Tennis Elbow

A pain in the outside of your elbow when you lift something or twist your arm could be tennis elbow, otherwise know as Lateral Epicondylitis. Any repetitive or excessive use of the muscles that extend the wrist and fingers can result in degeneration of the muscle tendons near the elbow.

A Little Bit of Anatomy:

The most commonly affected muscle is Extensor Carpi Radialis Brevis, which allows you to extend your wrist. Other muscles that can be affected are Extensor Carpi Radialis Longus, Supinator (another wrist Extensors), Extensor Digitorum (extends the fingers), Extensors Digiti Minimi (extends the little finger) and Extensor Carpi Ulnaris (another wrist Extensor). This can also affect the muscles on the other side of the wrist that flex the wrist.

What’s Happening?

It was commonly thought that Tennis Elbow was an inflammatory condition. Recent research has shown that it is in fact a symptomatic degeneration of the tendon. As you load the tendon it responds by increasing cross linkages and depositing collagen. If the load or stress on the tendon is more than the tendon’s tolerance to stretch, then micro-tears form. When multiple micro-tears form this can lead to degeneration of the tendon, which is known as tendinosis.

Risk Factors:

Tennis elbow will affect between 1-3% of the population. The biggest risk factor is if you have had the tendon issue before. After that it appears to be most prevalent in the middle-aged population, with no preference to gender.

How to Fix it?

You may think that resting the injury will help it heal. While this will allow the tendon to recover and will reduce you pain, it also weakens the tendon and reduces it’s tolerance to stretch.

  • Release the tight – you need to massage the tight muscles in the forearm, both the extensor and flexors. You also need to stretch the muscle to maintain the tolerance to stretch
  • Strengthen- Tendons actually love being loaded; they just need the right kind of load to recover. Start with Isometric exercises first, that are relatively pain free.
  • Get your posture checked – often the overload on the elbow is due to poor posture elsewhere. You can do a quick posture check by reading about it here.
  • Modify you activities – to begin with you may need to modify how you are doing thing to help reduce the load on the elbow.
  • Splints and braces – sometimes it is necessary to try a tennis elbow brace or even to use a wrist splint to limit the load on the tendons. See one of our expert physiotherapists to see if this is right for you.

Timeframes:

Everyone will be different some will get almost instant relief while others will need to look at their posture and start to change that before they start to get relief. If you do nothing the research suggests that the condition is self-limiting, however it may take 12-18months to resolve.   Physiotherapy studies have shown greater improvement with stretching and strengthening than the traditional rest regime.

Book an appointment:

Elbow pain stopping you from doing what you love?   Book in for your treatment now with one of our team by calling (07) 3398 9556. 

Changes to DVA treatments for Allied Health

After a recent discussion with a DVA patient I realised that the changes to the allied health referrals were not well understood. The new changes came into affect on the 1st October 2019 and affect both white and Gold card holders. Only holders of a Totally and Permanently Incapacitated (TPI) marked Gold Card holders are not affected.

 

Firstly this new system will not limit you to only 12 sessions. It is 12 sessions per referral or treatment cycle. If your allied health provider believes that you require further treatment, they will send a report to your GP. The GP will use this report to review the treatment progress and assess if further treatment is clinically required or whether other treatment options are needed.

 

Secondly, if you had a current referral on the 1st of October 2019, then you are covered for 12 treatment sessions or until the expiry of the referral, whichever comes first. This is regardless of whether you had a 12 month referral or an ongoing referral. Once you have completed 12 sessions or your referral expires you will need to ask you treating therapist for a report and make an appointment to see your GP for another referral.

 

Thirdly, our staff are here to help you get the most out of your treatment. We aim to work with you toward your goals, whatever they may be. Exercise can benefit you in so many ways, for more information on benefits of exercise head here.

If you have any further question please call our friendly administration team on 3398 9556.

 

Lower Limb Posture

When everything is going well we take our bodies for granted. It’s when we get pain that we start to think about our joints, bones and muscles. The alignment of our lower limb chain can affect everything from ankles and knees to the hips and lower back. Doing a quick check of your alignment, in the mirror, can help show where potential issues may be and what areas you need to work on to maintain good health and prevent injury.

A bit of biomechanics

Good Lower Limb posture begins from your feet. When standing you should have:

  • A straight line from you big toe to your heel, if you curve in or out then the alignment is not optimal.
  • Your knees should point in line with the middle of your foot.
  • From the side your hip-bone should be directly above your ankle-bone.

If your standing posture looks good, then you may need to add a little bit of load to the system by doing a squat.

How do you fix it?

1. Become aware of your posture

Begin to adjust your standing posture back to a more normal posture. Some good cues for changing your posture is to:

    1. Ensure your hips are over your ankles
    2. Weight to outside edge of the feet
    3. Symmetry when standing

You will not be able to hold this all day so aim for 5-10 second holds to begin with and repeat often throughout the day.

2. Release the tight

You need to stretch and release the tightened and overloaded muscles. If you are walking and standing in poor lower limb posture al day you need to go back the other way. You can use rollers and trigger balls to release the tight muscles or sitting Piriformis stretch.

4. Get Strong – It is essential that once you have released the tight muscles, in the pelvis, that you then strengthen the weak gluteal muscles. A good exercise for this is Crab walking.  Put  some theraband around your ankles, keep you feet parallel and step sideways.   Make sure that you can feel the muscles working in your buttocks.  If you can’t then you may need some help.

Timeframes:

This depends on a number of factors, how often you do your exercises and stretches, how often you do or don’t correct your posture and how often you overload your system. Generally speaking you will start to notice changes in 2 weeks. After 6-8 weeks your body will be stronger with the new posture and be able to maintain it for most of the day giving you the benefits of less load on your lower limbs and low back.

Book an appointment:

Do you have chronic or reoccurring ankle, knee, hip or Low back pain? Book in for your treatment now with one of our team by calling (07) 3398 9556. Read more about our team here.

How Long Should I Stretch For?

The answer to that question will depend on the reason you are stretching. The main reason we stretch is to lengthen a muscle and thus increase range of movement (ROM), but a muscle can become tight or shortened for a number of reasons. Once you discover why you need to stretch, then you can work out how long and what type of stretching you should be doing.

Why are you stretching?

Are your muscles shortened due to habitual postural positioning (such as sitting for long periods) or scar tissue from surgery or an injury; are your muscles tight due to spasm or contractures. Or are you stretching as a warm up or cool down for a particular sport?

 

Types of Stretches

Generally there are three types of stretches static, dynamic and pre-contraction stretching.

  • Static is the most common type of stretching where you hold a position for a set amount of time.
  • Dynamic stretching is active and generally involves taking a limb to end of range multiple times.
  • Pre-contraction stretching involves a type of muscle contraction prior to relaxing the muscle. There are a number of techniques for this. Some of these techniques include Contract Relax, post-isometric relaxation (PIR), and muscle energy techniques.

Which stretch is for me?

General Exercise Program

  • STATIC stretching for 15-30sec, 2-4 reps at least 2-3 times per week.
  • Older adults – there is some evidence to suggest that longer holds of 60sec are required for changes.

Note: Stretching the muscle can reduce the tension that it can exert and therefore may decreased overall strength and possibly performance.

Warm up for Sport

  • STATIC stretching is more beneficial for those sports that require flexibility.
  • DYNAMIC stretching has been shown to increased AROM and have no lose in strength or performance.

Rehabilitation

  • A Muscles strains responds better to STATIC stretching
  • Recovering from an Orthopedic surgery such as total knee replacement will respond to any type of stretching is beneficial.
  • People with chronic muscle pain can see an increase in tolerance to stretching in 3 weeks and a decrease in trigger point pain using the PIR technique
  • Contractures – there is no evidence that stretching improves contractures.
  • Neurological patients – stretching on its own has no benefit for neurological conditions.

Overall stretching will increase your ROM, regardless of the technique. You need to think carefully about why you are stretching and what you are aiming to achieve through stretching. Talking with your physiotherapist can help you optimise your stretching program for your specific issue.

Book an appointment:

Feel like your current stretch program isn’t working for you? Book in for your treatment now with one of our team by calling (07) 3398 9556. Read more about our team here.

Plantar Fasciitis

How to fix your Plantar Fasciitis

Symptoms:

Having heel pain on rising in the morning or after a period of rest? Often pain will improve with movement, however it is aggravated by long periods of weight bearing. Palpating the medial side of the calcaneus (heel bone) will reproduce pain. Often pulling the big toe back will also produce pain.

 

A Bit of Anatomy:

The plantar fascia is a thick fibrous connective tissue that arises from the calcaneus with multiple connections within the foot. The role of the plantar fascia is to support the arch of the foot.

 How to Fix it:

First you need to modify your current activities to reduce the load on the plantar Fascia. Sometimes adding a heel wedge or over the counter orthotics can help. Secondly stretch and massage the plantar fascia and calves daily. Third use ice for pain relief. Last correct the risk factors that are in your control.

Knowing your risk factors:

There are a number of factors that need to be looked at to limit risk of re-injury. They include:

  • limited ankle range of motion
  • short Achilles tendon
  • over pronation
  • weak intrinsic foot muscles and ankle plantar flexor muscles
  • being overweight.
  • Other factors that can increase your risk of injury include hard surface, prolonged weight bearing, poor footwear, poor lower limb biomechanics and inadequate stretching.

Timeframes:

Realistically you are looking at 6-8 weeks before you will see significant improvement.

Book an appointment:

Heel pain stopping you from doing what you love?   Need help correcting your risk factors? Book in for your treatment now with one of our team by calling (07) 3398 9556. Read more about our team here.

Chronic Ankle Instability

Up to 60% of lateral ankle sprains will progress to chronic ankle instability.  

Knowing what to do at each phase of your recovery will get you back to your best earlier, and may prevent you from ending up with chronic ankle instability.

What is an ankle Sprain?

An ankle sprain is a tearing of the ligaments that connect the bones and stabilise the joint. It results from a force being applied to the ankle that causes excessive movement.   You will usually be immediately aware of the injury and may hear an audible “pop’ or “snap” due to the tearing or over-stretching of the ligament.

Some of the anatomy:

The ankles stability comes from the structural arrangement of the bones and the corresponding ligaments. These ligaments prevent movement of the ankle from side to side. The outside of the ankle is stabilized by 3 small ligaments; Anterior Tibiofibular Ligament (ATFL), Calcanenofilular Ligament (CFL) and Posterior Tibiofibular Ligament (PTFL). The most commonly injured ligament is the ATFL, if the force is more server; then the CFL and less likely the PTFL will also be injured.

Risk Factors:

Proven risk factors for ankle sprains are previous ankle sprain, increasing age, reduced strength and stability of the ankle, decrease or extreme flexibility of the ankle joint, poor balance and sudden change in direction.

What to do about it:

Immediate treatment should consist of the RICER protocol.

    • Rest the injured area
    • Apply Ice for 20min every 2 hours. The aim is to reduce the bleeding and welling with in the joint.
    • A compression bandage should be applied to limit the swelling in the joint.
    • Elevate the injury, ideally above the heart.
    • Referral or assessment by your physiotherapist or Doctor to diagnose and assess the extent of the injury.

The no HARM protocol should also be applied to limit swelling and bleeding. No heat, alcohol, running or massage. These will increase your circulation and in turn increase the bleeding and swelling at the site of injury.

Time Frame for recovery:

Majority of ankle sprains will resolve in 2-6 weeks, depending on the severity of the injury, some severe sprains can take as long as 12 weeks. How you respond to your injury in the early stages can be the difference between a quick or prolonged recovery.

A rehabilitation program that is tailored to you should include returning ankle range of motion to normal, balance, strength and neuromuscular control exercises to reduce recovery time and probability of re-injury.

Book an appointment:

Have you sprained your ankle – new/old/reoccurring? Book in for your treatment now with one of our team by calling (07) 3398 9556.

Read more about our team here.

Poor Posture or Stress?

Have you been told that you “carry your stress in your neck and shoulders”? While stress doesn’t help us, it is more likely that “your stress” is due to your posture. Having good posture can reduce strain on the body, while bad posture will increase the stress on the body.

A Bit of Anatomy

Good Posture aligns you ears, shoulders and hips while sitting and in standing, the ankles. When you slump and lean forward to read a computer screen a number of muscles become lengthened and weakened over time. This then leads to over load or increased stress on other muscles such as Upper Trapizeus, Sternocleidomastoid, Suboccipitals, Pectoralis Minor.

How do you fix it?

Become aware of your posture – begin to adjust it back to a more normal posture. Some good cues for changing your posture is to :

    • Lift your chest
    • Open across the front of the chest
    • Draw the back of your head up
Poor Posture
Poor Posture
Good Posture

You will not be able to hold this all day, so aim for 5-10 second holds to begin with and repeat often throughout the day.

Release the tight – You need to stretch the tightened and overloaded muscles. If you lean over a desk all day, you need to go back the other way. You can use rollers and trigger balls to release the tight muscles or active range of motion exercises such as the Archer demonstrated by here. You can do it with or with out theraband and standing or lying down.

Strengthen the weak – Then you need to strengthen the weakened muscles. Through tailored exercises for each weakened area. The type of exercise that is right for you will depend on your current level of pain and strength.  A good all over strengthening exercise is a prone snow angel demonstrated here.

 

Timeframes:

This depends on a number of factors, how often you do your exercises and stretches, how often you do or don’t correct your posture and how often you overload your system. Generally speaking you will start to notice changes in 2 weeks. After 6-8 weeks your body will be stronger with the new posture and be able to maintain it for most of the day giving you the benefits of less “stress”.

Book an appointment:

Do you have neck and or shoulder aches or recurrent headaches? Book in for your treatment now with one of our team by calling (07) 3398 9556.  Read more about our team here.