Many people think physiotherapy is limited to helping those with sporting injuries. But each year physiotherapists keep people healthy, mobile and independent through the prevention, maintenance and treatment of a wide variety of injuries and chronic health conditions.
The ‘I Love My Physio’ campaign is designed to spread the word about how physiotherapy can help treat, manage and improve everything from neck and back pain, to soft tissue injuries, to pelvic floor issues and even recovery from accidents that affect the brain, balance and coordination.
So if you have a story about how physiotherapy has helped you, a loved one or a friend, feel free to share your story online at ilovemyphysio.com.au
You can win some great prizes and help to spread the positive word about physiotherapy in the community.
For details go to: ilovemyphysio.com.au
Like all things in life there are trends and fads. The world of sports medicine is not averse to such things either, with some classic examples being the LARS graft for ACL reconstructions and PRP injections for so many musculoskeletal conditions. The ‘’fashionable’’ condition in recent years has been Femoroacetabular impingement or FAI. One of our physiotherapists, Josh Heerey, has recently started a PhD looking into FAI and he took some time to out to talk about his project, and what it will mean for patients who have FAI.
FAI is a bony condition found within the hip joint of both males and females. It commonly presents as hip or groin pain that occurs during or after exercise or vigorous activity. Most commonly it is seen in people who put the hip joint in positions that require greater amounts of flexibility that is normally associated with everyday activities like walking, standing or sitting. To be diagnosed with FAI you need to have two things:
- Symptoms reproduction with clinical testing used by physiotherapists
- MRI/Xray confirmation of the bony changes commonly seen in FAI
In the last 10 years there has been an exponential increase in the rate of arthroscopic surgery for this condition without a real understanding as to whether conservative management (physiotherapy and exercise) can be used instead to manage FAI.
I am currently undertaking my PhD looking at the natural disease course of FAI. We are following a group of male and female soccer players for two years who have FAI which is diagnosed with clinical and radiological assessment. We are interested in seeing what factors such as strength, flexibility and/or movement patterns result in people improving or developing worsening symptoms during the two year period. As part of this project I will also be looking at the ways that the muscles around the hip joint function in people with FAI.
The project will provide us an understanding about the factors that lead to disease improvement or progression and also give us a better understanding about how to use rehabilitation to improve hip muscle function in people with FAI.
Joshua (Josh) Heerey
B Physio, PhD candidate, La Trobe university
Josh graduated from physiotherapy in 2008. He completed his Post Graduate Certificate in Sports Physiotherapy in 2013 and has started a PhD in 2015 looking at Femoroacetabular impingement (FAI). His project is looking at the risks factors associated with progression of FAI, as well as the effectiveness of exercise for FAI.
He has developed clinical expertise in managing hip and groin pain in athletes from his time working in both soccer and VFL. He also has an interest in acute and chronic shoulder conditions.
Recent research investigating plagiocephaly (1) has received significant media attention as it found that children treated with helmet therapy did no better than a control group that received education regarding counter-positioning. However closer inspection of this study indicates a number of flaws which may indeed compromise their results. These flaws included the possibility that the helmets being prescribed were not appropriately fitted, as the study does note that 73% of children experienced issues with the helmet not fitting, and 96% had skin irritation whilst wearing the helmet. This is not the norm for children who receive a helmet in Melbourne.
In contrast Jordan Steinberg and colleagues (2) from the Lurie Childrens Hospital in Chicago followed over 4000 children over a seven year period using a standard treatment algorithm. The children were placed into a conservative group who received education and training regarding positioning and tummy time (RT) +/- biweekly physiotherapy (PT), or a Helmet therapy group, who received a cranial remoulding orthoses (helmet), plus RT +/- PT. Some children in the conservative group who were deemed to not be improving were shifted across to the helmet group.
Complete correction was achieved in 77.1 percent of conservative treatment patients; 15.8 percent required transition to helmet therapy and 7.1 percent ultimately had incomplete correction. Risk factors for failure included poor compliance, advanced age, prolonged torticollis, developmental delay and severity of the head asymmetry at initial examination. Complete correction was achieved in 94.4 percent of patients treated with helmet therapy as first-line therapy and in 96.1 percent of infants who received helmets after failed conservative therapy. Risk factors for helmet failure included poor compliance and advanced age.
At Clifton Hill Physiotherapy we follow a similar treatment programme. Families are educated on the importance of positioning and tummy time, and may also be shown stretches if the child has neck stiffness. Additional developmental sessions may also be required for those children whose development is delayed. We monitor the child until approximately six months of age, when a decision regarding helmet therapy is made. We aim for complete correction using both conservative and orthotic/helmet interventions.
- Van Wijk, R., van Vlimmeren, L., Groothius-Oudshorn C., Van der Ploeg, C., Ijzerman, M., Boere-Boonekamp, M. (2014) Helmet therapy in infants with positional skull deformation: randomised co
xntrolled trial. British Medical Journal, 348:g2741 doi: http://dx.doi.org/10.1136/bmj.g2741
- Steinberg, J., Rawlani, R., Humphries, L., Rawlani, V., Vicari, F. (2015) Effectiveness of Conservative Therapy and Helmet Therapy for Positional Cranial Deformation. Reconstr. Surg. 135: 833-842, doi: 10.1097/PRS.0000000000000955
Brendon Egan, Physiotherapist
Brendan is an experienced paediatric Physiotherapist having spent over sixteen years working at the Royal Children’s Hospital treating children and adolescents with a range of conditions. He has presented at national and international conferences and is co-author and editor of a book on sporting choices for boys with Haemophilia.
Brendan’s particular expertise is paediatric musculoskeletal issues with many years of experience treating children with persistent pain, haemophilia, juvenile arthritis, scoliosis and burns management. Other interests include advising families on developmental issues such as flat feet, knock knees and torticollis/wry neck. Children and adolescents requiring rehabilitation following trauma, fractures and surgery would also benefit from Brendan’s expertise. Dora Konya and Brendan Egan our Paediatric Physios, can address any concerns regarding your child and Plagiocephaly. Call 94861918 for any enquiries.
We have some exciting news to share – Clifton Hill Physiotherapy is proud to announce we have a new Clinical Pilates and Rehabilitation gym, conveniently located just 3 doors down next to Bendigo Bank.
We have joined forces with Bodylogic Pilates (a longstanding leader and provider of excellence in pilates in the Clifton Hill area) to create Clifton Hill Pilates and Rehab.
With this new facility we will offer a full range of Clinical Pilates, mat based pilates, specialised classes (for example – pre and post natal pilates, strength training for women), comprehensive rehabilitation post injury/surgery and Podiatry services.
Please contact us for more information or ask your physiotherapist for further details about how you can participate. We plan to renovate this new space during the September school holidays and launch to market soon after.
Clifton Hill Physiotherapy offers help for mastitis sufferers
Earlier in the year Cathy Derham and Alison Harding attended professional development on “The lactating breast for physiotherapists” run by The Continence and Women’s Health Physiotherapy Australia Group.
Cathy and Ali reviewed the most recent research and current best practice in the management of conditions of the lactating breast. The most common of these is mastitis. Mastitis is defined as “inflammation of the breast” resulting in a blockage of the ducts that transport milk to the nipple for the baby to feed.
Mastitis occurs in as many as 1 in 3 women during the post partum period, with the highest incidence occurring 2-3 weeks post partum. Mastitis is the most common reason to wean in the first 12 weeks post partum.
Some common risk factors for mastitis include: previous episode; a sudden change in number of feeds; incomplete breast emptying; suckling replaced by pacifiers or bottles; finger/ pump/tight bra compression; positioning and attachment problems or direct blow to the breast.
Breastfeeding is considered the biological norm, and the World Health Organisation (WHO) recommends breastfeeding for the first two years of a baby’s life due to the enormous health benefits for both baby and mother. Therefore, best practice in the management of mastitis is directed towards resolution of the inflammation and unblocking any blocked ducts while supporting continuance of breastfeeding.
Cathy and Ali have recently conducted Mastitis update inservice to staff at Clifton Hill Physiotherapy, ensuring that your Physiotherapist at Clifton Hill Physiotherapy is delivering best practice for management of these conditions.
B Physio (Hons) M Physio (Sports Physio)
Low Back Pain Research at Clifton Hill Physiotherapy using Vimove Technology
Acute low back pain (LBP) is a very common musculoskeletal complaint seen in primary care. It is commonplace for people to seek care from their physiotherapist for episodes of low back pain. If you have been in this situation yourself, you may have experienced rigid taping as a part of treatment.
In the clinical setting, rigid taping is a commonly used treatment strategy to reduce pain and improve function by normalising movement. Despite its widespread use, there is limited evidence regarding rigid taping for low back pain.
At Clifton Hill Physiotherapy we are fortunate to have access to DorsaVi Vimove technology to assist in the care and treatment of our patients. Vimove is a specialist movement based technology suitable for many clinical situations.
Due to the high number of patients we see with low back pain, we recently carried out a study using our Vimove technology. We assessed a series of lumbar spine (low back) movements and functional tasks in a group of ten people without pain. We repeated these tasks with rigid taping and without and have collected the results.
The results showed a difference between movement in a step down task and also low back movements (side bend and back bend), between the two groups. This provides us with valuable information and has encouraged us to complete a second stage of this study- in a group of people with pain.
We anticipate the results will provide valuable evidence to support the use of taping in acute low back pain, furthering our commitment to evidence based practice here at Clifton Hill Physiotherapy. Watch this space for further updates.
You can email Ali on email@example.com with any inquiries.
The Continence Foundation of Australia has developed an incredibly useful free app for women.
The app provides examples of exercises that are pelvic floor safe and exercises to avoid if you have a weak or dysfunctional pelvic floor muscles. This is not only useful for people that are having symptoms of pelvic floor weakness, it is great for anyone wishing to use their core properly in their exercise regime.
The app has a series of workouts designed by Physiotherapist and fitness leader Lisa Westlake with both visual and verbal instructions to guide you through the exercises.
In clinical practice I find The Pelvic Floor First app a valuable adjunct to pelvic floor physiotherapy. In particular I recommend the app to pregnant or post natal women returning to exercise. I treat many women who are keen to continue exercise during pregnancy or in the post natal period but are not sure which are the best exercises for protecting their pelvic floor muscles.
The app provides a wide range of exercises for all fitness levels, to ensure people enjoy the benefits of a total body work out that also looks after their pelvic floor muscles.
Please note, if you are experiencing any symptoms of pelvic floor weakness (bladder or bowel leakage, vaginal heaviness or bulging, pelvic or lower back pain, pre or post pregnancy) it is important to have a consultation with a pelvic floor physiotherapist to ensure your exercise program is suited to your individual needs.
If you have any questions regarding the Pelvic Floor First app please speak to Kiera Hannigan, Clifton Hill Physiotherapy’s pelvic floor specialist physiotherapist.
Kiera is a pelvic floor physiotherapist and clinical Pilates instructor with a keen interest in helping men and women across all ranges of fitness and life stages perform effective and pelvic floor safe exercises as part of their general fitness and rehabilitation.
WHAT WERE WE THINKING?
–Clifton Hill Physiotherapy likes this evidence based App for new parents.
The Jean Hailes Foundation www.jeanhailes.org.au has developed an App for smartphones and mobile devices that offers practical guidance to support parents in the important first 100 days of their baby’s life. Expert advice is available form Maternal & Child Health nurses and Psychologists as well as a parental blog! It provides support in an evidence-based, supportive and non-judgemental environment. It has quizzes, tools, videos and helpful innovative information for parents.
Download it from iTunes App store today – https://itunes.apple.com/app/what-were-we-thinking/id925235935?mt=8
PELVIC PAIN REPORT
From Clifton Hill Physiotherapy
The $6 Billion Woman and the $600 Million Girl’ – Pelvic Pain Report
“Pelvic pain, while common, is often a hidden burden to the lives of many women. With emerging national and international knowledge about pain and the heavy toll it poses on individuals and society, it is timely that this report ‘The $6 Billion Woman and the $600 Million Girl’ raises pelvic pain to public attention as an important health issue. This call for action is overdue in a much neglected area of health and healthcare impacting the lives of so many women and girls in our community.”
Dr. Christine Bennett
Adequately addressing Pelvic Pain is an issue very close to us at Clifton Hill Physiotherapy. The Australian Government has made a commitment to Australian women to ensure a sustainable, high quality health system, which is responsive to all women now and in the future with a clear focus on illness prevention and health promotion as part of the National Women’s Health policy.
The Pelvic Pain Report highlights addressing pelvic pain must be a cornerstone of that commitment.
Kiera Hannigan and Jennifer Langford (Pelvic Physiotherapists at Clifton Hill Physiotherapy) share a strong passion for empowering women and men with pelvic pain with knowledge and strategies to overcome the burden of pelvic pain and live a fulfilling life.
Along with providing appropriate treatment with a compassionate and understanding approach, Kiera and Jen have a particular interest in a biopsychosocial approach to pain management, educating patients in the current concepts of pain science so that they understand their pain and how to manage it.
B Physio (Hons)
Post Grad Cert(Pelvic Floor Rehab)
Clinical Pilates Instructor
Kiera has worked in numerous tertiary hospitals, private practice and aged care settings, and currently also works across all areas of Women’s Health at The Mercy Hospital for Women. Call 9486 1918 to make an appointment with Kiera or Jen.
INJECTION THERAPIES: DO THEY WORK?
Recently we have noticed an increase in the number of people being offered injection therapies for management of their musculoskeletal conditions. The rise in popularity for such therapies has many patients asking – is there actually any scientific evidence to support this treatment approach?
What do we mean by injections therapies?
Injection therapies consist of treatments that inject blood products or cells (from the patient) into a joint, muscle or tendon. It is commonly used to treat acute muscle injuries and joint or tendon degeneration. We have seen a significant increase in one in particular, called platelet rich plasma, or PRP.
So what is PRP?
PRP is a component of the patient’s own blood. The blood is taken from the individual having the PRP injection. It is then put through a process of centrifugation, which separates the PRP from platelet poor blood and red blood.
What does PRP do?
PRP has an abundance of cells that stimulate and aid in healing of tissues within the body. It has been proposed that injection of PRP into an injured muscle or tendon will provide an optimal environment for healing or regeneration.
What does the science say?
PRP is commonly used in many different musculoskeletal problems. Two of the most commonly seen applications are in muscle strain injuries and tendon injuries. But there’s still some conjecture from a scientific perspective. Here are some key findings:
Muscle injuries: A recent systematic review demonstrated a distinct lack of quality human studies showing beneficial effects of PRP injections.
Achilles tendon: A systematic review regarding PRP use in chronic Achilles tendon problems failed to show that it is an effective treatment.
In summary, there is no concrete evidence supporting the use of PRP in commonly seen musculoskeletal conditions at this current time. With more research into the area this may very well change in the future. But for now we suggest that other treatment modalities commonly used by your physiotherapist is probably the best way to go.
About Josh: Josh is an experienced physiotherapist with a keen interest in musculoskeletal and sporting injuries. He is currently completing his Masters of Sports Physiotherapy at Latrobe University.
Vannini, F., Dimatteo, B., Filardo, G., Kon, K., Marcacci, M., & Giannini, S. (2014). Platelet-rich plasma for foot and ankle pathologies: A systematic review. Foot and Ankle Surgery, 20(1), 2-9.
Hamid, M. S., Yusof, A., & Mohamad Ali, M. R. (2014). Platelet-Rich Plasma (PRP) for Acute Muscle Injury: A Systematic Review. PlOS ONE, 9(2), 1-7.
Clifton Hill Physiotherapy
111 Queens Parade
Clifton Hill VIC 3068
P| 03 9486 1918
F| 03 9486 5650