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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.

Sport Australia recently released the latest AusPlay data which details sports participation across the nation.

Netball has retained its position as the leading team sport for women and girls in Australia, with over 1 million actively participating in netball and choosing netball as the sport they most closely identify with.

It is fantastic to read that female participation is on the rise in many other sports as well- in particular there has been a surge in women participating in AFL since the introduction of AFLW. In the 2017 survey there were 31,542 women participating in AFL once a week .  This number has risen to 59,504 in 2018.  The number of women participating in AFL twice a week or more has risen by 154% growing from 19,005 to 48,225!

We are also seeing an improvement in the professionalism of women’s sport, and it is fantastic to see so many role models emerging.  As young girls are able to see more and more high level women’s sport, hopefully we will continue to see participation rates increase and girls will be more likely to continue playing sport as they grow through adolescence to early adulthood.
Athletes such as Jo Weston (Australian Diamonds netballer), Alyssa Healy (Australian cricket player), Erin Phillips (AFLW player), and Samantha Kerr (captain of the Matildas soccer team), are becoming more familiar names championing women’s sport and demonstrating high performance behaviours for young girls to aspire towards.  The benefits of sport and physical activity are well known, and the more we can foster our young girls and young women to participate the better.

Netball, as a female dominated sport that has been around for a long time, has a well established pathway for participants.  From NetSetGo for 5-10 year olds, through to club netball and pathways for elite performance, there are also avenues for recreational participation for all ages.  There are many social netball competitions around Melbourne as well as Vic Health and Netball Victoria’s “Rock Up Netball” initiative which enables people to play when they like without the weekly commitment of a club or team.

Hopefully over time we begin to see these similar pathways across many other sports to help bring more young girls and women into sport and keep them involved across their lifespan.

Jane Higgs

Physiotherapist, Pilates Instructor, Netballer

References
https://www.clearinghouseforsport.gov.au/research/smi/ausplay/results
https://www.sportaus.gov.au/media_centre/news/australias_top_20_sports_and_physical_activites_revealed
www.rockupnetball.com.au
www.netsetgo.asn.au

We are constantly being told these days how good exercise is for us. It can improve our physical fitness, our mental health and reduce the risk of numerous chronic diseases such as diabetes and heart disease.

Pregnant women used to be told to rest or take it easy, as it was believed that exercise might be harmful for the mother and /or her baby. These days there are more and more studies showing us that lifestyle behaviours during pregnancy can have a huge effect on the woman’s health and that of her baby. Physical activity is now being proposed as a therapeutic measure to reduce pregnancy complications and optimise maternal-fetal health worldwide.

Some of the suggested benefits of physical activity for pregnant women include:

• Improved muscular strength and endurance
• Improved cardiovascular function
• Reduced back and pelvic pain
• Reduced fatigue, stress, anxiety and depression
• Reduced risk of pregnancy-related complications such as pregnancy-induced hypertension or pre-eclampsia
• Reduction in excessive gestational weight gain with fewer delivery complications, and
• Prevention and management of urinary incontinence

What exercise should you do during pregnancy?

• If you were inactive prior to falling pregnant the recommendations are to start being more active by slowly increasing the duration of gentle exercise, such as walking.
• Pregnant women should accumulate at least 150 minutes of moderate intensity physical activity each week to achieve clinically meaningful reduction in pregnancy complications
• This physical activity should be accumulated over a minimum of 3 days/week, however being active daily is encouraged.
• Pregnant women should incorporate a variety of aerobic and resistance training activities to achieve greater benefits. Adding some gentle stretching, such as yoga or pilates may also be beneficial
• Pelvic floor muscle training exercises should be performed daily, to reduce the odds of urinary incontinence. It is advised to get proper instruction on technique to get maximal benefits.
• Women who experience light-headedness, nausea or feel unwell lying on their back are recommended to modify their position and avoid exercising in this position. Do. not exercise on your back in the second and third trimesters.

Some safety precautions for exercising whilst pregnant, include:

• Avoiding activities which involve physical contact or danger of falling, as this may increase the risk of foetal trauma (such as martial arts, horse riding, skiing, hockey, gymnastics, cycling)
• Avoid scuba diving
• Avoid physical activity in excessive heat, especially with high humidity
• Maintain adequate nutrition and hydration – drink water before, during and after physical activity.
• Know the reasons to stop physical activity and seek medical advice immediately if they occur.

First trimester: Correct pelvic floor exercises, proper technique for core exercises, fix any postural imbalances and continue exercising.

Second trimester: Correct pelvic floor exercises, no exercising on your back, no heavy lifting, no new exercise (except Pilates), prevent pelvic pain, maintain muscle strength, improve deep core strength.

Third trimester: Pelvic floor exercises, no exercising on your back or tummy, maintain fitness and strength.

Post-natal:  Whether you had a natural or caesarean delivery, the first 6 weeks is gentle. Enjoy being a mum and focus on walking, pelvic floor exercises and correct deep core exercises. It is best to get your tummy and pelvic floor muscles checked by a physio before returning to exercise. When your baby is 12 weeks old and you have been cleared by your health professional, you can slowly return to your normal exercise routine.

If you have any concerns regarding exercising whilst pregnant or have any aches and pains during your pregnancy it is probably best to seek some advice from a health practitioner, such as your doctor or physiotherapist.

The team at Clifton Hill Physiotherapy have a lot of experience in helping women to start and continue exercising during their pregnancy by managing any aches and pains you have.

We also run small supervised group exercise classes at our Clifton Hill Rehabilitation and Pilates site. Here we provide a tailored exercise program for you to help you to achieve your exercise goals.

 

Clare Williamson

Physiotherapist

Pilates instructor

References:

Mottola MF, Davenport MH, Ruchat S-M, et al. 2019 Canadian guideline for physical activity throughout pregnancy, British Journal of Sports Medicine 2018; 52: 133-1346

https://sma.org.au/sma-site-content/uploads/2017/08/SMA-Position-Statement-Exercise-Pregnancy.pdf

 

 

 

The dreaded “M” word

What is mastitis?

 

• Defined as “inflammation of the breast”. The term is generally used in reference to the lactating breast.
• Is thought to occur when pressure within the ducts is greater than the surrounding tissue. This causes milk products to leak into surrounding tissue and the body produces a dramatic inflammatory response.
• This in turn can cause painful, red, hot and inflamed breast tissue.
• Incidence of mastitis has been reported to be as high as 1 in 3 women post partum, 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 (Wöckel et al 2008).

Symptoms may include:

• Breast tissue feeling tender
• Increased temperature of the breast tissue
• Redness in a wedge-shaped or striped pattern on the breast tissue
• Chills, ache and flu-like symptoms, similar to a systemic illness
• The inflammation may or may not involve a bacterial infection (the only way to rule out a true infection is by doing a milk sample testing – but this step is often skipped as it takes a long time)

“A tender, hot, swollen, wedge-shaped area of breast associated with increased temperature, chills, ‘flu-like’ aching and systemic illness. The inflammation may or may not involve a bacterial infection” (Amir 2014).

Risk factors and things to avoid:

• A previous episode of mastitis
• A sudden change in number of feeds (ie. infant sleeping longer overnight, skipped feeds)
• Switching to 2^nd breast before 1^st breast is finished
• Suckling replaced by pacifiers or bottles
• Compression- including flange of expressing pump, tight bra/garment
• Positioning and attachment problems (eg. from tongue tie, nipple damage)
• Pendulous large breast tissue
• A direct blow to the breast

 

Here, at Clifton Hill Physio, we have a great team of Women’s Health Physiotherapists, including: Adriane, Issy, Kiera, Ali, Clare, Jane, Jen and Sal.

 

Our physio’s can help you with:

 

• Diagnosis and advice- including appropriate referral
• Treatment:
• Therapeutic Ultrasound can be very effective in the management and treatment of mastitis. This will likely form part of your treatment and will be explained by your physiotherapist.
• Education regarding manual handling of your breast: This must always be gentle. Respect your pain.
• Self-management techniques: Effleurage or draining massage, breast rotating/breast lifting techniques. 

• Kinesiotape can be very helpful in facilitating lymphatic drainage of swelling. Your physiotherapist will show you how to apply this if necessary.

• Positioning advice:

It is important to have a number comfortable positions to rely on for feeding.

Recumbent or ‘laid back feeding’, football hold and side lying hold.

Special extra tips:

 

• If possible try to bring you baby with you as it is helpful to have your baby feed immediately after the session.
• Develop the habit of feeling each breast after each feed to highlight any areas of tension.
• Always maintain adequate hand hygiene and breast pad hygiene.
• If it is safe to do so, Non-Steroidal Anti-Inflammatory medications (NSAIDs) may be recommended.
• It is almost always ok for your baby to continue feeding if comfortable.
• Avoid over-stimulating the breast tissue
• Ensure the duration between feeds is short enough so breasts do not feel uncomfortably full.
• Expressing must be comfortable and/ or relieving.
• Take care that the flange does not compress the breast
• Avoid wearing tight compressive garments, ie, tight bra/flange of expressing pump. Garments should not indent skin.
• Catch it early: look out for early signs to prevent the condition from becoming debilitating or a more serious health problem that might threaten yours and the baby’s well-being.

 

At Inner North Physiotherapy, we understand how distressing mastitis can be and will always try our best to book you in as early as possible.

Our physio’s will strive to fit you in within the day to help reduce your symptoms and provide you and the baby with some relief as quickly as possible.

 

 

WHEN TO SEE YOUR GP/LACTATION CONSULTANT:

 

• If your symptoms are persisting
• If you have a nipple infection
• If you have signs of thrush
• If you require a breast ultrasound (as advised by your physiotherapist)
• If you become acutely unwell

Adriane Kabulyuk

Physiotherapist

 

References:

 WEBSITES:

The Australian Breastfeeding Association

https://www.breastfeeding.asn.au/aboutaba

The International Breastfeeding Journal

http://www.internationalbreastfeedingjournal.com/

Positioning advice:

www.biologicalnurturing.com

 

ARTICLES:

-Amir, L., (Revised March 2014). Clinical Protocol #4: Mastitis. The Academy of Breastfeeding Medicine Protocol Committee ABM.

-Cooper, M., (2015) The lactating breast for physiotherapists. Course Notes – Continence & Women’s Health Physiotherapy Australia Group, Australian Physiotherapy Association.

–Struebe, A., & Schwartz, E., (2010). The risks and benefits of infant feeding practices for women and their children.Journal of Perinatology, 30, 155-162

– Wöckel, A., Abou-Dakn, M., Beggel, A., Arck (2008). Inflammatory breast diseases during lactation: health effects on the newborn – a literature review. Mediators of Inflammation, Article ID 298760, 7 pages doi: 10,1155/2008/298760.

It’s an exciting time to be involved in woman’s sport. In fact, it makes me wish I was a teenager again with the opportunities that our young women have to pursue their dreams of becoming a professional athlete. From the rise of the Matilda’s, to the restructuring of the National Netball League, and of course the introduction of the AFLW. There are more pathways than ever for young female athletes to follow into the professional ranks.

But with this rise in popularity, we have also seen a rise in the rate of serious knee injuries in female athletes.

I am excited to be taking up a role in the AFLW for the upcoming 2019 season as one of the team physiotherapists for North Melbourne Football Club. It will be the inaugural season for North Melbourne in the AFLW. Exciting times for all involved.

The AFLW Injury Report shows that compared to their male counterparts, woman in the AFLW have a 9.2x greater risk of suffering an ACL injury. This figure sits even above the 2-5x greater risk that woman participating in all sports have of rupturing their ACL. Should we be concerned? The reasons for the increased risk in the female athlete are complex and multifactorial – from our genetics/anatomy, to hormonal considerations, to overall strength and conditioning, quality and skill of movement patterns, as well as factors such as footwear. There is much discussion and research occurring around this topic as we speak. Although the injury rates have been high in the first 2 seasons, there is plenty that can be done to reduce injury risk and enhance athletic performance. Injury Reduction Programs (IRP’s) have been shown to be an effective way to reduce the risk of injury by up to 50%!

IRP’s include different components of warm up, preparation, movement quality training, and strengthening exercises for key muscle groups. In the AFLW, teams have all developed programs for the female athletes to undertake at training and before games to help decrease their risk of injury. Professional athletes themselves are becoming more aware of the importance of participating in IRP’s. But there is still much work to be done at the grassroots and community level.

With the massive uptake of sport, especially footy, in girls at the grassroots level, it’s important we begin to educate and talk to our community level athletes about how they too can reduce their risk of injury and enhance their performance. As physio’s we want to encourage our young female athletes to take up sport, and participate fully in their passion of footy, without having an overshadowing fear of impending injury. The benefits of young people participating in sport still far outweigh the risks! The key is for young female (and male) athletes to develop good movement patterns and skills specific to their sport, progressively develop their strength and load capacity as they grow and develop, and be aware of how to prepare their bodies for training and game day with an appropriate warm up. Recovery is also a big key and should be holistic in nature. Gone are the days where recovery is just putting an ice pack on after a game. Recovery should include considerations such as appropriate sleep patterns, nutrition, training load management, general wellness, and self-management strategies.

As a physio, my passion is to not only work with elite athletes in exciting opportunities such as the AFLW, but also with community level and young athletes.

If you or an aspiring young athlete you know want to learn more about what IRP’s involve, or how to recover better, come in and see us at Inner North Physiotherapy. Remember prevention is better than cure!

Mel is part of the Research team at La Trobe University looking at injury prevention in Women’s footy.

Melissa Haberfield

Physiotherapist