Archive for category: Uncategorized

Shin Pain – an insight into the condition and its rehabilitation.

Medial tibial stress syndrome presents as pain along the shin bone and is often referred to as “shin splints”. It is a relatively common injury and can affect athletes involved in impact sports, and up to 35% of runners.

The cause of shin pain is usually related to a sudden increase in load as one increases training intensity in view of an upcoming running event or game. This means an increase in either kilometer distance achieved, or pace and speed, or type of terrain (concrete vs grass vs soft sand etc), or tackling more hills or inclines. In some situations, it can even be caused by a sudden change in training shoes, which results in different biomechanics and way of loading the lower limb.

It is hypothesised that pathology of medial tibial stress syndrome involves dysfunction in the muscles that attach along the shin bone (tibia), namely posterior tibialis and flexor digitorum longus muscles. It is thought that that increase in load can result in increase in tension within these muscles, causing greater shear forces at the attachment sites of these muscles on the tibia. This in turn may result in symptoms such as pain, swelling and edema. In some severe cases, medial tibial stress syndrome can even lead to micro-fractures along the periosteum of the tibia if left untreated and aggravating triggers are not addressed.

Novice runners who have just picked up running as a new year resolution, for example, are particularly likely to develop this type of injury as their body has not conditioned and adapted to the demands of the new activity yet. Runners with higher body mass index (BMI), decreased hip strength and increased foot pronation were also found to be at higher risks. Females were also more prone to developing this type of injury due to having a larger pelvis and its implications on the biomechanical function of the lower limb.

So, what do I do if I have shin pain? – Does this mean I have to stop running?

Nope. Not necessarily…

Treatment of medial tibial stress syndrome involves an array of different approaches, including reducing load. This does not however mean that you should stop running altogether. It may be essential in some situations to have a temporary break from running until the acuteness and severity of your symptoms diminish to allow you to start a rehabilitation program towards starting to run again. But in most cases, it is a matter of allowing a relative reduction in load – run less distance, run smarter – and start a strengthening and conditioning program to address the biomechanical deficits identified by your physiotherapist.

In the early stages, the physiotherapist may treat the surrounding musculature to reduce any potential tension along the tibia and teach you some useful stretches and management techniques.

The physiotherapist will assess your biomechanics range of motion and strength, review your training volume (kilometers distance achieved per week), help you break down the intensity of your training and assess your running technique.

Overall, you will learn to train smarter, run better and understand how to work the fine line of challenging your body towards improving your performance, and also allowing adequate room for your body to strengthen, condition and adapt accordingly to prevent resurgence of injuries.

So, do not hesitate to see one of our friendly physiotherapists for an assessment and start your journey to fitness and wellness.

 Adriane Kabhlyuk , Physiotherapist and Pilates instructor

References:

Collins, N, Bisset, L, McPoil, T, Vicenzino, B. (2007). Foot orthoses in lower limb overuse conditions: a systematic review and meta-analysis. Foot & Ankle International; 28:396–412.

Geoffrey, J. (2014). Dynamic foot function as a risk factor for lower limb overuse injury: a systematic review. Journal of Foot & Ankle Research: 7: 53.

Janice and Reiman (2017). Lower Extremity Kinematics in Running Athletes with and without a History of Medial Shin Pain. International Journal of Sports Physical Therapy: 7(4): 356-364.

Luedke et al. (2016). Influence of Step Rate on Shin Injury and Anterior Knee Pain in High School Runners. Medicine and Science in Sports and Medicine; 48(7): 1244-50.

Newman, P, Witchalls, J. Waddington, G, Adams, R. (2013). Risk factors associated with medial tibial stress syndrome in runners: a systematic review and meta-analysis. Journal of Sports Medicine; 13(4): 229-241.

Saeki et al. (2017). Ankle and toe muscle strength characteristics in runners with a history of medial tibial stress syndrome. Journal of Foot and Ankle Research; 10: 16

Saeki et al. (2017). Muscle stiffness of posterior lower leg in runners with a history of medial tibial stress syndrome. Scandinavian Journal of Medicine & Science in Sports.

Winkelmann, Z.K. et al. (2016). Risk Factors for Medial Tibial Stress Syndrome in Active Individuals: An Evidence-Based Review. Journal of Athletic Training. Dec;51(12):1049-1052.

Zachary et al. (2016). Risk Factors for Medial Tibial Stress Syndrome in Active Individuals: An Evidence-Based Review. Journal of Athletic Training; 51(12):1049-1052

Did you know Josh trained as a Podiatrist before becoming a  Physio? 

Here are his expert tips on choosing your running footwear:

As Physiotherapists we are asked for advice on appropriate running footwear several times each day. Footwear companies often make exaggerated and misleading claims about the wondrous properties of their shoes, which can make it difficult to determine what type of running shoe is right for you.

In recent times ‘Barefoot’ or ‘Free’ running has gained popularity. Advocates will argue that because cavemen would have run barefoot this is a more natural way for our body to function when moving, and is more in line evolutionarily with how our foot and ankle are meant to be used.

The reality for present day adults is that a good degree of conditioning and adaptation is necessary for our bodies get used to running without footwear. Cavemen didn’t have to contend with surfaces such as hard bitumen or concrete. The right shoes play a critical role in reducing the shock caused to our bodies by these surfaces.

Numerous studies have demonstrated a marked change in loading patterns (how weight and pressure are distributed) through the feet and legs during running with and without shoes. Rapid change in any exercise training does not allow our bodies enough time to adapt, and adaptation is important for injury prevention. If you wish to trial barefoot running it should be a transition that is quite structured and measured so as to minimise the associated risk of injury. As this is a complicated process, it is best to seek the advice of a trained practitioner with specific knowledge and understanding of the biomechanics of running.

At the other end of the scale to bare feet, is footwear that does not permit normal functioning of the foot. Our feet and ankles are intricate in their design and function very well in normal situations to assist smooth and strain free patterns of movement through the body. Footwear that is rigid and does not accommodate foot motion can have equally detrimental effects to running without shoes.

So what does this all mean?

The long and short of this, if you’ll pardon the pun, is that there is no one-size-fits-all approach to selecting footwear. We each have distinctive running patterns and anatomical variations of the foot and ankle that mean we each need shoes with different features.

It is hard to know where to start with such a vast array of options available. When you walk into your local shoe store, even the staff may have little idea as to the features of each shoe, which is not to denigrate them, but shows how complex the technical components of shoe design and manufacture are.

Reputable brands and stores will have various styles with different features to enable selection of footwear that is appropriate to your own foot type and biomechanics. Remember that cost does not always equate with quality; the most expensive shoe may not work well for you personally. It is much more important that you have a shoe suitable to your foot type and your running regime than it is to spend a lot of money.

There are some common mistakes made when it comes to choosing running shoes.

Always measure shoe size while standing, and allow approximately the width of your thumbnail from your longest toe (which for some people is the second toe, not the big toe) to the end of the shoe. This allows for expansion of the foot during exercise, which is especially important in warmer weather. The width of the shoe is equally important. A good guide is to pinch the top of the shoe over the widest part of your foot. A small amount of the material should bunch between your index finger and thumb. A sign that the shoe is too big is that your whole foot will feel like it slides back and forth in the shoe.

If you wear orthotics, always ensure you wear them when fitting new shoes. You may find you need to go up a full size to accommodate the orthotic device.

Make sure the heel counter, the stiff part at the back of the shoe that covers your heel, is deep enough. If your heel feels like it loses contact with the sole of the shoe when you walk you may need to adjust the arrangement of the lacing of the shoe, or failing that, choose a different style of shoe that offers more depth. This is very important because the position of the back of your foot influences how well the front of your foot functions. Particularly with shoes that have in-built rear-foot control features, such as running shoes, it is essential that the heel sits right on the insole and snugly against the back of the shoe

Lastly, select a shoe that allows your mid-foot and fore-foot to move easily. To check this pick up the shoe with one hand cupping the heel, and the other cupping the toes. Twist the shoe gently between both hands. The first two-thirds of the shoe should twist under pressure and the heel should stay relatively stiff. The flex point of the shoe, where it bends most easily, should be where the ball of your foot would be, ideally around the first third of the shoe. It’s best to avoid shoes that bend in half, as your foot does not bend naturally at this point.

I hope this has provided some food for thought when it comes to running and footwear. Remember there can be a large degree of trial and error when choosing footwear, but a good retailer will have a more in-depth understanding of appropriate shoe types for you, so don’t be afraid to ask questions and do your homework.

 

—

Josh Neeft

M Physiotherapy (GE), B. Podiatry

Inner North Physiotherapy
734 High Street
Thornbury VIC 3071
P: (03) 9089 6666
F: (03) 9089 6644
E: josh@innernorthphysiotherapy.com.au
W: innernorthphysiotherapy.com.au

Clifton Hill Physiotherapy
111 Queens Pde
Clifton Hill VIC 3068
P: (03) 9486 1918
F: (03) 9486 5650
E: josh@innernorthphysiotherapy.com.au
W: cliftonhillphysiotherapy.com.au

An exercise and education program for people with hip or knee osteoarthritis (OA) symptoms.

The GLA:D program is an exercise and education program developed by researchers in Denmark for people with hip or knee osteoarthritis symptoms.

Results from the GLA:D program in Denmark have shown:

• Symptom progression reduction of 32%
• Less pain
• Reduced use of joint related pain killers
• Less people on sick leave
• High levels of satisfaction with the program
• Increased levels of physical activity 12 months after starting the program

 On the success of the GLA:D program in Denmark, this program has been implemented in other countries, and most recently it has been launched in Australia.

The GLA:D Australia program consists of:

• Two education session which teach you about OA, how the GLA:D Australia exercises improve joint stability, and how to retain this improved joint stability outside of the program
• Collection data on your current functional ability
• Group neuromuscular training sessions twice a week for six weeks to improve muscle control of the joint which leads to a reduction in symptoms and improved quality of life

OA is the most common lifestyle disease in individuals 65 years of age and older, but can also affect individuals as young as 30 years of age. Current national and international clinical guidelines recommend patient education, exercise and weight loss as the first line of treatment for OA. In Australia, treatment usually focuses on surgery. The GLA:D Australia program offers a better and safer alternative. The GLA:D program is unique in that the education and exercises provided can be applied to everyday activities. By strengthening and correcting daily movement patterns, participants will train their bodies to move more effectively, prevent symptom progression and reduce pain.

At Clifton Hill Physiotherapy and Pilates and Rehab we were one of the first practices in the country to implement this program which reflects the latest evidence in OA research. We have now been offering the program for more than two years and have had more than 30 participants complete the program. Our graduates have consistently achieved good gains in their physical functioning, high levels of satisfaction with the program. Preliminary analysis of the outcome measures collected from our cohort doing the program at Clifton Hill Physiotherapy have shown the following improvements 3 months after starting the program:

• A reduction in pain levels
• Mean improvement of 7% in walking speed
• Mean improvement of 20% in sit to stand functional test performance
• Significant improvements in quality of life measures

We have also been very pleased to see that our graduates have made active steps towards maintaining their gains and setting new goals either by continuing with the GLA:D sessions as an ongoing program, or by adherence to a progressive home exercise program of both specific neuromuscular control exercises as well as general exercise.

We have also had a few participants complete the GLA:D program at our center as a result of being referred via the trial currently being conducted by La Trobe University on the delivery of the GLA:D program. This trial is still actively recruiting participants, and if you are interested be sure to check out the following link:

http://semrc.blogs.latrobe.edu.au/knee-pain-clinical-trial/

At Clifton Hill Pilates we are currently running the exercise sessions for this program at the following times:

• Mondays at 10.30am
• Tuesdays at 3pm
• Thursdays at 10.30am
• Fridays at 11am

All GLA:D sessions at Clifton Hill Physiotherapy are currently run by Physiotherapists who have officially trained in the GLA:D program including Cathy Derham, Billy Williams, and Adriane Khablyuk.

Be sure to get in touch with our team at Clifton Hill Physiotherapy to find out more about the program if you experience any hip and/ or knee osteoarthritis symptoms, regardless of severity.

Cathy Derham

Continuing with the successful format from last year, our in-house Masterchef comp has a “lucky dip” for the budding chef to pick the feature ingredient. Each dish is judged on taste, presentation, and how well they showcased the feature ingredient.

For an additional twist this year, some new ingredients have been added to spice things up- anchovies, olives, and lemongrass (yummm!)

As the reigning winner from Masterchef 2018, I kicked off the season with the ingredient almond, and made a ‘Chinese almond jelly with goji berries and lychee’. Unfortunately, this did not turn out to be as delicious as I hoped, so it looks like the Masterchef title is up for grabs!

We have had delicious savoury dishes such as Billy’s ‘Mini Baked Potatoes with Mushroom Topping’ and Adriane’s “Cheese Sable Biscuits’.

Some current front-runners are Debbie’s ‘Passion Fruit Slice’, which was the perfect balance of sweet and tart. Ali’s ‘Lemon Sensation Tart’ (pictured) let lemon be the star. Brendan E also dished up a ‘Salted Caramel Brownie Slice’, which was demolished within seconds. Amanda’s ingredient mint was creatively used in a ‘Mint Slice Cheesecake’, which was presented as a giant replica of a Mint Slice! A mint and chocolate lover’s dream come true!

Strong contenders so far, everyone’s waistlines are looking suspicious and we are looking forward to the upcoming delicious creations!

Sonja Tun 

Physiotherapist

Pilates instructor

Masterchef CHP/CHPR/INP Champion 2018

Passionate supporters in the AFL community will more than likely be familiar with the once frequently used diagnostic term, ‘osteitis pubis’. In the early 2000s, it seemed every second player was reported to be suffering from this troublesome injury of the hip/groin which was responsible for significant amounts of missed game time and a complex, challenging recovery period.

However, in recent times you may have noticed that it is very rarely being reported in the media by elite sports clubs. But why is this? Are therapists better at managing groin pain in sport? Is the term extinct? The answer might surprise you…..

Leading into 2014, there was a large amount of disagreement and uncertainty regarding the use of diagnostic terms for hip and groin pathology within the sports medicine and physiotherapy industry. Osteitis pubis, or OP, was often used as an umbrella term to describe a number of injuries which were potentially co-existing, and as such became easily recognisable by the public. It was widely accepted that an athlete with OP would require a lengthy rest period and a graded rehabilitation back into training and sport.

In November 2014, 24 experts in groin pain from a number of backgrounds and countries (including surgeons, sports physicians and physiotherapists) attended Qatar for a meeting to discuss the inconsistencies in hip and groin diagnostics. Prior to the meeting, each expert was given the same two case study examples. These included descriptions of relevant clinical symptoms, results of clinical tests and imaging findings for an athlete who was experiencing groin pain. They were then asked to independently provide their expert diagnosis.

For case study one;

NINE different diagnostic terms for primary diagnosis were used!

For case study two;

ELEVEN different diagnostic terms were used!!!

Across the two case studies, 22 different clinical terms were used to describe primary, secondary or tertiary injuries of the same two case studies! This clearly highlighted the need for an agreement on what should be considered accurate terminology when describing hip and groin pain. This would be critical in understanding the anatomical details of each athlete presentation and facilitating clear cross-referral between practitioners.

This meeting is known as the ‘Doha Agreement’. It advocated that long standing groin pain be classified under the following clinical entities;

• Adductor-related groin pain
• Iliopsoas-related groin pain
• Inguinal-related groin pain
• Pubic-related groin pain
• Hip-related groin pain
• Other conditions (including non-musculoskeletal diagnosis)

 

These clinical entities are often broken down with further more anatomically descriptive terminologies for deeper accuracy. However, many terms, including osteitis pubis, were not recommended for clinical use by the group of experts.

Since the Doha agreement clinicians are gradually becoming less comfortable with using the term osteitis pubis, and as such the public are hearing it less often. It is still occasionally used as it is easily recognisable by many sports fans, and this helps with honest translation of information from clubs to their fans.

Next time you hear OP mentioned in the media, understand that it is likely an injury related to one or more of the many tissues around the hip and groin such as the adductor muscles, the pubic bone, the hip joint or other physiological structures. An accurate and correctly descriptive diagnosis of a hip or groin injury can be obtained by collaborating information from reported symptoms, high quality clinical assessment and then complemented by diagnostic imaging findings. Once an accurate diagnosis is achieved, an appropriate rehabilitation and return to activity plan can be prescribed.

This accurate diagnosis is relevant if you are an athlete, if you enjoy non-competitive exercising or even to improve your ability to complete common daily tasks such as walking or shopping. The fantastic physiotherapists at CHP/CHPR/INP are experienced in working with sporting and non-sporting patients, and are your perfect first stop to work towards getting the answers to your troublesome hip or groin…. Hint; It’s not osteitis pubis.

 

Billy Williams, APAM

Bachelor of Physiotherapy

Graduate Certificate of Sports Physiotherapy

REFERENCE:

Weir. A., Brukner. P., Delahunt. E., et al. (2015). Doha agreement meeting on terminology and definitions in groin pain in athletes. British Journal of Sports Medicine. 49(12). 768-774.