No more RICE, call the POLICE!!

No more RICE, call the POLICE!!

Physios love our acronyms, from ACL to VBI and every letter in between (unfortunately no acronyms begin with ‘Z’) we have acronyms for everything. The most well known of these is one thrown around in every sporting field in the country…..RICE. ). It’s easy,  every coach, player or parents knows; Rest, get the ICE, COMPRESS the area, and ELEVATE! That’s the correct thing to do right? RIGHT?  As soon as someone goes down with a sprain or strain “QUICK, get the ice” (as though ice has magical healing properties I was not aware of).  Alas, while ice can help numb the pain it does not speed up recovery (may actually hinder in some cases but that’s for another blog). With what the evidence tells us, it may be time for an update to this outdated practice.

We see soft tissues injuries from sports all the time in the clinic; whether it be muscular strains (Commonly hamstring) or ligament strain (ankle). It’s frustrating from a physio standpoint to see these relatively simple, common injuries managed so poorly in the acute stage. The blame lies primarily with ‘old school’ practitioners avoiding change to traditional methods that have been in place for decades. As the adage goes ‘you can’t teach an old dog new tricks’.

Fear not though, here comes the POLICE to the rescue. Another acronym I know ( I told you we love them) but one that actually aids the healing progress from minute one. You will notice that the ‘ICE’ remains the same…. ‘Phew I don’t need to remember 5 new words’.  The ‘P” = protect which is really just the same as the ‘R’ but it wouldn’t be right if our acronym didn’t form a cool word, ROLICE doesn’t have quite the same ring to it.

The critical point of difference here is the ‘OL’. Which lead us to this term of “Optimal load” which you may have heard if any of you have been to see us before in clinic. Sounds good, but what does this fancy term actually mean? Ahhhh you see, this is where you’re friendly neighbourhood physio comes in to guide you.

I call this the ‘Goldilocks principle’. Just like Goldilocks, we want to find Kellogg’s ‘Just Right’ (I may not have been paying attention in fairy tale class). That is, the adequate amount of load on the injured tissue that will aid tissue healing and recovery. Instead of playing a guessing game like goldilocks did, your physio can help guide you with finding that sweet spot. However if you decide to brave it alone, a good rule of thumb is to let pain guide you. *Unpopular pinion time – Pain is awesome (acute pain) because without it we don’t know when things hurt (duh).It’s surprisingly critical for our survival (ask anyone who can’t feel pain how day to day life feels). We use this important sense to determine what is a safe amount to ‘load’ things up. Think safe as anything that stays within 1-3/10. You WILL NOT damage to the tissues with this amount of pain. Pain DOES NOT equal damage.

So next time you go down with an injury optimally load that baby

Key points:

– No more RICE (stick to potatoes or pasta for your starchy carbs)

–  Call the POLICE (not literally, maybe call us instead)

–  Optimally load that injury (get into the clinic Goldilocks)

Ankle Sprains

Ankle Sprains

Hey I rolled my ankle….. It’s Achilling me

Poor jokes aside, it’s an injury we treat all the time…The dreaded ankle sprain. Almost everyone who’s played sport has felt the sting of an ankle sprain (70% of the entire population will have at least one in their lifetime!), especially those in jumping & landing sports. It’s not surprising that it’s one of the most one of the most common injuries we see at Rozelle Physiotherapy. We’ve heard all the weird and wonderful ways people have managed to sprain their ankle from rolling over it on the Bay run,  to falling down a flight of stairs a little worse for wear in heels. From the sportiest of the sporty  to your couch potato no one is completely immune to the lateral ankle sprain.

While extremely common, only 50% of sprainers seek specific treatment. This may be due to the supposed simplicity of such a common injury, but 85-95% of those not receiving treatment will go on to sprain their ankle again. Each time we sprain the ligaments around the outside of the ankle get looser leading to a negative cycle of spraining over and over.

It’s only logical then to seek out excellent treatment & rehabilitation in this early stage, especially if you’re a first time sprainer. This ensures a safe return to sport/exercise/work, minimising risk of recurrence and maximising performance.

When can I go back to sport/exercise/work?  is the question we most often hear.  It’s a very relevant question, but one that will generally require a thorough assessment and treatment plan from a physiotherapist.

In general, guidelines dictate:

Grade 1 sprain: 2-4 weeks
Grade 2 & 3 sprain: 6-8 weeks

However, general timeframes are just that….general and are not individualised to the level of strength, balance, functional control and demands of an individual’ssport/work. The decision to return to sport is a little more complex, with multiple factors that we take into account to help determine when it is safe to return to play.

“Can’t  pain just tell me when it’s fine to return to play?Unfortunately not, quite the opposite in fact. Pain is actually an extremely poor indicator of the state of the tissues and relying on pain to guide recovery leads to an increase in recurrence of ankle injuries due to returning to early.

“How can I tell when to go back then”  ….I’m glad you asked.  Fortunately,  we use various performance measures (not just pain) focused around strength, balance, &control we use in clinic that guide us in determining when you’re ready to go back and be your best on field or at work.

Key takeaways!!

Don’t just leave it
Early rehab for first sprain = back to sport quicker, safer and better
Pain = poor indicator of readiness
Let us help

Do you even lift?

Do you even lift?

Do you even lift?

Whether you’re a powerlifter, manual labourer or a new mum, I’m betting you probably need to lift things every day.
“Keep your back straight”, “use your legs”, “bend your knees” are phrases we hear all the time as conventional wisdom (unfortunately, from many physios too). Conventional wisdom is not always the ‘wisest’ of advice it seems, especially when it comes to backs.

 

Mythbusting

There is this huge misconception in the general population that backs are structures that need to be wrapped in cotton wool – protected to the point of not using them for what they were specifically designed to do i.e. bend and lift. Backs truly are a feat of incredible evolutionary engineering. Have a think of what we ask of our backs on a daily basis. Twisting, bending, lifting or even all three combined (imagine adding an unruly 2 year old to the mix!!), it’s no wonder that sometimes they can get a bit sensitive and painful.

Yet the advice above stays as prevalent as ever in manual handling training, trickling into public perception….Youtube every heavy deadlift video from present day to the advent of humankind and one common thing prevails…. a flexed lower back!!!!!……..”BUT, BUT people say you shouldn’t bend your back when lifting”. It’s interesting that the way these giants lift, bears a striking resemblance to how we are not supposed to lift, yet the sport is extremely safe – in actual fact approx 1-4 injuries /1000 hours, 3x safer than soccer and AFL. Riddle me that!!……If backs were fragile things in need of protection I doubt they could cope with lifting up to 500kg with a flexed spine – just a tad bit more than the average toddler 😉

 

Loading

What it comes down to then is not so much the HOW we actually lift, but how familiarised (or adapted) the back is to doing the task. Which brings us to one of my favourite words – ‘Loading’. We are adaptable creatures capable of doing amazing things if loaded in a paced way; adding little bits at a time. Just like you wouldn’t decide to climb Everest without preparing for the high altitude, you can’t expect to lift things (awkward, heavy or otherwise) without adequate preparation to adapt to the load.
As someone that likes to lift heavy things in the gym for the fun of it, I can attest to this awesome phenomenon of adaptation. We lift heavier and heavier things, in multiple ranges of spinal flexion and wallah, the back can cope with more load……..MEANING that it can handle all those awkward and/or heavy toddlers in everyday life without issue. A simple rule to follow for my own training and with every client: The body will allow you to cope with most of the stresses you place on it, provided you give it the time to adapt. Key word being TIME. Now, I’m not advocating for Granny to go out and start strongman training tomorrow – I AM advocating for people to go out and use their backs for what they were designed for…..bending baby!!

Take care of the muscles, ligaments and joints and they will take care of you. That is where your physio comes in! Optimal strategies to strengthen and load your back, individually tailored to your environment to ensure that risks to the back are minimised. At Rozelle Physio, This is what we excel in, so let us help you with that.

Key points:

– Unwrap that cotton wool
– Bend the back
– Graded load increase over TIME

What’s the benefit of taping for neck pain

What’s the benefit of taping for neck pain

Taping is thought to have more of a neuro-physiological effect versus a actual mechanical effect on tissues. K-tape can benefit patients due to increased proprioception and increased postural stability. Taping can also affect blood circulation to the area by providing continuous stimulation to the skin and subcutaneous tissues.

When we have a sore area what do we do? Generally we rub it.

The tactile pressure and stimulation of the receptors in our skin make us feel better. The tape provides gentle tissue-sheering all day therefore providing a beneficial analgesic effect on the area. In addition, the tape gives us feedback to prevent painful and/or improper posturing. Tape can also be used to facilitate a muscle, inhibit a muscle or provide structural support to the joint.

Depending on the goal of the physio, k-tape will be applied with a muscle in a stretched or shortened position, and different tension is applied on the tape during application. Many areas or body parts can be treated effectively with this tape. Taping an unstable ankle can increase reaction time and help with rehabilitation and prevention of re-injury.

Taping a shoulder can help with posture correction and awareness. The tape can help facilitate or inhibit muscles as deemed necessary by the therapist. The stretchy qualities of the tape will allow full range of motion and stimulate proprioceptive rehabilitation of weak muscles.

Back pain can also be effectively treated using this taping technique. Tape can provide an analgesic effect by stimulation of receptors in the skin as well as helping the client by providing feedback when the client goes into a poor position or incorrect posture. The tape can inhibit over-reactive muscles causing us pain including levator scapulae, trapezius, paraspinal and erector spinae muscles.

Postural Neck Pain

Postural Neck Pain

Postural correction may be necessary in patients who have had a neurological dysfunction, but it may also be helpful for persons who do not have a clinical complaint. Poor posture can contribute to breathing problems, back, neck and shoulder pain, fatigue, indigestion and sleep problems.

In other instances, poor posture may be the result of pain, for which the person is trying to compensate. Physiotherapists are very concerned about the posture of their patients, as it can make a huge difference in a person’s recovery.

Correct posture allows you to keep the head in midline, bear weight, weight shift in all directions and have proper balance. You are guided in exercises and imagery that will help you keep your head, neck and spine in correct alignment.

Abnormal postures will be addressed with a number of techniques to improve posture. In some instances where muscle tone is compromised as a result of illness, such as Parkinson’s or stroke, we may use bolsters, pillows or wedges to stretch the muscles and aid in posture correction. Taping is another means of correcting posture. Taping the body in the correct postural position makes it difficult for the person to deviate.

Poor posture is usually accompanied by pain, therefore we can address this first with manual therapy, massage, or manipulation. Trigger point dry needling therapy to get rid of trigger points has been proven helpful in relieving pain and relaxing muscles. The individual is taught a series of exercises to progressively the muscles and aid in correcting posture. Most see results in fewer than 4 sessions.

​Poor ergonomics can also contribute to poor posture which in turn can contribute to some of the problems listed above. We can assist with the design of your home or office to make it more efficient and less challenging to your health. In most cases only simple adjustments may be required to help improve your posture and alleviate back pain for good.

Is Bracing Effective?

Is Bracing Effective?

Lateral epicondylitis, or tennis elbow, is one of my least favorite injuries.  It can be disabling, nagging, and sometimes even relentless!  A commonly recommended treatment involves the use of a tennis elbow strap.  There has been some support in the literature regarding these orthotics, however results in the literature have varied.

A nice new study published in a recent issue of JOSPT assessed the efficacy of these devices in a group of 52 subjects with lateral epicondylitis.  The study examined the amount of pain-free grip strength and maximum grip strength is subjects with a variety of tennis elbow straps, including a placebo strap.

How Do Tennis Elbow Straps Work?

The theory behind counter-force bracing is similar to the mechanics of a guitar.  When a finger is placed on a string along the neck of the guitar, it reduces tension on the string distal to the fret where your fingers are located.  A counter-force tennis elbow strap can be thought of as your fingers on the neck of the guitar (your forearm) and the extensor muscles, especially the extensor carpi radialis brevis, would be the guitar string, thus reducing tension of the muscles as they attach to the lateral epicondyle.  The authors of the study review this concept well.

Counter-force Bracing is Effective

Results indicate that strapping was effective in allowing subjects to produce significantly more pain-free force.  Subjects were able to produce 16% more strength without pain using a strap.  There was no difference between two of the devices they used (a strap vs. a sleeve with a built in strap), indicating the strap itself is likely the significant factor.  The image below on the left is just the strap and the image on the right is the sleeve with a built in strap:

One of my original concerns with the study involved the rest time between repetitions of grip strength.  As anyone that routinely assesses grip strength knows, the amount of force produced can drop significantly if the rest time between repetitions is not adequate.  However, the study design used a mean of 4 repetitions for each device and allowed 5 minutes of rest between testing sessions.  This was adequate for me and I was happy to see this methodology.

Clinical Implications

  • I like this study because bracing is simple, cheap, and effective.
  • Counter-force tennis elbow straps are effective at allowing patients with lateral epicondylitis to produce more grip strength with less pain.
  • The strap should be placed around 2.5 cm distal to the lateral epicondyle.
  • While it is unclear if the size of the strap is important, the study used straps that were between 5-8cm in width.  Considering there is some conflicting results in the literature, I would recommend you try to replicate the width of the strap.  There are some straps on the market that are very skinny.
  • Straps can be an effective way to allow people with lateral epicondyltis to return to athletics or weight lifting when painful gripping can severely limit activities.
Elbow Bursitis- What is it and What can i do about it?

Elbow Bursitis- What is it and What can i do about it?

The elbow contains a large, curved, pointy bone at the back called the olecranon, which is covered by the olecranon bursa, a small fluid-filled sac that allows smooth movement between the bone and overlying skin. Inflammation of this bursa leads to a condition called olecranon bursitis.

The causes of elbow bursitis may include trauma or a hard blow, excessive leaning on the elbow, infection through puncture wounds or insect bites, or conditions such as gout and rheumatoid arthritis. People in certain occupations such as plumbing or air conditioning technicians which involve a lot of crawling on the elbows are highly prone to this condition.

Swelling is your first symptom of elbow bursitis. As more and more liquid fills into the bursa, the swelling increases and can cause pain. This pain is generally mild, but can increase with direct pressure or bending of the elbow. If the bursa gets infected, your skin can become warm and red, and may spread to other parts of the arm or even the blood stream if not treated immediately.

Elbow bursitis can be diagnosed by reviewing your medical history and undergoing a thorough physical examination. Your doctor may also order an X-ray and biopsy of the bursa fluid to test for infection.

If bursitis is caused due to an infection, your doctor may recommend removal of fluid from the bursa with a needle and prescribe antibiotics. Elbow bursitis not caused from infections, can be treated with an elbow pad to cushion your elbows, avoiding activities that place direct pressure on the swollen elbow, taking anti-inflammatory medications to reduce swelling, or injection of corticosteroid medication directly into the bursa to relieve pain and swelling. When these methods do not help, the bursa is surgically removed.

Protection of your elbow from excessive friction may prevent bursitis, or an elbow pad can be used when you need to lean on your elbow while working

Golfers Elbow

Golfers Elbow

Eccentric training of the wrist extensors has been shown to be effective in treating chronic medial epicondylalgia. A study conducted by Tyler and others in 2014 studied the efficacy of adding eccentric exercise to standard physiotherapy consisting of ultrasound, cross-frictional massage and self-stretching, heat and ice.

The specific isolated eccentric wrist flexor strengthening exercise performed by the patients involved twisting a rubber bar (Flexbar, Hygenic Corportation, Akron OH) with concentric wrist flexion of the non-involved arm and releasing the twist by eccentrically contracting the wrist flexors of the involved arm. This was performed 3×15 twice daily. Changes in symptoms were assessed using the DASH questionnaire. (Disability of the Arm, Shoulder and Hand).

Symptoms related to  chronic medial epicondylalgia were markedly improved with the addition of an eccentric wrist flexor exercise to standard physical therapy

This novel exercise is an easy way to utilise eccentric training in the treatment of chronic medial epicondylalgia.

What’s the Latest with Tennis Elbow Strengthening?

What’s the Latest with Tennis Elbow Strengthening?

Load Management

 

Load management and activity modification are vital in the rehabilitation of tennis elbow. From the elite athlete to the weekend warrior this can often feel like the end of the world. This can be achieved by reducing the aggravating activities within possible occupational and recreational limits. Through use of appropriate education and communication the athlete can be

 

Tendon disorders have been closely studied in Australian physiotherapy circles. Researchers have found the following exercise protocol to be the most effective avenue to successfully recover from tendon issues.

 

  1. ISOMETRIC PHASE
  • Muscle contraction whereby the targeted muscle does not move
  • 5 repetitions of 45 seconds, 2-3 times per day

 

  1. ISOTONIC LOAD
  • Muscle contraction where the targeted muscle and limb is taken through its range of motion
  • 3-4 sets at a load of 15RM (repetitions max) – progressing to a load of 6RM, every second day
  1. ENERGY- STORING LOAD
  • Initiation of high velocity (e.g plyometrics) movements in preparation for the return to sport phase.
  • Volume and intensity are progressed gradually using exercise to replicate the demands of the sport. E.g double leg boundsàsingle legs hopsà
  1. RETURN TO SPORT
  • This marks the return to play phase. Training drills and match simulation are undertaken to prepare the athlete for return to play. The athlete must be able to perform all competition drills in order to successfully return to play.
What Is Tennis Elbow?

What Is Tennis Elbow?

What is it?

Tennis Elbow, also known as lateral epicondylitis is an overuse injury of the forearm and the wrist extensors tendons, primarily the extensor carpi radialis brevis and common extensor tendon typically presents as progressive pain over the lateral aspect of the elbow.

It is primarily due to repetitive strain from tasks and activities that involve loaded and repeated gripping and/or wrist extension. It historically occurs in tennis players but can result from any sports that require repetitive wrist extension, radial deviation, and/or forearm supination. Relating to occupational and athletic population tennis elbow is often precipitated by poor mechanics, technique or improper equipment.

Symptoms:

Patients will typically report:

  • Pain over the lateral elbow. It can typically occur 1-3 days after performing unaccustomed activity involving repetitive wrist movements
  • Decreased ability to perform tasks that involve gripping, forearm rotation or wrist movements due to pain
  • Pain when touching the lateral aspect of the elbow

Latest research indicates the following for optimal recovery:

  • Relative rest from aggravating activity as guided by the level of pain.
  • Ice (particularly after activity)
  • Ultrasound
  • Dry Needling
  • A graded exercise program initially focusing on isometric muscle strength
  • Bracing and/or taping

It is important to know that any tendon condition may take 12 to 24 months to completely resolve. Persistence and adherence to the recovery plan is vital for optimal rehabilitation and successful return to activity.