Working out – it’s about YOU!

Exercise programs can be found online, in magazines, by watching TV shows, listening to the radio, getting tips from your friends or work colleagues, fitness enthusiasts, “fitness gurus”, etc.…. there are hundreds of “helpful” tips and advice available to us that are beneficial to everybody. Right? Actually, this is where many people with good intentions to improve their wellbeing get it very wrong.

Starting or changing an exercise routine without seeking advice and guidance from an experienced and qualified health professional will expose you to many problems, including poor technique, excessive loading, poor exercise choice, performing too many exercises, poor time management, setting unrealistic goals, all of which may lead to injury and/or a failure to reach your potential.

The most important exercise tip is that your exercise program needs to be about YOU. Yes, an individualised exercise prescription is the most important aspect of any training, rehabilitation, weight loss, strength or lifestyle modification program. Only a qualified health professional, trained and accredited to prescribe exercise should be giving you guidance and support to help with your journey towards better health.

An individualised exercise prescription by an Accredited Exercise Physiologist or Physiotherapist enables you to safely and effectively work towards achieving your goals whilst avoiding the pitfalls of injury and poor compliance. Collaboration between these health professionals enables your exercise program to be coordinated and delivered in a safe and effective manner, and most importantly will be tailored towards your individual needs.

Understanding how your body and mind will potentially react to an exercise routine is essential for longer term success. With education, patience, and great technique you can achieve your desired state of health and wellbeing.

So next time you need to set up a new routine or have an injury concern, speak to our staff about an individualised exercise program that focuses on YOUR NEEDS. We’ll get you started on a wonderful journey towards achieving your ultimate goal!

 

Mike Fitzsimon 

(Bachelor Applied Science (Physical Education) / Graduate Diploma Sport & Recreation Management)

Welcome Mike Fitzsimon

Clifton Hill Physiotherapy is excited to announce Mike Fitzsimon is joining the team as our new Exercise Physiologist.

We are really excited to welcome Mike to the team at Clifton Hill Pilates and Rehab. Mike is an experienced Accredited Exercise
Physiologist
 who has owned and operated his own business  No Limits Exercise Physiology since 2001, he has extensive experience in managing a private exercise physiology practice. He excels at prescribing evidenced based exercise that rehabilitates injury, improves performance and sustains well-being. Mike’s services empower you to make better decisions and enable you to reach your full potential.
Mike specialises in;
  • Continually delivering high level performance for the rehabilitation, management & prevention of injury and chronic disease
  • Collaborating with physiotherapists, medical practitioners, and other allied health professionals to deliver and coordinate care which is both evidenced base and person centred
  • Delivering evidenced based exercise to more than 120 clients per week
  • Maintaining the highest professional standards by adhering to best practice principles
  • Attending continuing education and professional development seminars, courses and conference
mike3Professional Memberships
Exercise & Sports Science Australia (ESSA)
Medicare Provider

Medical imaging for low back pain

“Doc, should I get a scan?”: Medical imaging for low back pain

By David Thwaites

Low back pain is extremely common. According to current research, three quarters of the population will report at least one episode of back pain in their life time.  Back pain is often excruciating, leading to withdrawal from activity, time off work and decreased productivity while at work.  So given this, it would make sense to get an X-ray, CT or MRI to work out the cause of your back pain, right? Actually, for most people this is not the case.

Imaging doesn’t improve outcomes

One large study compared people who had usual care (staying active, hot pack, over the counter medication) for low back pain against people who received early imaging.  They found no difference between the groups for measures of pain, function and quality of life.  There are a few reasons why this might be the case.  Firstly, the prognosis for acute low back pain is good, with most people seeing significant improvements in the first month after onset, so imaging is unlikely to speed this up.  Secondly, there is a poor correlation between what we see on scan and people’s symptoms.  One study scanned 67 people who had never had back pain in their life and found almost 90% of them had either bulging or degenerative discs.  So really, most findings on scans are so common, they could be viewed as normal signs of aging.

Harms of imaging

The harms of imaging for low back pain are twofold.  There are the obvious direct harms of things like radiation, especially with CT scans. And also the direct costs of the scans themselves to the patient and health care system.  Harms that people are often not aware of are the indirect harms of things such as “labelling”, or unnecessary treatment procedures that are performed due to imaging results.

Labelling refers to when a patient is told they have a condition they were not previously aware. As noted before, imaging will often find things like disc bulges or degenerative discs, even in people that don’t have back pain. So when people with back pain have medical imaging they are told that their back is “damaged”, often with things that most likely have nothing to do with their problem.  Labelling causes people to adopt a “sick role” and to see themselves as fragile.  We now understand that this sense of fragility can be a pathway to chronic back pain.

The association between imaging and surgery is strong. One study found that an MRI in the first month after onset of back pain lead to an 8 times greater risk of surgery, and 5 times greater medical costs compared to people who did not have an MRI.  A scary thought given those imaging findings may not be related to why people have pain!

Appropriate use of imaging

Medical imaging may not always be a bad idea.  For example, when a person presents with worsening nerve symptoms, or there is a thought that a serious underlying condition such as cancer or fracture may be the cause of their back pain.  These signs are called “red flags”.  Red flags are uncommon, but a physio will always check if any of these are present before deciding if imaging is appropriate.  Red flags for back pain include:

  • Bowel or bladder dysfunction or numbness in the saddle region
  • Signs of fracture (traumatic incident, or history of osteoporosis)
  • Signs of inflammatory disease (night pain, long periods of morning stiffness)
  • Signs of infection (fever, history of IV drug use)
  • Signs of cancer (unremitting pain, unexplained weight loss)

So if you don’t have a red flag, imaging for back pain is not really required.  As usual, your physiotherapist will be the best person to guide you.

If you have further questions please contact one of our friendly staff at Clifton Hill Physiotherapy or Clifton Hill Pilates and Rehab.

Knee Pain in Children and Adolescents

Brendan Egan and David Thwaites recently attended a professional development course on patellofemoral (knee) pain, run by the La Trobe Sport and Exercise Medicine Research Centre. Here’s a brief summary.

Knee pain is a very common occurrence in children and adolescents, with recent studies putting the number of children aged 15-19 having knee pain at 33%. Within these studies they investigated these children further and found that 7% of the entire group had patellofemoral pain (PFJP). The onset of the symptoms though was generally between 10-14 years. PFJP is more common in girls than boys and generally occurs in children who are very active with their sporting interests.

Strength training is often seen as a core component of any rehab for PFJP.  However a group of researchers in Denmark also found the use of education regarding the child’s activity loads, and activity modification if required, is very important to the child’s recovery. The combination of education and strength training was more beneficial than education alone.

Within this study the researchers also reviewed the amount of times/week the adolescent completed their exercises, and noted that the adolescents who completed 4 or more sessions/week were more likely to have a good result than if they did 3 or less.

In addition to education and strength training, the use of orthotics for short periods of time has also been shown to assist in pain reduction, particularly in the short term. Off the shelf types can be used and so custom-made orthoses are not necessarily required. Your Physiotherapist can advise you on the most appropriate orthoses for your situation.

Your Physiotherapist can also demonstrate a specialised taping technique that is also able to reduce pain, whilst allowing you to commence appropriate strength training.

To learn more about this topic please speak to one of our physiotherapists, who will be pleased to help.

Paul Jackson’s Gym Tips

Spring is a great time of year; we have just switched our clocks forward and the days are getting warmer. I have noticed a lot of new faces at the local gym, which has inspired me to pass on some tips about strength training. If you are keen to get moving for summer and have joined the gym, take a moment to consider how you might optimise your time.

It is important to understand that exercise is similar to medication – doctors determine the correct dosage to optimise the effect of the medication. We are also often advised to avoid alcohol or eat prior to ingesting medication.

Just like medication, in order to develop strength or increase bone density, we need to consider how often we should go to the gym, the correct dosage of exercise for a particular muscle group, and dietary habits pre and post work out. Just as an antibiotic takes a few weeks to take effect, strength gains take approximately 6 weeks.

Here are my tips to optimise your time in the gym:

  1. Start with big muscle groups before small muscles e.g. Lat pulldowns before bicep curls
  2. The dosage to optimise strength is 8 to 12 repetitions. Try doing 3 sets with 1 min rest between sets for each major muscle group. The exercise should become difficult by around the 10th repetition
  3. Make sure you are not hungry prior to your gym workout
  4. Avoid alcohol pre and post gym, as it effects muscle growth
  5. Allow one day’s rest between gym sessions to allow your muscles to repair and grow

It will take 3 sessions of just 30min for 6 weeks to see these strength changes and by this point you are in routine!

Paul Jackson
M Physio B App Sc (Human Movement)

Managing Postural Related Pain At Work

Postural stiffness and pain is one of the most common reasons patients seek treatment from a physiotherapist. Many sedentary working tasks are conducive to prolonged positions that can be sustained for hours at a time and many manual jobs involve persistent, repetitive movements. Due to these factors and more, many people experience significant pain and disability during their occupational tasks. However, there are most definitely strategies that you can put in place to address work related pain.

Pain can take a considerable toll on the health and well-being of an individual. It can be exhausting and significantly affect a person’s mental health. It can also increase perceived work demands, and arguably work performance. A study of nurses from India investigated the relationship between musculoskeletal disorders and perceived work demands. It was found that nurses with lower back and knee pain experienced a feeling of higher working demand and difficulty compared to those who did not experience musculoskeletal disorders. While this may sound obvious, it clearly highlights that managing your occupational pain is a critical factor in your professional performance at work, but also for optimising your own mental health.

A common question asked by patients is, “what exercises can I do to help my pain?”. The answer is not always straightforward, as is depends on the specific demands of your work day.

Physiotherapists can offer an individually structured exercise program to address your work day postural pain after an assessment of the postures you typically undertake at work. These exercises are often made with respect to directional movement and will be realistically completed at your office or worksite without undue inconvenience.

A recent study of building painters investigated the risk of pain associated with hours spent painting. The authors of this study found painting a vertical wall for over 2.5 hours at a time put a worker at an increased risk of injury. This was lengthened to 3 hours if the painter used a painting-roller.

The authors hypothesised that this increased injury risk for prolonged painting was due to excessive stretching of the lumbar and cervical spine into an extended (or backward arching) position. When treating this type of worker a physiotherapist may suggest therapeutic exercise that reverses these prolonged postures so as to periodically unload stressed areas of the spine and preserve normal functional movement.

As you can imagine, the prolonged postures adopted by painters would be significantly different to those used by desk workers who sit for long periods. Hence, the prescribed exercises given by a physiotherapist would likely be dramatically different and focus on spinal extension type movements to reverse forward head and neck postures associated with desk work.

In conclusion, movement exercises can considerably improve your postural pain if appropriately prescribed. Your pain may be further improved with manual therapy techniques or other self management strategies like self-massage, heat packs or ergonomic workplace adjustments. Every occupation presents with different physical demands, and as such are best negated with specifically targeted interventions.

For more information, you can consult one of the many experienced physiotherapists at Clifton Hill Physio/Clifton Hill Pilates and Rehab.

 

Bill Williams

Physiotherapist and Pilates Instructor

Welcome Rosie Purdue

Clifton Hill Physiotherapy welcomes our newest team member – Rosie Purdue.

Rosie graduated from Charles Sturt University in 2011 and has worked in variety of settings. Over the past five years, Rosie has developed a particular interest in sports and women’s health.

Rosie’s passion for learning has seen her complete additional courses in APPI Pilates, pre and post-natal Pilates, the DMA method, high-level suspension training, women’s health, dry needling and strength and conditioning.

Rosie has worked as a physiotherapist, Pilates Instructor and sports trainer at both international and local levels. Rosie says a highlight of her career was working as a physiotherapist with elite mountain bike riders at the Langkawi International Mountain Bike Challenge as part of the UCI world tour.

Rosie enjoys educating clients about their injuries so that they can make long-term, positive changes for their health. She believes in the importance of developing collaborative goals in order to optimize physiotherapy treatment and rehabilitation. This includes educating clients about the importance of manual treatment in combination with a specific home exercise program and clinical Pilates.

Rosie has travelled extensively and has now settled back home in Melbourne where she grew up. She keeps active with social team sports and playing hockey.

Clinical Pilates – moving beyond core stability for low back pain

For many years Clinical Pilates has been the popular vessel of Physiotherapists to prescribe “core stability” programs for people with low back pain.  Historically, these core stability programs have encouraged clients to engage core muscles and maintain this contraction while they perform a series of movements. Recently, there has been a growing mass of research showing this approach is not as beneficial as we once thought.  A recent systematic review of the literature suggested that in people with low back pain, core stability programs are no more effective than general exercise.  It is even hypothesised that encouraging these heightened contractions and rigid postures can breed unhealthy beliefs around pain and movement, and perpetuate symptoms.  Given this shift in thinking, it is imperative that Physiotherapy, and in particular Clinical Pilates evolves.

Thankfully, Clinical Pilates has the capacity to move beyond this stability approach. Clinical Pilates can be used as a platform to explore movement rather than promoting rigidity.  It can take focus away from isolated contractions and concentrate more on factors science is telling us contributes to pain. I have listed below a few areas in which I believe a modern Pilates approach can be helpful in people with low back pain.

Body Awareness

Altered body schema has been observed in people with low back pain. This manifests as a lack of awareness of body position with movement. Performing movements with tools such as mirrors for visual feedback in various positions can help reconnect with movement and improve movement co-ordination.

 De-threatening movement

The experience of pain with a given movement is linked to the perceived level of danger to the body’s tissues with that movement, not the actual state of the tissues. Meaning, if you subconsciously think a movement will hurt, it probably will, whether there is any damage occurring or not.  This also means that performing a similar movement in a different functional context or position can be completely pain free, as there is no perceived threat by the brain in that scenario.  Exploring these different positions and progressing back towards the original movement can start to diminish the perceived danger with that task.

Tissue loading

Tissue loading with exercise can have an effect on several levels. Firstly, loading muscles, tendons and joints around a painful area can initiate a neurophysiological response, diminishing symptoms for short periods (similar to that of manual therapy). Secondly, mechanical loading can promote tissue repair in muscle, tendon, cartilage and bone through a process called mechanotransduction. Loading tissues appropriately through a variety of targeted mobility and strength based drills can make use of these factors.

In summary, discouraging rigidity and being liberal with movement can contribute to a more modern and evidence based Clinical Pilates approach for low back pain.  As always, chatting to your Physiotherapist about the benefits of exercise for your problem is the best place to start.

 

David Thwaites

B Physio

Welcome to our new Podiatrist, Sara Fearnside

We’re very excited to announce the appointment of our new Podiatrist to the Clifton Hill Pilates and Rehab team.Sarah

Sara Fearnside consults in all areas of podiatry but has a special interest in Diabetes foot care and prevention of diabetes related foot problems.

Sara initially has appointment availability on Thursday mornings but will be extending her hours in the future.

She looks forward to the opportunity to improve your foot health and general well being in the near future and we warmly welcome Sara to our team.

Sara graduated from Charles Sturt University in 2009. Having completed her graduate year at Caulfield General Medical Centre she gained exposure in all areas of podiatry but particularly in management of the diabetic foot, high risk foot conditions and wound care. After completing her graduate year Sara moved to the United Kingdom where she worked in both private practice and in the public health sector. On returning to Australia Sara completed a short term contract in aged care before taking 12 months maternity leave. Sara has a special interest in Diabetic foot care, paediatrics and treatment of musculoskeletal foot pathologies.

Obetstric Brachial Plexus Palsy

Obstetric Brachial Plexus Palsy (OBPP) is a rare birth injury resulting in reduced movement and sensation of the affected arm. The shoulder(s) of a baby born with OBPP gets caught in the mother’s pelvis during delivery, leading to a stretching of the nerves originating from the neck.

To understand if your child has OBPP, here are common symptoms:

  • A “floppy” looking arm (due to weakness or paralysis). As a result, your child may not use their affected arm as much as their non-affected arm
  • Muscle tightness/joint stiffness
  • A broken collar bone
  • A broken upper arm
  • A drooping of one or both eyelids and a slightly smaller pupil (on the side of the trauma)

The following are risk factors for OBPP:

  • Shoulder dystocia (shoulder becomes stuck in the pelvis during labour)
  • Macrosomia (birth weight greater than 4kg)
  • A narrow maternal birth canal
  • Maternal overweight
  • Breech delivery (buttocks or feet emerge first)

What can be done to treat OBPP?

Treatment depends on the severity of the injury and the specific nerve roots involved. Physiotherapy treatment requires an experienced paediatric physiotherapist and involves assessing and monitoring the severity of the injury. Paediatric physiotherapists can assist in the maintenance and improvement of muscle length and joint range of motion in order to prevent contracture (shortening and hardening of muscles) and dysfunction. Your physiotherapist can teach you gentle exercises for this. Occasionally, surgery may be required to repair the damaged nerves.

When can treatment be commenced?

Treatment may be commenced 10 days post-delivery.

Do I need a referral to see a Paediatric Physiotherapist?

No. Physiotherapists are primary healthcare professionals, which means that no referral is required to make an appointment. At Clifton Hill Physiotherapy we have 2 experienced Paediatric Physiotherapists who can assess your child or answer any concerns. Contact us on 9486 1918 for further information.

Dóra Kónya, APAM

Dóra is a Physiotherapist at Clifton Hill Physiotherapy with a Masters and postgraduate qualifications in Paediatric Physiotherapy.