Pelvic Girdle Pain

Pelvic girdle pain (PGP) refers to pain felt at the back of the pelvis, on either side of the pelvis and/or over the joint at the front of the pelvis which is called the pubic symphysis. PGP is common during pregnancy and studies report more than half of all pregnant women experience some PGP. Fortunately, almost all of these women (90%) recover before their baby has turned one. It is important to know that pelvic girdle pain cannot harm your baby, but by reducing the symptoms you are more likely to remain active and comfortable during your pregnancy.

Cause

The cause of pelvic girdle pain is normally a combination of changes happening in your body as your baby grows. Your growing baby stretches your abdominal muscles and the position of the baby changes your centre of gravity. This can affect your balance and the way you stand and walk. The pelvis is actually made up of three bones; a left and right pelvic bone and the sacrum, which is the triangular shaped bone at the base of the spine. These three bones are held together like a jigsaw and the joints do not normally move.  When you are pregnant your body produces a hormone called relaxin. Relaxin loosens your ligaments so that the pelvis can widen to hold the growing baby and helps prepare your body for the birth. When the ligaments in the pelvis are looser, the muscles around the pelvis have to work extra hard in order to maintain good support for the pelvic joints.

Symptoms

The symptoms of PGP range from pain in the pelvis as mentioned above, but can also refer into the lower back, hips, groin, thighs and even sometimes knees. Often the pain is made worse by movement such as walking long distances, getting in and out of the car, climbing the stairs, rolling over in bed or during sexual intercourse. PGP can be mild or severe and can occur at any stage of the pregnancy, but it is more common in the second and third trimesters.

Treatment

PGP can be treated at any stage of the pregnancy and the quicker you get help from your health professional, the more comfortable you will be. Your physiotherapist can help treat both the symptoms and the cause. Using ice to settle inflammation and resting the joints for a couple of days is a good place to start. Some ways you can help reduce PGP are standing with correct posture, sitting to get dressed, keeping your legs together when getting in and out of the car and lying with a pillow between your legs to sleep.

If your muscles are overworking, they probably need loosening and they will certainly need strengthening. Your physio can show you safe exercises to strengthen your core muscles including your pelvic floor, back and deep abdominals as well as your glute muscles. In some cases, if your muscles require extra support, then your physiotherapist can fit you with tubigrip (a bandage to give your tummy support), or a pelvic belt that provides firmer support to the pelvis. Very occasionally, if your symptoms are more severe and persistent, then your physio may recommend using crutches

Remember, PGP is not something you just have to ‘put up with’ until your baby is born. Early diagnosis and treatment relieves symptoms and our experienced Physiotherapists can help you continue with your normal everyday activities and be well for this exciting time in your life.

Please speak with us if you have any enquiries and remember our new Pelvic Smart Pre- Natal Pilates classes begin in April on Monday evenings and Saturday mornings (9486 1918).

 

Rosie Purdue

Physiotherapist

Rosie has particular interest in sports and women’s health having recently completed the APA Level One Continence and Pelvic Floor course’. Rosie also has extensive pilates experience and has continued her education with courses in APPI Pilates, pre and post-natal Pilates, the DMA method and high-level suspension training.

 

Slow and steady wins the race

“The Biggest Loser” – a TV show that reinforces the myth that exercising to near breaking point will help you. There’s a lot to learn from observing the participants Ex-Phys-img01flogging themselves to near breaking point. I commend them for trying to improve their wellbeing; it takes courage and perseverance to undertake such a change. They feel better from exercising and challenging themselves, they lose weight quickly and they gain self-belief.

But the show is a perfect example of why so many people fall short of their expectations when exercising. This model of exercise is unsustainable in the longer term and significantly increases the risk of injury, poor compliance, and poor results!

For most of us (elite athletes may be an exception, although they are not exempt) exercising at maximal or near maximal intensities in a boot camp style environment is an excellent way to injure yourself and will ultimately prevent you from achieving your wellbeing goals.

An exercise routine requires a few essential ingredients: it should be tailored to individual needs, coordinated and delivered by a team of health professionals (collaboration between an Exercise Physiologist and / or Physiotherapist and / or GP), be evidenced based, target specific outcomes (weight loss, rehabilitation, mental wellbeing, chronic disease, increased muscle tissue), be person centred, be clearly understood by its participants, and be designed to gradually overload the body. It is this ingredient, gradual overload, which is often neglected.

Gradual overload is the consistent and steady increase in exercise load and volume over a mid to long term period that can be as little as 2 weeks and as much as 10 years. There are many examples of people “getting it wrong” when overloading. It is one of the most difficult ingredients of any exercise routine to get right, as it requires an understanding of our unique individual physiology. If we maintain a consistent routine at moderately graduated loads, then we increase our chances of success significantly!

Where do we start? Who do we ask for advice? How do we determine an appropriate training load? What exercises are the best to do? How will our exercise routine deliver results safely and effectively?

Engaging the services of a health professional who specialises in Exercise Prescription is the best way to ensure your progress will be gradual, consistent, safe and ultimately effective. Moving correctly, learning good technique, activating the key muscles that promote stability and control, before gradually increasing loads to build endurance and strength is the safest and most effective approach. Learning good movement patterns and unlearning faulty movements enable you to gradually overload the body safely and effectively.

Have a chat to one of our team so that we can enable you to discover that when it comes to exercise routines, “slow and steady wins the race”!

Are you listening to your body?

Our physiology is extremely efficient at letting us know how we feel. Fatigue, soreness, tightness, anxiety and stress tell us our physiology is not as it should be. It’s ok to experience these feelings from time to time, but learning strategies to manage and minimise their negative effects is essential to living a healthy and happy life.

An evidence based exercise routine is one of the best ways to enhance our physiology and our wellbeing! Exercise that focuses on our individual needs, prescribed by an experienced and highly qualified Exercise Physiologist, in collaboration with your physiotherapist and GP, is one of the safest and most effective methods of understanding your physiology and improving your life!

Your exercise routine should enable you to listen to your body. Learning how to perform correct movements that minimise injury and maximise outcomes is essential. Identifying potential injuries and understanding the causes of existing ailments will give you the confidence to undertake your own training. Starting or changing your exercise routine should be done with the support of your health professional who will guide you on your journey.

So listen to your body! If you don’t like what you hear, consult one of our friendly and highly experienced staff to help you learn skills and strategies that enable you to exercise safely and effectively.

Mike Fitzsimon 

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

Anterior Cruciate Ligament Injuries and Gender

With the establishment of the AFL Women’s competition next year there has been a large increase in women who are eager to participate in our national code of football. This is a great initiative to promote physical activity and its associated health benefits, but also a brilliant medium to experience the fun and friendship of team sports.

However, as a sport adapts and evolves we often see a change in injury incidence. This is not something new, and professionals are consistently reviewing their training and rehabilitation methods to meet the most current demands of sport and physical activity.

For example, many would be familiar with the substitute rule that was implemented (and then excluded) from the AFL between 2011 and 2015. Injury prevalence was altered as a result of these changed playing characteristics, and hence training regimes were aimed to reduce these new injury risks.

With the pre-season underway for the AFL Women’s competition, we have unfortunately already seen some stars go down with ACL injuries, including Kiara Bowers (Fremantle) and Kendra Heil (Collingwood). Women are known to have an increased risk of knee injury compared with men who participate in the same sport, and professionals are harnessing this knowledge by utilising targeted interventions during their preseason programs.

There are thought to be a number of external risk factors (aspects we CAN change) for ACL injury. BMI (body mass index), jumping and landing mechanics, muscular imbalances, fatigue and many more are thought to contribute to overall ACL injury risk.

A structured and appropriately progressive pre-season program of strength and conditioning is essential to modify potential ACL injury risk. Such a program should include jumping and landing practice, change of direction training and appropriate practice of each of the specific demands associated with the athlete’s chosen sport. Athletes with certain previous injuries or other physiological findings may benefit from a more targeted pre-season approach under the guidance of a physiotherapist or sports and exercise professional.

It is essential to remember that while risk of injury is associated with all sports, the health and wellbeing benefits of being fit, active and social within a group of like-minded people is invaluable. There are many ways to optimise your ability to stay injury free including specific training and home exercises, diet plans and adequate rest.

All the best for the pre-season and best of luck to any new Australian Rules Footballers in 2017. As always, your physiotherapist is more than happy to assist you if you have any specific questions about pre-season training.

 

Bill Williams

Physiotherapist

Chief Physiotherapist Fitzroy Reds Football Club

Maintain a routine and enjoy the festive season

At this time of the year life can get really busy! It’s easy to be distracted by the pressures that come with the festive season and year’s end. Our priorities can shift from maintaining our “normal, healthy” routines to avoiding exercise and eating and drinking too much.

This can result in a few kilos being added, a loss of lean muscle mass, our aches and pains return or worsen, and we are left feeling exhausted as we enter the new year. Sound familiar?

One of the best ways to maintain our health and wellbeing during the festive season is to engage in a moderate exercise routine. Whilst enjoying the pleasures that eating and drinking bring exercising in moderation is the key. Moderate exercise such as swimming, walking, body weight resistance training, stretching, and floor exercises enable us to return to our normal routines in good shape and feeling great!

It’s important to focus on the bigger picture. Don’t stress if you over indulge on one or two occasions. Last time I checked there are 52 weeks in a year, so a few days here and there of no exercise and eating too much won’t actually change your overall health.

Enjoying a break from structured and intense exercise can be really beneficial to assist with recovery and preparation for the next phase of your routine. Use the festive season to focus on your weaknesses, such as improving your posture, resting muscle groups that have been overused at work, or doing your rehab specific exercises prescribed by your health professional.

Our minds and bodies enjoy a routine, so it’s important to continue to exercise during the festive season. Maintaining an exercise routine enables you to recover more quickly from any excesses, reduces your risk of injury and prepares your mind and body for the new year.

Speak with our experienced and qualified staff and we’ll set you up with an exercise routine that’s individualised, that’s portable (you can do it on holiday), and that enables you to maintain your health and enjoy the festive season!

Mike Fitzsimon 

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

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)