Return to sport ~ Ankle injury

How do I know when it’s okay to return to sport?

Knowing when to return to sport following an ankle injury can always be a bit tricky. The chance of reinjuring your ankle is always going to be higher than before, so it’s important to ensure that you are ready. A big mistake that a lot of people make is returning to sport once there is no more pain, but most of the time this is still too early.

 

When assessing if someone is ready to return to sport, there are a few things that we look for. The first thing that we assess is to see if someone’s muscle strength and power is within 10% of their injured side. We commonly assess this by testing if someone can perform a single leg hop and achieve a similar distance to their uninjured side. We also assess if the landing is controlled and stable.

 

The next test that we normally assess is the triple hop. This involves hopping three times in a row, and the usual return to sport criteria is to achieve within 10% of the same distance of the uninjured side.

 

We also assess for balance and proprioception (the body’s ability to sense joint position) which are both vital to avoid reinjury following an ankle injury. There are a number of tests that we use to assess balance and proprioception, and a common test that we use is the Y-balance test. This involves balancing on one leg and attempting to tap as far forward, and behind to the left and right without losing one’s balance. Similar to the previous tests, the most valid return to sport criteria is to be able to reach within 10% of the uninsured side.

 

Although a simple ankle injury may seem to be resolved, it’s important to clear the above return to sport criteria to avoid a reinjury, which may mean that you’ll need more time off. If you’ve recently experienced an ankle injury and are unsure if you are ready for sport yet, make sure to book in with one of our physios who will help guide you towards performing at your best!

 

TMJ (Temporomandibular Joint)

The sneaky reason for your Jaw Pain, Headache or Neck Pain?

The TMJ or Temporomandibular Joint broadly refers to the joint between your lower jaw (mandible) and your temporal bone of the skull/upper jaw. Each side works together as a hinge to help you talk and chew.

 

Dysfunction can occur here either within the joint (Intra-articular) or outside the joint (Extra-articular). 

 

Like any joint surface, over time, intra-articular factors such as osteoarthritis could be a contributing factor to your discomfort. Also, a small disc like structure which helps the jaw to glide open and closed can sometimes move too far forward and/or become stuck, which may result in clicking and locking. 

 

Extra-articular factors of the joint muscles can become overly tight due to overuse and fatigue from movements such as excessive clenching or chewing, which can result in headaches/soreness in the jaw and even neck! 

 

Dysfunction symptoms can include:

• Clicking/Locking
• Soreness/tightness at the side of the head above the temple/on the jaw/behind the jaw
• Often accompanied by neck tightness and pain
• Headaches
• Nasal Pain
• Unable to open your jaw or mouth very wide ie yawning or the dentist

 

How can my Physiotherapist initially treat my Jaw?

 

Education

 

• What is your resting jaw position? Do I clench a lot when I concentrate?
• What does your neck posture look like (as this can influence the jaw)?
• Do I need to make some short term adjustments to eating – such as reducing hard foods or foods which need excessive chewing (sorry, this might mean a delicious steak)?
• Do I need to change habits which use my chewing muscles excessively – such as chewing gum?
• What does my posture look like at the office? Do I need to look into changing my desk ergonomics (could mean an exciting trip to Kikki K/Kmart/Officeworks)?

 

Manual Therapy

 

 

Depending on the Stage, particularly early Stages, of Dysfunction around the TMJ (which your Physio will Assess), general manual therapy or hands on will most commonly improve your jaw dysfunction. Such as:

• Dry Needling or Soft Tissue Massage, which can be highly effective on the muscles which lift the jaw (most commonly affected). 
• This can also be highly effective when targeting the neck muscles or muscles underneath the skull.
• Mobilising the jaw joint (encouraging the joint to sit in it’s optimal position, which also in turn relaxes tight muscles).
• Specific exercises which encourage better stability in the joint (particularly if you are experiencing clicking). 
• Even teaching the muscles around the joint to recognise where they are in space in a better way, otherwise known as proprioceptive neuromuscular facilitation (PNF).

 

There are many other reasons for jaw dysfunction, particularly if you may be in the later stages. If you think you may be experiencing some jaw dysfunction, have tried some of the tips above and would like further assessment & relief from one of our team, come into the clinic for an Assessment! 

 

This isn’t something you have to live with, you’ll wish you had come in earlier!

 

 

Plantar Fasciopathy

Plantar Fasciopathy and my own personal experience

~ Nathan Andijanto, Physiotherapist

Plantar fasciopathy affects 10% of the population. If you have ever been part of that unfortunate 10% of people, you may know how draining and frustrating the experience can be. You will also appreciate the impacts it can have on your daily function. Everyday activities, sports, fitness training and walking are just some of the things that can become limited by stubborn heel pain. 

 

Common symptoms associated with plantar fasciopathy include stabbing pain on the bottom of your foot, typically near the heel. This pain is normally worst when taking your first few steps after waking, and can also be present after long periods of standing or when getting up from the chair. It is also common for the pain to be manageable during exercise, but to worsen afterwards. The onset of pain is usually preceded by a quick change to the load placed on the plantar fascia. This can occur with spikes in training or exercise load and may also occur after gaining weight (increased BMI). 

 

My own experience of plantar fasciopathy was related to a combination of these two components. My exercise load increased rapidly when the soccer season began and the off-season was a particularly lazy one which led to some weight gain. Although these wouldn’t have been the only factors, they were certainly the largest ones that I was able to identify. The heel pain gradually got worse and worse over the period of about 2-3 months. It started with some mild discomfort during my first few steps in the morning and progressed to a stabbing pain in my heel any time I rose from a chair. 

 

Being a physio, I knew what was considered the best possible management by the research. The research literature currently supports a multi-faceted approach which includes some symptoms management (massage, cryotherapy etc.), ankle mobility exercises (eg stretching), activity/load modification, reducing BMI and strengthening the plantar fascia. This was easier said than done; however, I persisted with the exercises that I would prescribe to patients for up to ~6 months. It made the symptoms far more manageable, but did not eliminate one of the biggest contributing factors in my scenario, which was the high amount of load. I found it difficult to reduce load during soccer as it actually felt quite good whilst training or playing. 

 

In my case, I was able to modify my routine enough to manage the symptoms whilst continuing to play soccer. It wasn’t until I had a significant change in load (when the soccer season ended) and also lost some weight (reducing my BMI) that I was able to achieve complete symptom management. 

 

To summarise, heel pain due to plantar fasciopathy has a number of contributing factors. In order to have a significant improvement to the pain, there are many factors that need to be considered and addressed. Addressing all of these factors will give you the best chance of complete resolution of your heel pain. We would love to help you identify the contributors and set up a structured plan of action to help you get on top of your heel pain. 

 

Advice for Rowers

Rowing advice to manage your pain and improve your performance!

It’s important to have a well set out plan when it comes to rowing and managing your pain with physio. In a world of temporary fixes the “plan” often consists of massage, mobilisation or needling to manage pain and not much more. Whilst this can be helpful in the short-term, is this really helping you to row better or find opportunity to address the underlying causes of your pain?

The way we row can often be a contributor to the pain we experience. Rowing is a very technical sport and requires rhythm, strong sequencing and a resilient body to tolerate the loading pattern. If one of these is not up to scratch then it may need to be addressed if you are experiencing lower back pain or chest wall pain. In my personal experience as a rower, these aspects are often neglected in favour of pain-relieving techniques that have short-term outcomes (although these are nice and useful at times) and maybe a token exercise. 

My aim as an rower turned physiotherapist is to provide rowers with a plan to tackle their pain long-term. Alongside pain-relief techniques such as dry needling and mobilisations, my plan looks at the underlying deficits in range of motion, strength, tolerance to loading, movement planning and rowing technique to help create long-term change to movement which will ultimately help you learn to control your pain and improve your rowing. 

This doesn’t happen in a week or even two weeks. Good plans and support come long-term and I give 6 weeks to help coach rowers through a change in their movement.

If you want to move a boat faster, or move a boat with less pain then it might be time to look at how you’re moving and find an opportunity to learn to move better. This is the true leading edge you can get on your competition. 

Matt is an ex-SASI rower and qualified physiotherapist practicing at our Mile End clinic. He is also a qualified strength and conditioning coach and rowing coach. Alongside these, he draws on his personal experiences in rowing to help provide rowers with a strong plan of action over 6-weeks to help them achieve their goals.

 

Posture

Your next posture is your best posture!

What is ‘good posture’? Traditionally you would think of sitting with a perfectly straight back, a tucked tummy, and your shoulder blades pulled back. But how realistic is it to assume you could maintain that for every minute of the day you spend sitting? Perhaps more importantly, would it even help? 

Our most current understanding of ‘good posture’ is that it really doesn’t exist. Instead, we should reshape the way we think about posture. Rather than HOW we sit, we should think about HOW MUCH we sit, or, perhaps more importantly, HOW LITTLE we move. Think of pain at the end of a long work day as your body’s alert system to say you might’ve been in one position too long. 

So rather than trying to sit one way all day, think about all the different ways you could sit throughout your day and try to schedule some time to change your position. Sit tall and straight, sit slouched, put your feet up, cross your legs, get up and walk around the office, do a couple neck and back twists, and you’ll feel better for it. Acknowledge your body’s alert that it wants you to move, or better yet, keep moving so your body doesn’t even need to remind you! Morale of the story – Your Next Posture is Your Best Posture.

 

How to manage stiff and painful necks

What a pain in the neck!

A common problem we see in the clinic is people coming in with a very rigid and painful neck, and usually they’ll tell us that there wasn’t anything in particular that caused this, they just woke up like this! This type of pain can be pretty concerning for a lot of people, and it can often be really limiting, stopping people from being able to do the simplest tasks with their daily activities! 

While this sucks, and can be extremely painful and scary, we can be quite sure that this pain is not going to hang around forever. In the absence of any physical trauma, or neurological deficits (e.g. weakness or numbness in both arms), this type of neck injury is called a non-specific neck pain. 

What does non- specific neck pain mean? 

All it means is that there is likely a number of different contributing factors that might have led to this pain, but there is no distinguishable damaged structure in your neck. This also means that you won’t have to wait for anything to heal up, you just need to make it through the really painful phase and wait for the irritation to subside back to normal, which usually happens within a week or two. 

The key to manage this issue is to remain as active as tolerated, to recover quicker and remain doing what you love. Even if it’s painful or uncomfortable, it is still perfectly safe to stay moving, and it’s still very difficult to cause any damage to your tissues. If it is too painful for you to complete an activity, try to modify the task to make it more manageable by decreasing the load, taking frequent breaks, or trying to shift your position to find a comfortable one. 

 

Stiff and painful necks are horrible to experience, but they generally come good quite quickly, and don’t usually lead to any long term disability. If your pain is quite concerning, book in for a thorough assessment with one of our physios to ensure what the best plan going forwards is for you. 

 

Prehabilitation (Pre-hab)

Why Prehabilitation?

If you’ve had your surgery postponed due to COVID-19, or simply want to delay surgery or make the most of your capabilities, there is some work you can do to prepare and boost your postoperative recovery.

 

Prehabilitation is a strategy that involves exercise and strength training to improve your functional capacity before you go under the knife. Increasing evidence has shown that patients who participate in prehabilitation have less postoperative pain, improved physical function and decreased length of hospital stay following surgery.

 

Particularly for those undergoing joint replacements, exercise and strength training is an important factor in the management of osteoarthritis which is the leading cause for hip and knee replacements. Exercise can help improve joint pain and stiffness associated with osteoarthritis, and can improve your overall quality of life.

 

Surgery can be a very daunting process and may leave you with many questions about the procedure and what is expected in the rehabilitation process. Prehabilitation programs are designed to educate and empower you on what is expected after your surgery, and to prepare your body for the rehab process ahead.

 

Pre-covid, the average waiting time for elective surgery was just 24 days, however this is set to explode due to the thousands of people back logged on lists around the country. Especially in a time like this, when many surgeries are delayed, prehab poses as the perfect opportunity to help optimise your recovery.

 

If you would like to find out more about our Prehabilitation Program, come in and speak to the team at PhysioWest!

Building Good Habits

Tips for developing good habits & daily routines 

~ Matt Nowosilskyj, Physiotherapist & Clinical Mentor

I have recently read the book “Atomic Habits” by James Clear. I’d highly recommend it to anyone, so I thought I’d share some top take-aways relevant to health and exercise. 

 

“Success is the product of daily habits – not once in a life-time transformations.”

We don’t have to reinvent the wheel or make a dramatic shift in our health or exercise to achieve the outcome we are after. Simple, small, regular habits are key to making a sustainable shift to where we would like to be. All too often we see people boom & bust, where they have ramped up their exercise to overload levels. Taking it slow yet steady with a consistent and gradual approach is far more achievable.

 

“The most effective way to change your habits is not to focus on what you want to achieve, but who you want to become.”

Starting with our personal identity is the first step to adding meaning to our behaviours. If you know who you want to be, you can work backwards to the steps it takes to make it happen. If you want to be John the swimmer – what does that look like? Maybe it means you swim twice a week at the local pool for 30mins. If you want to be Sue the reader, maybe it means you turn off the TV at night and pick up the book. If you want to be healthy and fit, what does that mean to you? Ask yourself, then work it back. 

 

“Good habits make time your ally. Bad habits make time your enemy.”

The longer we sit on the couch, the harder it is to get up. Bad habits are tricky to shake, particularly the longer they’ve been ingrained. On the flip-side, although a small good habit at first may seem insignificant, the longer we can complete it consistently, the more exponential it’s impact. Knowing this, what better time to start than now?

 

As we mentioned at the top, there is a temptation to try and change the world and flip everything on it’s head in our quest for healthy exercise routines. Resist it if you can, and focus on one or two simple changes you can tweak as easily and consistently as possible. It could be putting your runners next to your bed each night ready for the morning. It could be setting your alarm to go off with your favourite song to wake up and move to. Make it easy, make it fun, and let the habits stack up to be the healthy and active version of yourself you want to be.   

Postpartum Recovery

What to expect once you’ve expected …

Sure, we all hear about what to expect when you’re expecting but what should we expect once the babies actually here?!

You go through 9 tough months of huge changes to and within your bodies and now have this incredibly gorgeous little bub which makes it all worth it!

But, what you don’t think about are those aches and pains that can come about with the demands of being a new mum. 

A common complaint is neck and upper back pain. This is due to the demands placed on these structures with frequent nursing and breastfeeding. Your muscles become tight and fatigued over time, which can result in stiff and painful joints. 

Our Physiotherapists and Remedial Massage therapists can help relieve muscle tension and provide you with some self-management strategies/exercises you can perform at home to help reduce this increase in tightness. However, it’s just as crucial to strengthen these muscles to prevent them from getting tight in the first place. A combination of release techniques and strengthening will provide the most benefit and help you get back to enjoying all the activities of early motherhood pain free!

Another common complaint, however, often unreported are issues with your pelvic floor. Most women will experience some sort of compromise to these muscles throughout their pregnancy and birthing journey so you’re not alone and it’s nothing to feel ashamed about. 

The facts:

• 50% of women who have given birth have some level of prolapse and urinary incontinence.
• 57% of women never tell anyone about their pelvic floor issues.
• 72% never seek treatment for it.

Whether it be that little leakage that catches you off guard, luckily there a range of treatment options that may help. 

Pelvic floor strengthening exercises are a simple yet effective tool that when prescribed appropriately can be very effective within just 2 weeks. 

There are also a range of compression garments that can help provide support and activate your pelvic floor muscles to reduce those leakage occurrences. SRC are an Australian brand endorsed by the Australian Physiotherapy Association. They not only have pregnancy/maternity garments but also a ‘recovery’ product line that caters for the new mums out there. These ‘recovery’ garments have been shown to help reduce incontinence and improve quality of life!

So if you are a new mum that’s suffering from pain or little inconveniences throughout the day, come speak to Soph, Zoe or Lauren. We’ll work alongside you to explore appropriate options to help get you  back to enjoying every moment of motherhood pain free!

 

Strength Training

The relationship between strength decline and ageing – is it inevitable?

One of the only few true absolutes in life is that we all get older and along with that comes the seemingly inevitable decline in strength. I’m sure we have all had the thought that we can’t do something like we were able to when we were younger. It is well documented that as we age our muscle mass and strength declines by anywhere from 3-5% every decade after age 30. It is often thought that strength decline is just a part of ageing and something we have to live with, but what are the factors that lead to strength decline? 

It is true there are unavoidable physiological changes as we age related to hormone changes and often reduced number and size of muscle fibres. These changes are largely out of our control, but research shows the biggest contributor to strength declines as we age is simply decreases in physical activity. As we get older we tend to do less, work less and move less. Our bodies adapt to this reduced activity and strength tends to follow and decline as well. This means that the greatest factor in strength loss is a modifiable one and therefore not one that we have to live with. One of the best features of our muscles is their ability to adapt to its demands throughout their life span. This means that no matter your age if you increase the demands on your muscular system they will adapt and increase in strength. 

Therefore strength training is one of the most important tools to minimise the effects of ageing and a key requirement to help maintain our strength in spite of physiological changes. Reduced strength isn’t simply ‘getting old’.

Pop into the clinic if you would like help to develop an individualised strength program that you can do either at home or in the gym to prevent your strength decline as you age!