Have you had COVID-19? Perhaps you know someone who has?

 

Given the recent spread of COVID-19 over the past number of months in Sydney (and more broadly), it is highly likely that we all know someone who has had COVID-19 or have even had it ourselves! Many people are quite aware of the symptoms of COVID-19 infection including fever, cough, sore throat, runny nose, lethargy, loss of taste and in more serious circumstances shortness of breath and blood clots.

 

Muscle and joint aches and pains are also fairly common symptoms associated with COVID-19. Reports indicate that these aches and pains can be new or can even see the return of prior aches and pains that may have previously disappeared. It has also been demonstrated that muscle aches and joint pains can persist beyond the time of the acute COVID-19 infection and are part of the long COVID phenomenon.

 

The trouble with muscle aches and joint pains that present during or following COVID is that we are uncertain of the origin.

 

We have now started seeing a number of patients in the clinic who have had relatively recent COVID-19 infections and have developed aches and pains around the time of COVID infection and in some circumstances lasted. There is still much we don’t know about these aches and pains experienced in some people following COVID-19 infection. That said, these aches and pains can be disconcerting for these experiencing them and there is often uncertainty as to whether they are related to having COVID-19 or whether they are from another cause.

 

So, if you do have aches and pains following a recent COVID-19 diagnosis, what can you do?

 

Like all unexplained aches and pains, especially if they persist, you might want to get them checked out by a health professional. Our physiotherapists are experts in assessing musculoskeletal issues (that is things to do with muscles, joints, ligaments, nerves, etc) and can help out. They can also help with managing these aches and pains as well.

 

The good news is that our physios are having good success in assisting patients who have been presenting with these aches and pains post COVID-19 infection.

 

For appointments with our physiotherapists, call 8850 7770 or click here.

GROWTH PLATES. Many of you will have heard of them. Yes they can be damaged in kids, but how worried do you need to be?

Fractured bones can occur to anyone at any stage of their life. There are a few things unique to children when it comes to bones and fractures. The primary difference is that children are yet to have reached skeletal maturity – that is, they are still growing and as are their bones. In growing bodies, many of the bones have what is known as epiphyseal plates (more commonly known as growth plates). Fractures can and do occur through growth plates. These fractures are referred to as Salter-Harris fractures.

There are a number of different types of Salter-Harris fractures, depending on whether the fracture occurs through or across the growth plate and on which side of the growth plate the fracture extends. It is also possible to compress (squash) or distract (pull apart) the growth plate, which leads to a special sort of fracture. The problem that often arises with these compression or distraction type injuries is that they are very easy to miss, even for experienced health professionals. The reason for this is that an x-ray will appear fine as there is no “crack” in the bone. Often there is a need to x-ray the other side of the body as well to compare whether the growth plate appears narrower or wider compared to the other side. Alternatively, an MRI is often needed to be performed to exclude the presence of any fracture through the growth plate in a child.

The good news is that the vast majority of fractures involving the growth plate, will heal well with appropriate immobilisation (or in some cases surgical alignment). It is important to ensure that these fractures do ultimately heal well, so follow-up imaging is common. Whilst it is rare, there can be circumstances where the fracture heals in such a way that compromises the growth plate and can impact on further growth in that bone. Hence, why it is important to consult practitioners who are familiar and competent in managing Salter-Harris fractures.

We frequently see children presenting to the clinic with suspected fractures. Given the experience we have in assessing for potential fractures, we can conduct a thorough assessment to determine whether a fracture is possible. We are then able to refer for xray or MRI imaging as necessary.

When it comes to treating fractures, we are able to apply casts, manufacture custom thermoplastic splint or provide immobilisation boots (and crutches if necessary).

We also have good relationships with a number of orthopaedic surgeons, whom we often send imaging to for comment, to determine the best course of treatment and for the more severe fractures, whether surgery may be required. These relationships have saved many of our patients having to present to hospital emergency departments or having to run around to doctors to get an unnecessary referral to an orthopaedic surgeon and having to wait until they can get an appointment, before their fracture can be appropriately managed.

At Arrow Physiotherapy, we’ve got your fracture management covered!

The game of netball is such that injuries can and do happen, as much as we may not want them to. However, is there a way of preventing them? Well, the short answer is YES! The single best means of preventing netball-specific injuries, is through the use of the NETBALL KNEE PROGRAM.

Netballers will well know that, netball injuries tend to occur most commonly in the ankles and knees. One of the most concerning injuries, which is common to netballers, is the anterior cruciate ligament (ACL) rupture in the knee – this can account for up to 25% of serious netball injuries and often results in surgery, extensive rehabilitation and a lengthy period of time out of netball. As the name of the program would suggest, the NETBALL KNEE PROGRAM does specifically target knee injuries.

Regular completion of the NETBALL KNEE PROGRAM has been show to reduce all lower limb injuries and in particular ACL injuries in the order of 40-70%!!! You can check out the Netball Australia Flyer regarding the NETBALL KNEE PROGRAM here.

The NETBALL KNEE PROGRAM is designed as a series of exercises to be used as a warm-up prior to training and games. There is no need for any additional warm-up to take place. The program is designed to be used by netballers aged 10+ and there are 3 different levels of the program – junior, recreational & elite. Completion of the program should take between 10 & 12 minutes each time.

Netball Australia has produced a wealth of resources for the NETBALL KNEE PROGRAM including videos of each of the exercises. To access these resources, visit /https://knee.netball.com.au/

As physiotherapists with a strong interest in sport, we would love to see all netball players (aged 10+) completing an appropriate injury prevention program as a warm-up. We cannot see any reason why this shouldn’t be standard practice for coaches, clubs & associations to implement. The evidence is there to indicate that this is the single best injury-prevention measure available and as such there simply shouldn’t be any excuse not to use it.

If your coach, club or association is not using the NETBALL KNEE PROGRAM, you may wish to point this out to them. We are always more than happy to speak to coaches, clubs or associations and discuss the program with them and any concerns they may have along with directing them to all the appropriate resources. Get them to get in touch with us.

Our principal physiotherapist, Brendan Limbrey is a Nationally Endorsed Provider of Netball Australia’s KNEE Program. If you would like any further information regarding the NETBALL KNEE PROGRAM, you can contact Brendan Limbrey (APA Sports & Exercise Physiotherapist) directly by email and he will be more than happy to help you out.

Football (or soccer) injuries can and do occur, whether we like it or not. The most common injuries being that of the lower limbs including ankles, knees, groin, hamstrings and calves. One injury of note, which is particularly troublesome and has a high incidence in football, are anterior cruciate ligament (ACL) ruptures in the knee, which can result in the need for surgery, significant rehabilitation and a lengthy period of time on the sideline (typically in the order of 12 months).

How do you prevent football (soccer) injuries?

The single best way to reduce football-specific injuries, including ACL ruptures, is through the regular completion of the FIFA 11+ warm-up program. It is a series of exercises, which has been proven to reduce injury rates in footballers of all levels, ages (14+) and genders. There is also a FIFA 11+ kids version for those 7 – 13 years – see below for specific details. The FIFA 11+ is designed to be used as a warm-up prior to all training sessions and there is an abbreviated version to be used prior to games. The FIFA 11+ program is your warm-up – there is no need for coaches or players to implement any additional warm-up!

There are ample resources available for FIFA 11+ program, including exercise posters, instruction manuals and more – read on for details on how to have these sent out to you.

As physiotherapists with a strong interest in sports, we would love to see all soccer players (14 years and older) completing the FIFA 11+ program as a warm-up. We cannot see any reason why this shouldn’t be standard practice for coaches to implement. The evidence is there to indicate that this is the single best injury-prevention measure available and as such there simply shouldn’t be any excuse not to use it.

If your coach is not using the FIFA 11+, you may wish to point this out to them. We are always more than happy to speak to coaches and provide them with resources (for free!) – so get them to get in touch with us.

If you would like copies of any of the FIFA 11+ resources to implement yourself or with a team that you coach, we would be more than happy to provide these. Simply contact Brendan Limbrey (APA Sports & Exercise Physiotherapist) by email and he will send them out to you.

Is there a football injury prevention program for kids?

Yes, there is a separate football-specific injury prevention program for children aged 7-13 called the FIFA 11+ Kids. As younger children are not as skeletally mature as older children or adults, they are subject to a completely different type of injuries. As such, a separate set of warm-up exercises have been devised to help prevent injuries in soccer players of this age.

The FIFA 11+ Kids works in a similar manner as that of the FIFA 11+, in that it should be performed prior to training and games.

There are ample resources available for FIFA 11+ Kids program, including exercise posters, instruction manuals and more – read on for details on how to contact us to have these sent out to you.

As physiotherapists with a strong interest in sports, we would love to see all soccer players (including kids) completing an appropriate injury prevention program as a warm-up. We cannot see any reason why this shouldn’t be standard practice for coaches and clubs to implement. The evidence is there to indicate that this is the single best injury-prevention measure available and as such there simply shouldn’t be any excuse not to use it.

If your coach or club is not using the FIFA 11+ Kids, you may wish to point this out to them. We are always more than happy to speak to coaches or clubs and provide them with resources (for free!) – so get them to get in touch with us.

If you would like copies of any of the FIFA 11+ Kids resources to implement yourself or with a team that you coach, we would be more than happy to provide these. Simply contact Brendan Limbrey (APA Sports & Exercise Physiotherapist) by email and we will send them out to you.

Arrow Physiotherapy is proud to be running the GLA:D (TM) program. The GLA:D (TM) program is considered to be the best first treatment for hip & knee arthritis. It is an education & exercise program developed by researchers in Denmark for people with hip or knee osteoarthritis symptoms.

What does GLA:D (TM) involve?

The education and exercise program reflects the latest evidence in osteoarthritis (OA) research. It also includes feedback from people with OA and trainers on what works in the real worls to help patients manage OA symptoms.

GLA:D (TM) Australia training consists of:

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

 

For further information about our GLA:D (TM) program, click here

You can also visit the GLA:D Australia website at https://gladaustralia.com.au/

 

Our next GLA:D program is due to commence on 5 August 2019.

The program will run for 6 weeks (2 x 1 hour exercise sessions each week) + 2 x 1 hour education sessions towards the beginning of the program. The program will be run by Chris Musgrave (physiotherapist). Full details to be confirmed.

To express interest in the program or if you have any questions, please contact the clinic on 8850 7770 or email the clinic at arrow@arrowphysiotherapy.com.au.

The team at Arrow Physiotherapy recently worked to refine the core values of the organisation.

Arrow Physiotherapy’s core values are:

• Our patients are at the centre of everything we do,
• We are results & outcomes oriented,
• We are committed to delivering the best possible care,
• We are driven to excel & exceed expectations,
• We are actively involved in The Hills community.

Being stressed is something that you can probably relate to. However, have you ever put any thought to how stressed your bones might be?

Normal day-to-day activity places a certain level of stress on your bones – this is generally healthy and helps keep your bones strong.

Failure to stress your bones much (i.e. lack of physical activity and minimal incidental activity with day-to-day activity) can contribute to loss of bone density and in time osteoporosis.

Physical activity (especially of the weight-bearing kind) places additional stress on your bones. In most circumstances, your body will respond to this activity load and stress to become stronger and more resilient to higher levels of activity (bone stress) in the future.

Repeated bouts of physical activity or weight-bearing activity, especially if for prolonged periods of time or repeated regularly without adequate periods of rest in between, can lead to over-stressing your bones. Initially this will result in a bone stress reaction, which is where there is oedema (or swelling within the bone) and can be painful. If the bone is continued to be stressed, this can result in a stress fracture!

We see lots of people in the clinic with varying degrees of bone stress reactions & stress fractures. Identifying a bone stress reaction or fracture ASAP is incredibly important, as continuing to place stress on the bone can worsen the injury. Most of these injuries require rest from activity for a certain period of time as part of the required treatment. The worse the bone stress reaction or if a stress fracture has occurred the longer the required period of rest and this may require you to be non-weight bearing which can have considerable impact on work, physical activity and day-to-day activities.

As you can see, bone stress to some extent in normal and actually healthy. It is a continuum and you ideally want to be stressing your bones enough to keep them healthy and strong to be able to tolerate the level of activity that you do whether that be with day-to-day activities or sporting/recreational pursuits.

How would I know if I had a bone stress reaction or stress fracture?

It can often be difficult to differentiate a bone stress reaction or fracture from other injuries – many people will often think that they have a muscle strain or some general post-exercise soreness. There are some key defining features of most stress reactions/fractures:

• Completion of regular weight-bearing activity or exercise in the lead up to onset of symptoms. This is usually at a higher intensity, duration or frequency than previous levels of activity.
• Pain tends to be present during activity that places stress through the bone and gets worse as activity is continued.
• Pain eases after activity, although may linger as the condition worsens (lingering pain especially at rest typically is associated with more significant stress reactions or stress fractures).
• Pain tends to be quite focal initially and if left to worsen often becomes more disperse.

There are a number of other factors which can influence the likelihood of sustaining a bone stress reaction or stress fracture. These include:

• Reduced bone density, hormonal factors & low body mass are all associated with an increased risk of bone stress reactions/fractures.
• Various anatomical differences can increase the risk of certain bone stress reactions/fractures e.g. reduced foot arch height and shin stress injuries.
• Certain sports are associated with particular types of bone stress injuries:
  • Running sports/walkers – feet & shins
  • Rowing – rib
  • Cricket fast bowlers & gymnasts – lumbar spine
  • Dancers – feet
  • Retail workers (or people standing on their feet for considerable period of time) – feet & shins
• Other factors can include activity technique, footwear, surface on which activity is performed.

What should you do if you think you may have a bone stress reaction/fracture?

It is incredibly important to get an accurate diagnosis, such that you know whether you do have a bone stress injury and how bad it is. It is also important to know exactly which bone is involved, as different bones require different treatment and differing time-frames to heal. Different bones also have different risk factors which also need to be looked at to ensure that once the injury has healed, that you don’t sustain it again in time.

So, it is incredibly important to see a health professional who has lots of experience in assessing and managing bone stress injuries (we can help with this! Click here to make an appointment for us to assess your bones). If it is suspected that you do have a bone stress injury, you will likely be sent for some form of imaging to help confirm the injury. In most cases this will require an MRI or bone scan. Xrays are not good for looking at bone stress injuries – they only show stress fractures when they are really bad (we often find that people are sent for these to rule out bone stress injuries – they don’t!!).

What treatment is needed for a bone stress reaction/stress fracture?

The treatment required is dependent of the extent of bone stress injury, which bone is involved and whether there are any underlying contributing factors to address. In general, all bone stress reactions will require a period of reduced activity (so as not to continue to stress the bone) – the extent of injury will dictate the length of time for this and how extensively activity needs to be reduced. Once the symptoms have settled and there is evidence of healing, activities that stress the injured bone are gradually re-applied. Whilst the above management of the injury is being conducted, it is important to address any contributing factors to ensure (or reduce the likelihood) that the injury doesn’t reappear – this can be checking bone density, working with coaches to better manage activity load, addressing strength/biomechanical/technique issues or fixing footwear.

From everyone at Arrow Physiotherapy, we hope that you are stressing your bones adequately to keep them strong and healthy, but hopefully staying short of over-stressing them!

Introducing our NordBoard. Our physio, Chris Musgrave, has put his handyman skills to good use recently in constructing this fantastic piece of equipment. To see a video of it in action visit this link.

Chris has written the following information about NordBoards and the benefits they have for those with a history of HAMSTRING strains.

What is the NordBoard?

A recent study (Baker et al. 2018) examining a small group of people doing 2 hours of computer work at a standing desk, resulted in:

general body discomfort
lower limb swelling
cognitive function
mental state

However on the plus side, it resulted in:

creative problem-solving ability

As you can see, standing desks should be approached with caution. If you have been a patient of ours and had discussions with us around sitting or standing at work, you will probably have heard us talking about the need to avoid prolonged sedentary postures, whether sitting or standing. The best thing to be doing is to try to move often and if possible vary your work position.

Perhaps as an alternative, we all need a treadmill desk!! If you have been in the clinic at times, you may have seen our physio Chris turning our treadmill into a desk (see photo).

Ref: https://www.tandfonline.com/doi/abs/10.1080/00140139.2017.1420825?journalCode=terg20