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Dietitians, the missing part of the injury recovery puzzle.

Dietitians, the missing part of the injury recovery puzzle.

 

By Antonietta Del Pinto & Fiona Kupresanin 

 

Has your physiotherapist ever referred you to a dietitian before? Because they probably should have! 

Imagine if you could win the race by having a 50m head start. This kind of edge is the power of combining both physiotherapy and dietitian guidance in your injury journey. 

Here are a few examples of how adding a consult with a dietitian can help your injury process and give you that head start. 

 

Injury Prevention: 

Physiotherapists don’t just work towards returning you to sport or helping decrease your injury pain. They continue the process assisting to decrease your chance of secondary injuries. This can include long term strengthening programs and ongoing load monitoring adjustments, to ensure you have the best chance of decreasing any secondary injury. So what role does seeing a dietitian have in injury prevention? Fuelling your activity adequately can assist with energy levels and fatigue prevention, in turn reducing the risk of overtraining and injury.  Seeking individual advice from a dietitian can assist you to make food choices that ensure you are getting energy delivered at the right times for your chosen sport or activity to prevent fatigue and injury.

Did you know that Johnston ., et el 2013 found that athletes who don’t have adequate time to recover between training, fatigue will accumulate compromise performance and result in an increase risk of injury and illness. 

 

Joint Pain: 

Joint pain and osteoarthritis are one of the most commonly seen injuries in the clinic. Physiotherapists can assist to manage daily pain levels, by restoring your joint range of movement and increase your overall strength levels. Increasing your strength can decrease the loads going through your joints. A long term strength program can also decrease your joint pain and allow you to participate in more sport and activity. 

How can a consult with a dietitian assist your joint pain? 

It is well researched that diet and lifestyle changes can decrease your joint pain. 

Messier ., et el 2005 found that each kg of weight reduction, decreased the compressive force within the knee joint. So every kg of weight lost was shown to have a 4 fold reduction of load going through the knee. Some studies have reported up to 50% decrease in knee pain with a 10% body weight loss. 

The Mediterranean Diet has also been shown to reduce inflammation and pain in those with joint pain and osteoarthritis. The Mediterranean Diet is a way of eating that is high in anti-inflammatory and anti-oxidant nutrients including plenty of fruit, vegetables, legumes, wholegrains, nuts, seeds, herbs, spices and olive oil. 

 

Improving Performance: 

How can physiotherapy and dietetics help to improve your sports performance? As mentioned before, physiotherapist’s don’t just return you to sport. They can help take you to a higher level, faster and stronger post injury. Throughout your rehabilitation stages there will be a time where you transition into some form of training. This means added training sessions and rehab sessions. To maximize your return, working closely with a dietitian can assist you achieve your return to sport goals. 

Sports performance can largely be influenced by the correct fuelling of macronutrients prior to sport and more importantly the right dosage after activity to help your recovery. Training under fuelled can result in poor performance and feeling like you are lacking energy and unable to perform at your best, it also increases your risk of injury and illness. Dietitians can also discuss the use of supplements to help you achieve the best performance you can. If supplements are right for you and your sport, a dietitian can help prescribe how best to incorporate these into your diet. 

These are just a few examples of how combining the power of physiotherapy and dietitian guidance can give you that 50m head start in winning your injury race. Every injury is different and every case if different from the next, therefore it is important to get tailored guidance that is individualised for you. At Redfern Physiotherapy & Sports Medicine we believe incorporating the whole team can give you the best outcome in your journey. If you are looking for that cutting edge in your injury journey, speak to your physiotherapist about booking a dietitian consult now. 

References: 

Johnston RD, Gabbett TJ, Jenkins DG (2013) Influence of an intensified competition on fatigue and match performance in junior rugby league players. J Sci Med Sport. 16(5):460-5.

Messier S, Gutekunst D, Davis c, DeVita P (2005) Weight loss reduces knee joint loads in overweight and obese older adults with knee Osteoarthritis. Arthritis & Rheumatoidism Journal. 52:2026-2032. 

Hoffa’s Fat pad impingement- is it causing your knee pain?

Hoffa’s Fat pad impingement- is it causing your knee pain?

If you’re suffering from a pain at the front of your knee then it may be coming from your fat pad! We aren’t saying you have a weight problem – we all have a pad made of fatty soft tissue just behind the bottom of our knee cap. 

There are three fat pads at the front of the knee however, the Infrapatella Fat Pad, sometimes called Hoffa’s Fat Pad, is one of the more common causes of pain.

How does Fat Pad Impingement present?

  • Pain in the front of your knee exacerbated by extension or prolonged flexion – prolonged standing will be provocative, sometimes even a straight leg raise will hurt. Prolonged sitting may also irritate the pain.
  • The fat pad is tender to touch – this will be just below the knee cap
  • puffy anterior knee –the fat pad is a bit like a sponge and when inflamed will become engorged in fluid.
  • Pain may be worse when barefoot or wearing flat shoes compared with a heeled shoe

 

Treatment: Acute vs Chronic

The main difference between treating acute or chronic infrapatellar fat pad pain is screening for and correcting causative factors. When acute trauma is identified as the reason for inflammation, then focus is concerned primarily on offloading the fat pad and allowing it to settle. When the pain is a persistent issue that has developed over time, it’s likely there is an underlying reason that needs to be resolved.

This process can be described in two stages:

Stage 1: Reduction of Inflammation

  • Activity Modification – reduce aggravating activities which may mean reducing walking or running time/distance, reducing prolonged standing and anything else provocative
  • Wearing heeled shoes (no we don’t mean high heels but anything with a good heel lift and support) – avoiding barefoot or flat shoes especially if it is painful
  • Ice Massage over the tender area
  • Offload Taping – lifting the inferior patella away from the fat pad with a ‘V-Tape’ technique. This may be applied 24/7 until symptom free. Our experienced team of physios will be able to teach you the appropriate taping technique.

 

An example of ‘V-tape’ technique to offload the fat pad

Stage 2: Recondition the limb / Fix the cause

  • Progressive loading exercise: with a strong focus on the quadriceps and also considering glutes and hip external rotation exercises for control of the knee.
  • Isometric Knee Exercise: may be useful in the early stages, working within a safe zone of 20-40° of knee flexion can be manageable if the pain is irritable.
  • Stretching: of the quadriceps and hip flexors may be beneficial.

 

 

Things your physiotherapist will assess:

  • Knee Hyperextension – if the patient has poor control over inner range quadriceps or stands often in a hyperextended position then this may irritate the fat pad. Quads control exercises may be prescribed to correct this.
  • Patella Hypermobility – the patella may have a large amount of movement which can impinge the fat pad. Dynamic quad exercises can be prescribed to treat this.
  • Patella position – tight structures on the lateral aspect of the knee may cause a lateral pull or maltracking. Treatment and focussed stretches can help to manage this.

These two stages are not mutually exclusive and quite often will overlap.

If you have any of the symptoms listed above or are suffering from any other type of knee pain, consult our team at Redfern Physiotherapy and we will get you on the right path to recovery.

Planning to eat a plant-based diet in 2021?

Planning to eat plant-based in 2021?

The popularity of plant-based diets has been on the rise for some time and there is evidence to suggest that this trend is here to stay. The shift to plantbased diets has been predominately driven by concern surrounding health, animal welfare and the environment. 

So, what is a plant-based diet? Exactly as it suggests, a diet that is based on plants. 

Plant foods include fruit and vegetables, wholegrains, nuts and seeds, lentils and legumes and healthy fats such as olive oil. 

A vegetarian diet is an example of a plant-based diet with some flexibility. While it doesn’t include any meat, poultry or seafood, it does allow animal-derived products such as dairy, eggs and honey. 

A vegan diet on the other hand, strictly excludes all animal and animal derived products (dairy eggs and honey included). 

Other variations of plant based have also immerged in recent years, such as a pescatarian diet (vegetarian diet plus seafood) and a flexitarian diet (vegetarian diet with occasional consumption of meat, poultry or seafood). 

Health benefits of going plant-based

The health benefits of plant-based diets are numerous. Plant foods are nutrient dense, packed with vitamins, minerals, antioxidants and fibre. It is therefore not all that surprising that plant-based diets have been associated with lower levels of chronic diseases such as type 2 diabetes, cardiovascular disease and certain cancers. Diets high in fibre and resistant starch, found in plant foods, have also been associated with improved gut health now linked to mental health and other positive health outcomes.  

You don’t necessarily need to go vegetarian or vegan to get the health benefits associated with plants foods. A moderate change to your diet such as replacing one serve of animal food with plant food a day can have a great impact on your health. 

Despite all these potential health benefits it is worth noting that not all plant-based diets are created equal. A plant-based diet focused primarily on processed or packaged foods will not necessarily be any healthier than its animal-containing alternative. A wholefood diet approach is always best to minimise saturated fat, salt and added sugar.

Plant-based diet downfalls

 

Following a strict plant-based diet (i.e., vegan), or even vegetarian diet, requires some planning to ensure nutritional adequacy. While most nutrients we require are abundant in plant foods, there are a key few vitamins and minerals that are only found in animal foods or are better absorbed when they come from animal sources. Strict plant-based diets can also make it harder for those with particularly demanding energy requirements to meet their energy needs (e.g., adolescents or athletes).

 

Key nutrients for consideration in plant-based diets:

Iron

Iron is found in both animal and plant foods, however, the type found in plants (non-haem iron) is less readily absorbed making requirements harder to meet. 

Vitamin B12 

Only found in animal foods, and essential for healthy blood cells and neurological function, Vitamin B12 must be added by consuming fortified foods (e.g., breakfast cereals, dairy milk alternatives) or supplementation. 

Protein 

A key macronutrient in meat, poultry, seafood and animal derived foods. While there are plenty of plant-based proteins too, think tofu, lentils, legumes and quinoa, they can often be overlooked when transitioning to a plant-based way of eating.  

Calcium 

Essential for muscle function and bone health, the highest amounts of calcium are found in dairy products. Adequate calcium intake may not be a big issue for less strict plant-based diets; however, vegan diets require considered planning to ensure calcium intake is adequate. 

Omega-3 fatty acids

Found in the highest quantities in fish, and extremely beneficial for health, omega-3 supplementation may be required. 

As you can see while the health benefits of going plant-based are plentiful, so are the nutritional considerations.  The consequences of nutrition deficiencies can be greatly detrimental, so it is highly recommended that you seek individualised nutrition advice from your doctor and a dietitian when following a strict plant-based diets. Please don’t just rely on social media, websites on the internet and advice from family and friends. 

Nutrition in Managing Osteoarthritis

The Role of Nutrition in Managing Osteoarthritis 

Osteoarthritis (OA) is the most prevalent form of arthritis, affecting a rising number of people worldwide. 

The pain associated with OA is one of the key barriers to maintaining physical activity in those with the condition, which in turn can greatly impact quality of life. Those affected would benefit from ways to self-manage their condition and this is where nutrition can play an important role.

Is there a diet to cure OA? 

Is there a diet to cure OA? Short answer, no. However, while there is no miracle diet that can cure OA, we do know that maintaining a healthy body weight and ensuring nutrient needs are met can help symptom management and improve quality of life. 

Maintaining a healthy body weight is one of the important ways diet can assist with OA management. OA occurs when the protective cartilage that cushions joints wears down over time, so reducing unnecessary impact on these joints is an effective management strategy. Excess body weight can cause increased wear and tear as well as joint inflammation and pain for those with OA. Research suggests that a reduction of as low as 5% in body weight can improve pain felt in affected joints. Everyone has different energy requirements and understanding what this is for you can be difficult. Seeking individualised nutrition advice from a dietitian can help make sure you are mastering nutritious, balanced meals and getting your portion sizes right. 

What should I eat?

 

What should I eat? Research suggests that the Mediterranean Diet could help reduce inflammation and pain in those with OA. The Mediterranean Diet has been thought to assist with OA management due to the anti-inflammatory and antioxidant nutrients abundant in this way of eating. It includes plenty of fruit, vegetables, legumes, wholegrains, nuts, seeds, herbs, spices and olive oil, a moderate amount of fish, seafood, poultry, eggs and dairy, and small amounts of red meat and sweets. It also emphasises enjoying food socially, in moderation, and has been seen to be beneficial in maintaining a healthy weight. 

Nutrition research in the area of OA is constantly evolving, and while there is currently limited evidence to suggest any one particular nutrient can prevent or delay OA, certain nutrients have been deemed to be important for symptom control. For example, adequate protein intake is important for those with OA to ensure adequate muscle mass and strength is maintained as low muscle strength has been linked with increased pain. Research has also shown that vitamin E may have an anti-inflammatory role that may reduce the progression of OA, and higher intakes of vitamin D has been implicated in less progression of cartilage damage. Future research is sure to shed more light on the importance of specific nutrients. 

For more information about the benefits of healthy eating in OA management our dietitian is available for in clinic and telehealth appointments. To make an appointment call us on (02) 8068 5158 or book online by clicking here.

Eccentric Training – why do we use it?

If you have ever been to the Physio, chances are that you been asked to perform some eccentric exercises – but what exactly does this mean?

 

‘Eccentric movement’ refers to a muscle contracting whilst it is lengthening. On the contrary, ‘concentric movement’ is when a muscle is contracting whilst shortening.

 

The simplest example to explain this is performing a bicep curl.

  • The upwards part of the movement (hand to shoulder) is when the bicep is shortening under load, thus contracting “concentrically”.
  • The downwards part of the movement (hand lowering down) is when the bicep is lengthening under load, thus contracting “eccentrically”.

 

Without knowing it, you work several muscles eccentrically every day!

 

  • Every time you take a step – The tibialis anterior muscle in the front of your shin bone helps to flex the foot upwards when you run or walk, but then works “eccentrically” to help lower the toes to the floor. Without this control, your feet would slap the ground every time.
  • Every time you go down the stairs – The quadriceps muscles contract “eccentrically” to prevent the knee from collapsing too fast or too far forward.

 

Notice that these two examples often correspond to body parts that tend to be sore after exercising. This is because eccentric contractions are deemed a more efficient way to exercise the muscles compared to concentric contractions given they are able to work the muscle harder with less energy expenditure.

 

It is for this reason that the phenomenon of delayed-onset muscle soreness (DOMS) is greatest when a muscle has been placed under a greater eccentric load. This i explains why your shins are sore after running on a firm surface and why your quadriceps is sorer after running down hill.

 

But why are eccentric contractions so important for rehab?

Eccentric training is commonly used to treat tendinopathies, hamstring strains and for preventative purposes in a wide array of sports.

 

Research has suggested that the implementation of eccentric exercises for the treatment of common injuries such as Achilles and Patella tendinopathies can help to significantly decrease pain levels, improve function and increase tendon strength. It is suggested that this is achieved by increasing the muscle strength at longer lengths by exposing the tendon to a greater load, and therefore progressively being able to withstand loads that could have caused the initial damage.

 

This is further evident in a study by Mafi et al, 2001, which found that when comparing eccentric and concentric exercises in the treatment of mid-portion Achilles tendinopathy, patients performing eccentric contractions had greater improvements compared to those performing concentric contractions. The results found that 82% of the eccentric exercise group were able to return to their baseline function and activity compared to only 36% of the patients who performed the concentric exercise regime.

Hamstring strains are another common injury seen in various sports and also has a high recurrence rate. As a result, eccentric training has been well researched and has formed part of the gold standard rehabilitation process for these types of injuries. The Nordic Curl is a popular and highly effective eccentric hamstring exercise for the prevention of hamstring strains.

 

A study by Mjølsnes et al, 2004 found that eccentric hamstring training resulted in an 11% increase in eccentric hamstring strength and a 65% reduction in hamstring strains in football teams that implemented the Nordic Curl exercise compared with those that do not.

 

All our rehab programs at Redfern Physio are tailored to your specific needs and these may include eccentric exercises. Now, the next time you’re asked to perform these as part of your rehabilitation plan we hope you have a little more understanding into the reasons why. To book an appointment with one of our experienced therapists please click on the link below or call us on 8068 5158

Running Into Trouble

Running Into Trouble

 

With the weather warming up, and many of us finding ourselves with more time to exercise as we work from home, people are taking to running in order to maintain health and fitness. Whilst this means everyone is getting up off the couch, eating better and getting fit, it is also leading to a wide range of overuse and training related injuries.

With all chronic overload injuries, load management should be the cornerstone of any rehabilitation program. An initial reduction of 30% intensity and volume of training is recommended. If this does not result in pain free activity, a further 10% reduction should be applied every week until training does not result in pain. Load should then be progressed gradually (approximately 10% per week) until pre-injury levels are reached.

Other treatment options that will aid in the reduction of intensity and occurrence of lower limb injuries from running include:

  • Gait and footwear analysis: to identify abnormalities such as excessive pronation, coordination issues and excessive shock or strain. This may involve retraining the walking/running pattern, increasing the cushioning of shoes or inserting orthotics.
  • Range of motion exercises for the hip, knee, ankle and foot to improve blood circulation, reduce inflammation and relieve pain.
  • Strengthening of the muscles through eccentric exercises as well as developing core stability via training of the abdominal, gluteal and hip muscles to improve running mechanics.
  • Proprioceptive balance training which is crucial in neuromuscular education and will increase the efficiency of joint and postural stabilisation muscles which in turn help the body to react to changes in surface whilst running.

Here are 3 very common conditions related to running and how to manage them:

Achilles Tendinopathy

The Achilles tendon is the largest tendon in the body, attaching the calf muscles onto the heel bone. This band of connective tissue, mostly made up of collagen fibres, can become painful when subject to repetitive and sudden changes in load. Achilles tendinopathy is the term used to describe an overuse injury to this tissue. Tendons that are inflexible and stiff are at a greater risk of injury.

Often those suffering from an Achilles tendinopathy will feel stiffness and pain into the heel/calf in the morning. Symptoms can ease with movement however, the tendon often reaches a threshold point with activity and can become symptomatic again. Swelling or thickening of the tendon may or may not be seen at the site of pain.

Typically, tendons do not have a good blood supply in comparison to other tissues in the body; subsequently any healing takes place on a much slower timeframe. Research has shown the most effective way to rehabilitate a tendon and enable it to tolerate load again is through eccentric strengthening exercises. This program will be put together by your physiotherapist following a detailed assessment and will be tailored to your specific needs.

 

Self-massage and stretching will also be beneficial in the rehabilitation of the Achilles tendon and these will also be demonstrated by your treating physiotherapist to form part of your program. By releasing the calf muscles, the load on the Achilles tendon can be reduced leading to a reduction in pain.

 

 

Medial Tibial Stress Syndrome (MTSS or Shin Splints)

Medial Tibial Stress Syndrome (MTSS), commonly referred to as Shin Splints, is an exercise induced condition that is characterised by pain and discomfort of the lower leg along the inside border of the tibia. Shin Splints are the result of a training error (poor technique) or overload (intensity, duration and repetition) occurring primarily in running and jumping athletes. Tightness and weakness of the calf muscles along with other supporting muscles in the lower leg are the most common cause of MTSS.

Muscle tightness and weakness leads to fatigue and ultimately altered running or jumping patterns. This can place excessive strain on the Tibia causing chronic inflammation of the attachments and bony changes, all leading to pain. Typically, this pain will be experienced at the start of the workout and dissipate once warm, before returning after cooling down. However as the condition worsens it may be experienced throughout the activity leading to being unable to continue.

MTSS is the most prevalent lower leg condition and accounts for 13% to 17% of all running-related injuries. Dancers have been shown to have injury rates of 22% whilst younger population runners and athletics are 13%. Risk factors for developing shin splints include cold weather exercise, poorly trained people, overweight runners, excessive pronation at the foot and excessively tight calf muscles. Symptoms can include:

  • dull pain and mild oedema along the second third of the posteromedial tibia
  • pain that develops either side of shin during exercise
  • swelling, heat and redness of the shin region
  • numbness or weakness in the feet
  • associated muscle pain of the legs

Ceasing the provocative activity is the most effective treatment for MTSS along with ice to relive pain and inflammation. Symptoms will return upon resumption of exercise unless preventative treatment and rehabilitation program is applied in consultation with you physiotherapist.

Acute phase: involves mainly rest for a period of 2-6 weeks depending on severity. Pain relief is generally through the use of anti-inflammatory medications (in consultation with your doctor) and ice immediately after exercise for 20 minutes. Manual therapy can include dry needling and soft tissue mobilisation such as massage, trigger point therapy and stretching.

Subacute phase: should be focussed on behaviour and training modification such as decreased distance, intensity and frequency by as much as 50%. Uneven surfaces should be avoided and cross training with minimal impact (x-trainer, stationary bike) should be utilised during rehabilitation to compensate for the drop in training load. A stretching/ strengthening (eccentric loading) regime for the calf muscles will prevent muscle fatigue and further exacerbation of symptoms upon return to normal running loads.

 

Gluteus Medius/Minimus Tendinopathy

A Gluteal Tendinopathy (GT) is a non-inflammatory tendinopathy of the Gluteus Medius and/or Minimus muscles. It is due to excessive hip adduction (hip drop) in combination with other muscle or bone factors and results in moderate to severe disabling pain in the lateral hip region (Greater Trochanter). The gluteus medius and minimus muscles are two muscles found in the posterior aspect of the pelvis. Their places of origin and insertion are very close to one another, which means they act synergistically.

Traditionally a GT was diagnosed as Trochanteric Bursitis due to the similar presentations and focal point of pain. Recent research has shown however that GT is the most common source of hip pain with the condition affecting primarily runners and less active people. Women are 2-4 times more likely than men to develop a GT and as many as 1 in 4 females over 50 are likely to be affected by a Gluteal Tendinopathy. Research has shown that as much as 35% of those with low back pain (LBP) develop a GT with increased duration of LBP resulting in an increased risk of developing a tendinopathy.

A GT is a result of repeated and excessive loading of the tendon due to factors mentioned above. Some symptoms may include:

  • Pain is often described as a constant ache or bruising on the side of the hip
  • Increased pain and stiffness during the night or first thing upon waking
  • The area is tender, warm, red or swollen
  • A crunch sensation during weight bearing
  • Pain when you run, walk up and down stairs, or balance on one leg
  • Discomfort at night or trouble finding a comfortable sleeping or sitting position

Physiotherapy has been shown to be the best treatment option for managing GT. Initial management involves rest, avoiding the aggravating activity and ice for pain relief (20min every hour for first 72hrs). Gentle range of motion exercises and stretching are important to prevent stiffness, as well as specific treatment modalities applied by your therapist. Other management options that will aid in the recovery from a gluteal tendinopathy include:

  • Gait analysis: to identify abnormalities such as excessive foot pronation, coordination issues and hip control issues. This may involve retraining the gait pattern or inserting orthotics.
  • Strengthening of the hip, abdominal and core muscles including eccentric exercises for the glute muscles to provide stability and improve tissue tolerance to load.
  • Retrain hip and core control.

See your physiotherapist at Alexandria Physio for a detailed assessment and tailored rehab plan to manage any of your injuries arising from your running program.

My Disc Has Slipped

My disc has slipped!

 

That is a phrase I hear way too often as a physiotherapist, and it can lead to a poor attitude and approach to how people understand and manage their back injury.

 

I want to explain the usual timeline that occurs with back pain. Most people will often visit the GP to get some pain medication to help make functional movements bearable. Of course, this is only a band-aid solution for the injury and your pain often persists or worsens. It can become so debilitating that you’re sent off for an X-ray, CT scan or MRI to provide some clarification of what is actually going on beneath the surface. And wallah! It is a ‘slipped disc’. Now you’re probably walking around like the tin man of the Wizard of Oz because you fear any movement that involves the back.

Luckily for you, I’m here to tell you that discs don’t “Slip”. This is a complete misnomer and should never be used to describe a back injury. This term is actually referring to a bulging or a herniation of the disc. These injuries are far more common than you think and, furthermore, these bulges and herniations can exist even in the absence of pain or dysfunction!!

 

What is a disc?

I want you to picture a jam donut. Like the donut, discs are composed of two parts; a tough outer portion and a soft inner core. The outer layer is designed to withstand large compressive forces and has cartilaginous end plates that firmly attach the disc to the vertebrae above and below.

Together with the inner structure, the discs are designed to act as shock absorbers for the spine. Each vertebral joint in the spine has a disc that sits between each bone and these are surrounded by many spinal ligaments.

 

What is a disc bulge/herniation?

Discs are incredibly strong. But they do get damaged by excessive compressive or torsional forces. So it’s not a good idea to lift heavy items off the floor with an extremely flexed spine or with a jerking twisting motion. They can also be damaged and deteriorate over time from bad posture, poor movement patterns and simple wear and tear. As the cartilage deteriorates (Think of the outer shell of the donut), the gelatinous nucleus (The inside of the jam donut) starts to push out against and distend the disc. Hence the name, bulging disc. If the nucleus breaks through the outside of the disc, that is then a disc herniation.

 

Herniations come in two varieties, extrusions or sequestrations. Put simply, extrusions are when the disc material has come out of the disc but is still intact with the remainder of the nucleus. Whereas sequestrations are when a portion of the disc material has come away from the rest and now resides in the layers of the annulus or possibly into the spinal canal. Pressure on the spinal cord or spinal nerve roots can cause serious problems so a correct diagnosis is vital.

 

What signs are seen with a disc herniation?

For a lumbar (lower back) herniation, you might be experiencing any of the following:

  • Back pain and spasms
  • Muscle weakness in either or both legs
  • Numbness in either or both legs
  • ‘Pins and needles’ or Tingling
  • Pain down the back of either or both legs
  • Loss of lower-body motor function.

 

Is treatment necessary?

Herniated discs DO often heal on their own. However, they don’t necessarily heal well. As mentioned above, the discs play an important role in the mobility of your spine in addition to shock absorption. If incorrectly healed or rehabilitated, the affected segment will have reduced mobility and therefore place additional strain on the segments above and below. Over time, they can become unstable and develop their own bulge and this can become a never-ending problem.

Pain and damage to the spinal structures, including the discs, will lead to reflex wasting of the spinal muscles and persistent weakness. Symptoms may often resolve on their own but this does not mean that the underlying cause of the injury have been addressed, or that the supporting muscles have been completely rehabilitated. Our advice is always to be proactive with your injuries, not reactive.

 

Can you fix a bulging disc?

The majority of symptoms can be relieved by working with your physiotherapist and getting the right exercise program for you! Yes, you read that correctly. Rest isn’t best. Movement is key! So, your first step with treatment should involve having a thorough assessment by a physiotherapist to determine all the contributing factors to your pain. Scans are rarely recommended for the typical back pain as they are often misleading and not useful for all care. There will be some rare cases that require injections or even surgery, but the majority of symptoms can be relieved by working closely with your physiotherapist.

Your treatment options after your initial assessment will include:

  • Postural advice and retraining movement patterns
  • Education and advice surrounding safe lifting techniques
  • Following a home exercise program working on your posture & core control
  • Conditioning and rehabilitation exercises
  • Manual therapy

Experiencing back pain that hasn’t gone away for some time now? Ceased exercise or sports because you have been told it could make your ‘slipped disc’ worse? Then call us on 02 8068 5158 so we can help take care of your spine.

Meal Prep Your Way Through Winter

Meal Prep Your Way Through Winter

 

When it comes to healthy eating, there is one strategy that works time and time again –meal prepping. Why? Because making healthy food choices is the hardest when we are busy, tired and stressed. By planning ahead and having plenty of prepped ingredients in your fridge, all it takes is a little last-minute assembling to create healthy and varied meals during the week.

 

Putting aside just 1-2 hours for meal prep every weekend is usually enough and can save you countless hours in the kitchen during the week. Not only will meal prepping mean one less thing to worry about during the week, it will save you money by limiting ingredient wastage and the temptation to order-in when you come home to an empty fridge.

Winter is an ideal time to meal prep entire meals. Soups, curries and slow cooker meals are all perfect to cook in big batches and store in the fridge or freezer in individual serve containers for reheating during the week.

 

Meal prepping ingredients over full meals is another great way to meal prep and avoid eating the same reheated meal over-and-over again during the week. This will take a little longer than just popping a meal in the microwave but if you have all the components of the meal ready to go it should only take you 5 or so minutes.

 

How to ingredient prep

 

There are so many ways you can meal prep but changing up the ingredients you use weekly is important to ensure nutrient variety. Choosing 1-2 ingredients from each of the categories below is a great start. Remember, the goal is to have enough prepped ingredients to make assembling meals quick and easy.

Protein

  • Baked salmon fillet
  • Poached and shredded chicken breast
  • Marinated tofu
  • Boiled eggs
  • Black bean burgers
  • Turkey or lean beef mince meatballs
  • Cooked legumes (e.g. chickpeas, cannellini, borlotti beans)

 

Carbohydrates

  • Overnight oats or homemade muesli
  • Roasted sweet potato
  • Cooked brown rice, quinoa or barley
  • Baked polenta
  • Cooked legumes (e.g. chickpeas, cannellini, borlotti beans)

 

Vegetables

  • Washed and pre-chopped vegetables to use in stir-fries
  • Roasted and pre-cooked vegetables for re-heating
  • Spiralled vegetables for pasta sauces
  • Washed and pre-sliced salad vegetables for sandwiches

 

Snacks

  • Washed and sliced fruit
  • Mixed nuts and dried fruit
  • Pre-chopped vegetable sticks
  • Hummus or Tzatziki dip
  • Roasted chickpeas
  • Homemade raw nut and date balls

 

In addition to the ingredients you prep, make sure you have a few staples ready to help flavour your meals – extra-virgin olive oil, avocados, lemons, fresh or dried herbs, nuts and seeds, hummus dip, olives and feta cheese are flavours that work well with virtually any meal.

If you’d like some more meal-prep ideas or help with any of your nutrition needs our dietitians are available for both in-clinic and telehealth appointments. To make an appointment……

Running Related Injuries Series – Part 1

Running Related Injuries Series – Part 1

 

With the difficulties we have faced over the past 3 months due to COVID-19 restrictions, we have seen a huge percentage of people rediscovering the importance of their health and fitness. Many of us have utilised this extra time we have to eat healthier and get fit. And with many also returning to team sports very soon we are seeing a huge spike in running related overuse injuries.

This is the first part of a series dealing with running related injuries and how to manage them:

ITB friction Syndrome

Iliotibial Band (ITB) friction syndrome is a very common overuse injury resulting in pain and tenderness in the outside of the knee. It is commonly seen in runners, accounting for up to 22% of all lower limb injuries, however it can also be seen in any active population.

The ITB is a thick band of connective tissue which runs down the outside of your thigh. At the top of your thigh it attaches to your Tensor Fascia Latae muscle and your Gluteus Maximus muscle, and at the knee it attaches to the top of your tibia (shin bone) as well as the end of your femur (thigh bone).

When the knee is bent, the ITB slides across the outside of the knee with the maximal compression occurring between 20-30° of knee bend.  ITB friction syndrome occurs when excessive tightness or biomechanical issues cause increased compression at the knee leading to an increase in friction.  This increased friction combined with high repetition involved with running causes the tissue to break down and become inflamed.

ITB friction syndrome presents with pain localised to the outside of the knee however can occasionally refer pain up the leg. You will find that the pain gets worse with activity with the majority of cases being pain free at rest or walking unless the syndrome progresses to an extreme level.  You will likely experience that downhill running is more aggravating than flat ground as it places more stress on the muscles around the knee. Quite often, the onset of pain can be attributed to recent and sudden change in training load, type of activity (eg. more hill running) or equipment (eg. change of footwear).

Conservative treatment is very successful in most people suffering from this condition and it is recommended that you see your physio immediately for a detailed assessment and management plan. Management of this condition usually involves relative rest (never complete rest) to allow for tissue healing, massage to release tight muscles, stretching and strengthening of the muscles around the hip and knee, and correction of any contributing biomechanical issues. Relative rest refers to modifications to running load or the type of training which allows you to maintain strength and fitness without aggravating the inflamed tissue.

‘Hands-on’ treatment is ideal in the acute phase, when pain and inflammation at the insertion is felt. The use of a foam roller on tight muscles is also highly beneficial and our therapists can demonstrate the most effective technique for this, allowing you to treat yourself at home. Exercises to strengthen muscles that stabilise the hip such as band resisted side walking, glute clamshells, hip hikes and thrusters should form the main part of any rehab program. All sound a bit confusing? Our experienced team of physiotherapists will talk you through all of these exercises and send you home with a detailed and specific program tailored to your individual needs.

physio foam roller

Finally, load management is an integral part of managing and rehabilitation with a recommended reduction initially of 30% intensity and volume of training. If this doesn’t result in pain free activity a further 10% reduction should be applied until training doesn’t result in pain. Load should then be progressed gradually (approximately 10% per week) until pre-injury levels are reached. While these are very rough guidelines, and need to be varied for every individual, it highlights the importance of managing training loads in an overuse injury.

Redfern Physio – Working From Home Guide.

With the craziness thatis COVID-19, most of the world has had to rapidly transition to work from home until further notice in order to practice social distancing.

For some, the chance to be able to work from the couch will be a difficult offer to resist. After a couple of days of working from home, your neck, back, shoulders, hips, elbows and wrists, are likely already letting you know that this isn’t going to be a sustainable working arrangement. Physiotherapists all around the globe have already seen a reduction in sports related injuries, but an increase in postural related pain as a result of poor work setups in the home.

 

COVID-19 is certainly still in it’s early days in Australia and continues to spread, so ensuring that you have an optimal ergonomic working set up at home is going to be well worth your while. While you may not have the space or cash flow to purchase new fancy furniture, physiotherapists possess many tools and tricks that are free or cheap and have the ability improve your setup and comfort.

A few generic tips include: 

  • Ensure that your feet are well supported on the floor and knees are at or close to 90˚
  • Aim to have your screen height so that the top half of the screen is at eye line
  • If you are using a laptop, obtain a separate keyboard so that the above is possible
  • Try to change your posture and move regularly. Sustained postures in the one position pose the biggest risk to muscular aches and pains

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For some more detailed information on ideal workstation setup, refer you the blog in our series titled ‘Workstation Setup’.

If you think that you need individualised advice, and you are feeling well and have not recently travelled from overseas, our Physiotherapists are always available to conduct ergonomic assessments. If you are feeling unwell or would prefer to practice social distancing, we are now offering appointments via video consult. Simply contact our friendly team at Redfern Physiotherapy and Sports Medicine via phone or email to arrange a telehealth time to suit you.