Tennis Elbow

Pain on the outside of your elbow?

What is tennis elbow?

Tennis elbow (also known as lateral epicondylitis or lateral epicondylalgia) is an irritation or weakness of the wrist extensor tendon that attaches to the outside portion of the elbow. The wrist extensors are responsible for lifting the wrist upwards, similar to a tennis backhand, and are active while gripping items.

What causes tennis elbow?
The condition is not only found in tennis players, but is commonly caused by repetitive activities that involve heavy gripping and use of the wrist and hand. If the wrist extensor tendon can’t handle the repetitive load that is placed through it, it can become irritated and possibly weakened which leads to pain. Tennis elbow is most commonly seen in people aged 30-50, and approximately 40% of people experience tennis elbow in their lifetime.

How do we treat tennis elbow?
There are a number of different treatment methods that may alleviate pain from tennis elbow which include;
● Rest or activity modification
● Ice
● Non-steroidal anti-inflammatory drugs
● Massage and manipulation
● Dry needling
● Tennis elbow taping or bracing

These treatment methods are great to reduce pain in the short-term, however it is vital that they are used in conjunction with a structured exercise program. Exercises to strengthen the wrist extensor muscles and common tendon are important to prevent pain from returning once you return to the activities that can cause pain. This includes sport such as tennis or manual labor which involves repetitive use of the wrist and hand. An exercise program for tennis elbow would normally involve a progressive resistance training program which would include lifting weights and using resistance bands. If you have been experiencing elbow pain as a result of sport or work, make sure you book in with one of our physios to get you started on an in-depth rehab program to get you back on track.

 

Achilles Tendinopathy

An insight into ‘Achilles Tendinopathy’ and likely rehab journey

Rehab for an aggravated achilles tendon can be a slow, frustrating process. The medical term for this achilles tendon dysfunction is ‘achilles tendinopathy’ and it tends to be an overuse injury which is brought on by excessive overload of the tendon. 

An aggravated tendon can fall under 3 different stages which describe the state of the tendon and changes that have occurred. The three stages are: reactive tendinopathy, tendon disrepair and degenerative tendinopathy. These stages can be thought of as a continuum and a tendon may slide up and down the continuum throughout the rehab process. Too much load may cause the tendon to slide along the continuum in a negative way; however, if completed properly, should result in progression along the continuum. Finding the right amount of load (or exercise) is often the trickiest part of rehab; however, this will often mean some modifications to your current activities and optimising recovery, whilst beginning some targeted exercises to improve the state of the tendon. 

In most cases, your physio will encourage you to continue moving and provide you with strategies to avoid flare-ups during your recovery. It is important to continue moving because complete rest will often be detrimental to long term outcomes as it will likely promote deconditioning of your calf muscles and achilles tendon; thus meaning that the tendon will be able to tolerate less load. 

The first goal should be to aid in pain reduction which may include exercises, hands-on therapy and activity modification. During this stage, a graded exercise program should be started which aims to load the achilles tendon in a tolerable manner. The exercise program will likely be progressed from strength building exercises towards functional exercises. Once base strength and tendon tolerance has improved, the exercise program will likely progress towards explosive movements and/or sports-specific movements if these types of movements are part of your goals. 

The rehab process can take anywhere from 3-6 months before significant symptom improvement occurs, so being patient, but diligent is very important to achieving great outcomes. At a very simple level, the aim of rehab is to settle the tendon down, then gradually build it back up to improve the amount of load the tendon can tolerate. We would love to help guide you through the process at PhysioWest, so please get in touch or come see us in clinic!

 

Hamstring Strain

I’ve Strained a Hammy!! What do I do?!

How do I know?

A ‘strain’ is an overstretching or tear that can occur in the muscle tissue. A hamstring strain feels like a sudden sharp pain at the back of your leg and an audible “popping” sound might be heard. 

 

How bad is it?

Hamstring strains are graded into 3 different categories:

Grade 1 is a mild muscle pull. There is no reduction in strength, there is full active and passive range of motion and pain & tenderness are often delayed to the next day.

Grade 2 is a partial tear usually accompanied by bruising, a dull pain & a minor reduction in muscle strength.

Grade 3 is a complete tear or rupture of the muscle. This means either the tendon is separated from the muscle belly or the muscle belly is actually torn in 2 parts. Severe swelling, pain and a complete loss of strength & function will be experienced.  

 

What do I do?

Initially, the RICE protocol (Rest, Ice, Compression and Elevation) is important to reduce discomfort & necessary in the acute stage of healing. It is important to progress to a rehabilitation stage as soon as possible, recent research points towards as early as 2 days post injury is more effective than 9 days. 

 

Who should I see after straining my hammy?

Visit your Physiotherapist as soon as possible. Your physiotherapist will be able to diagnose the type of strain to plan the appropriate management that is right for your case as well as to address the biomechanics that may have led to the strain.

The most common mechanism of injury is an overstretched hamstring under high loads. Athletes most vulnerable play sports that incorporate running, sprinting, frequent stop starts such as basketball & soccer.

Your Physiotherapist may initially incorporate in your plan hands on techniques as an effective way to decrease discomfort and encourage the breaking up of scar tissue. This will be followed by returning mobility, flexibility, strength & stability via the right exercises depending on your goals and sport you would like to return to. 

Prevention is best! Start your pre-season now or start prepping to achieve a personal best by utilising PhysioWest’s Physiotherapy Team to strengthen your Hamstrings (and other weak spots) and hopefully never experience a Hamstring strain again. 

 

Individual Experience

Understanding “YOU”!

Empathy is defined as “the ability to understand and share the feelings of another”. This is a trait I like to think the physios at PhysioWest have in spades. Throughout the week the theme has been that as physios we have had our own share of current and past injuries. The aim was to highlight how we are not infallible and that we share some very similar experiences to the people we want to help. I even referred to myself as a “reformed boom-buster” in the Friday post. I hope it resonates clearly that we are not above anyone and that we all experience similar things to the people we want to help.

Part of being a physio is trying to understand someone in pain. Understanding someone in pain isn’t just a matter of nodding along and agreeing either. Sometimes lending an ear is enough, but often it is about sharing the experience and giving part of our own lives and experiences over as well. How comforting is it to hear that someone has felt a similar pain to you and has found a great exercise that worked to help manage it? Or how comforting is it to know I also struggle with the pattern of pushing through pain until I’m indistinguishable from charcoal toast? I often ask the people I see to consider what else is going on in their life and how it might be influencing their own pain. This is because it is well known that pain is modulated by things such as stress and emotions and often it can be good to recognise how these play into your own pain. This week has been a tough and emotional week for myself external to work and I find that my shoulder (read up about it in my previous blog post) has been sorer this week. Part of this might be attributable to the stress and reduced sleep, so I’ve been trying to do some things I enjoy to keep some balance. Again, I am a physio, but I am a human first. I experience a lot of the same things as those I want to help and I hope it comes across to those I see. 

PhysioWest wants to help you through pain by understanding you. I want to help you through pain by understanding you. I want to know when you are struggling emotionally, or when I give you too much homework (exercises), or when you’re worried your pain might be serious. I’ve been there and we’ve all been there and we feel you.

Come in for a chat, we’d love to help!

Interpreting Scans and Imaging Results

What does a baseball player’s shoulder look like on MRI? It’s probably not what you’d expect…

A study back in 2002 looked at a small group of professional baseball players’ shoulders. The purpose of the study was to use an MRI to image the players shoulders and see what types of changes might be occurring with this highly active group. 

 

14 players were included in the study which meant 28 shoulders in total were scanned. The MRI’s were performed and each players Rotator Cuff Tendons (the important muscle group that creates a lot of the function and movement around the shoulder) and Labrum (the capsule that houses the shoulder and provides stability) were assessed, along with numerous other local shoulder structures.

The findings of the MRI’s showed –

• In their non throwing shoulders 86% of the players had abnormal changes to their Rotator Cuff Tendons.
• In their throwing shoulders 79% of players had abnormal changes to their Rotator Cuff Tendons.
• In both their throwing and non throwing shoulders 79% of players had abnormal changes to their Labrums.

 

Like many, your first thought is probably something along the lines of – Wow… those numbers seem high, their shoulders must be toast. Or, you must need to be super lucky to not ruin your shoulders playing baseball at that level.

Now here’s the really interesting caveat – All the players included in this study were ‘asymptomatic’. Meaning, none of the 14 players reported shoulder pain, in either shoulder, or were dealing impaired function or performance. So I would suggest re-reading the above findings again, and knowing what you know now, how does it change your interpretation of the above?

So what should the take away be from a study like this? I think the moral of the story is that scan findings don’t represent the full picture. If you analyse these players based on their scans, you would assume they would be in some kind of trouble. If you analyse the findings in the context of the person, their shoulders are as healthy and functional as they have ever been. That’s why it’s super important to discuss your scan findings with a medical professional that explains your findings within the context of you as a person, not that what the scan shows because based on the above, we know that can be misleading.

 

Reference –

Miniaci, A, Mascia, AT, Salonen, D & Becker, EJ 2002, ‘Magnetic resonance imaging of the shoulder in asymptomatic professional baseball pitchers’, The American Journal of Sports Medicine, vol. 30, pp 66-73.

 

Understanding Pain

Pain, the overprotective warning system

Picture, if you will, that pain is like an over protective guard dog. When the dog barks, it’s warning you of potential intruder to your house, much like how pain is warning you of potential damage to your body. A well trained dog knows the difference between what is a threat and who is your lovely Auntie Pam coming to visit, but if your house has been broken into a couple of times and traumatised your dog, they might start barking at anyone that evens walks past the front door! 

Similarly, your past experiences with pain and injuries can influence the sensitivity of your warning system, and increase your pain when it might not be advantageous to you. How is Auntie Pam supposed to come visit if your dog is getting in the way? How are you supposed to engage in life if pain is limiting your function? 

The trick is to start slow. Pick something that is uncomfortable, but tolerable, and slowly get used to it over time and build up your tolerance to it. Retraining your pain system can be as difficult as teaching an old dog new tricks, but the key is to practice consistently.

Graded exposure is one of the many tools we like to use at PhysioWest, as it helps people to re-engage with life again! If this intrigues you, come in to have a chat about it with any one of our knowledgeable physios. 

 

Low Back Pain

Coming back from back pain

Low back pain is one of the worlds most prevalent health conditions, with around 1 in 6 (16%) Australian’s experiencing back pain each year, and up to 90% of people experiencing it at some stage of their life. 

Here are some tips on how to overcome your low back pain.

 

Don’t be put off by medical jargon

Some terms we hear a lot within the clinic are that patients have ‘slipped a disc’ or have ‘put there back out of place’. These phrases sound very harmful and scary, and are a highly inaccurate representation of what’s going on in the spine. The truth is that our spine and intervertebral discs are an extremely strong, robust structure that are so securely attached, that they simply CAN NOT slip out of place. 

Remember that your back is a strong, stable structure built to bend, twist and move with your body. If you experience a severe, sudden episode of back pain after lifting, remember that nothing has slipped out of place.

 

Don’t be put off by your MRI results

All too often when you’ve had scans, it will come back with some kind of ‘abnormality’, ‘disc degeneration’ or ‘disc protrusion’. For someone who doesn’t understand these terms, it can be quite frightening. The truth is that these changes are a normal part of aging and just like our skin, our joints can show wrinkles or grey hairs as well.

 

The key is to remain active and avoid bed rest

For back pain that has come on recently, it is often tempting to rest and lie in bed all day until it gets better. Research now shows that those who remain active and avoid bed rest (even when in pain) recover quicker and are less likely to have chronic pain and disability. We suggest that you find a balance between allowing your back to settle, and performing gentle exercise.

 

Exercise and strengthening helps prevent re-occurrences

Exercise is very healthy for our backs and living a physically active lifestyle is the best approach to preventing re-occurrences. You may be wondering what forms of exercise is safe, and quite simply, it can be any form of exercise that you enjoy. Whether it’s walking, running, cycling, swimming, yoga, pilates, hiking, gym.. The list goes on! Even running that was once deemed to be damaging to our spine has no link to the development of low back pain. 

To find out more information about low back pain, book in and come speak to the team at PhysioWest.

 

 

Proprioception

Proprioception: Prevention or Performance?

Many of us have gone out to sports training, thrown on our runners or boots, done a light jog around the oval, a couple of static stretches and called it a “warm up”. 30 years ago this was the status-quo and widely accepted approach to preparing for exercises, however more and more emerging evidence suggests otherwise.

Whether it be at elite, semi-professional or amateur levels, the importance of a dynamic and sports specific warm up have never been clearer, however it remains poorly adopted among the sporting community. 

Participating in proprioceptive neuromuscular training drills has been shown to reduce injury risk in the lower limb by 22% (Finch et.al 2016). Despite this, prevention unfortunately isn’t quite “sexy” enough, and these programs can be neglected. Maybe we should be re-framing their value?

Not only can these drills reduce injury risk, they also have been shown to improve performance in balance, jumping and sprinting outcomes (Ayala et.al 2017).

In a performance driven industry, where even at grass roots level everyone loves to perform at their best, encouraging dynamic warm ups to improve performance as well as reduce injury may be a better way to get the buy in required for them to be widely accepted. 

If you are a player, coach or parent – come into the clinic for a chat, and spread the word to create a safer and more enjoyable sporting community for all.

 

Pilates

The Stereotypes, Common Misconceptions & Benefits of Pilates

I’m sure we’ve all seen the stereotypical audience that Pilates attracts on American TV shows; Women in their tight fitting activewear, with their almond milk lattes, having a juicy gossip sesh. So, I’m not surprised when I hear my patients expressing concerns that they don’t think they are suited to Pilates or the pilates ‘crowd’. BUT, pilates does not exclude, it is for everyone!

 

When offering Pilates as an option for treatment to my male patients, I often get a smirk or laugh as a reply because the majority view it as an exercise for women only. But, that is the furthest from the truth. Pilates was actually developed by a male, Joe Pilates, in an attempt to improve his own health and physical fitness. He then implemented it in camps during World War I to help rehabilitate injured soldiers. Joe, born and raised in Germany, originally created a series of 34 mat based exercises which soon developed into a number of different exercises, incorporating a range of different equipment. In 1925 Joe emigrated to the US where he opened his own studio, broadening his audience to both men and women.

Times have evolved and since, Pilates is now commonly assumed to be a Women’s form of exercise with only 25% of participants being Men.

But what you maybe didn’t know… David Beckham, football star and legend took up pilates, practising it for one hour a day. He reaped the benefits – improved mobility, flexibility, coordination, balance but he also experienced a loss in body fat, in which he expressed that he was “in the best shape in years”. So, there you have it men… if you want a supple muscular body like Beckham, come give Pilates a crack! We can learn a lot through Pilates and definitely improve our performance throughout other daily activities in doing so.

 

Pilates is a great form of exercise and unlike most other types of exercise, it targets the whole body (with particular emphasis on the deep core muscles). Pilates works to improve flexibility, stability, control and strength. Attention is drawn to technique, postural alignment, body awareness, control and breathing. A number of studies have even shown its effectiveness in reducing pain and disability in those suffering from Chronic Low Back Pain.

These are all great, yes, but my favourite thing about Pilates is that it can be tailored to any individual, no matter what age, gender or skill level. There are a number of exercises that can be performed either on a mat, reformer, trapeze table or using additional equipment. Each exercise can be as gentle or physically demanding as you want it to be.

One of the reasons I love taking our Body Reform class is because of the variation, fun and laughs had. In a class I can have a middle aged male increasing his intensity with some 7kg dumbbells, a teenager pumping out some leg work on the reformer, a 70+ year old woman doing a single leg press on the trapeze table or a mum doing some gentle core and stretching mat work.

Each class is like a family, inclusive of all and with a common goal to improve physical and mental well-being.

Come tone up, improve your control, strength and perform at your peak every day!

 

Interested yet? Click the link below to book in with our Pilates guru Soph and she’ll help create a pilates program fit for you, whether that be a home program or program to follow along in one of our classes.

 

PhysioWest Team Reflection

Team Reflection

I joined the PhysioWest family early this year, in January, and I was so eager to start a new career in a new industry! I started in a new role that was created to make sure that our patients and clients get the best experience, every visit – Clinic coordinator! What does my job entail, you ask? To help our team go above and beyond for our everyday patients. At the time I thought I had found the perfect place to continue to build on my personal and professional growth.

 

Just as I had completed my induction and was getting ready to take a big leap into my shiny new career, we encountered the biggest hurdle the world has seen in a while – COVID-19. This put a major pin in my plans to take on this role and run with it! As we all well and truly know, the effects of COVID-19 came in fast and hard. We had big plans for our clinics and suddenly, seemingly overnight, we had to change tactics. This forced us, like so many businesses, to take a look at how we were running. We needed to make sure, most of all, that our team and patients were safe and healthy. Then we needed to work out how we could continue to care for, educate and empower our patients during such an uncertain time. Our passionate management team spent many, many hours making sure that we would be able to continue all doing what we love. We switched to new session formats like telehealth, we had to adjust to new behaviours and restrictions. With each announcement of new restrictions, we had to pivot. We all felt the pressure to make sure that the experiences in the clinic and via digital mediums were just as warm and friendly as before COVID. Alongside this, our clinics had a downturn of visitors which meant reducing operating and working hours. The mental load that this time brought with it was immense and meant that we were all feeling out of sorts and unsure on how we would pull through.

 

With our clinics back running at full capacity I have been able to take a look back at that time with less cloudy vision and see that, while the times were uncertain, the support that we all had in our management team and each other was rock solid! While COVID-19 is still somewhat looming over us I am confident that we have bonded and grown throughout the last 5-6 months and have come out knowing that whatever we face moving forward, each one of us has the support of our teammates. Remember how I said, “At the time I thought I had found the perfect place to continue to build on my personal and professional growth”? You know what… I was right! I am so thrilled to be a part of this group of super cool humans and we can’t wait to look after you in our clinics. 

 

Signing off for now,

~ Alexandra