). Patellofemoral pain syndrome. Clinics in sports medicine, 29(3), 379-398.
  5. Collins, N. J., Bisset, L. M., Crossley, K. M., & Vicenzino, B. (2012). Efficacy of nonsurgical interventions for anterior knee pain. Sports medicine, 42(1), 31-49.

Comment

Shoulder bursitis

Comment

Shoulder bursitis

What is shoulder bursitis?

The shoulder contains numerous structures (muscle, bone, ligaments, tendons and bursae) that work closely together to allow optimum functioning. Within each shoulder is two purse-like sacs that contain fluid: the sub-acromial and sub-deltoid bursae. These both help to reduce friction over adjacent surfaces (i.e. muscle on muscle, bone to muscle) [1]. When irritated, this leads to a thickening of the bursa causing a painful condition known as bursitis [2].


This is considered an active warning sign that the surrounding structures have undergone repeated trauma from overuse or have been involved in a single incident (i.e. collision) [1, 2, 3]. Poor body mechanics can also be a contributing factor to the onset of bursitis [2]. It has been commonly associated with chronic shoulder pain, rotator cuff tears and degenerative tendinitis of the rotator cuff [3].

Shoulder-Bursitis.png

Presentation?

  • Tender, swelling, painful when directly palpated
  • Pain when lying on shoulder
  • Pain when lifting shoulder
  • Limited range in all directions due to pain
  • Gradual onset of pain and limitations
  • Difficultly doing overhead activities

 

Complications – Septic Shoulder

Is a rare condition in which the bursa becomes infected. Sepsis is caused in the bursa because of direct contact piercing through the skin in the form of isotretinoin therapy and corticosteroid injections [4]. Individuals will feel the same symptoms as listed above, however, they may also become feverish, tired and sick. The shoulder may appear red and radiate heat [2, 4, 5]. Treatment should be sought from a medical practitioner to provide antibiotics to prevent the spread of the infection [2, 4, 5].

 

How can Physiotherapy help?

  • Perform a thorough postural and movement examination of the upper body to provide education and understanding into condition.
  • Provide tailored strategies and modifications to correct improper biomechanics of the shoulder, i.e. taping, ergonomic assessment.
  • Design a personalised exercise program tailored to resolving muscle imbalances that would otherwise cause shoulder bursitis.
  • Assist with improving range and pain management strategies.
  • Provide education on self-management techniques.

If you have any questions regarding your shoulder pain, please give us a call at (02) 8411 2050. At Thornleigh Performance Physiotherapy, we can give you an accurate diagnosis and treatment, to help you get back in action as soon as possible. We are conveniently located near Beecroft, Cherrybrook, Hornsby, Normanhurst, Pennant Hills, Waitara, Wahroonga, Westleigh, West Pennant Hills, and West Pymble.

References

  1. Lennard, T. (2011). Pain procedures in clinical practice / Ted A. Lennard ... [et al.]. (3rd ed.). Philadelphia: Saunders
  2. What is shoulder (subacromial) bursitis? (2013). https://www.arthritis-health.com/types/bursitis/shoulder-subacromial-bursitis
  3. Santavirta, S., Konttinen, Y., Antti-Poika, T., & Nordström, I. (1992). Inflammation of the subacromial bursa in chronic shoulder pain. Archives of Orthopaedic and Trauma Surgery,111(6), 336-340.
  4. Drezner, J., & Sennett, B. (2004). Subacromial/subdeltoid septic bursitis associated with isotretinoin therapy and corticosteroid injection. The Journal of the American Board of Family Practice, 17(4), 299-302.
  5. Khan, H., & Al-Tawil, K. (2013). Spontaneous Isolated Infection of the Subacromial Bursa. Case Reports in Orthopedics, 2013, 3

Comment

Stress & Pain

Comment

Stress & Pain

Do you often feel more pain during times of increased stress?

Pain is regulated by inputs from the brain, spinal cord and the environment and is influenced by multiple factors such as mood, thoughts, activity, sleep and stress [1]. These factors can influence the severity of pain and affect your prognosis. Often when the pressures of family, work and everyday life are weighing on you, not only do you experience an emotional impact but this can also increase your pain intensity and duration. Additionally, experiencing physical pain also makes people feel more stressed, thus creating a vicious cycle that may even lead to chronic injury. Therefore, managing stress is a significant factor to reduce pain and improve quality of life [1,2].

 

Effects of stress on the body

Psychological factors can contribute to increases in muscular tension and postural abnormalities that can accentuate the severity of physical injuries. These changes in muscle and posture can prevent muscles from functioning appropriately resulting in increased pain [1, 3].

For example, in patients following neck injuries, especially if the mechanism of injury was traumatic, they may experience increased muscle tension in the head, neck or upper limbs in addition to adapting abnormal postures that can heighten physical findings in the neck. The body’s response to stress and pain also varies widely among individuals, and these psychological factors could drive pain and take longer to resolve. Due to this variability, it is important to identify factors that may influence a patient’s recovery to potentially prevent re-occurrence [1].

Other effects of stress on your body and behaviour:

  • Fatigue
  • Sleep disturbances
  • Anxiety and/or depression
  • Lack of motivation or focus
  • Changes in mood/irritability
  • Social withdrawal
  • Reduced physical activity

 

What has research shown?

People suffering from psychological distress were shown to be five times more likely to suffer from chronic pain [4]. Current evidence supports the use of pain education for chronic musculoskeletal disorders in reducing pain, improving function, encouraging movement, lowering disability, and minimizing healthcare utilisation [5].

Research also demonstrated the effects of participating in regular exercise as an effective strategy for managing stress. Studies showed that post-exercise there was a significant impact on blood pressure responses to stress that may have implications for cardiovascular health [6,7].

Studies also recommended relaxation techniques such as deep breathing, yoga or meditation. These techniques encourage abdominal breathing which has been shown to promote stress reduction [3].

Overall, multidisciplinary biopsychosocial rehabilitation programs are recommended especially to those who suffer from chronic pain. These programs typically included pain education, pacing physical activities, and psychological treatment to address mood problems, sleep disturbances, unhelpful thoughts and behaviours in addition to medical management [2].

 

Coping strategies

Here are some tips to manage your stress:

  • Practice relaxation techniques such as deep breathing, yoga or meditation
  • Participate in regular exercise (at least twice a week for approximately 150-300 minutes of moderate intensity physical activity)
  • Ensure you have good quality sleep (between 7-9 hours)

 

How can physiotherapy help?

  • Complete a thorough assessment and physical examination of the individual and provide suitable recommendations on ways to improve posture and pain
  • Provide appropriate interventions to reduce muscle tension and pain with manual therapy techniques including massage
  • Create a individually tailored exercise program to increase physical activity and encourage self management
  • Provide education about your condition and help assist you locating appropriate resources to prevent re-occurrence

If you have any questions regarding whether we can help you manage your stress and pain better, please give us a call at (02) 8411 2050. At Thornleigh Performance Physiotherapy, we can give you an accurate diagnosis and treatment, to help you get back in action as soon as possible. We are conveniently located near Beecroft, Cherrybrook, Hornsby, Normanhurst, Pennant Hills, Waitara, Wahroonga, Westleigh, West Pennant Hills, and West Pymble.

 

References

  1. Brukner, P. (2012). Brukner & Khan's clinical sports medicine. North Ryde: McGraw-Hill.41-52, 332-333.
  2. Kamper, S. J., Apeldoorn, A. T., Chiarotto, A., Smeets, R. J. E. M., Ostelo, R. W. J. G., Guzman, J., & van Tulder, M. W. (2015). Multidisciplinary biopsychosocial rehabilitation for chronic low back pain: Cochrane systematic review and meta-analysis. Bmj, 350, h444.
  3. Berger, B. G., & Owen, D. R. (1988). Stress reduction and mood enhancement in four exercise modes: Swimming, body conditioning, hatha yoga, and fencing. Research quarterly for exercise and sport, 59(2), 148-159.
  4. ABo, S. (2007). National survey of mental health and wellbeing 2007 (Cat. no. 4326.0). Canberra2007.
  5. Louw, A., Zimney, K., Puentedura, E. J., & Diener, I. (2016). The efficacy of pain neuroscience education on musculoskeletal pain: A systematic review of the literature. Physiotherapy theory and practice, 32(5), 332-355.
  6. Hamer, M., Taylor, A., & Steptoe, A. (2006). The effect of acute aerobic exercise on stress related blood pressure responses: a systematic review and meta-analysis. Biological psychology, 71(2), 183-190.
  7. Hobson, M. L., & Rejeski, W. J. (1993). Does the dose of acute exercise mediate psychophysiological responses to mental stress?. Journal of Sport and Exercise Psychology, 15(1), 77-87

Comment

Our First Handstand Workshop is here!!

Comment

Our First Handstand Workshop is here!!

Want to learn how to do a handstand?  Or get your technique tweaked by the master?  Join our handstand workshop!!

 

WHO – Beginners to Intermediate Level.  Anyone looking to improve their handstands from the handstand master, Aleea Newton, former Australian Olympic Reserve Gymnast and current physiotherapist at Thornleigh Performance Physiotherapy.

 

WHAT -

Learning Objectives

-        Ideal shaping for a safe handstand

-        Common issues and difficulties

-        Tips and tricks for learning/progressing handstands without injury

-        Training Progressions for every level

 

WHERE – Thornleigh Performance Physiotherapy Gym

 

WHEN – Tuesday September 4th, 2018 7PM

 

HOW TO BOOK – As spaces are limited bookings are essential.  First 6 attendees are FREE (first in best dressed), thereafter $25 ($30 on the day). Register online at https://www.stickytickets.com.au/74405

Or email Tina tina@thornleighphysio.com.au

Comment

Medial tibial stress syndrome

Comment

Medial tibial stress syndrome

What is medial tibial stress syndrome?

Medial tibial stress syndrome (MTSS) is a common condition mostly affecting runners and recreational sports players. It is an overuse injury resulting from repetitive stress to the bone in the lower leg, the tibia. Stress reactions occur on the tibia and the surrounding muscles when the body is unable to heal properly, and with repetitive stress and inadequate healing, this creates an overuse condition. Tibialis posterior, a muscle in the back of the calf has been the main muscle responsible for this condition. However recent studies have identified that several muscles are involved, including flexor digitorum longus and the soleus, which are two muscles in the calf as well.

 

What are the symptoms?

The symptoms of MTSS include:

  • Vague diffuse pain in the lower leg near the shin bone
  • Pain that gets worse at the beginning of exercise but eventually subsides
  • Pain the following morning
  • As the condition worsens the pain may persist during activity

 

What are the risk factors?

The risk factors for MTSS is influenced by your individual biomechanics of movement, and the type of training you are performing. This means that the way your body moves and its positioning during walking and running can make you more susceptible to this condition. Some of these risk factors include:

  • Flat feet (excessive pronation)
  • Training errors
  • Sudden changes in physical activity e.g. sudden increase in intensity or duration
  • Shoe design
  • Surface type
  • Fatigue
  • Decreased flexibility
  • Muscle dysfunction

 

How do we treat it?

The foundation of treatment for medial tibial stress syndrome is based on identifying the risk factors involved, and treating the underlying pathology. This will ensure that we are treating the cause of the problem so it will not return in the future. Treatment begins with providing relief through rest and ice. In order to keep you active and still exercising you are able to completed pain free activities such as swimming or cycling.

Your physiotherapist will then begin a careful assessment of how your foot, knee and hip alignment are affecting your running and walking. Taping may be used to control your foot pronation (flat foot), and other techniques including strengthening and stretching of muscle imbalances, mobility exercises, motor control and stability exercises. Your physiotherapist will tailor these treatment options to your specific biomechanics which will reduce the stress placed on the tibia.

 

If you have any questions regarding shin pain, please give us a call at (02) 8411 2050. At Thornleigh Performance Physiotherapy, we can give you an accurate diagnosis and treatment, to help you get back in action as soon as possible. We are conveniently located near Beecroft, Cherrybrook, Hornsby, Normanhurst, Pennant Hills, Waitara, Wahroonga, Westleigh, West Pennant Hills, and West Pymble.

 

References

  1. Galbraith, M. Lavallee, M. 2009. Medial tibial Stress syndrome: conservative treatment options. Current Rev in Musculo Med. 2(3) 127-133.
  2. Batt, M. 2011. Medial Tibial Stress Syndrome. British Journal of Sports Medicine. 45(2)1-8.
  3. Franklyn, M. Oakes, B. 2015. Aetiology and mechanisms of injury in medial tibial stress syndrome: current and future development. World J of Ortho. 6(8) 577-589.

Comment

Gua Sha

Comment

Gua Sha

What is gua sha?

Gua sha is commonly known to be a traditional eastern medicine technique where a blunt tool, such as a ceramic soup spoon, is used to scrape the skin to improve blood circulation and oxygen supply to the soft tissue. A modern take on this technique is often referred to as instrument-assisted soft tissue mobilisation (IASTM).

 

What happens during tissue injury?

Inflammation usually occurs following an injury to generate new cells. The formation of scar tissue reduces elasticity of the injured tissue and results in adhesion. The scar tissue may also limit oxygen and nutrient supply and thus affect tissue regeneration. If left untreated, chronic inflammation may lead to tissue degeneration and contribute to chronic pain. These areas may also be more susceptible to re-injury.

 

How does gua sha work for injured tissue?

Adequate pressure and shear force applied during soft tissue mobilisation create micro-trauma in the affected area. This can facilitate the inflammatory response during the healing phase of the tissue. By using an instrument to assist, the clinician is able to deliver a greater force and stimulate adhesive points deeper within the tissue. Removing scar tissue and releasing adhesions help collagen synthesis and realignment. These in turn improve soft tissue function, range of motion, decrease pain and speed up healing.

 

Do I need gua sha?

Gua sha can be beneficial for conditions including but not limited to:

  • Tennis elbow
  • Patella tendon injury
  • Hamstring tendinopathy
  • Achilles tendinopathy
  • Partial muscle tears
  • Plantar fasciitis
  • Chronic neck pain
  • Chronic low back pain

 

What should I expect when receiving gua sha?

The clinician will typically start by rubbing lubricant such as cream to the skin before applying the instrument at a tolerable pressure onto the affected area. The clinician will perform smooth firm strokes over the affected area while feeling for restrictions or soft tissue irregularities. This process may take about 5-15 minutes depending on the affected area and condition.

In physiotherapy, gua sha may be used in conjunction with stretching and strengthening exercises depending on the type of injury and the stage of recovery. These exercises help restoration of function and prevent re-injury.

 

Are there any side effects with gua sha ?

Gua sha should not be painful during treatment. The rubbing and scraping may cause small blood capillaries near the surface of the skin to burst and result in redness, light bruising or soreness. These symptoms should resolve in a few days and can be managed with ice if necessary.

 

If you have any questions regarding whether gua sha can help, please give us a call at (02) 8411 2050. At Thornleigh Performance Physiotherapy, we can give you an accurate diagnosis and treatment, to help you get back in action as soon as possible. We are conveniently located near Beecroft, Cherrybrook, Hornsby, Normanhurst, Pennant Hills, Waitara, Wahroonga, Westleigh, West Pennant Hills, and West Pymble.

 

References

  1. Kim J, Sung DJ, Lee J. Therapeutic effectiveness of instrument-assisted soft tissue mobilization for soft tissue injury: mechanisms and practical application. J Exerc Rehabil. 2017;13(1):12-22.
  2. Lambert M, Hitchcock R, Lavallee K, et al. The effects of instrument-assisted soft tissue mobilization compared to other interventions on pain and function: a systematic review. Physical Therapy Reviews. 2017;22(1-2):76-85.

Comment

Triangular Fibrocartilage Complex

Comment

Triangular Fibrocartilage Complex

What is the TFCC?

The TFCC (triangular fibrocartilage complex) is a cartilage structure located on the small finger side of the wrist, it consists of ligaments and tendons. The function of this group of structures is to provide stability and smooth movement of the wrist joint. The TFCC keeps the forearm bones, the radius and ulna, stable when the hand grips objects or when the forearm rotates. An injury or tear to this structure can cause chronic wrist pain.

 

Types of TFCC injuries

There are two types of TFCC injuries:

  • Acute injuries: this is a traumatic tear. This can result from a fall onto the hand or from excessive arm rotation.
  • Chronic injuries: this is a degenerative tear or a tear that has lasted a long time. This can occur due to repetitive loading over a long period.

 

Symptoms

The symptoms of a TFCC tear include:

  • Pain at the base of the pinky side of the wrist
  • Pain worsens as the wrist is bent from side to side, and any activity that requires forearm rotation produces pain. For example: turning a doorknob or a key in the door, or lifting a heavy pan with one hand.
  • Tenderness over the back of the wrist
  • Reduced grip strength
  • Sometimes a clicking in the wrist

 

How is it diagnosed?

TFCC tears are diagnosed through careful assessment of the wrist and forearm. This involves your physiotherapist determining how your pain began, looking at the location of your pain, and how your pain is affecting the movements of your fingers, wrist and forearm. From here your physiotherapist is able to implement a treatment program.

 

How is it treated?

Throughout your assessment your physiotherapist would have determined the likely cause of your pain, which movements are painful and which movements are affected by your injury.

If the wrist is still stable, conservative treatment is taken. This involves beginning to decrease inflammation and pain around the area. You may be given a splint to wear for a short period of time to assist in pain reduction, and activity modifications will be applied to movements which cause pain such as heavy grasping and turning and twisting the wrist. Your physiotherapist will assess how you perform daily tasks, so these activity modifications can be manageable in your every day life.

Once pain and inflammation have been controlled, the focus of treatment will be on strength and mobility of the wrist and hand. Mobility will be addressed by improving the bending and straightening of the wrist, turning the palm up and then turning it back, along with making sure all of your fingers have proper mobility as well. Strength exercises will be prescribed to improve your grip strength, your ability to exert force when twisting the wrist, grabbing items, and bearing weight through the wrist. Additional exercises will be prescribed for you to be able to perform your activities of daily living with no pain.

Through mobility and strength exercises given by your physiotherapist you should be able to return to sport and return to normal activity.

 

If you have any questions regarding your wrist pain, please give us a call at (02) 8411 2050. At Thornleigh Performance Physiotherapy, we can give you an accurate diagnosis and treatment, to help you get back in action as soon as possible. We are conveniently located near Beecroft, Cherrybrook, Hornsby, Normanhurst, Pennant Hills, Waitara, Wahroonga, Westleigh, West Pennant Hills, and West Pymble.

 

Reference

Lubiatowski, P. Romanowski, L. Splawski, R. Manikowski, W. 2006. Treatment of injury of the Triangular Fibrocartilage Complex TFCC. Ortop Traumatol Rehabil. 30:8(3). 256-62.

Comment

Extensor Tendinopathy

Comment

Extensor Tendinopathy

History

A 53 year old female presented with gradual onset of pain to her right elbow localised to the lateral side of elbow and forearm.  She described her pain to worsen with gripping, reaching and lifting tasks, especially when attempting to use scissors at work. What can physiotherapy do to help?

 

Clinical examination

At rest, with her forearm relaxed on a pillow the patient had minimal to no symptoms. During active and passive range of motion examinations, pronation (inward rotation) of her forearm with the elbow extended and flexion of the wrist were the most provocative movements. Resisted extension of her wrist and 3rd finger also reproduced her symptoms and she was tender upon palpation over the lateral side of her right elbow and presented with painful and decreased grip strength. No reproduction of symptoms was evident following a screen of her right shoulder and neck, indicating a non-referral pain diagnosis.

Her mechanism of injury and clinical presentation indicate an extensor tendinopathy or commonly known as “tennis elbow”.

 

Management

A multimodal treatment incorporating education, unloading of the tendon from aggravating factors, pain relief and restoring tissue capacity and control was used to manage her extensor tendinopathy appropriately. Pulsed ultrasound was firstly used to promote the initial healing of soft tissue. She had active trigger point pain along her forearm muscle, that is a common occurrence in the presentation of extensor tendinopathy. The patient responded well with dry needling to her right forearm muscles which assisted in relieving muscle tension and forearm pain. She was provided with education regarding the use of ice as a form of pain management and unloading strategies. Isometric muscle activation exercises and stretches were also prescribed to be completed at home. She was also provided with a counterforce brace to be worn during working hours to assist her in gripping with reduced pain.

Over the next couple of weeks, the main focus was to restore the tissues capacity to withstand loads with minimal to no pain. This is achieved through appropriate rest and unloading of the tendon. Completing a progressive home strengthening exercise program with appropriate loads and tendon stretching. These strategies allowed time for the patient’s tendon to heal appropriately and reduce the symptoms the patient was experiencing. Manual therapy techniques and dry needling were used in conjunction to relieve any associated muscle tension. Following a couple weeks, she was able to return to full work duties with minimal to no issues.

 

If you have any questions regarding elbow pain, and need an assessment, please give us a call at (02) 8411 2050. Here at Thornleigh Performance Physiotherapy, we can give you an accurate diagnosis and treatment, to help you get back in action as soon as possible. We are conveniently located near Beecroft, Cherrybrook, Hornsby, Normanhurst, Pennant Hills, Waitara, Wahroonga, Westleigh, West Pennant Hills, and West Pymble.

Comment