Rehab On The Net

Low Back Pain. Why Me?

Tue, 20 Jul 2010 14:00:00 GMT

Depending on which study you read, anywhere from 60 to 90% of all people will suffer a significant episode of back pain at some time in their life. So what makes some people more susceptible than others? Some of the risk factors include:

Physiological

Genetics

Poor trunk strength

Poor core strength

Low physical fitness

Work related activity

Lot’s of lifting and twisting

Heavy manual work

Whole body vibration (eg plant/machinery operator)

Prolonged sitting (Twice the load on your low back when sitting instead of standing)

Health and lifestyle

Smoking and excessive alcohol increase your risk

A lot of people see us at the clinic and make comments like ‘I’ve always had a sore back, there is not much I can do about it’. You CAN reduce your risk factors. Get fit, change your work practices, stop smoking. If unsure, see physiotherapist or similar health professional.

Greg Condon

Physiotherapist

Director of Clinical Services, Physio Place P/L

Director of Research and Content, Recovery Guides P/L

Ski like a winter olympian - maybe...

Tue, 16 Feb 2010 14:00:00 GMT

Those downhill skiers are just awesome to watch. Huge speed, low down, in control - just! This obviously takes lot's of practice, natural talent, no fear, and loads of training.

Although the event only takes just under 2min, the skiers are just shattered at the end of the run. A lot of training goes into ensuring they have the necesary fitness and strength in their legs to maintain a good, low position at high speeds

The muscle group which is under the most stain when skiing are your quadriceps, the group of 4 muscles at the front of your thigh. There are a range of exercises to strengthen this muscle group, the easiest and most convenient been the ball or wall squat (see below)

Simply squat down until your thighs are parallel to the floor (unless you feel pain, then you can either stop earlier or cease the exercise) and then back up again. Initially squat up and down without pausing at the bottom. As your strength improves, add a pause at the bottom of the squat, and lengthen this pause as you continue to improve.
Eventually, you may perform the exercise using one leg only, which will improve your ability to transfer weight from side to side as you ski.

Ski safe!
Greg Condon
Physiotherapist / exercise scientist
Author - Recovery Guides

Billy Slater - Doing all the right things

Fri, 12 Feb 2010 14:00:00 GMT

A common question to physiotherapists is 'Mr X had the same injury, and he was back at sport the next week, why aren't I?' There are many reasons for this, including variations in the severity of injury, and access to constant treatment and medical advice.

Also, and probably most importantly, the steps taken in the hours immediately after injury vary greatly. Professional athletes tend to have access to immediate medical advice and treatment starts right away. This is paramount to injury recovery and usually involves simple steps that any of us can follow.

When Slater injured his ankle he was immediately taken from the field, the weight off the injured leg, and his ankle placed in a compression bandage. In any picture since, his injured ankle has had either a compression bandage or sports tape on it. These immediate steps, in particular Rest, Ice, Compression, Elevation, in most cases, are the most important factors in determining how quickly you return to sport. Compression in particular can take days off the time taken to return to sport as it restricts bleeding and swelling into the joint.

Follow these steps for the first few days after injury, see a physio, and get back to sport sooner!

Greg Condon
Physiotherapist
Author - Recovery Guides

ACL REconstruction - Avoiding re-injury

Wed, 10 Feb 2010 14:00:00 GMT

Rehabilitation from ACL reconstruction takes time, a lot of effort, and careful planning on the part of the therapist/trainer. Although failure rates have decreased as surgical techniques improve, damaging the new ACL graft is still a real posssibility. It is important steps are taken to reduce this risk.

The two periods in which failure are likely to occur are firstly during the period 6 to 12 weeks after surgery, and secondly, upon return to sport.

The new graft is generally wekaest 6 to 12 weeks after surgery making this a time where you need to be very careful. Avoid 2 things:

1. Highly dynamic/demanding physical activities eg running
2. Excessive alcohol - this has contributed to the majority of failures I have seen during this time period.

When you do return to sport you need to make sure you have prepared as well as physically possible. This does not just mean spending endless hours in the gym. The final phases of your rehabilitation need to be as relevant to your sport as possible. For example, if you are involved in a sport such as football, you need to make sure you have not only a lot of running and change of direction drills, etc, but also sport specific ball work, opposition challenges, etc.

Many of the sports people that come through our clinic comment that they feel better prepared for their chosen sport than they ever did prior to the surgery. Work hard and you can be as good as you ever were, if not better!

Greg Condon
Physiotherapist
Author - Recovery Guides

Gaining knee bend after total knee replacement.

Mon, 08 Feb 2010 14:00:00 GMT

Its fairly common to leave hospital with approximately 90 degrees knee bend or flexion after total knee replacement. If you have more - great!. However, if you have less than 90 degrees, you will have some work to do. Don't be too alarmed if your knee seems to get a bit stiffer and you actually lose a bit of knee bend once you get home. Your knee will be swollen, sore, won't appreciate walking for too long and remember despite appearances, you just had major knee surgery.

It is important to find a balance in getting your knee moving (both knee flexion and knee extension) from the word go, but also not overdoing it and causing further swelling in your knee. Its best to time your exercises to 30-40 minutes after taking your prescribed pain relief as you will be able to accomplish more exercises and push your knee movement further.

Common reasons as to why your total knee replacement won't bend:
1. Pain or inadequate pain relief - remember to follow your doctors instructions
2. Swelling. The fluid in your knee wont compress, so if there is alot of swelling, elevate and ice!
3. Stiff kneecap. Start self patellofemoral mobilisations.
4. Tight quadriceps, ITB and adductors. Remember that you should see your physiotherapist to start massage from approximately 2 weeks post-surgery.
5. Not doing you exercises!!

Below you'll find an easy exercise to do soon after surgery called a heel slide. Slide your heel up and down whilst lying down in bed. If this is difficult, place your foot on a plastic bag to make your foot slide easier. Slide your foot up bending your knee as far as possible within limits of pain. Some discomfort is ok, just don't bend it beyond the point of strong pain. Complete 2-3 sets of 12 repetitions up and down, 3-4 times day.

This exercise is really only appropriate in the early stage of your recovery (ie first 2-4 weeks). You will need to commence self mobilisations, quadriceps stretching, foot slides with assistance, calf and quadriceps strengthening, calf stretching and more....

The Recovery guide to total knee replacement has the full protocol and DVD to guide you through it. Follow it to get stronger and more knee movement sooner. Find out more at www.recoveryguides.com.au

Kind Regards,

Brendon Burnett
Physiotherapist, Exercise Physiologist, Co-author of Recovery Guides series 2006-2010.

Having trouble getting your total knee replacement to straighten?

Thu, 04 Feb 2010 14:00:00 GMT

Often we see patients who have had a total knee replacement and are having difficulty regaining their range of movement.

Let me just say that I believe all patients undergoing a total knee replacement should have a followup physiotherapy review at least at 2 and 6 weeks post-operatively, at the time a review is usually conducted by their orthopaedic specialist. This could be done at a private clinic or as an outpatient at the hospital where you had surgery.
This should screen for those patients struggling to get their knee moving and check that post-operative exercises are being performed regularly and that they are appropriate for your stage of healing.

Physiotherapy that involves deep tissue massage, joint mobilsation and passive stretches etc will definitely assist you in getting your knee to flex (bend) and extend (straighten). Sometimes 2 sessions per week for a few weeks is appropriate whilst patients doing well often need exercise advice only. It is not as simple as walking for a while then getting on the exercise bike! You must work at it! The complete recovery guide from hospital discharge to 6 months post-operative is available at www.recoveryguides.com.au

Common causes of being unable to straighten knee:
1. Tight calf and hamstring muscles - see you physio for some hands-on treatment
2. Inadequate pain relief - particularly whilst doing home exercises
3. Early post-operative phase - alot of healing is happening so go easy!
4. Excessive swelling - Remember to elevate and Ice if necessary
5. Tight joint capsule - often due to insufficient stretching and mobilising at home

STANDING CALF STRETCH

This calf stretch is performed on the edge of a small step (or telephone books as shown). Place the front of your foot on the edge of the step and your heel on the ground. Straighten your knee as much as possible and push your hips forward. You should feel your calf stretch. Hold this for 30 seconds to 1 minute and repeat twice. This may be performed often throughout the day to assist in improving your knee extension. Please note: this particular stretch is usually performed after 3-4 weeks. Prior to this a seated calf stretch can be performed. There are other techniques you can utilize to get your knee to extend - so stay tuned I'll update you soon.

Please see the Total Knee Replacement Recovery Guide at www.recoveryguides.com.au for more information.

Kind Regards,

Brendon Burnett
Physiotherapist & Exercise Physiologist
Co-author Recovery Guides Series.

Injury Prevention and the stress of life

Tue, 02 Feb 2010 14:00:00 GMT

The way our body performs as it ages is largely governed by two things:
1) Genetics – unfortunately nothing you can do. Thank your parents.
And 2) What you do with it through life. This includes what you do for work and sport; the postures you carry yourself in; how well you rest your body; how you counter the stress your body is under – eg stretching & strengthening
A good example is the office worker. This seems like a job that creates very little stress on the workers body. This is not necessarily the case.

Firstly, there is double the load on a lumbar disc when sitting compared to standing, leaving the office worker at considerable risk of disc injury.

Secondly, sitting causes tightness or shortening of the muscles at the front of the hip, putting your pelvis and low back in a vulnerable position.

The office worker can reduce the risk of future back pain essentially in two ways. They can change their work habits, for example they can not sit for more than an hour at a time, perform some tasks in standing (eg talking on phone), etc.

And

They can stretch and strengthen the appropriate muscles to counteract the stress of the job. There are three simple exercises that will significantly reduce the risk of future back injury. These exercises will take 4 – 5 minutes a day, similar to the time most people spend cleaning their teeth. Most people are happy to clean their teeth to protect them, it is cheaper, easier, and less painful to fix your teeth than it is to fix your back surgically!

Exercise, eat well, relax, and live a long and active life!

Greg Condon

Physiotherapist and Exercise Physiologist

Author - Recovery P/L

Torn ACL. What do I do now?

Thu, 28 Jan 2010 14:00:00 GMT

A torn ACL is a significant knee injury that can leave your knee very unstable, and leave you with some big decisions to make!

Replacing a torn ACL graft through surgery is the only way to return your knee to it's previous level of function (you can view this procedure at www.recoveryguides.com.au). There are really 3 reasons why you would go ahead and have the surgery:

1. Your day to day function is severely affected eg constant collapsing and pain;

2. To returnt to sports or activities which you love and that require a high degree of lower limb stability and coordination;

3. It reduces the risk of osteoarthritis of the knee. This is a very important factor in the decision making process.

I think if you are young and have access to the right facilities, there should be no question. As the population ages and we are active for longer, more and more people into their 40's and 50's are having this procedure done. I have seen several 50 something yr olds in the last 12 months alone, and they have all done very well. The recovery tends to be a little slower and on average more painful, but 12 months down the track the results are very good and similar to younger patients.

Greg Condon
Physiotherapist
Co-author recovery guides rehabitation booklets

Exercises after Rotator Cuff surgery

Wed, 27 Jan 2010 14:00:00 GMT

Many of our patients ask us, "How long will I take to recover after rotator cuff surgery?".

There is no ONE answer. Recovery timeframes depend on many factors and there is definitely no shortcuts. A quick peruse of youtube or similar sites will provide a lot of largely misleading information based upon an individuals own personal experience.

The size of the tear, level of weakness, anatomy of glenohumeral (shoulder) joint, multiple injuries (such as additional tears in other rotator cuff muscles - not just the supraspinatus), age, general health (diabetes, smoking eg.), type of procedure (open versus arthroscopic repair) all play significant roles in how long full recovery should take.

As a rough guide, most people should regain full or near full range of movement by 3-4 months post-operatively with hands-on physiotherapy assistance. Exercises commence as soon as you are discharged from hospital. Often gym programs carefully designed by a physiotherapist or exercise physiologist experienced in rehabilitation can be commenced by around 5 months post-op. Then, at least 3 months of gym based rehab is a good idea so full recovery and return to most sports or manual work is possible around 7-8 months. This really is approximate only.

DON"T FORGET..... REHAB STARTS THE MOMENT YOU LEAVE HOSPITAL!!

Very specific and careful prescription of passive, active - assisted, active and resistive exercises is necessary to avoid damaging the repair, allowing adequate healing time and restoring a range of movement that will enable strength exercises to be slowly introduced.

Strengthening of the Rotator Cuff muscles should be done carefully as often simple errors will cause pain. For example, a common exercise started approximately 13 weeks after surgery is an external rotation. The picture above shows the FINISHING POSITION of the exercise. Going much beyond this point can stress the repair and cause some pain. We see this often being done poorly.

The Recovery guides books and DVD's are an exact program to follow over a 6 month period with minimal equipment at home. Nothing like these exist on the web today. The Recovery Guides team are all experienced physiotherapists and exercise physiologists who have worked with olympians during their careers.

Findout more a www.recoveryguides.com.au

Kind Regards,
Brendon
(Australian Physiotherapist & exercise Physiologist)

Get a diagnosis and rehab your ankle sprain!

Thu, 21 Jan 2010 14:00:00 GMT

The most common ankle injury is a “rolled ankle” or inversion injury. Here the outside or lateral ankle ligaments can be stretched, torn or completely ruptured. There is also more than one ligament on the outside of your ankle.

Diagnosis of ankle injuries relies upon information from our patients such as:

How did it happen?
How much swelling, bruising and pain?
Could you continue playing or were you carried from the field?

We use special tests, patient history and careful palpation of ankle structures to diagnose the type and severity of the injury. This certainly affects whether the athlete can return to sport in a few weeks or a few months. Diagnostic xrays, CT-scans or MRI investigations may also required to assist diagnosis and provide you with an indication about the severity of your injury. The severity of injury, and which structures are involved, will also determine how quickly you progress through your rehabilitation and whether close supervision is required by a physiotherapist.

Here is a skateboarder landing poorly and "rolling his ankle".

Had an ankle sprain?

Appropriate care for your injury should occur immediately and begin with RICE: rest, ice and elevation in a comfortable position. Limit weightbearing or walking and get a diagnosis!

We commonly see patients who have had a more severe type of ankle sprain, but present to the clinic after 6 weeks because “Its just not getting better…”. Often their injury has been made worse and a prolonged rehabilitation time is required because the injury wasn’t managed well in the first place. Afterall, the biggest risk factor to an ankle sprain is having had one before!

Brendon Burnett
Physiotherapist / Exercise Physiologist