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All you need to know about hip labral tears

All you need to know about hip labral tears

Have you ever experienced a deep pain in the front of the hip or groin region? You may also experience a locking, clicking or catching sensation when you move your leg. Whether this is from a fall, a sporting injury, if it has been going on for a while, you may end up getting a scan, often an MRI - a magnetic resonance imaging scan. If you look through the scan report, you may see the words “labral tear”. This blog is going to take you through what a hip labral tear is, its signs and symptoms, causes and contributing factors, and the recent evidence on effective management.

Let’s have a look at the anatomy first!

What is a hip labral tear?

A labral tear of the hip joint is an injury to the labrum. The labrum is a tough, fibrous cartilage that lines the rim of the hip socket (called the acetabulum). The hip joint is a ball-and-socket joint, where the ball of the thigh bone (femur) inserts into a socket in the pelvis. The labrum acts as a suction seal for stability of the hip joint, as well as a shock absorber for distributing pressure during movements.

What are the symptoms of a hip labral tear?

More than 90% of people diagnosed with labral tears report pain at the front of the hip and groin.1 In some cases, the pain may radiate to the knee.2 People with labral tears are less likely to experience pain over the side of the hip or in the buttock.3 Clicking of the painful hip is another possible sign of a hip labral tear, but there are many other reasons why a hip might click. Other symptoms such as locking, catching or giving way may also be noticed by those with a labral tear.

For the majority of people with hip labral tears, their symptoms start to become noticeable slowly over time.1 Patients seeking help from a health professional commonly report a constant dull ache with episodes of sharp hip or groin pain. Activities like walking, stair climbing, pivoting, sitting for long periods of time (more than 30 minutes) and running often bring on the sharp pain. In addition, patients with hip labral tears may find themselves limping when walking. Their ability to walk longer distances on inclines or uneven surfaces may also be reduced.

Is a hip labral tear always painful?

Hip labral tears are common in both people with and without hip pain. One review reported that on average, 62% of those with hip pain have labral tears present on imaging, while 54% of those without hip pain also had hip labral tears.4 What this means is that it is possible to have a hip labral tear but no hip pain. It also means that although a labral tear may cause pain, just because a hip labral tear is reported on scans, it does not necessarily mean it is the source of pain. Information provided by the patient and a physical examination are required to determine if the imaging results are likely to be related to the current pain. It has been reported that it takes on average more than 2 years to obtain an accurate diagnosis of a hip labral tear. So it’s important to ensure you have a thorough clinical examination by a health professional experienced with hip conditions.

What causes hip labral tears?

Traumatic hip labral tears

 

Injury to the labrum is frequently observed if trauma to the hip is experienced, such as during a motor-vehicle accident, falls and sudden impact to the hip during contact sports. These types of labral tears can occur with other injuries, like hip joint dislocation.1 Although a tear sounds like it would always be associated with some form of trauma, in fact most labral tears develop over time secondary to natural bony shape or flexibility and/or repetitive activities.

 

Hip labral tears and Femoroacetabular Impingement

It is very common to have a variation of bony anatomy of the hip in healthy populations. The natural formation and alignment of the hip joint may increase the likelihood for some people to have a hip labral tear. It could be the bone structure of the thigh bone (femur) or the socket (acetabulum) that creates natural restriction in hip flexibility, called femoracetabular impingement or FAI. This kind of restriction may result in compression and shearing of the hip labrum. The labrum is more prone to injury during extremes of movement, particularly bringing the knee to the chest and with full rotation of the hip. In some people with this bony anatomy, pain related to a hip labral tear may develop – this condition is then called Femoroacetabular Impingement Syndrome (FAIS).5

Hip labral tears and acetabular dysplasia or hip dysplasia

The bony shape of the socket or acetabulum can also increase the risk of hip labral tears. People who have a shallow socket or a change in the natural orientation of the hip socket are also more likely to develop hip labral tears. Up to 90% of people with hip dysplasia and a painful hip will have a labral tear.6 This is due to less bone in the socket available to absorb forces and therefore a greater amount of force is absorbed by the labrum that lines the edges of the socket.

Hip labral tears and hyper-mobility

 

People who are naturally very flexible in their early years, may be at higher risk of sustaining hip labral tears. Instead of reduced hip motion like in people with hip FAI, these patients usually have greater than normal hip flexibility due to more relaxed capsule and ligaments around the hip. In this situation, the labrum may again need to absorb larger forces, increasing risk of injury.

 

 

Hip labral tears, repetitive motion and age

Repetitive and forceful motion into the extremes of hip joint range may over time cause changes in the labrum. Court and field sports involving lots of hip rotation and sports involving large ranges of motion such as dance and gymnastics may cause increased stress at the hip joint and the acetabular labrum. These stresses are normal, but high repetition of strong forces may eventually result in a labral tear and in some people the tear may become symptomatic. This does not mean these sports are necessarily dangerous for your hips – it depends on many factors like your bony shape and natural flexibility as mentioned above, how much of certain activities you do, how you do them, and your age. Over the years, our body is naturally exposed to more repetitive forces and so it is not surprising that age is also related to development of labral tears.

 

What is the treatment for hip labral tears?

Activity modification and exercise for hip labral tears

The first line of treatment is education and exercise, and physiotherapy plays a significant role in this management approach. A physiotherapist may advise how to appropriately minimise aggravation of the hip. A graduated exercise program is developed to address any weakness around the hip and improve the ability of muscles to absorb the forces travelling through the hip joint. This can help reduce forces placed on the labrum.

Corticosteroid injections for hip labral tears

Corticosteroid injections into the hip joint can help reduce pain in the short term but do little to help the condition in the longer term. There are also concerns about adverse effects that cortisone may have on the hip cartilage, particularly in younger individuals. For this reason, trying at least 3-6 months of activity modification and rehabilitation is usually recommended prior to undertaking more invasive procedures such as injections or surgical interventions.

Surgery for hip labral tears

Surgical treatment for hip labral tears is most commonly performed through keyhole surgery (hip arthroscopy). The surgeon generally ‘debrides’ - trims up - any flaps or rough areas at the site of the labral tear. It is important to be aware that such treatment does not ‘fix’ the labrum or restore its normal function. Sometimes a surgeon may attempt to repair the labrum but this is less common as the labrum naturally has poor blood supply and is not so easy to repair.

Surgery can help with reducing pain and improving ability to perform normal activities and sport, but many people do not return to sport or to their previous level of sporting activity. Some can be no better or even worse after surgery – this is more likely to occur in those who already have some osteoarthritis within the hip joint.

Scientific research has not yet determined which people will have the best outcomes from surgery, so it is always wise to try an extended period of physiotherapy treatment prior to opting for surgery. If surgery is then required, you will be much better placed for a quicker recovery if you have done a good period of ‘pre-habilitation’ before surgery. Rehabilitation after surgery is recommended for a minimum of 3 months, but this may be longer depending on what activities you need to return to.

Getting help for your hip labral tear?

If you have a hip labral tear or think you may have a tear, please book a consultation with one of our physiotherapists at Physiotec. All of our Physiotec staff have higher level experience in the treatment of hip pain and injuries. We will provide a thorough examination and an evidence-informed treatment program to give you the best chance of returning to the things you need to do and the things you love to do! We can also assist you with modifying activities to keep your hip as happy and healthy as possible for the longer term, and if surgery is required, we can assist you through this process to ensure the best result.

Ph: (07) 3342 4284    Email: [email protected]

 

2021 Wrap Up

2021 Wrap Up

Despite the challenges of 2021, at Physiotec we have remained steadfast in our efforts to bring you the best possible health service and committed to helping you return to the things you need to do and most importantly, the things you love you to do. Our Physiotec team has continued to hone their skills with regular group training, individual mentoring and attendance at courses and online conferences. Dr Alison Grimaldi has continued her local and international courses for other health professionals. The international teaching has all been online again this year, but Alison has taught 'virtually' in Canada, Germany, Switzerland, Ireland and Korea and provided regular live meetings for her Hip Academy members from all over the globe.

We have been aiming to keep you up to date with health advice in our regular blogs and newsletters. If you've missed any of these, you might like to visit our blog page. Below you will find a snippet of our top blogs for this year written by our highly skilled team at Physiotec. In this 2021 wrap up, you'll also find an update from the Physiotec Dance team and also from Not Just Bendy and Julie Allen on their services provided at 23 Weller Rd. Hope you enjoy our 2021 wrap up!

Merry Christmas from our PhysioTec team

Alison Grimaldi
Eric Huang
Joanne Manning
Kevin Doan
David Pierce
Rhianna Tunks
Irene Li

Top Blogs of 2021 from our Physiotec Team

The most popular blog of 2021 was: Shall We Dance? - The Health Benefits of Dancing - at any age. Health benefits do not only come from exercising or going to the gym, dancing has been proven to have a wide variety of health benefits. This blog, written by Jo Manning our lead dance physiotherapist, offered great insights into the health benefits of dancing, and how whatever age you are, you can reap the benefits that dancing has to offer.

Click Here to Read this Blog

 

 

Second place of our top blogs of 2021 goes to: Knee Osteoarthritis - Myths vs Facts.  'My scan will show exactly what is causing my knee pain', 'I shouldn’t exercise my knee as it will worsen the damage in my knees', and 'Surgery is required for all cases of osteoarthritis' - are all common myths surrounding knee osteoarthritis. In this blog Kevin Doan, sports physiotherapist, shares some evidence-based facts about knee osteoarthritis and explains why an individualised strengthening programme is so important for cartilage health and maintaining function in those with arthritis

Click Here to Read the Blog

 

The 3rd blog to make our Top list of blogs in 2021 is: Music is Physical - The Importance of Exercise for Musicians. Musicians spend much of their time practicing. But how much time is devoted to keeping fit? It is a less-known fact that fitness and exercise are important for musicians too. This blog written by Dave Pierce who has a special interest in assisting musicians, explored the importance of being 'fit to play'.

 

Click Here to Read this Blog

 

And the 4th blog to make our Top list of blogs in 2021 is: Whole-Body Strength Training - For Cyclists. Many cyclists, in a bid to to improve their cycling performance, focus on exercises that target the legs. After all - stronger legs means more power on the bike. And there's certainly no shortage of leg workouts for cyclists on the internet. But is that all you really need? This blog was written by our highly experienced Cycling Physio, Eric Huang, where he discusses the importance of whole-body strength training for cycling performance and injury prevention.

Click Here to Read this Blog

Dance Physiotherapy Wrap up for 2021

Our dance physiotherapy service has gone from strength to strength this year. Jo Manning is our wonderful clinical lead for our Dance physiotherapy services,  and she was joined this year by Rhianna Tunks, who brings her street dancing experience to the team.

Here's a few things about Jo & Rhianna that you might not know:

Joanne Manning - Physiotec Dance Physiotherapy Clinical Lead

Joanne graduated from the University of Queensland in 2014 with a Bachelor of Physiotherapy Honours Class l. A skilled dancer, choreographer and director, Joanne forged a highly successful career internationally and more specifically on Broadway before transitioning to a career in physiotherapy. Joanne has had an extensive career within physiotherapy,  in both private practice and hospital settings. We are honoured to have Joanne as our clinical lead for the Dance Team at PhysioTec. Joanne is also very happy to treat non-dancers, with special interests in the hip, back and lower limb (knee, ankle foot, thigh & calf).

Rhianna Tunks - Physiotec Dance Physiotherapy Team

Rhianna joined our Dance team in June this year after completing a full-time commercial dance course in Sydney. Rhianna is passionate about street dance, currently training and competing with the Home Base. She enjoys treating all kinds of dancers with experience working with young ballerinas just starting their dance journey to professionals in the industry including the Dream Dance Company. Rhianna is enthusiastic about helping pre-professional dancers get the most out of their training as she understands the sudden increase in demand on the body and the impact this can have on a dancer’s experience during full-time training. Rhianna is also available for pre-pointe profiles for those preparing to commence pointe training soon, dancers that may expecting to start pointe next year or dancers already training en pointe that want to improve their technique. Rhianna is also happy to treat musculoskeletal pain and injury in non-dancers.

Dave Pierce also has a wealth of experience in management of pain and injury in performing artists. He continues to assist with our dancers, although his main focus is now on musicians and optimising sports performance through the use of technology for athlete assessment and biofeedback.

Hoping to progress onto pointe next year? Now is the time to start preparing.

As the sun begins to set on 2021, dance classes wind down and students embark upon their summer holidays. Leotards are replaced by swimmers and the ballet shoes are left in the back of the cupboard. If your child is one of those excited young dancers hoping to begin pointe in 2022, then a pre-pointe profile is highly recommended, and this is an ideal time!

During a typical profile, we look at the strength of the legs, ankles, and feet as well as control and alignment. We look at the flexibility of the dancer – too much flexibility without the control can be just as problematic as too little. We’ll also assess stability around the trunk and check their balance – both so important for pointe work. Finally, we take a history of the dancers training and any injuries.

It’s not uncommon to find elements that need addressing before pointe work is commenced and the school holidays can provide an ideal time for the dancer to work on any potential issues. We will provide an individualized exercise program for the dancer, teach the exercises, and take time to explain why they are important. We’ll then schedule a follow up session to see how the dancer is progressing.

Our dance physios, Jo and Rhianna, understand how important and exciting making that step onto pointe can be for young dancers and are here to help them in achieving that goal as safely and successfully as possible. Call now to book in for Pre-Pointe Profile and get the dream started!

For advice on prevention of dance injuries, or for rehabilitation and treatment of dance injuries, make an appointment with Rhianna or Joanne today.

Call 3342 4284 or Click Here to book

Not Just Bendy Hypermobility Services 2021 Wrap Up

Not Just Bendy Hypermobility Services provides services to those with complex hypermobility issues, within the Physiotec building at 23 Weller Rd, Tarragindi. After opening in mid- 2020 Not Just Bendy Hypermobility Services has continued to grow quickly in 2021.

We started the year with three physiotherapists (Sharon, Dr Chen and Marlisa) working with our complex hypermobility population.  Then this year we welcomed four highly skilled and experienced physiotherapists to our team: Belinda, Lucy, April and Maria.  We have also welcomed Rosalind for administrative help behind the scenes.

Our in-service training program (for our physio team) this year has focused on making connections with allied health professionals interested in this area.  We have had speakers on a wide range of topics from podiatry, hand conditions, braces and wheelchairs.  Five members of our team also attended the online program from the Ehlers Danlos Society called Allied Health EDS Echo immersing themselves in the frontline research and clinical knowledge from experts in their fields. Sharon has also been working on mentoring and teaching physiotherapists and other allied health professionals about hypermobility – to work towards the goal of a greater understanding of this issue in South East Queensland and Australia.  Sharon also recorded a podcast, presented at the Australian Physiotherapy association and provided training to many other physiotherapy practices.

NJB team trying out some new skills with Paint & Sip team building.

(From the left: Sharon, Lucy, April, Belinda, Rosalind, Marlisa, Maria.  Absent Chen).

Next year will bring new challenges and relationships with our first Exercise Physiologist joining the team at Not Just Bendy – Avery Wu.  Some of you may already know Avery as one of PhysioTec’s pilates instructors.  Avery will be available for individual or small group pilates or strengthening programs for our hypermobile clients from January 2021.

The team at Not Just Bendy Hypermobility Services wish you and your loved one and safe and happy Christmas season and look forward to helping you achieve your goals in 2022.

The Pentimento Project 2021 Wrap Up

Julie Allen provides cancer care services within the Physiotec building at 23 Weller Rd, Tarragindi. This year, despite COVID and lockdowns, The Pentimento Project has had the opportunity to engage with people on the cancer continuum more than ever before and I am so very grateful. It has been both challenging and rewarding to embrace the available technologies and enter more homes virtually. Importantly, it has also coincided with people using these unprecedented times to prioritise their health, exercise, and wellness goals.

In collaboration with Leukaemia Foundation, I have had the opportunity to record podcasts and information series, contribute to the development of a much-awaited App for Blood Cancer patients and present webinars on The Physical Impacts of Cancer, to approximately 400 participants. Excitedly, the podcast will launch nationally on your podcast app on December 15 as part of the Leukaemia Foundations series, Talking Blood Cancer. If you would also like to access the webinar information, it will eventually be available online and I will include the link in our newsletter as it becomes available.

As the year draws to a close, I’d like to thank every person that I have had the absolute honour and pleasure to meet and treat through The Pentimento Project this year.  I have loved helping to guide you towards achieving your goals. Many of you, I have known for a while, whilst others are new acquaintances, but you have all made such a lasting impression.   I am always amazed and in awe of your willingness to be open and honest with me and allow me to walk beside you in often extremely vulnerable circumstances.  I wish you all a truly blessed and magical Christmas filled with joy, peace, and love.  May the New Year be one of new beginnings, continued hope and optimism and the drive to keep you moving forward beyond your cancer experience. 

Much love, Julie Allen, The Pentimento Project

And that's a wrap for 2021! 

Thank you to all our wonderful patients, referrers and other readers for supporting us through 2021.
Have a wonderful Christmas and we look forward to helping you towards a happy, healthy 2022.
Enjoy some downtime, spend precious time with family and friends and recharge the batteries for the year ahead.
See you then,

Alison

Dr Alison Grimaldi,
Practice Principal Physiotec

Muscles and Ageing – Use it or Lose it

Muscles and Ageing – Use it or Lose it

We all know the importance of maintaining bone strength as we get older, and the importance of bone strength in maintaining independence, and reducing our falls and fracture risk. But what about muscle strength?

In a previous blog, we discussed low bone density and its strong correlation to falls risk. In this blog, we will talk about the health of muscles and tendons and their role in our physical function.

Sarcopenia – What is it?

Sarcopenia is the generalised loss of muscle strength as we age – or specifically, reduced muscle mass and strength. It’s normal to experience some muscle loss as we get older; however sarcopenia is severe age related muscle loss. It’s estimated that sarcopenia affects almost a third of older adults living in the community, varying by age and ethnicity (Daly & Maier, 2019).

Sarcopenia more commonly affects older adults, but can also present itself earlier in life. Muscle mass starts to decline around the age of 30, but the loss of muscle tissue progresses more rapidly when a person reaches their 60s (Volpi, Nazemi, & Fujita, 2010).

 

Symptoms and Causes of Severe Muscle Loss

According to De Pietro (2017), while ageing is the predominant cause of sarcopenia, there are other contributing factors, for example:

  • Inactivity. Living a sedentary lifestyle increases a person’s risk of developing sarcopenia
  • Poor nutrition. Sufficient protein and calorie intake is important in maintaining muscle mass
  • Hormonal changes. As a person ages, there are changes in the production of the sex hormone (testosterone) and growth hormones, which affects muscle growth and mass

People with sarcopenia generally experience weakness and loss of stamina, which hinders their ability to perform physical activities. And this decrease in physical activity leads to even further muscle loss (Thorpe, 2017) .

Signs of Sarcopenia
Source: (Thorpe, 2017)

Why is maintaining muscle mass important?

Muscle loss is associated with a higher risk of fractures due to an increased likelihood of falling, as reduced muscle strength may influence the ability to control the body during the a fall (Hsu, Wei-Li et. al, 2014). Scientists have shown a close relationship between falls and muscle weakness of the buttock, thigh and ankle muscles (MacRae, PG et. al, 1992) (Hsu, Wei-Li et. al, 2014).

Sarcopenia can have a significant impact on a person’s everyday life, and affect their ability to perform basic tasks, such as climbing stairs, lifting objects, and walking.

How to fight age-related muscle loss

There are two main things we can do to fight Sarcopenia:

1. Nutrition

Proper nutrition is essential to treating sarcopenia, and can even prevent or delay the condition. In 2008, the Society for Sarcopenia, Cachexia, and Wasting developed nutritional guidelines for the prevention and management sarcopenia (Dorner & Posthauer, 2012).

The guidelines state that protein intake is an important dietary consideration – studies have shown the correlation between dietary protein and muscle mass. Some easy ways to increase your protein intake (Lillis, 2019), depending on food intolerances and choices, include:

  • Introduce plant proteins to your diet, such as legumes and nuts
  • Eat more dairy, such as cheese and Greek yoghurt
  • Eat more lean meat
  • Try a protein shake

Another recommendation from the guidelines is the supplementation of vitamin D, as low levels of vitamin D levels are associated with low muscle strength (Dorner & Posthauer, 2012).

2. Exercise

Apart from the obvious benefits of exercise – feeling good, weight control, helping to boost energy, promoting better sleep and helping to prevent and manage a variety of health problems – the related improvements in strength and mobility help us to maintain independence. Additionally, exercise improves quality of life, especially in the areas of physical function such as balance and reducing pain related to musculoskeletal conditions (Hsu, Wei-Li et. al, 2014).

Fight muscle loss with resistance training

While both resistance and aerobic training can improve overall health and wellbeing, the only proven method for the prevention and management of sarcopenia is progressive resistance training. Resistance training focuses on exercising large muscle groups, using an external force. In a progressive training program, the challenge of the exercise including use of weights and number of repetitions are altered over time, based on your individual capabilities.

Examples of progressive resistance training are:

  • Bodyweight exercises such as simple squats, lunges and step ups
  • Exercises using external resistance such as hand weights or resistive bands
  • Either strength and conditioning/gym type exercise or Pilates training

 

At  Physiotec, one of our major areas of interest is rehabilitation of those with hip and pelvic pain and injury, who generally have associated muscle weakness around the hips and sometimes the whole legs. We are passionate about restoring healthy hip muscles and see first-hand the improvements in quality of life and functional capabilities of people who engage in a tailored exercise programme. One study has also found that there is an association between reduced size of the deeper hip muscles  (gluteus medius and minimus) and the risk of bone fractures related to falls (Chi, AS et. al, 2015). There is also a relationship between muscle weakness, painful knee or hip osteoarthritis and an increased risk of falls  (Doré, AL et. al, 2015).

A final thought..

We may not be able to stop the ageing process in its track, but with regular exercise and resistance training, as well as proper nutrition, people can prevent sarcopenia from developing, or slow the progression of the condition.

 

Physiotec physiotherapists are able to develop a targeted and specialised program for you, using evidence from the most current research available. These programs are specifically designed to target individual areas of muscle weakness or other concerns such as falls risk or difficulty with everyday tasks or recreational/sporting activity. Our programs may incorporate posture and body awareness training along with balance and proprioceptive exercise aimed at reducing the risk of falls, joint overload and injury. For others, the focus may be on reconditioning after an injury or surgery and getting you back to all those things you need and love to do.

For more information about developing a program just for you, call 3342 4284 to book an appointment with one of our physios.

 

Bibliography

Chi, AS et. al. (2015). Association of Gluteus Medius and Minimus Muscle Atrophy and Fall-Related Hip Fracture in Older Individuals Using Computed Tomography. Journal of Computer Assited Tomography, 00, 1-5.

Daly, R., & Maier, A. B. (2019, July 9). The muscle-wasting condition ‘sarcopenia’ is now a recognised disease. But we can all protect ourselves. Retrieved from The Conversation: https://theconversation.com/the-muscle-wasting-condition-sarcopenia-is-now-a-recognised-disease-but-we-can-all-protect-ourselves-119458

De Pietro, M. (2017, July 21). Sarcopenia: What you need to know. Retrieved from Medical News Today: https://www.medicalnewstoday.com/articles/318501

Doré, AL et. al. (2015, May). Lower Limb Osteoarthritis and the Risk of Falls in a Community-Based Longitudinal Study of Adults with and without Osteoarthritis. Arthritis Care and Research, 67(5), 633-639.

Dorner, B., & Posthauer, M. (2012, September). Nutrition’s Role in Sarcopenia Prevention. Retrieved from Today’s Dietitian: https://www.todaysdietitian.com/newarchives/090112p62.shtml

Hsu, Wei-Li et. al. (2014). Balance control in elderly people with osteoporosis. Journal of the Formosan Medical Association, 113(6), 334-339.

Lillis, C. (2019, June 25). What are the best ways to eat more protein? Retrieved from Medical News Today: https://www.medicalnewstoday.com/articles/325552

MacRae, PG et. al. (1992). Physical performance-measures that predict faller status in community-dwelling older adults. Journal of Orthopaedic & Sports Physical Therapy, 16, 123-128.

Runge, CF et. al. (1999). Ankle and hip postural strategies defined by joint torques. Gait & Posture, 10(2), 161-170.

Thorpe, M. (2017, May 25). How to Fight Sarcopenia (Muscle Loss Due to Aging). Retrieved from healthline: https://www.healthline.com/nutrition/sarcopenia

Volpi, E., Nazemi, R., & Fujita, S. (2010). Muscle tissue changes with aging. Retrieved from National Center for Biotechnology Information: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2804956/

 

Reducing falls and fractures in osteoporosis

Reducing falls and fractures in osteoporosis

Good balance is vital for reducing falls and fracture in osteoporosis. Balance is particularly important for those living with osteoporosis, where the risk of fracture is much higher than for those with good bone density. Fractures in older people can also have a big impact on mobility, independence and quality of life.  There are a number of factors that can increase the risk of falls.

Factors that increase the risk of falls:

  • Older age
  • Poor muscle strength
  • Poor balance
  • Previous falls
  • Reduced ability to walk and move around with ease
  • Poor vision
  • Trip hazards, particularly at home

          (Osteoporosis Australia Medical & Scientific Advisory Committee, 2019)

While of course there is nothing we can do to change our age, there is much that can be done to improve muscle strength and balance. A history of recurrent falls needs to be investigated as the more falls you have had, the more likely you are to have further falls. Medical causes of poor balance, such as low blood pressure, inner ear problems and possible effects of some medications should be investigated by your doctor. A physiotherapist can assess muscles strength and balance. The home should also be assessed for trip hazards. Did you know that 50% of all falls occur around the home?  (Osteoporosis Australia Medical & Scientific Advisory Committee, 2019). All these potential factors need to be assessed and addressed when reducing falls and fracture in osteoporosis.

How do we minimise the risk of falls?

There are several ways we can reduce the risk of falls:

  • A targeted exercise program
  • Optimising nutritional intake
  • Addressing medical conditions and medications
  • Ensuring a safe home environment
    (Osteoporosis Australia Medical & Scientific Advisory Committee, 2019) (Australian Government, 2011)

Exercise for Bones Osteoperosis

Exercise

Physiotherapists can assist with implementing a falls prevention program. This includes a combination of balance and strength training. We will take a closer look at falls prevention programs below. Physiotherapists can also assist with managing conditions such as hip, knee and foot arthritis which may cause episodes of giving way, increasing risks of falls. Arthritis may also reduce activity levels and muscle strength, again increasing risk of falls.

Nutrition for Bones Osteoperosis

Nutrition

Nutrition is an important factor in falls and fracture prevention. A diet deficient in nutrients such as calcium and Vitamin D can reduce ability to increase bone density. A nutrient rich diet is also important for falls prevention due to its effect on strength, mobility and brain function. Intake of alcohol also has effects on reaction time and steadiness.  It is therefore important to eat a well-balanced diet consisting of a variety of foods including fruit, vegetables, dairy and whole grains, and moderate intake of alcohol.

Medical for Bones Osteoperosis

Medical

There are many medical conditions that may influence balance. These include medical conditions such as blood pressure issues, arthritis or depression, as well as short term conditions or illnesses, for example the flu, infections, or recent surgery. It is important to check in with your regular doctor to address these conditions. A review of your medications is also a good idea to ensure these medications are not impacting on your balance.

Home House for Bones Osteoperosis

At Home

Minimising risk in the home is vital as half of all falls occur at home. A health professional can provide suggestions to help you with this. See some general tips below.

 

Ways to reduce the risk of falls at home:

  • Ensure your rooms are brightly lit, especially near steps or routes you may use at night
  • Installing handrails and using non-slip mats
  • Removing clutter and trip hazards (e.g. loose cords, maintaining outside pathways)
  • Replace carpets with holes or worn areas

 

Exercise for reducing falls and fracture in osteoporosis

There is mounting evidence that exercise alone can reduce the risk of falls (Sherrington, C et. al, 2011). One recent study looked at a balance training program incorporating strengthening exercises with proprioceptive (body awareness) training (Miko, I et. al., 2017). In other words it used an “inside out” approach to training – people in the study worked on improving function of the deepest muscles around their trunk and pelvis first. They then progressed to the next phase which involved maintaining good control around the trunk and pelvis while using larger, more superficial muscles during arm and leg exercises. The final, functional phase aimed to achieve automatic stabilisation of the body whilst performing higher level dynamic exercises involving greater balance challenges. The study found that there were significant improvements in measures of balance and also a reduction in falls in postmenopausal women with established osteoporosis. You can read more about the importance of osteogenic exercises for the management and prevention of osteoporosis in our previous blog.

Exercise for Osteoperosis

Because exercise is so important to bone health, confidence and overall health, Physiotec provides a unique and specialised group program based on the most current research available. It is designed to increase bone health and density through weight training, also incorporating posture and body awareness training along with balance and proprioceptive exercise aimed at reducing the risk of falls, joint overload and injury. Body – Bones – Balance (Body integration – Bone strength – Balance control) incorporates a group warm up followed by a targeted station-based exercise program that stimulates the whole body, with a special focus on improving health and strength of bones, muscles and tendons and optimising dynamic balance.

Read more information about our class here.

References

Australian Government, D. o. (2011). Don’t fall for it.

Miko, I et. al. (2017). Effectiveness of balance training programme in reducing the frequency of falling in established osteoporotic women: a randomized controlled trial. Clinical Rehabilitation, 31(2), 217-224.

Osteoporosis Australia Medical & Scientific Advisory Committee. (2019). Osteoporosis Australia.

Sherrington, C et. al. (2011). Exercise to prevent falls in older adults: An updated meta-analysis and best practice recommendations. NSW Public Health Bulletin, 22(3-4), 78-83.

TeleHealth Physiotherapy- Here to Stay

TeleHealth Physiotherapy- Here to Stay

COVID-19 brought plenty of changes to our lives in 2020, including the way we deliver physiotherapy at PhysioTec. Telehealth allowed our physiotherapists to continue providing tailored treatments and essential support during the lockdown period, via online video consultations. If you are new to Telehealth and would like to learn more, click here.

The uptake of TeleHealth was quick, with many people appreciating the flexibility and convenience of online healthcare. This is why we believe that, at PhysioTec, Telehealth has a continuing role to play in the future of physiotherapy. Here are some examples of how Telehealth benefited our patients during and outside this unusual period.

*Respecting patients’ privacy, names of the cases below are not real.

Scenario 1:

John*, a 68-year-old man living in rural Queensland, had been suffering from pain in the side of his hip for a number of years. The distance from a physiotherapist, particularly someone experienced with more persistent hip pain, made it difficult for him to get the help he really needed. His pain was gradually worsening over time.

When the COVID restrictions were introduced, John wasn’t able to continue seeing his local therapist and his hip pain worsened, keeping him awake at night. John, desperate for a solution to his pain, did some research on the Internet and came across a clinic in Brisbane (Physiotec) with physiotherapists who specialise in the management of hip pain. In the past, John would never have considered accessing help in Brisbane due to the long drive, but this new Telehealth opportunity allowed him to access someone with expertise in his problem area, without having to leave his own home.

After his initial Telehealth session, John was diagnosed with gluteal tendinopathy and provided with a treatment plan, an exercise program and access to “PhysiApp”, an online platform where he was able to view his prescribed exercise videos. This allowed him to feel confident in what he needed to do and get on with a targeted and effective rehabilitation program.

 

Scenario 2:

Mary*, a 46-year-old full time office worker, had intermittent flare-ups of buttock pain due to a history of proximal hamstring tendinopathy. Mary enjoys long distance running in her spare time, and her goal was to improve her running distance, without aggravating her buttock pain.

Mary decided to give Telehealth a try as she had a very busy schedule – this way she could get professional advice without leaving her house or sitting in traffic. Through Telehealth, Mary was able to perform physical tests under the physiotherapist’s instructions; and her physio was able to identify areas of improvement for Mary. Mary was provided with tailored strengthening exercises and she noticed improvements after two TeleHealth sessions. Mary then only needed monthly TeleHealth checkups to progress her program and ensure she was achieving her goals. In between Mary’s monthly reviews, she keeps in contact with her physio via “PhysiApp” regarding her exercise progress. Telehealth allowed Mary to actively manage her condition while pursuing her running goals and minimising time spent away from home or work.

 

Scenario 3:

Vanessa, a 29-year-old new mum experienced sharp, sudden lower back pain that was exacerbated with all movements except lying down. Vanessa needed the care of a physio but found it difficult to leave the house with a 3-month-old baby. With the back pain, she would have struggled to drive and move the baby in and out of the car. Vanessa decided to use Telehealth so she could easily and conveniently access physiotherapy from home.

During her TeleHealth consult, Vanessa was taken through an interview and physiotherapist-instructed self-assessments. Vanessa’s lower back pain was confirmed to be musculoskeletal in nature. She was provided with education and advice on how to best manage her pain at home. Gentle exercises were prescribed to help reduce Vanessa’s muscle spasm and optimise her movements. Vanessa’s partner expressed interest in helping her recovery. During the following Telehealth session, the physiotherapist was able to instruct on massage techniques and give real-time feedback.

These days, Vanessa alternates hands-on face to face treatments and Telehealth consults as she thinks they make a good combination for her pain management. Her exercise program has been progressed and the higher level exercises are easily checked via Telehealth, with the live video of Vanessa and her physio side-by-side providing excellent visual feedback.

 

What does the existing evidence tell us about Telehealth?

Modified physical examination, in the case of Telehealth, consists of virtual self-assessment. For hip-related conditions, research evidence has found that this form of modified examination is not inferior to the traditional in-clinic examination (Owusu-Akyaw, Evanson, Cook, Reiman, & Mather, 2019). The same result was seen in diagnosing chronic conditions in other areas, such as the lower back, knee and shoulder (Cottrell, et al., 2018). One unique benefit of Telehealth is that it allows the physiotherapist to conduct a real-time assessment within the home or work environment, where problems may be occurring. This helps in the development of very specific and meaningful strategies for each individual’s unique situation.

There is also an increasing body of research showing the effectiveness of Telehealth in the treatment of a variety of musculoskeletal conditions. One such study by Cottrell, Galea, O’Leary, Hill, & Russell (2017) showed that the treatment outcome in pain and physical function is comparable to the outcomes of conventional in-clinic treatments. Even in patients who underwent surgery like total hip replacement, evidence showed a high level of patient satisfaction with Telehealth, without compromising rehabilitation results (Nelson, Bourke, Crossley, & Russell, 2020).

 

Telehealth: Convenient online healthcare, from anywhere

Telehealth greatly improves access to physiotherapy services and expert advice. It allows clients who live in rural or regional areas, or those with mobility issues or disabilities, to receive quality care without the need for long commutes over vast distances. TeleHealth is also ideal for those who are time-poor, who have inflexible schedules or who are unable to travel due to their pain or disability.

Whether you have just developed a problem or you require ongoing support in managing an ongoing health condition, Telehealth could be a useful and convenient way of accessing physiotherapy.

Eric Huang Telehealth Physiotec

If you are interested in giving Telehealth a go, call us on 3842 4284 for more information. We are looking forward to seeing you online!

 

Bibliography

Cottrell, M. A., Galea, O. A., O’Leary, S. P., Hill, A. J., & Russell, T. G. (2017). Real-time telerehabilitation for the treatment of musculoskeletal conditions is effective and comparable to standard practice: a systematic review and meta-analysis. Clinical Rehabilitation, 625-638.

Cottrell, M. A., O’Leary, S. P., Swete-Kelly, P., Elwell, B., Hess, S., Litchfield, M.-A., . . . Russell, T. G. (2018). Agreement between telehealth and in-person assessment of patients with chronic musculoskeletal conditions presenting to an advanced-practice physiotherapy screening clinic. Musculoskeletal Science and Practice, 99-105.

Nelson, M., Bourke, M., Crossley, K., & Russell, T. (2020). Telerehabilitation is non-inferior to usual care following total hip replacement — a randomized controlled non-inferiority trial. Physiotherapy, 19-27.

Owusu-Akyaw, K. A., Evanson, R. J., Cook, C. E., Reiman, M., & Mather, R. C. (2019). Concurrent validity of a patient self- administered examination and a clinical examination for femoroacetabular impingement syndrome. BMJ Open Sp Ex Med.

 

 

6 Tips To Bulletproof Your Running This Summer

6 Tips To Bulletproof Your Running This Summer

It’s spring time and for many it’s a sign to start getting fit for summer. For those who had been hibernating during winter it is worth taking note of these following tips to bulletproof yourself for the months of running ahead.

 

  1. Remember you are exposing your body to increase stresses and strains that it may not be accustomed to. Many runners experience injury in their first 8 weeks by doing too much, too fast, too soon. Increase running volume by no more than 10% every 2 weeks.
  2. If you are taking up running for the first time, allow 48 hours between runs during the first four weeks. You can do other lower impact exercise on alternate days such as cycling, swimming and strength training.
  3. Break up your first few runs into run/walk intervals. For example 1 minute run/1 minute walk for 20-30 minutes. 
  4. Run with a shorter step and higher cadence. Pick the foot up as you swing the leg through and land with a verticals shin and bent knee joint in the front of the hip. Run tall with an upright posture. As you improve in fitness and strength your running technique will feel easier.
  5. Strength Training/Pilates will help your running performance and reduce the risk of injury. Runners need strong hips, trunk muscles and ankles to move well, maintain good posture and prevent injury. Two-three #strength training sessions is recommended per week focusing on whole body ground based exercises such as squats, lunges, deadlifts and step ups. Good movement and technique must be trained before adding resistance.
  6. Make sure you have the appropriate equipment/footwear. Nothing more likely to cause injury/discomfort than this. Find the runner that is most comfortable for you or a brand you trust and have used previously in the past with good results.

 

If you have pain running and you’re unsure about why, STOP! Go see your GP or Physiotherapist, find out why you have a problem and then deal with it. Many running related pains are easily dealt with, but some, if left untreated, can become chronic problems.

Enjoy your running! Every session you do doesn’t have to be better than the last one. Schedule easy runs for yourself where you don’t worry about pace and just enjoy a nice easy trot!

When is your child safe to begin resistance training?

When is your child safe to begin resistance training?

When is it safe to begin resistance training?

It is a common misconception that resistance training in children stunts growth. Many parents and coaches remain convinced that weight training will result in short stature, due to potential damage to the growths plates (epiphyseal plate).

In actual fact, The Australian Strength and Conditioning Association (ASCA) have developed a position stand on youth resistance training, which is in contrast to these beliefs.

At PhysioTec, we believe there is a place for strength and condition in children. We maintain that supervision is essential, and believe that this is an ideal time to condition young developing children and adolescents to a level where there body can not only withstand, but excel in their chosen field.

Are you still unsure?

Well, if a child is ready to participate in organised and structured sports, such as cricket, football, rugby and basketball then they are generally ready to perform a supervised resistance-training program. This will allow them to handle even the most intensive sporting schedules

 

September 2017

Physiotec’s 7 laws of Strength Training

Physiotec’s 7 laws of Strength Training

 

7 laws of Strength Training

1 Train Consistently

Consistency with training is vitally important. Those who train week in and week out will experience steady improvements in fundamental lifting skills, strength and muscularity over time. Assess your weekly routine and see when you can fit in at least 2-3 30-45 minute sessions per week into your schedule

2 Warm Ups are essential:

The “RAMP” system provides a method by which warm-up activities can be classified and constructed. This system identifies three key phases of effective warm-ups.

Activities included in the ‘Raise’ section can be used to increase body temperature and blood flow. The ‘Activate and Mobilise’ section can be used to optimise strength, control and dynamic flexibility around areas central to performance in the gym. The ‘Potentiation’ section provides an ideal time to carry out activities such as speed and plyometric training in order to prepare the body to work at maximal capacity.

3 Use Good Form:

You do need to be very strict with your exercise form, and you need to learn the right type of form for your body on various lifts. This is especially important for bigger exercises like squats and deadlifts where the risk of injury is inherently higher than, say, dumbbell curls. Developing competency in the major compound lifts such as the deadlift, squat and lunge will reduce the likelihood of injury in the gym and can ensure you train consistently throughout the year and reach your goals.

4: Stimulate the muscles of the entire body:

To make a muscle grow, it must be stimulated on a regular basis. Compound exercises are designed to stimulate a lot of muscles throughout the body. For example the deadlift stimulates the forearms, traps, lats, scapular retractors, spinal extensors, glutes and hamstrings, even the core and quad muscles This helps explain why deads are such a great exercise. However, if all you did was deadlift, your pecs, delts, and biceps wouldn’t come close to reaching their full hypertrophy potential. Make sure your programs regularly incorporate enough exercises that combine to thoroughly hit the entire body.

5; Basic Strength Must Improve:

 Progressive overload is the most important aspect in the strength game. If you embark on a strength training regimen and fail to get stronger, you won’t gain much muscle. You must use heavier loads and perform more reps over time.

As you get more experienced in the gym, you should see dramatic strength progress compared to your beginning level in a squat variation, a deadlift variation, some kind of upper body press, and an upper body pull. And if you want to be your absolute best at anything, be it squats, deadlifts, bench press, power cleans, or even Turkish get-ups, then you need to perform the lifts consistently to groove the neuromuscular patterns and maximize motor learning. Failing to do so will leave unachieved progress on the table.

6 Muscle is made in the gym and built in the kitchen.

 Nutrition is key when it comes to strength development. The best training program in the world is no match for a poor diet.

If you want to develop strength and perform optimally, then you must take nutrition seriously. You need to take in the right amount of calories and the right blend of macronutrients for your goals and physiology. You don’t have to be perfect 24/7, but eating a consistent amount of carboydrates, protein and fats can help with strength and hypertrophy gains.

7 Sleep.

Some folks need more sleep than others and some can perform well with less, but you should still care about your sleep (quantity and quality) and prioritize it. Make a genuine effort to be consistent with your sleep schedule if you’re serious about getting results. Failure to do so will hinder your pursuit of strength and hypertrophy.

Regarding stress, your goal shouldn’t be to eliminate it altogether, but rather to optimize it. It’s good to be challenged in life, but there’s a fine line between eustress (positive stress, like a good workout) and distress (negative stress, like 65 hours a week at a job surrounded by toxic co-workers). Aim to stay in eustress most of the time for maximum results. Step back and analyze your life choices and habits. This is an area in which many lifters can make adjustments that lead to immediate results.

 

Resistance training for persistent pain

Resistance training for persistent pain

Resistance Training for Persistent Pain

Resistance Training

At Physiotec, we see many people with persistent hip and lower back pain. A lot of them are fearful regarding resistance training or are unsure what types of exercises are appropriate for them. There is often a misconception surrounding resistance training regarding its potential to be harmful or unsure for patients with persistent pain. At Physiotec, we aim to create an environment, which promotes strengthening in a safe and graduated way.

Benefits of resistance training

There are many benefits of resistance training including improving muscle mass and bone density, injury and falls prevention and overall movement patterns. In our new strength and conditioning gym, you have a unique opportunity to be closely monitored by a physiotherapist who combines their excellent knowledge of pain science and resistance training in the overall management of your condition.

Assessment and management programs

All our assessment and management programs are 100% individualized to suit your specific needs. Whether you are young or old or are experienced or inexperienced with resistance training, our Gymstart program offers you a new and exciting approach to the management of your presentation.