In the last few weeks, one of the only studies looking at the long-term effects following ACL rupture has been published – van Yperen et al. 2018.

Cutting to the chase, after 20 years following ACL rupture there was found to be equal rates of knee osteoarthritis irrespective of whether one was to have an ACL reconstruction or not.

Muscle soreness following exercise, known as DOMS, is very common for people to experience this time of year as lots of people start or resume exercise – for more read on below.

If you have increased your exercise in recent weeks as part of a new year resolution or got back into exercise after a holiday or perhaps you have started football preseason, you may have experienced some muscle soreness! Muscle soreness after getting back into exercise or on starting a new exercise regime is common – it is typically referred to as DOMS! DOMS stands for Delayed-Onset Muscle Soreness.

If you have had trouble standing up or sitting down or even negotiating stairs for a few days after some leg exercises, it was probably DOMS. For your upper body, if you have had trouble lifting things or even putting on shirts after some upper body weights, it was probably DOMS.

DOMS usually kicks in 24-48 hours after exercise and lasts for a couple of days. It is basically a response to you overstressing your muscles – you will have created quite a bit of microtrauma within your muscles. Your body will adapt to this and future exercise efforts of similar intensity, should not evoke the same response.

DOMS is much more prevalent to exercises like running downhill, activities involving lots of landing or exercises involving a particular type of muscle contraction, known as an eccentric contraction – where your muscles are working hard whilst lengthening at the same time!

So, how do I know if I have or had DOMS?

Basically, if you have exercised heavily (especially with exercises that are either new to you or you haven’t done for some time) and have developed a muscular ache type pain in the proceeding 24-48 hours, then it is likely DOMS!

If your symptoms start immediately during or following exercise or last longer than 48 hours, then it may not be DOMS! Similarly, if the pain is located near your joints rather than your muscles, then it may not be DOMS! In these cases, you should consider seeing your physiotherapist to see if you have actually injured something more significantly.

If I have DOMS, what can I do to help it?

If you have DOMS, the best thing to do is to gently keep moving (e.g. gentle walking or even slow stationary cycling with limited resistance). This is better that resting in static positions. Icing the affected area can also assist. Gentle massage and the wearing of compression garments (e.g. skins) has been shown to shorten the duration and lessen the extent of symptoms.

You should avoid vigorous/strenuous exercise whilst the symptoms are present. Deep tissue massage should also be avoided for the first 24-48 hours. Once symptoms have resolved, you can gradually resume exercise. If you need further guidance, you should consult your physiotherapist.

In summary, DOMS is very common following starting an exercise program or when completing strenuous exercise. The typical symptoms are a dull muscular ache in the affected regions for 24-48 hours. The best thing you can do is to gently keep moving. Compression garments, icing the affected region and gentle massage can also assist with the recovery. If the symptoms persist beyond 48 hours, are not limited to muscle areas, start during or immediately after exercise or return regularly after exercising, then you may not actually have DOMS – in these cases you should consult your physiotherapist for assessment and to be diagnosed accordingly such that appropriate management can commence.

With Christmas just over a week away, we wanted to share 5 of our best tips with you to keep you & your family healthy & injury free this festive season.

Every year, we see a spike in certain injuries just after Christmas. There are a number of things for you to be aware of, to make sure these don’t happen to you.

So, here are our top tips to consider this holiday period.

1. DON’T GET SLACK WITH YOUR INJURY MANAGEMENT ROUTINE.

If you have a regular routine of exercises, stretches, icing, etc to manage a particular condition, make sure you continue with this over the holiday period. Every January we see an increase in people presenting to physiotherapy with injury “flare-ups” due to taking a holiday from their injury management routine.

2. SOME THINGS ARE BEST LEFT TO THE KIDS!

Every year we hear some impressive (& sometimes disastrous) injury stories of adults mucking around with kids toys. So, if you are going to be tempted to play with your child’s new Christmas present, make sure that it can tolerate your weight & perhaps think about the last time you did something like that (e.g. riding a skateboard for the first time in 20+ years often results in broken arms!).

3. BE SURE TO EXERCISE.

The Christmas period can be a wonderful time of fun, family, food, drink & relaxation. See if you can find some time to get some exercise in. You may even have more time than normal to go for a walk, a bike ride or a swim down at the beach. Exercise is a great way to keep the body moving well.

4. WATCH OUT WHEN YOU DRINK!

Alcohol can be a major factor of many injuries over holiday periods. With alcohol consumption comes impaired judgement, reduced steadiness, in-coordination & reduced inhibitions. This combination is perfect for all manor of injuries. So without trying to sound like the Christmas Grinch, perhaps think about what activities you do and take care if you choose to drink this Christmas.

5. MAKE A RESOLUTION TO LOOK AFTER YOU PHYSICAL HEALTH IN 2018!

If you have been battling with injuries or illness, make a resolution to better manage or continue to manage these as best you can in 2018. If you don’t have any particular health issues requiring attention, may we suggest the following physical health resolution for 2018 – to commit to meeting the Australian Physical Activity Guidelines at a minimum. For adults these are:

• Accumulate 2.5 to 5 hours of moderate intensity physical activity or 1.25 to 2.5 hours of vigorous intensity physical activity, or an equivalent combination of both moderate and vigorous activities, each week; and
• Do muscle strengthening activities on at least 2 days each week.

Have a safe festive period & wishing you a healthy 2018!

Sharp, shooting pain, electric shocks, burning, tingling, pins & needles.These are common descriptions that our patients tell us when they experience nerve injury. You may be able to associate with some of these.

Nerve pain (or neuropathic pain) can be quite different to other forms of pain. It can be quite unrelenting in some circumstances & incredibly debilitating until the underlying cause is addressed.

Nerves send electric impulses around the body conveying messages about all of our senses (touch, taste, sound & smell) as well as messages telling our muscles to work & when to relax, among many other things.

When nerves are damaged through injury or disease, they can cause pain, pins & needles & even numbness. In more serious circumstances, they can even result in loss of strength in the muscles that the nerves supply & even loss of reflexes (this is something that you likely wouldn’t notice yourself!).

You have probably experienced nerve pain at some stage in your life. Knocking your “funny bone” in your elbow is actually nerve pain! It’s not actually a bone at all – it’s what is called your ulnar nerve, & when you compress it against the underlying bone, you get that uncomfortable pain & sensation that you are probably familiar with.

We see many forms of nerve pain in our clinic from all sorts of conditions. Some of the common ones are:

• Carpal tunnel syndrome – this is where the median nerve gets compressed by the carpal bones (a ring of bones forming a tunnel – hence carpal tunnel syndrome), resulting in pain & potentially pins and needles, numbness & weakness in the hand.

• Nerve root compression – the part of the nerves that exit our spines are known as nerve root. Nerve roots can be compressed or irritated by a number of spinal conditions including disc bulges. In these circumstances, the disc presses against the nerve root & can result in pain along the length of the nerve which is impacted. This is why you can have a back injury & not necessarily have any pain or symptoms in you back – only pain & symptoms in your leg!

There are also many other forms of nerve pain from trauma, diabetes, inflammatory conditions, side effects from certain drugs & neurological conditions (e.g. multiple sclerosis).

As you can see there are numerous things that can cause nerve pain. If you experience nerve pain, the most important thing is that you find out what is causing your nerve pain – that is, you need a diagnosis! Only once you have this, can you seek the appropriate treatment required for your condition.

As physiotherapists, we routinely see people with nerve pain. Physiotherapy is often a key treatment for many nerve related conditions. Other treatments depending on the condition require certain medications or medical management that target nerve pain or the underlying cause.

If you are experiencing nerve pain, our physiotherapists are able to assist with diagnosing the cause of your pain & in many circumstances providing the appropriate treatment for the condition.

If you would like to make an appointment to see one of our physios, call 8850 7770 or click here to book online.

Got a sore back? A new car might be the answer!

Whilst this may sound extreme, it is exactly what I recommended to one of our patients recently! And guess what…the patient called me just this week to advise that their back pain had gone since getting a new car!

So, you might be thinking – how did I know it was the car that was causing the back pain?

Well, you see we take the time to thoroughly examine our patients as well as get a detailed history of what has been going on to develop a comprehensive picture of the injury, including all the contributing factors (in this case the car!).

The key elements of this patient’s presentation, were:

• the back pain was relatively new;
• the pain seemed to have commenced roughly around the time of getting a new car;
• the patient drove the car for in excess of 3 hours a day commuting to and from work (often 6 days a week);
• the pain was better on days when they didn’t work,
• the lumbar support in the car was pretty poor (yes, I physically went and inspected the car to check this out);
• after conducting a full physical examination, the back pain did not appear particularly serious in nature;

With this information, it seems pretty clear that the car appears to have been a significant contributing factor to this patient’s pain! Yet, the patient themselves hadn’t really linked the two.

This happens commonly for us in that what may appear obvious in hindsight, often isn’t the case to someone in pain. Getting to know the patient and taking the time to ask the relevant questions and conduct a thorough assessment means that we can identify the contributing factors.

Was getting a new car entirely necessary? Possibly not. We could have explored means of trying to improve the back support in the car and also means of making the patient’s back more resilient to the posture the car held him in (with an appropriate exercise program).

I’m sure you can see that getting a new car won’t fix everyone’s back pain! However, if you have back pain or any injury for that matter, you might want to think about things in your life that may be contributing factors. As in this example, it isn’t always clearly obvious to the patient, so it may be worthwhile to see one of our physiotherapists who can conduct a thorough history and examination to help you understand your condition and any underlying circumstances that may be contributing. Only once the contributing factors are identified, can you go about addressing the issue!

To make an appointment with one of our physios, call 8850 7770 or click here to make an appointment online.

Brendan Limbrey
Principal Physiotherapist

• Are your mini athletes getting enough sleep each night?
• Are your kids getting fatigued whilst playing sport?

We see lots of children and adolescents in the clinic with all manner of aches, pain and injuries. When asked about sleep patterns, it would seem that many are not getting enough shut eye!

So, how much sleep is enough? And what are the risks of not getting enough sleep?

There is clear research that shows that the risk of injury increases if you are not recovering from bouts of activity with appropriate sleep combined with good nutrition. Consistently good sleep partnered with nutritious food intake can help your children perform at your best. This may not sound surprising to many; but are your children actually getting enough sleep?

A 2016 study of adolescent athletes showed that getting more than 8 hours of sleep significantly reduced the risk of injury by 61%. A further study in 2014, showed that adolescents who received less than 8 hours of sleep a night were 1.7 times more likely to sustain an injury compared to those receiving 8 or more hours of sleep a night.

The message here is simple – children and adolescents need to be consistently getting 8 hours or more of sleep a night to ensure they are playing their best and minimising any risk of injury.

If your children do have any niggling injuries, sleep is not the only factor to consider. Our physios are well equipped to assess and treat any aches or pains that your children may be experiencing.

von Rosen, P. et al. (2016), Too little sleep and an unhealthy diet could increase the risk of sustaining a new injury in adolescent elite athletes. Scand J Med Sci Sports. doi:10.1111/sms.12735

Milewski et al. (2014). Chronic lack of sleep is associated with increase sports injuries in adolescent athletes. J Pediatr Orthop. 34(2); 129-33.

Do you get pain behind your knee? Does it feel like you have a lump behind your knee? If so, you may have a Baker’s cyst.

Baker’s cysts can be quite common however are often misunderstood even by many health professionals.

Femoroacetabular Impingement (FAI) syndrome is a term used to describe a certain type of pain arising from the hip joint. Basically it is a situation where the bones of the hip abut each other resulting in pain in the bones themselves or pinching other material within the hip between these bones. It is related to the bony morphology (shape) of the hip joint and describes a range of things that can contribute to an imperfect fit of the ball (femoral head) within the socket (acetabulum).

Recent new guidelines (The Warwick Agreement on FAI) have identified 3 criteria that need to be present to be diagnosed with FAI syndrome. These include:

1. Patient reported symptoms,
2. Symptoms reproduced on clinical testing, and
3. Changes on radiological imaging.

Without all three of these you cannot be diagnosed with FAI syndrome.

In a large proportion of people there may be bony changes on imaging without any symptoms. This is not FAI. It is important to remember that without symptoms these findings on imaging represent an individual’s normal bony morphology and does not necessarily need to be treated.

Symptoms?

The most common complaint of those with FAI syndrome is groin pain on the affected side, however this pain pattern can vary. Approximately 85% of those with FAI will have groin pain, 50% will have lateral (side) hip pain and around 5-10% will have posterior hip pain (bottom pain).

Usually these symptoms are reproduced with certain positions or movements – most commonly bending the hip up (flexion) and twisting movements. These may occur in everyday life in situations such as getting into a car or can occur during sporting or athletic activities.

Who is at risk?

Trying to determine who is at risk is a complex process. A large number of people will have deformities on imaging that do not correlate with pain thus imaging findings need to be taken with a grain of salt.

In saying that, those who have a history of hip problems, missing developmental milestones in childhood or a history of hip dysplasia (abnormal development) may be at an increased risk of FAI syndrome.

Treatment?

The evidence now suggests that an actual diagnosed FAI syndrome does not normally resolve on its own. If you have FAI syndrome there are broadly 3 treatment options:

1. Conservative management – involves education on the condition especially around understanding positions which the hip is like to pinch in, activity modification to try to avoid these positions (usually only temporarily) and potentially pain relief using anti-inflammatories or cortisones injections.
2. Physiotherapy rehabilitation – this will comprise of activity modification and education as above. In addition, a program of exercises looking at improving strength, range of motion and neuromuscular control of the hip would be implemented.
3. Surgery – usually this is reserved for patients who have failed to respond to the above treatments. In broad terms, it aims to improve the structural “fit” of the ball in the socket.

If you think that you may have FAI, you should consult with one of our physiotherapists who have been trained to assess and treat this condition.

In addition, our Principal Physiotherapist, Brendan Limbrey, is a treating physiotherapist on a large international hip study (FASHIoN) for those with FAI which is looking at the outcomes gained from surgery compared with physiotherapy and conservative management.

More specifically, a Morton’s foot is when the long bone in your foot connecting to your 2nd toe is longer than the long bone connecting to your big toe. You can recognise a Morton’s foot if the indent (gap) between your 1st and 2nd toe is lower than that of the indent (gap) between your 2nd and 3rd toe.

There is nothing abnormal with having a Morton’s foot as somewhere in the order of 20% of the population have them.

There are some subtle biomechanical diiferences between those who have a Morton’s foot and those that don’t. Having a Morton’s foot does not mean that you will have any weird or wonderful issues with your feet. In saying this though, we do know that having a Morton’s foot can place you at increased risk of:

• plantar fasciitis
• foot stress fractures
• calluses under the ball of your foot
• pain through the forefoot
• neuromas (nerve pain)
• hammer toes
• having altered biomechanics which may cause ankle, knee or hip issues.

If you have a Morton’s foot and aren’t having any issue then there isn’t anything you need to do about it…you just know that your foot shape now has a name!

If you do have issues as outlined above then you should consult with a physiotherapist (or podiatrist) who understands how to assess and manage the conditions, taking into consideration your foot shape.

What are cervicogenic headaches?

Cervicogenic headaches describes a headache which is caused by irritation or dysfunction in your neck. These headaches can be caused by a number of issues within the neck including muscles, joints, nerves or ligaments in the neck. Typically, the area of concern is in the upper neck region. Each presentation is different and is typically a combination of issues to muscles, joints, nerves and ligaments in the upper neck.

How do these headaches present?

Common features of these headaches can be a constant dull ache. It will typically feel like it is coming from the base of your skull, the front of your face or behind your eyes. It can be felt on one or both sides of your head or even like a tight band around your head. As these types of headache originate from issues in your neck, it is common to feel some discomfort or restriction in your neck prior to headaches coming on. It is also common to feel that certain head and neck postures can influence your pain. It is also possible to feel dizzy, light headed or even nauseated when these headaches occur.

How can physiotherapy help cervicogenic headaches?

Firstly, it is important to recognise that there are numerous causes of headaches and it is important to determine whether issues in your neck are causing yours or whether it is being caused by other issues. A qualified physiotherapist can assess you and determine whether you are experiencing cervicogenic headaches and determine the factors influencing your pain. A full neck assessment and posture screen needs to be done so the best type of treatment can be tailored for you. Common treatments to assist in your acute cervicogenic headache symptoms can include posture education, joint mobilisations to target any restriction of movement in the neck joints and soft tissue release of the neck muscles. To ensure treatment is also focussed on the root cause a movement and strength assessment should be done. Strengthening of the deeper muscles of the neck along with muscles extending out to your shoulders can decrease the stress on your neck joints and help to improve your posture, in effort to prevent future headaches.

If you think you may be experiencing cervicogenic headaches, appointments with our physiotherapists can be made by phoning 8850 7770.