Author: Alison Grimaldi

Home / Articles posted by Alison Grimaldi
Developed hip pain during your covid isolation? Avoid these 3 exercises!

Developed hip pain during your covid isolation? Avoid these 3 exercises!

Have you developed some new aches and pains or aggravated some old ones after following free online exercise classes? Or perhaps you have increased your normal activity level by doing more walking, running, stair or hill climbing to try and stay fit and healthy during the COVID-19 restrictions. At Physiotec, we have seen an increasing number of people who have developed or aggravated their hip pain during the covid-crisis. In fact, pain over the outer side of the hip is one of the most common problems we see. This is usually related to a condition called gluteal tendinopathy, also sometimes referred to as trochanteric bursitis.

There are some challenges with going it alone with a new exercise program. If you do have a pre-existing or new injury, how do you know:

  • which exercises or programs are the best options for you?
  • what are the correct techniques to use?
  • how do you make the exercise harder or easier if you need to?
  • how do you alter your program if you develop pain?

If you are struggling with any of these challenges, a physiotherapist can assist with either a telehealth or face-to-face consultation. For many painful conditions, good education and advice will help you stay active while minimising the risk of pain or injury.

For specific hip conditions such as gluteal tendinopathy or trochanteric bursitis, many factors influence the health of the tendons and bursae at the side of the hip. Either too much or too little stimulus may result in changes in tendon health and consequently, your ability to perform normal activities without pain. Too little load may be associated with a sedentary lifestyle where the muscles and tendons aren’t working enough. Too much load may be associated with a quick increase in activity (either a new or existing activity). Particular sustained positions or repetitive movements may also contribute to reduced tendon health or the development of pain over time.

3 Exercises to avoid when you have gluteal tendinopathy

 

So, who is most affected with this condition and why? 18% of the population aged over 50 suffers with this type of hip pain, and women are 3 times more likely to develop the condition than men. While the causes are often multifactorial, a change in hormones is thought to contribute to the development of tendon changes. A common story we hear from our patients is that there was an onset of pain associated with a combination of the following:
• Peri or post menopause and the associated hormonal changes
• Weight gain during this time, and
• A sudden increase in activity levels to counteract the weight gain

It should be said that changes in the health of tendons and bursae are not necessarily painful. Pain may develop if weakened tendons are unable to cope with their workload. Pain is often triggered by sudden increases in activity levels, where the tendons have not been given adequate time to adapt to the new loads. Examples include taking up a new sport or activity, or returning to activity after illness, injury or pregnancy. Going on holidays and walking lots of hills or stairs or for long distances along the beach may cause a problem. Sudden loads on the tendon during a slip or fall can also result in pain and injury, or a gain in weight may add more load to these tendons that support your bodyweight when standing on one leg.

How do you know if you have a gluteal tendinopathy or trochanteric bursitis?

Pain over the side of the hip due to gluteal tendinopathy or trochanteric bursitis

Do you have pain over the side of the hip with any of the following?
• Lying on your side
• Walking up hills or stairs
• Standing on one leg
• Sitting in low chairs especially with crossed legs
• Getting up from chairs and during the first steps

If you answered yes to most of these, you may have gluteal tendinopathy or trochanteric bursitis. The good news? Education and exercise provided by a physiotherapist provides an 80% success rate, with significantly better outcomes than a corticosteroid (cortisone) injection or a wait and see approach (i.e. basic advice and monitoring the condition)*. The even better news? Dr Alison Grimaldi was instrumental in the development of this successful program and all physiotherapists at Physiotec have been trained in the protocol.

We are now back in clinic for face to face consultations – if you have flared or developed hip pain (or any other pain), give us a call to book in! We are also still offering Telehealth consultations for those who are continuing to isolate or those who find it more convenient to attend an appointment ‘virtually’. You can read more about our Telehealth service here.

 

*Mellor R, Bennell K, Grimaldi A, Nicolson P, Kasza J, Hodges P, Wajswelner H, Vicenzino B., 2018. Education plus exercise versus cortico- steroid injection use versus a wait and see approach on global outcome and pain from gluteal tendinopathy: prospective, single blinded, randomised clinical trial. BMJ. May 2;361:k1662. doi: 10.1136/bmj.k1662.

4 tips for pain relief when you’re stuck at home

4 tips for pain relief when you’re stuck at home

1. Manage your stress

The effect of the COVID-19 pandemic has been devastating worldwide. We are lucky in Australia that the spread of illness is now being well contained. However, the social distancing measures have not come without a significant cost for many businesses, their employees and our way of life. Higher levels of stress are common and in the coming weeks, parents will also be juggling home schooling and many people will experience pain working at home.

Stress has a direct and marked impact on pain levels, so if you experience pain working at home and your normal achy neck or back is worse than usual, stress may be playing a substantial role. Often one of the first things you notice when stressed, is muscle tension developing around the neck and shoulder region. You may also feel tension developing in the lower back, particularly if you are sitting rigidly on the edge of your chair. Be sure to sit back in your chair and relax, allowing the chairback to support you.

When you are feeling overwhelmed or feeling tension and pain build in your neck or back, try some relaxed deep breathing. It can work wonders!

 

2. Optimise your home working environment

Many workers have had no choice but to make a rapid transition to a home-office, with less than ideal ergonomic set up. Pain working at home can result.

Good Desk Set Up

Problem: Using a laptop or tablet for prolonged periods will mean a poor neck angle and substantial increases in loads on the joints and muscles of the neck and upper back.

Solution: Organise an external monitor and/or keyboard, to ensure you can look straight ahead at your screen. These were in very short supply but are available again now.

Problem: Your desk and/or seat height may not be suitable.

Solution: Most people won’t want to invest in a new home set up for this temporary situation. But you can improve the situation usually with pillows, back supports, footrests and even bricks to alter the height of a low desk!

Aim to avoid situations where:
a. your knees are higher than your hips
b. your elbows are bent more than 90degrees

If you need a wedge cushion, decompression cushion or a back support, you can drop by the clinic to pick one up or we can organise delivery.

One of our physiotherapists can also check out your home working environment via a Telehealth video consultation.

 

3. Continue (or start) your Physiotherapy Rehabilitation Program

Don’t let this golden opportunity pass you by! Often our patient’s lives are so busy with all the events they must attend for work or family, that their home exercise program goes by the wayside. This makes it difficult to fully overcome a persistent pain issue.

Now is the time to attend studiously to your home program and get on top of those problems once and for all. This will help control pain working at home and it’s also very important for athletes to use this time to maintain or improve conditioning to avoid injuries when returning to sport.

Our physiotherapists are now transitioning back into the clinic after a short break with COVID-19 social distancing, so you can:

  • organise a check up on your program,
  • address a problem you have been meaning to attend to for ages or
  • put a plan in place to maintain your conditioning to prevent injury when returning to sport or your regular physical activity

PhysioTec Physitrack

We can provide assistance either in the clinic or with our telehealth service.

Telehealth is a video consultation. It allows us to assess your movement, check exercise technique, and tailor an exercise program for home. If you do not have an existing diagnosis for your painful condition, we’ll take a thorough history and step you through a variety of tests. This will help us determine what the main problem is.

The telehealth consultation also includes a free app with an individualised program. These exercises have video, audio and text descriptions available. On top of this, the in-app features also include tracking so you can check off your exercises daily and a messaging system to keep in touch with your physiotherapist.

Read more about Telehealth here.

 

4. Engage in regular exercise

We already know the important benefits of exercise, some of which include:

  • Positive effects for mental health
  • Weight control
  • Improved sleep quality
  • Prevention and management of a variety of health problems
  • Physiological benefits for the body, such as improving strength and mobility, which in turn help us to maintain independence.

Additionally, and perhaps most importantly right now, we know that regular physical activity decreases the risk of a person contracting a communicable disease (such as viral and bacterial infections). It enhances the ability of a person’s immune system to control itself. (Campbell & Turner 2018, Dominski & Dominski, 2020). Therefore continuing, maintaining or starting an exercise program is encouraged.

While the gyms and Pilates studies are closed, your options are to exercise outside or at home. There are many free exercise classes available online, but for those with previous injuries, be cautious. Some of these low-quality programs will not be suitable and may aggravate your condition or produce a new one.

Our physiotherapists can check your home exercise technique easily with telehealth , helping you control pain working at home. If you have gym equipment at home, Eric Huang, our strength and conditioning physiotherapist is very happy to check your lift technique and provide some ideas to vary or progress your program.

Eric Huang Telehealth Physiotec

Did you know?

Our Pilates instructors are also providing a high-quality Online Pilates service. Each class is run by one of our qualified Pilates Instructors and lasts approximately 40minutes. The classes focus on strength and conditioning exercises with the aim of keeping you moving and helping you maintain good functionality.

Physiotec Online Pilates_2020

Those who have already started these classes with Alice or Lisa have been loving them! Each class is limited to 4 people, and exercises are adapted for every client’s condition or physical fitness. The small class sizes also allow the instructor to monitor your form and posture, thus maximising your performance and safety.

Classes are priced at $20 per session, sold in packs of 5.

Call us on (07) 3342 4284 or contact us today to book in your free class trial!

 

 

References

Campbell, J. P., & Turner, J. E. (2018). Debunking the myth of exercise-induced immune suppression: redefining the impact of exercise on immunological health across the lifespan. Frontiers in immunology, 9, 648.

Dominski, F., Dominski, B. (2020). Exercise and Infectious Diseases – Covid-19. British Journal of Sports Medicine Blog, March 17, 2020.

Our New Initiative – HipPainHelp.com

Our New Initiative – HipPainHelp.com

Today we have some exciting news about the launch of a new website – hippainhelp.com , founded by our Practice Principal, Dr Alison Grimaldi with two of our senior staff, Kirsty McNab and Sharon Hennessey. HipPainHelp has been a labour of love, developed out of a clear need to connect those in pain with high quality information. When our patients reach us, they have often picked up from non-evidence based websites, incorrect information and self-help advice that has been anything but helpful.

For this reason, we have developed a comprehensive and regularly-updated library of high-quality, evidence-informed resources for our patients and others in the community suffering with hip, groin and pelvic pain. This wealth of information is accessible in 3 easy ways – Hip Pain Explained, our Pain Locator Map and Specific Condition Pages.

The site also has a directory of health professionals that have a special interest in the management of hip, pelvic and groin pain –  we call these our Hip Pain Professionals (HPP’s). At Physiotec, over 50% of all our patients have pain around the hip and pelvis, as this is a special area of focus and expertise for our whole clinic. All of our staff have undergone extensive extra training in the assessment of hip, pelvic and groin pain under the guidance of Dr Alison Grimaldi and continue to participate in regular ongoing in-house training and individual mentoring. Dr Grimaldi also keeps the Physiotec staff updated with cutting edge research completed both within her UQ team and international collaborations and from recent publications and presentations at conferences she attends all around the world. You will find all of our Physiotec physiotherapists listed on HipPainHelp.com.

If you are unable to make it to Physiotec to see one of our highly qualified staff, you can visit the Find a Hip Pain Professional directory, or you might like to tell your friends or family to visit the site to find a HPP in their area. We will be continuing to grow our directory of HPP’s which will include university-qualified healthcare practitioners of varying types such as Orthopaedic Surgeons,  Sports Medicine & Exercise Physicians, Pain Medicine Physicians, Physiotherapists and more. If there is no-one listed in your region, contact us and we can do our best to find someone in your area. The directory will be a growing global directory, so feel free to contact us if you are located anywhere around the world.

We hope to see you soon then, either at Physiotec, or at www.hippainhelp.com 

 

 

 

 

Pregnancy, pelvic pain & safely returning to running

Pregnancy, pelvic pain & safely returning to running

Pregnancy is an exciting and special time but it can also come with a lot of questions. Whilst Google gives us access to a wonderful world of information, it can lead to more questions and sometimes concerns. This article will discuss the effect of pregnancy on the mother in terms of pelvic pain and the pelvic floor and returning to running after pregnancy, backed up by evidence and research. It is important to remember that not any one pregnancy is exactly the same!

Pelvic Pain & Exercise during Pregnancy

Based on various studies, approximately 50% of women experience low back pain or pelvic girdle pain (pubic, buttock, tailbone, pelvic floor regions) during pregnancy and 25% continue to have this pain 12 months after delivery (Davenport MH, et. al., 2019).

A panel of experts looked at 32 studies, which included a total of 52,297 women without absolute or relative contraindications to exercise (Davenport MH, et. al., 2019). For the absolute and relative contraindications, please click here. From this, it was found that physical activity during pregnancy decreased the severity of low back, pelvic and lumbopelvic pain. (Davenport MH, et. al., 2019). This is both during the pregnancy and in the early postpartum period. The exercise components of these studies included yoga, aerobic exercise, general muscle strengthening and a combination of resistance and aerobic training (Davenport MH, et. al., 2019).

Another study by Owe et. Al (2016) looked at 39, 184 pregnant women who had not previously given birth. This study found that exercising up to five times weekly prior to pregnancy was protective against pelvic girdle pain and also those women who reported participating in high impact exercises prior to pregnancy had the lowest risk of pelvic girdle pain during pregnancy. (Owe KM, et. al, 2016).

The most current guidelines state that an accumulation of 150 minutes of moderate intensity exercise each week is recommended in order to achieve the health benefits and reduce risks of pregnancy complications (Mottola MF, et al., 2018).

Pregnancy & the Pelvic Floor

In relation to the pelvic floor, the main recommendation part of the most current guidelines state that pelvic floor muscle training is associated with a reduction in prenatal and postnatal urinary incontinence (Mottola MF, et al., 2018). These exercises can be performed daily HOWEVER, it is crucial that women seek instruction from a trained health professional (such as a women’s health physiotherapist) to ensure proper technique in order to obtain the best outcomes/benefits from performing these exercises. This is especially the case for women who have never trained these muscles.

Returning to Running after Pregnancy
More recently (March 2019), three highly experienced physiotherapists – Tom Goom, Gráinne Donnelly & Emma Brockwell combined their areas of expertise to release a paper on returning to running postnatal and the guidelines for this population. The main findings that were included in the paper were that women in the post-natal period benefit from an individualised assessment and guided pelvic floor rehabilitation in order to prevent and manage pelvic organ prolapse (bladder, bowel or uterus descending into the vagina) (Hagen, S et al., 2014), manage urinary continence (Bø, 2003) (Dumoulin, C et al., 2018) (Price, N et al., 2010) and improve sexual function.

Based on expert opinion only, the following suggestions were made:

• Return to running is NOT recommended at all prior to 3 months post-natal OR beyond this time point if any symptoms of pelvic floor dysfunction are identified before or after attempting return to running
• Pelvic health, load impact management and strength testing should be assessed in order to establish if a patient is ready to return to running in the post-natal period
• Additional factors that should be considered in the postnatal evaluation are weight, fitness, breathing, psychological wellbeing/status, abdominal separation, breast support and feeding, running with a buggy and relative energy deficiency in sport (RED-S)

How we can help you at Physiotec:

It is imperative to see your physiotherapist before commencing physical activity, especially if planning a pregnancy, already pregnant or in the post-natal period.

Here at Physiotec, your women’s health physiotherapist can:
1. assess your pelvic floor muscles to ensure you are using them correctly
2. assess and address other areas of concern such as low back pain or pelvic pain
3. advise you on the safest exercises during pregnancy as well as into the post-natal period
4. perform a physical assessment to determine whether you are ready to return to running or other exercise after pregnancy 
5. perform a running assessment to ensure that your technique places minimal loads on your pelvic floor and joints following pregnancy

You might also like to join one of our Pilates classes to stay strong or build strength and control before, during or after your pregnancy.

Bibliography

Bø, K. (2003). Is there still a place for physiotherapy in the treatment of female incontinence? EAU , 145-153.
Davenport MH, et. al. (2019). Exercise for the prevention and treatment of low back, pelvic girdle and lumbopelvic pain during pregnancy: a systematic review and meta-analysis. British Journal of Sports Medicine, 53, 90-98.
Dumoulin, C., Cacciari, L. and Hay-Smith, EC. (2018). Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Cochrane Database of Systematic Reviews(10).
Hagen, S., Stark, D., Glazener, C., Dickson, S., Barry, S., Elders, A., Frawley, H, Galea, MP, Logan, J., McDonald, A., McPherson G., Moore KH, Norrie, J., Walker, A., Wilson, D. (2014). Individualised pelvic floor muscle training in women with pelvic organ prolapse: a multicenter randomised controlled trial. 282(9919), 796-806.
Mottola MF, et al. (2018). 2019 Canadian guideline for physical activity throughout pregnancy. British Journal of Sports Medicine, 52, 1339-1346.
Owe KM, et. al. (2016). Exercise level before pregnancy and engaging in high-impact sports reduce the risk of pelvic girdle pain: a population-based cohort study of 39 184 women. British Journal of Sports Medicine, 50, 817-822.
Price, N., Dawood, R. and Jackson SR. (2010). Pelvic floor exercise for urinary incontinence: A systematic literature review. Maturitas, 67(4), 309-315.

Physical Activity & Pregnancy

Physical Activity & Pregnancy

Physical Activity & Pregnancy

The Facts, the Figures & the False Conceptions

If you are pregnant or planning a pregnancy and you are unsure about the current guidelines for physical activity and what is safe, this is a must read! An excellent team of experts have appraised over 27,000 manuscripts and abstracts (Davies G & Artal R., 2019) in order to bring us the most up to date information and guidelines on physical activity during pregnancy.

THE FACTS:

Physical activity during pregnancy:

  • DOES NOT increase the risks of structural or functional birth defects which stem from in the womb (Davenport MH, et al., 2019)
  • Has a significant effect on reducing the severity of low back pain, pelvic girdle pain and lumbopelvic pain. (Davenport MH, et al., 2019)
  • Decreases the chances of using instruments during delivery (Davenport MH, et al., 2019)
  • Reduces the chances of depression during pregnancy as well as the severity of symptoms. Unfortunately, this does not apply to the post-natal period. (Davenport MH, et al., 2018)
  • Reduces the risk of excessive weight gain during pregnancy as well as weight retention postpartum. (Ruchat S, et al., 2018)
  • Results in a small increase in the mother’s body temperature which is safe for the baby. (Davenport MH, et al, 2019)
  • Effectively reduces the risk of developing gestational diabetes mellitus, gestational hypertension and pre-eclampsia. (Davenport MH, et al., 2018)
  • Reduces the odds of having abnormally large babies (Davenport MH, et al., 2018)

Additionally…

  • There is no association between physical activity during pregnancy and increased risk of miscarriage or perinatal mortality (stillbirth or deaths in the first week of life) (Davenport MH, et al., 2019)
  • There is not enough evidence to inform us if lying on our back to exercise is safe or if it should be avoided altogether during pregnancy (Mottola MF, et al., 2019)
  • There was no association found between exercise during pregnancy and complications with the newborn baby or harmful childhood outcomes (Davenport MH, et al., 2018)

THE FIGURES & RECOMMENDATIONS

(Mottola MF, et al., 2018)

  • An accumulation of 150 minutes of moderate intensity exercise each week is recommended in order to achieve the health benefits and reduce risks of pregnancy complications
  • Exercise over a minimum of 3 days per week, however daily exercise is encouraged
  • Variety is key in order to achieve greater benefits
  • Pelvic floor muscle training can be performed daily in order to reduce risk of urinary incontinence
  • Exercising flat on the back should be modified if the pregnant women is experiencing light headedness, nausea or feeling unwell
  • TAKE HOME MESSAGE: All women WITHOUT contraindications should be participating in physical activity during pregnancy

THE FALSE CONCEPTIONS

  • Exercise will harm the baby. The evidence has shown that there are no increased risks of miscarriage or a small baby when undertaking physical activity during pregnancy
  • Heart rate should be below 140 beats per minute. This is an outdated guideline from the 80s and there was no evidence to even support this guideline, it was based on expert opinion.
  • Exercise needs to be at a gym or with group fitness. Lots of studies that were looked at were walking programmes. Additionally, moderate intensity physical activity can include gardening, mowing the lawns and some household chores.

Other considerations for physical activity & pregnancy

There are other considerations specific to the mother during pregnancy and physical activity. These include, but are not limited to, the pelvic floor and risk of overload/prolapse as well as pelvic pain. If you are planning a pregnancy/already pregnant and have a history of pelvic pain or pelvic floor concerns, it is important to see your physiotherapist before commencing physical activity. Here at Physiotec, your women’s health physiotherapist can assess your pelvic floor muscles to ensure you are using them correctly, assess and address other areas of concern such as low back pain or pelvic pain and advise you on the safest exercises during pregnancy as well as into the post-natal period. You might also like to join one of our Pilates classes to stay strong or build strength and control before, during or after your pregnancy.

Download more information on Physical Activity during Pregnancy here

Try Torpedo Perturbation Training at PhysioTec

Try Torpedo Perturbation Training at PhysioTec

Perturbation Training

See one of our Physiotec staff, Colm Coakley, demonstrating some perturbation training using the CorMax Torpedo. Half filled with water, the Torpedo becomes an unstable load which your muscles need to figure out how to control. Consequently, it provides a great dynamic stability challenge! Also, due to the ever-changing stimulus, it keeps the nervous system guessing.  This requires the system to continually change the way muscles are stimulated to respond.

In response to pain, or sometimes due to excessive training in very rigid unvarying patterns eg like regularly holding a rigid plank for 2+minutes, the nervous system can begin to recruit muscles in very confined, ‘primitive’ patterns. This can lead to a loss of normal efficiency and load sharing-load sparing in muscle recruitment patterns. As a result, this can also potentially contribute to pain, injury and a loss of athletic performance. At Physiotec, we are always exploring and embracing strategies that can help our patients get the best out of their bodies and their lives. Come & join one of our highly qualified physio’s in an innovative and challenging workout.

Saturday Acute Injury Service

Saturday Acute Injury Service

Ever hurt yourself on a Friday night or Saturday and wished you could have your injury seen to? Did you know Physiotec now offers Injury Clinic every Saturday from 11:30am-1:30pm. One of our skilled Sports Injury & Performance Physiotherapists will be on staff every Saturday to cater for the acute injuries sustained during Friday night/Saturday. The right advice and early management makes all the difference. Get treatment/advice now. Don’t wait!!!

We also have a normal clinical service and pilates on Saturday morning, but reserve places with one of Sports Injury & Performance team specifically for acute injuries that require urgent assistance.