Can Pilates help my Low Back Pain?

Around 80% of Australians will experience some form of lower back pain (LBP) over the course of their lifetime – 10% of these will go on to suffer with significant disability and functional limitations. But there are many management pathways that can be used to help treat LBP. Pilates-based exercise is one such pathway and has many studies which back up its effectiveness in treating LBP. A recent study, published in the May 2012 edition of the “Journal of Orthopedic and Sports Physical Therapy”, set out to determine whether there is a link between certain attributes in individuals with LBP and their likelihood of a successful outcome with Pilates-based exercises. This particular study concluded that there were five variables that may ultimately determine the successfulness of a Pilates-based exercise program. These were:
1. Total trunk flexion (bending forward) range of 70° or less
2. LBP lasting for six months or less
3. No leg symptoms in the last week prior to treatment
4. Body mass index (BMI) of 25 or higher
5. Hip rotation range of 25° or greater
This study highlighted that if three or more out of the five attributes listed was present in a particular individual with LBP, the probability of a successful outcome with a Pilates-based exercise program jumped from 54% to 93%!
Though this is just a preliminary study, the results are exciting! By having prediction rules which can tell us the probability of a successful outcome with a Pilates-based exercise program, this will help us improve our clinical decision making thereby assisting us in giving our patients the best possible pathway to their road for recovery.

Wrist, hand or Elbow Pain?

Hand Therapy

Hand Therapy is a type of rehabilitation performed by an occupational or physiotherapist on patients with conditions affecting the hands and upper extremities. The hand therapist will work with patients to hasten their return to a productive lifestyle.
Hand therapy helps a patient regain maximum use of his or her hand after injury, surgery or the onset of disease. Hand therapists teach exercises, apply modalities and create custom splints to help the hand heal and protect it from additional injury.
Patients who are candidates for hand therapy may have been affected by an accident or injury leaving them with wounds, scars, burns, injured tendons or nerves, fractures, or even amputations of the fingers, hands, or arms. Others include patients who suffer from the effects of conditions such as carpal tunnel syndrome and tennis elbow, as well as from such chronic problems as arthritis.
Preventative, Non-operative or conservative treatment includes:
• Management of acute or chronic pain
• Sensory re-education after nerve injury
• Design and implementation of home exercise programs
• Training in the performance of daily life skills through adapted methods
and equipment

Postoperative Rehabilitation may additionally include:
• Management of open or sutured wounds
• Management of hypersensitive scars
• Reduction of swelling
• Instruction in home exercise program

The hand is a very commonly injured part of the body because of its constant involvement in almost all activities. Because of this it requires accurate and early diagnosis of wrist injuries to obtain optimal recovery. Minor hand injuries or wrist injuries if not treated appropriately can become chronic problems, affecting not only day to day activities but also your job requirements and lifestyle. It is advised that you seek the advice of a hand physiotherapist if you have sustained an injury to this area.
Everyone has had a wrist injury or hand injury at some stage in their life. These are commonly caused by:
• Overuse type injuries from work
• Sporting or recreational activities
• Falls
Wrist injuries or hand injuries such as wrist sprains are commonly seen by our hand physiotherapists and these are caused by a fall and trying to stop the fall with your hand. Commonly the wrist is bent backwards and symptoms will appear such as swelling, bruising, loss of range of motion and loss of wrist strength.
For this type of injury the hand physiotherapist will accurately diagnose the wrist injury and then work out a treatment plan accordingly. Usually RICE (rest, ice, compression and elevation) principles are the first part of the treatment, followed by other hand physiotherapy techniques. Some of these hand physio treatment techniques for the wrist injury include immobilization, exercise, stretching, splinting and strengthening exercises.
Most injuries can be separated into acute wrist injury or hand injuries and chronic wrist injury or hand injuries.
Acute wrist / hand injuries include:
• Bruises
• Torn ligaments such as skiers thumb
• Sprains – injuries to joints
• Strains – injuries to muscles
• Fractures
• Dislocations
Chronic wrist / hand injuries include:
• Tendinosis
• De Quervains disease
• Carpel Tunnel Syndrome

This article was written by Marinda Rothmann, Physiotherapist.

Does Dilation of Blood Vessels Really Cause Migraine?

The classical medical model of primary headache essentially contains 3 “groups”.

The first of these are “Tension Headaches”, the second is “Migraines” and the third group contains such headaches as Cluster, SUNCT and Chronic Paroxysmal Hemicrania.

This classical medical model considers that the cause of Migraines are likely to be related to a dilation of blood vessels in the brain.  However, is this really the case?  There is significant medical research over the past 15 years that give us reason to seriously doubt that an increase in blood vessel dilation in the brain is the cause of Migraines.

The research shows:

1. Dilation of blood vessels does not necessarily coincide with pain.  If dilation of the blood vessels in the brain was indeed the cause of migraines, it stands to reason that when they dilate, pain of the migraine would come on and when they constrict, pain reduce.  However, this is clearly not the case.
2. Dilation of blood vessels is the consequence of head pain, not the cause.
3. Not all migraine sufferers have dilation of blood vessels in the brain during their headache. There is evidence to suggest that many sufferers of Migraine get either no change to the blood vessels and in some cases a constriction of blood vessels in the brain during their headache.  If dilation of blood vessels is indeed the cause of migraine, shouldn’t all migraine sufferers get a dilation of the brain’s blood vessels during a headache?
4. The magnitude of dilation is thought to be about 9%.  Is this too small a change to cause migraine? Maybe, maybe not, but it is a really small change isn’t it?

At a recent headache seminar I attended, the presenter (Mr Dean Watson – MAppSc (Research – Manipulative Physiotherapy) and Consultant Headache and Migraine Physiotherapist, PhD Candidate) quoted research on Migraines that said:

“It cannot be excluded that noxious events in and around other pain sensitive structures, both extra and intracranially may contribute in addition”  (Thomsen, 1997)

This essentially means that other structures, either in or outside the head (like the neck) are being considered as alternative sources or contributers to the pain of Migraines.  The same researcher goes on to state in his study:

“…….that a possible mechanism of sensitisation to noxious inputs could be via heightened nociceptive sensitivity in the central nervous system” (Thomsen, 1997)

This poses the question that maybe the nerves that carry the “pain” message from the pain producing structures that are located in or outside the head to the brain are somehow sensitized. That is, a small change in intensity or mechanical stimulus causes a large response. Think about what happens when you talk into a microphone.  Even a small whisper can be audible over a wide area.  A small input, LARGE output.

This opens up the possibility that if we can desensitize these structures, maybe we can actually reduce the pain of Migraine.

Food for thought?

Exercise off those Christmas Kilo’s

Christmas.  Love it or hate it, it is here again.  Personally, I love Christmas.  It is a great time for catching up with friends and family, an opportunity to show goodwill to others and for… well…..eating!  Yes, no matter how hard we try, the endless Christmas parties, drinks and gatherings come with the inevitable gaining of a few extra kilos.  Following our Christmas grazing and gorging, New Year’s resolutions of diets, exercise and “working off” that jelly belly follow.  How many of us are successful in getting back into shape after Christmas?  Sure, there are the dedicated few among us, but for the majority, the New Year often means we reset the weight clock a few kilos heavier, only to go through the process again next Christmas.

Many will begin fitness regimes with high hopes and expectations of success, only to stumble after but a few weeks as they return to the business of regular routines.

Fitness habits are hard to form, and easy to break.  It takes commitment, time and consistent effort to achieve your desired results.  One sure sign that a fitness regime will fail is that there are no goals.  Goals provide us with a target to strive for.  They motivate and encourage us to continue – but only if they are realistic.  This is where the help of professionals can really enhance your efforts.  Setting unrealistic goals often leaves people frustrated and leads to giving up prematurely.  The expertise of a professional will ensure your goals are achievable.

Goals also take time to reach.  How much time are you willing to put in to reach your fitness goals?  Remember the well worn phrase, “You get out what you put in”.  Would you commit to a minimum 6 month plan of action to turn around your fitness and to improve your life and wellbeing?

Back Pain

80% of Australians will suffer low back pain at some point in their life.  This is a sobering statistic.  Of these, upto another 80% will have a recurrence within 1 year.  Why? This is the question that has been on researchers lips for decades and much has been done and studied to address this fundamental question.

Acute low back pain has a number of origins, but typically, a vast majority stem from lifting, bending and twisting injuries.  Some seem to arise after almost completely innocuous incidents, however the common thread is that it is a disabling and often terribly painful experience.

We know the body has the capacity to heal.  And in the case of low back pain, it does.  Why then do recurrences occur?

Researchers tell us that after an acute episode of low back pain, important deep stabilizing muscles (known as “core” muscles) switch off.  Research also shows that after the resolution of the pain and disability, these “core” muscles don’t necessarily switch back on again.  One very good study highlights that those people who do not specifically target these “core” muscles after resolution of an acute low back pain episode are approximately 80% likely to have a flare up within 1 year.  On the other hand, those people who do target these muscles with exercises are only a 30% chance of having pain again in the first year. That’s quite a remarkable difference.

So how can you target these “core” muscles?  There are many ways.  A physiotherapist will be able to accurately diagnose which muscles you should target and prescribe appropriate and safe exercises for you. You may like to try Pilates which also targets this area or one of the newer forms of rehabilitation available, Whole Body Vibration which has very good evidence in treating low back pain and activating your “core”.

Which ever way you decide to do it, don’t just leave it.  The pain and disability of chronic back pain can be diminished and avoided if you just get the right physiotherapy advice and put the right actions into place.

There is hope for your shoulder pain!

Have you ever thought about the amazing complexity of the shoulder? When you consider that in one action, we have our arm above our head holding a weight and in another it may be behind our back, the vast array of strength and agility demonstrated by the healthy shoulder is remarkable.

However, this balance between strength and agility is a fragile one. Often when this balance is interrupted, shoulder pain invariably results. While many people would have heard of terms such as “bursitis” and “tendonitis”, these pathologies are often the outcomes of a deeper, more complex problem.

While there are indeed structural reasons why a bursitis or tendonitis can occur, more often than not they are related to a complex muscle imbalance issue around the shoulder girdle. Work postures, leisure activities and other lifestyle choices can lead to changes in the muscle balance of the shoulder which commonly lead to insidious onset shoulder pain. When pain occurs in the shoulder, it leads to a limitation in function and the activities we love or are required to do.

The first step should you be experiencing gradual onset shoulder pain is to get thoroughly assessed by a physiotherapist. They will be able to inform you whether your problem is related to a muscle imbalance or whether there is likely some more structural reason behind its presentation. Once identified as being caused through a muscle imbalance, treatment through a dedicated exercise regime can be effective and sustainable.

However, it is important WHO you see, as unfortunately many professionals lack the ability to truly diagnose the underlying cause of your shoulder problem. If you are given the diagnosis of “bursitis” or “tendonitis”, ask them “why did I get this?” If they can’t confidently answer after your first 2 sessions with them – you have every right to get another opinion.

More often than not, simply using a therapeutic ultrasound, an interferential machine (the “tingly one”) and some gentle massage will not greatly improve your shoulder pain. Find someone who will prescribe the correct exercises to address the underlying cause of your problem and expect some improvement in 4-6 weeks.

Top 5 ways to get better value for money from your Physio.

In the current economic climate, we all want a better bang for our buck don’t we? While expert health and wellness advice does come at a financial cost, there are ways that we can ensure that what we are spending is worthwhile.

Who should we consult for our back pain? Who can help us with our neck pain or shoulder pain? If you are looking for a physio in Mount Barker, there are many options available to you. However, how do you know which one will give you the best VALUE – that is, achieve the result you are after without costing you are fortune.

Below are my top 5 tips to ensure you achieve value for money when dealing with Physiotherapists.

1. Get your first session for free. Find someone who will assess you and let you know what is going on without charging you. Why should you pay someone to check you over when they may be unable to help you? If you need financial or legal advice, you’d expect to get a free initial chat with no obligation to proceed, so why should you not expect the same courtesy with your health?

2. Have a final goal in mind. You need to ensure clear and achievable goals are set with your Mount Barker Physio from day 1. This may sound like common sense, but many of us fail to set clear goals with our practitioners. Without goals, how do you know when your course of treatment is over? It is a bit like playing football without goal posts – there’s a lot of action, but no way to actually know the outcome of the game. Your goals then need to constantly be monitored and reviewed by both you and your practitioner.

3. Get a treatment plan. Preferably written down and within the first 3 visits. Every practitioner should have an idea of what it will take to get you the result you have outlined. With a written plan, you are informed and can be realistic in your outcome expectations. You are then able to hold the practitioner accountable for any extra visits before you spend any extra money.

4. Package up multiple services. In most cases, once you have been delivered a plan of attack that you are happy with and that both you and your health professional are happy will lead to your desired outcome, pre-purchasing a block of sessions or treatment can save you plenty.

5. Best value does not always equal lowest priced. When you are looking to purchase a car, while cost must play some part in your decision, people usually look for reliability, features, running costs etc. When you are comparing the costs of one physio over another, you need to consider the “extras” that are part of the service. Things such as nice surroundings, friendly staff, free tea and coffee, variety of services and outstanding customer service where you are made to feel like the most important person in the room can have a large part in the “experience” and value of the service. Personally, I’d rather pay a bit extra for that nicer car that will last longer and cost less in the long term than purchase the bomb that will likely be only a short term solution.

Similarly, I’d rather pay a little extra for a more sustainable outcome to my low back pain than go the cheap, quick-fix option that will inevitably cause me to fork out more money over the longer term getting it treated more regularly.

By following these 5 simple principals, you can be assured that you will get the best value for money from your physiotherapist and not overspend unnecessarily.

 

Profile

After graduating from the University of South Australia in 1998, I worked for a year in Aged Care before relocating to Tasmania and working within a progressive sports physiotherapy practice in Devonport.  It was here that I became heavily involved in many local, state and national sporting teams and events.

I was the Physiotherapist for the Tassie Mariners Aussie Rules Football Club (U18 TAC Cup) from 2000-2002 and Tasmania Devils (Victorian Football League) from 2003-2004.  I also was the Tasmanian State U18 Australian Rules Football Team physiotherapist during the National u18 Carnival in Melbourne in 2001-2002.

From 2000-2003, I was a physiotherapist with the Devonport Triathlon, which was part of the National St George Triathlon Series, attracting International and National athletes.  In 2002-2003, I was Medical Trainer/Physiotherapist at the Devonport Futures ATP event.  This is an event for up and coming National and International tennis players and forms part of the Uncle Toby’s tour.

Our Private practice was the North West Coast of Tasmania’s preferred practice for Tasmanian Institute of Sport athletes who lived on the coast and we dealt with many elite level cyclists, kayakers and footballers.

On relocating back to Adelaide in 2004, I completed a Master’s of Sports and Musculoskeletal Physiotherapy at the University of South Australia.  During this time, I began work with a large sports clinic in Adelaide and began working with the Sturt SANFL football club.

In 2007 I was physiotherapist with the West Adelaide SANFL football club before joining the Back In Motion Health Group as a Director and Principal of the Mount Barker practice.

My primary areas of clinical interest include chronic low back pain, shoulder pain, headaches and migraines.

I hope that this blog provides you with valuable information regarding all areas of musculoskeletal health.