Whiplash
What is Whiplash?
Whiplash is defined as an acute acceleration/ deceleration injury to the cervical spine (neck), where the head is flung forwards and backwards at high speeds. Whiplash injury can result in damage to the joints within the neck, the bones, the soft tissue surrounding the neck or damage to the neural tissue. It can cause widespread pain to the neck, head, shoulders and arms.
How does it happen?
Whiplash most commonly occurs in high speed motor vehicle accidents, however it can also occur in sporting activities and falls.
What can a physiotherapist do?
The physiotherapist will provide a thorough assessment of your neck and thorax, and then determine the extent of your whiplash injury. If a fracture or serious damage is suspected the physiotherapist will refer you for further medical attention and imaging and can refer you for X-rays if required.
Initial treatment of a whiplash injury requires rest and avoidance from aggravating activity. Ice and anti- inflammatories may be recommended in the initial phase to reduce swelling. Correct posture is vital to avoid increased strain on the neck and aid recovery. The physiotherapist may provide postural taping or a neck brace to assist with this.
The physiotherapist will also provide further treatment to assist in optimal recovery including soft tissue massage, mobilisations, dry needling and electrotherapy. A rehabilitation program will be designed to help increase the movement, strength and stability of your neck and surrounding musculature.
The physiotherapist may also provide recommendations on appropriate pillows to provide your neck with the best support whilst sleeping.
What about work/sport?
Return to work and/or sport will vary greatly depending on the extent of your injury and the demands of your work and/or sport. In the initial stages of a whiplash injury sustained positions, heavy lifting and high intensity activity is not recommended therefore restricted hours and duties may be required. The physiotherapist will be able to provide you with the relevant ergonomic advice for returning to work.
Outcome
The overall outcome for whiplash injuries depends on the extent and severity of damage sustained. Best outcomes are seen with appropriate rehabilitation.
For more information or to make an appointment, you can BOOK ONLINE or call your local clinic. Vertigo (BPPV)
What is BPPV?
Benign paroxysmal positional vertigo (BPPV) is the most common disorder of the inner ear’s vestibular system, which is a vital part of maintaining balance. BPPV is benign, meaning that it is not life-threatening nor generally progressive. BPPV produces a sensation of spinning called vertigo that is both paroxysmal and positional, meaning it occurs suddenly and with a change in head position.
What causes BPPV?
The most common cause of vertigo, BPPV, happens when tiny particles in the balance centre of the inner ear are disturbed, usually by sudden movement. This causes the spinning sensation. It is a common problem that can affect people of all ages and is the cause of approximately 50% of dizziness in older people. Activities that bring on a dizzy spell can vary. They often involve moving your head into a certain position suddenly, such as looking up, lying on one ear, rolling over in bed, getting out of bed and bending over.
What are the symptoms?
The symptoms of BPPV are dizziness: this begins seconds after a certain head movement and lasts less than a minute; feeling light headed; balance problems, and nausea: feeling like you are going to vomit. These symptoms usually get better once you are in a different position. Pain, ringing in the ears (tinnitus) or deafness is not common. If you have more serious symptoms – speech difficulty, double vision, unsteady walking, difficulty swallowing, altered strength or feeling in your legs or arms, ringing in your ears or deafness – you should seek medical help.
What will the physiotherapist do?
The condition is diagnosed by a test called the Hallpike-Dix which involves moving you from a sitting position to lying down with your head over the edge of the bed. Your physiotherapist can treat BPPV by moving your head through a number of different positions. The aim is to move the crystals back out of the canal where they will be reabsorbed by your body. This treatment is very effective. Many people have complete resolution of symptoms in one to two treatments. However, the problem can recur in up to 30% of people. You may need to perform some balance exercises to treat any remaining balance problems once the BPPV has resolved.
Outcome
Research indicates a greater than 80% success rate within two physiotherapy sessions. If BPPV is an ongoing problem then it is best to do Brandt-Daroff exercises at home (see below). Brandt-Daroff exercises assist in dispersing the tiny particles from the balance centre in your ear, therefore getting rid of the cause of your dizziness.
You may be anxious that the exercises will bring back your symptoms. This is normal. However, the exercises will only work if you feel dizzy as you do them. The dizziness will get less with time.
Sit on the edge of the bed. Turn your head 45 degrees (look to the left). Lie down quickly on the right side. Ensure the back of the head rests on the bed. Wait 20-30 seconds or until the dizziness stops. Sit upright. Wait 20-30 seconds for any dizziness to settle. Repeat on the other side. Turn the head slightly to the right before lying down quickly on the left side.
Do five times on each side (takes about 10 minutes). Repeat three times a day.
For more information or to make an appointment, you can BOOK ONLINE or call your local clinic.
Total Knee Replacement (TKR)
What is a total knee replacement (TKR)?
When health professional use expressions such as ‘total knee’, they mean a joint replacement operation in which the complete knee joint is replaced. An artificial joint is called a prosthesis. There are many different kinds of prosthesis and are all made of materials such as metal, plastic or ceramic.
Why have a joint replaced?
The aim of having a joint replaced is usually to relieve severe pain and restricted movement, especially when other non-surgical treatments no longer bring sufficient relief.
In most cases the operation will reduce pain, improve mobility, make day-to-day activities easier and improve your quality of life. As with all other treatments, joint replacement is not a miracle cure. The artificial joint will not restore things to the way they were when the joint was completely normal and healthy, or when your body was at its physical peak. To achieve maximum flexibility and strength of the knee replacement, you will need to follow a program of physiotherapy in the weeks following the operation.
What is the long-term outcome?
Most joint replacements have a very good outcome. More than 90 per cent of knee replacements survive for 10 to 15 years. Some have lasted for up to 25 years.
What will the physiotherapist do?
Your physiotherapist will assess the range of movement of your knee and strength of the surrounding muscles. Your rehab exercises will be gradually progressed appropriate to your level and stage of recovery. The physiotherapist may also provide manual ‘hands on’ therapy to assist in further regaining range of movement. This can include mobilization of the knee cap and knee joint, and soft tissues massage. Your physiotherapist will also provide advice on pain and swelling control, the use of crutches and gait correction and the appropriate level of activity that you should be completing.
People vary greatly in their abilities post-operatively, so try not to compare yourself to others. How much physiotherapy will I need?
Generally most knee replacement patients progress very well. If your knee is a little stiff and swollen post operatively, you may require physiotherapy twice a week for two to three weeks to achieve maximum flexibility, then once a week for a couple of weeks. If you have good range of movement, you will probably require three to four sessions of physiotherapy, usually weekly.
Exercises
The exercises that you are prescribed will be the most effective exercises for regaining good flexibility and quadriceps strength, without unnecessarily aggravating your knee joint. Pain is very normal during exercises and should be minimized by analgesics taken prior to exercise. If you feel you are regressing in your ability to do some or all of the exercises, please advise your physiotherapist.
For more information or to make an appointment, you can BOOK ONLINE or call your local clinic. Tips for Self-care of your back
Back pain is rarely the result of one incident or injury. One of the keys to having a healthy back is understanding that most back injuries are the result of the cumulative effects of months or even years of poor posture, faulty body mechanics, stressful living and working habits, loss of flexibility and strength, and a general lack of physical fitness. It you understand that things such as stooped posture, slumped sitting, improper lifting, twisting, weak abdominal muscles, tight hamstring muscles, emotional tension and even smoking are risk factors that can lead to a back problem, it becomes clear that changing some of these factors can help prevent back problems.
Almost all back disorders are the result of:
Poor posture Faulty body mechanics Stressful living and working habits Loss of strength and flexibility General decline of physical fitness
Taking the following precautions to protect your back and help prevent further episodes of back pain:
Sit, walk and stand with a balanced, relaxed posture. Think tall, chest lifted, shoulders relaxed, chin tucked in and head level. Improve your footwear (avoid high heels). Take up Pilates: it both strengthens your core and improves your flexibility. Avoid sudden forceful movements. Bend and lift properly. Bend your knees. Take care not to twist when lifting. Avoid lifting heavy objects and avoid repetitive lifting. Sleeping – your mattress should be firm enough to support your natural shape. Driving – good support from your car seat will prevent back pain. If you need more support, use a lumbar roll. Lifting – wherever possible, use trolleys or other aides to lift and carry heavy or bulky items. Storage – store loads at waist height if you need to more them regularly. Choose chairs that give good support to prevent back pain. Use a lumber roll when sitting to support your back. Maintain a healthy body-weight. Exercise regularly – flexibility and strengthening exercises are especially important. Consider attending gym or pilates classes. Avoid staying in the same position, especially sitting, for too long. Stand, stretch and walk a little every half hour. Give up smoking. It’s linked to back pain so quitting may help reduce pain, and will also lower the risk of heart disease, cancer and other diseases. Go for a walk: it helps to relieve stress and improve your fitness.
For more information or to make an appointment, you can BOOK ONLINE or call your local clinic. Shoulder Impingement
What is shoulder impingement?
Shoulder impingement is a condition in which the tendons or bursa within your shoulder joint get trapped intermittently during shoulder movement. Trapping of these structures can cause sudden onset of pain and loss of movement, continually trapping or loading of these structures can result in tendonopathy or bursitis with ongoing pain.
Why does it happen?
Shoulder impingement occurs due to reduced space within the shoulder joint. This reduced space can be caused by several factors including; inflammation, altered biomechanics, an in- balance in muscle strength, reduced muscle length or injury to the shoulder or surrounding tissue. Altered biomechanics can involve physiological changes to the shoulder joint itself or faulty movement patterns of the shoulder or shoulder blade. Shoulder impingement is often aggravated with overhead activity or heavy manual labor work.
What can a physiotherapist do?
Your physiotherapist will complete a postural assessment in conjunction with diagnostic tests to help determine the cause of your shoulder pain.
Treatment for impingement based shoulder pain will vary for each individual and depends on the contributing factors. Treatment could involve soft tissue work or stretches to reduce the tightness of muscles that are having implications on the position of your shoulder joint. An exercise program will be developed to assist in the providing optimal biomechanical functioning of the shoulder. Faulty movement patterns of the shoulder complex can be habitual and take patience and perserverance to correct. The physiotherapist will be able to assist you with this and may use hands on facilitation or bio-feedback to help stimulate optimal muscle activation.
Return to sport/work
Return to work and sport varies to each individual and is often pain limited. The physiotherapist can offer adjunct treatment to help manage the pain during work and sport including ergonomic advice, postural corrections, supportive taping and self management techniques.
Outcome
Eight to twelve weeks of a thorough rehabilitation process is often recommended to have long term effects on your impingement based pain. If no improvement is seen over this time referral to an orthopaedic surgeon may be recommended.
For more information or to make an appointment, you can BOOK ONLINE or call your local clinic. Sever’s Disease
If you’re a young basketballer/netballer/footballer and have heel pain when playing basketball or sports involving running or jumping, you may have a particular growth pain disorder called Sever’s Disease.
What is Sever’s Disease?
It is a condition (not a disease) usually affecting 9-15 year olds that occurs at the back of the heel, where the Achilles tendon attaches to the foot. The Achilles tendon is the tendon connected to the calf muscles. Pulling of the calf muscles results in tension in the Achilles and in adolescents, repeated running/jumping can result in pain and inflammation at the heel – this is called Sever’s Disease.
Why does it happen?
Sever’s disease is often associated with a growth spurt, when the bones grow but the muscles do not. Therefore the muscles effectively become tighter which results in increased stress at the heel. It may also be related to unusual biomechanics, for instance poor foot posture, muscle tightness or muscle weakness. Overtraining or incorrect training can also play a part. Usually, the cause is a combination of factors.
What will the physiotherapist do?
The physiotherapist will thoroughly assess the affected areas and general mechanics to determine what factors may be contributing, also to rule out any other injuries or stress fractures, etc. Treatment focusing on the affected area will consist of modified rest, ice, massage, stretches and electrotherapy. A foam heel raise may also be given to help decrease pain. The physiotherapist may also treat other areas if biomechanical problems are noted. This may include massage, mobilization and exercises to stretch and strengthen certain areas. They may also refer the patient to see a podiatrist if they believe the foot posture is a factor.
What about sport?
The term relative rest is often used. It is difficult to quantify an amount of activity because everybody is different and does different amounts and levels of sport. Pain-free activity is important for recovery. This usually means decreasing the number of sports played or the amount of training. Complete rest is rarely required.
Outcome
Sever’s Disease will settle, usually within six weeks to 12 months, but symptoms may persist for as long as two years, especially if you do not manage the condition properly.
For more information or to make an appointment, you can BOOK ONLINE or call your local clinic. Safe Lifting
HOW LIFTING CAN INJURE YOUR BACK
When you lift, your back is put under stress.
Twisting or jerking while lifting and carrying can injure the small facet joints that guide movement of the back. The discs that separate the vertebrae (bones) and the ligaments that hold them together are also at risk. Discs are composed of a jelly-like core, surrounded by a strong fibrous ring. With repeated unsafe lifting, the fibrous ring or its supporting ligaments may tear or rupture. Lifting while bent forward will increase the stress on your spine. Contributing to this stress are factors like the weight of the load, how far it is held from your body, how often and how fast you lift and how long you hold the load. Back injuries are most likely when the spine is bent forward and twisted at the same time.
TIPS FOR BETTER LIFTING
Test the load. Before you lift, check the weight and make sure you can lift it safely. If not get help or use an assistive device. Keep your back in its natural curve. Bend at the hips and/or knees. With the low back erect, the forces are distributed safely. Maintain a wide base of support. A solid and wide base will help reduce the possibility of slipping. Hold objects as close to you as possible. This reduces stress on the back. Do not twist when carrying. Move or change directions with the feet. This decreases the stress and load on the back. Tighten stomach muscles when lifting. This prepares the abdominal area to help in the lift and reduce strain on the low back. Think before you lift. First think how you will lift the object. Plan the path and make sure it is clear. Lift with the legs or the large muscles. Using the large muscle groups helps to diminish the forces on the low back. Maintain good communication if two or more people are involved. Good timing on a lift reduces the likelihood of jerky or sudden unexpected movements. Move obstacles out of the way. Making sure the path is clear (clearing away toys, tools, loose rugs, etc.) decreases the risk of slipping or falling. Push rather than pull. It is easier to utilize your weight advantage when pushing. Eliminate repetitive lifting duties if possible. Place things or supplies that you constantly need or use at a better initial height to decrease lifting activities. Use equipment. Wherever possible, lift or carry heavy items with a crane, hoist or forklift. Instead of carrying parcels, use a hand trolley.
For more information or to make an appointment, you can BOOK ONLINE or call your local clinic. Rotator Cuff Repair
What is a rotator cuff repair?
The rotator cuff is comprised of four muscles and their tendons that attach from the scapula to the humerus. The muscles of the rotator cuff help stabilize the shoulder and enable you to lift your arm. The rotator cuff tendons can acutely tear or wear out as a result of degenerative changes. If the tear is causing significant pain and disability, surgery may be the best treatment to relieve pain and improve shoulder function. If a torn rotator cuff is not repaired, the shoulder often develops degenerative changes and arthritis many years later.
The three surgical techniques most commonly used for rotator cuff repair include traditional open repair, arthroscopic repair, and mini-open repair. The type of repair performed depends on several factors, including your age, the size of your tear, your anatomy and the quality of the tendon tissue and bone. The surgeon will choose the technique that is best for your repair. You may also have other shoulder problems in addition to a rotator cuff tear, such as osteoarthriritis, bone spurs or other soft tissue tears. This will be addressed at surgery also. There are three stages of recovery following a rotator cuff repair. These include protection stage, rehabilitation stage and functional restoration stage.
Protection stage (0-6 weeks)
Tendon healing is a slow process. It takes six weeks before it is safe to start using the arm under its own power. You need to be in a sling for six weeks following your shoulder operation. Your sling must stay on at all times, day and night except when you are performing your exercises or in the shower.
The goals of the protection stage are to allow healing of tendon to bone, protect the rotator cuff repair, control the post operative pain and inflammation and to initiate range of motion exercises to reduce post operative shoulder stiffness. During the protection stage, DO NOT raise your arm or elbow away from your body. Also, NO lifting of objects, no reaching behind, no excessive stretching or sudden movements and NO supporting of your body weight by your hands.
It is essential that you regularly loosen or release the sling to exercise and move your elbow, wrist and hand to prevent stiffness of these joints. This should be done at least four times per day. You will wear your sling over your clothes after your surgery. Always dress your operated arm first and undress it last. You will require loose clothing that preferably buttons down the front or tank tops with large sleeves. Avoid clothing with small buttons, hooks and zips. Ladies may find a bra uncomfortable and may prefer to wear a strapless or front fastening bra. To wash under the operated arm, bend over at the waist and let the arm passively come away from the body.
Rehabilitation Stage (6-12 weeks)
At six weeks the sling can begin to be weaned off. It is advised to wear the sling around large groups of people to avoid knocks. You are now able to use your arm actively or raise it on its own without the support of the unaffected arm.
The goals of the rehabilitation stage are to continue to protect the repair whilst beginning to restore range of movement (6-12 weeks) and restore strength (9 weeks+). Even though your tear has been repaired, the muscles around your arm remain weak. Moving your muscles on their own will gradually increase your strength and improve your arm control. During the rehabilitation stage, you are able to lift light objects but DO NOT lift anything heavier than 2kg, pull anything heavy or suddenly and avoid overhead lifting.
For more information or to make an appointment, you can BOOK ONLINE or call your local clinic.
Rotator Cuff Tear
What is a Rotator Cuff Tear?
A rotator cuff tear is a tear of one or more of your rotator cuff muscles that usually occur in the tendon where it connects onto the shoulder. You have four rotator cuff muscles which originate at your shoulder blade and attach to the top of your arm to the humerus bone. They work collectively to provide support and stability to your shoulder joint.
If you sustain a rotator cuff tear you are likely to experience shoulder and arm pain, restricted shoulder movement and pain at night. Sometimes rotator cuff tears can occur slowly without any pain or discomfort. This is thought to occur due to older age, compression (impingement) of the tendons and repetitive shoulder activity. After sustaining a rotator cuff tear you may have pain or difficulty raising your arm above your head, reaching out in front of your body and pain with lying on the shoulder at night. Small to medium tears respond well to physiotherapy. Large tears or ruptures may require surgery.
Why does it happen?
Rotator cuff tears can be caused by an acute fall or from chronic degeneration of the tendon. Impingement (pinching) of the rotator cuff tendons between the top of the shoulder blade (acromion) and the ball of the shoulder (humerus) is thought to be the main cause of rotator cuff tears. They can also occur in activities that involve overhead movements, repetitive arm activity, heavy lifting or some throwing sports.
What can a physiotherapist do?
In the initial stages of a rotator cuff injury the physiotherapist can help reduce the pain and maintain range of movement of the shoulder. The physiotherapist may refer you for further investigations to assess the extent of the rotator cuff tear.
Physiotherapy treatment may involve soft tissue massage, mobilization, electrotherapy, dry needling, supportive taping, and gentle range of movement exercises. The physiotherapist will further progress your exercises to improve the strength and stability of your shoulder as the condition improves.
What about activity?
Your physiotherapist will provide advice regarding the safe return to work and normal activity. Most of the time activities are able to be modified and do not have to be ceased completely. Outcome
Rotator cuff tears generally take time to heal. The recovery time is variable and may take several months. Being diligent by completing your exercises is very important. Most small tears heal well without surgery. Those who do not respond to physiotherapy despite adequate rehabilitation and time will benefit from a surgical opinion. Rotator cuff tears that require surgery will need an extensive rehabilitation regime. Full recovery is reached at 6 months to one year after surgery.
For more information or to make an appointment, you can BOOK ONLINE or call your local clinic.
Quadriceps Muscle Strain/Tear
What is a Quadriceps Muscle Strain?
A quadriceps strain or tear is where the muscle fibers in the front of your thigh are suddenly overloaded and a degree of damage occurs in the muscle. The quadriceps are made up of four main muscles that connect from the front of your knee and join up near your hip. Quadriceps muscle tears are most common at the point in which the muscle connects to the tendon. The tears can range in severity from a mild strain to severe tear of the muscle fibers.
Why does it happen?
Quadriceps tear is an acute injury that usually occurs during sporting activities, particularly those that involve running, jumping and kicking. Quadriceps tears are generally caused from sudden overload, muscle fatigue, muscle weakness, an imbalance between quadriceps and hamstring strength, a poor training program or insufficient fitness.
What will a physiotherapist do?
The physiotherapist will determine the extent of your quadriceps strain, assess contributing factors and complete a biomechanical assessment. The physiotherapist will provide information in regards to estimated time of recovery, appropriate rehabilitation methods and advice regarding RICE and No HARM principles.
The physiotherapy can employ treatments such as soft tissue therapy, dry needling, electrotherapy, ice or heat, compression garments, joint mobilisation, provide a home exercise program and advice regarding activity modification. Commencing an exercise program including quadriceps range of movement, muscle strengthening and stretching is essential in the management of quadriceps muscle injuries. The physiotherapist will develop an exercise program for you to complete which will involve gradual progressions before return to sport.
What about sport?
It is important that before return to sport a thorough rehabilitation process has been undertaken to avoid re-injury. This will involve graduated strengthening exercises, running, agility and sport specific drills throughout the rehabilitation stage. Guideline of days before return to sport with quadriceps strain is as follows;
Strain or minor muscle tear: 2 – 4 weeks Medium to large tear: 6 – 12 weeks Complete rupture (rare): 12+ weeks
Outcome
Quadriceps muscle strains usually have good recovery if appropriate rehabilitation is undertaken. Patients may be at greater risk of re-injury secondary to scar tissue formation and inadequate recovery.
For more information or to make an appointment, you can BOOK ONLINE or call your local clinic.