Archive for category General

We are seeing more and more patients with connective tissue disorders and although there are many different CT disorders (too many to cover in one blog) we thought it might be helpful to give an overview so you can learn the basics. The big question we hear you ask is “What is connective tissue?”.

Connective tissue is the stuff in our bodies that holds all of our cells together. It’s a bit like glue. It has a special role, allowing our skin and other tissues to stretch and then return back to their original state. You can kind of think of it like an elastic band that stretches and recoils over and over. Connective tissue is made of protein, and the main examples in the body include collagen and elastin.

Connective tissue disease can pretty much affect any part of our body. Our bodies are made up of trillions of cells (approximately 37.2 trillion!) which all require some form of glue to ensure we are held together in our human form. There are diseases that affect our skin, muscles and tendons, ligaments, bones and cartilage, blood and blood vessels, eyes and more!

Types of disease

To make things a little easier to get your head around, we can break CT diseases into two categories:

• Inherited diseases: These are diseases passed down to us in our genetic make-up. Most of these diseases occur due to a mutation of a single gene.
• Autoimmune diseases: These are diseases where our bodies create antibodies that fight against our own tissues. In this case, it’s the connective tissues that our body is fighting against.

Inherited diseases

Here’s a brief overview of a few inherited CT diseases:

• Ehlers-Danlos Syndrome (EDS): A group of 13 differing conditions that affect collagen in the body. Common symptoms include very mobile joints and excessively stretchy and fragile skin. People may also experience heart and lung problems as well as weakened blood vessels.
• Marfan Syndrome: A condition that affects the production of the protein Fibrillin-1 in the body. Symptoms are widespread, affecting the blood vessels, heart, bones, joints and eyes. Marfan Syndrome affects approximately 1 in every 5000 people.
• Osteogenesis Imperfecta: Also known as ‘Brittle Bone’ disease. This is a condition that affects collagen (specifically Type I) and leaves bone more fragile and prone to fracture. Other signs and symptoms include a blue tinge to the whites of the eyes, hearing loss and weak joints and teeth.

Autoimmune diseases

Here’s a brief overview of some autoimmune CT diseases:

• Rheumatoid Arthritis (RA): This is not to be confused with the more common Osteoarthritis (OA). RA is a condition typically associated with inflammation of the small joints of the body, like those found in the hands, feet and wrists. Joints become hot, red, swollen, painful and stiff as the body fights against the tissues that line and surround the joints. Over time, the joints go through degenerative change and may appear deformed. This condition may also cause inflammation around the lungs and heart, as well as affecting many other systems of the body.
• Systemic Lupus Erythematosus (SLE): A condition that causes inflammation of the skin, joints and various organs of the body. Symptoms are widespread and include a butterfly shaped rash on the face and nose, light sensitivity, mouth ulcers, kidney disease and mental illness including memory loss.
• Scleroderma: A group of conditions that lead to the thickening and scarring of the skin, organs and blood vessels. People may also experience Raynaud’s Phenomenon; a condition where the blood vessels in the fingers and toes go into spasm resulting in a lack of blood flow to the area. This will look like areas of white and blue over the skin with numbness being another symptom.

It is not uncommon for people with one autoimmune CT disease to show signs and symptoms of other autoimmune diseases too. In these instances, a person is referred to as having Mixed Connective Tissue Disease (MCTD). Many people with these overlapping conditions go on to receive a firm diagnosis of SLE or Scleroderma later in life.

We hope you found this blog a helpful tool for learning about CT diseases. If you have a CT disease or want to know more information on a particular condition, feel free to ask us next time you are in the clinic. Have a great month and stay safe everyone.

Welcome to this new world of telehealth! We are all in this together, but the funny thing is that telehealth has actually been used by physiotherapists for years, especially in remote locations. While we know the benefits of manual therapy and contact with in-person treatment, telehealth appointments have been shown in many studies to be just as effective as in-person treatment in achieving positive outcomes! So rest assured that your telehealth appointment will be safe, effective and delivered by a professional, experienced practitioner.

But of course, there are a lot of questions about telehealth, what it is and how it all works, including payments. So we’ve compiled a list of FAQs for you:

What is telehealth?

Telehealth is a virtual appointment. It’s just like your normal physiotherapy appointment, but done online using video calling software, Zoom. You can see your practitioner and they’ll be able to see you. You can chat to each other as normal, via your computer, tablet or phone. Telehealth also covers phone-only consultations, although most clinics will offer video consultations over phone consults.

How does it work?

You will be emailed a link before your appointment time. Click on the link and the software will open. We recommend that you test the link beforehand to check your computer sound. Helpful hints:

• Try and be somewhere with little background noise, or plug in headphones to help eliminate the background noise. But don’t worry if you have kids around and this is impossible – we get it!
• Make sure your room is well lit, and preferably have the light in front of you (this is so we can see you, rather than just your silhouette).
• Try to have two metres of space behind you. This is so you can perform any movements your practitioner may ask of you and so they can see your whole body in the screen.
• If you’re doing classes, have a towel and water bottle nearby.

Can I claim Medicare and be bulk-billed?

If you have a Chronic Disease Management (CDM) plan (formerly EPC), you can continue to claim appointment costs through medicare, with no out-of-pocket expenses. We bulk-bill Medicare directly and you will NOT have any gap payments for telehealth appointments. If you don’t have a CDM, but need one, book in for an appointment with your GP. This can also be a telehealth appointment, and the referral does not have to state ‘telehealth appointment’ – it is simply understood that appointments can be bulk-billed for either in-person or telehealth treatments.

Does my private health insurance cover it?

Every private health insurer is different, however many are now covering telehealth appointments. It’s best to contact your private health provider to check if you’re covered.

Hey everyone! This month’s blog focuses on the shoulder, more specifically the rotator cuff muscles and some common conditions we regularly treat here at Philip Wood Physiotherapy. The shoulder is one of the most common regions of the body that we treat. One of the main reasons the shoulder gets injured is that it’s a super mobile joint. It is the most movable joint in the body in fact! In order to have so much mobility, the joint has to sacrifice stability, and the lack of stability in the shoulder leaves it susceptible to injury.

Efficient movement in the shoulder largely relies on the proper functioning of the rotator cuff muscles. Read on to find out what they are, what they do, and what can sometimes go wrong with them.

What is the rotator cuff?

The rotator cuff is a group of four muscles – the Supraspinatus, Infraspinatus, Teres Minor and Subscapularis. If you have trouble remembering the names, just think ‘SITS’. Easy-peasy! Each muscle attaches from the shoulder blade (scapula) to the arm bone (humerus) and has a specific function to play in shoulder movement.

What does it do?

In a nutshell, the supraspinatus helps to take the arm away from the body (abduction), the infraspinatus and teres minor help to rotate the arm outwards (external rotation), and the subscapularis helps to rotate the arm inwards (internal rotation… Other muscles also help with these movements too). Collectively, the four muscles work together to keep the ‘ball’ of the arm bone centred over the ‘socket’ of the shoulder blade. By doing this, it allows us to have a relatively free and large range of motion in the shoulder in all directions of movement. But remember, lots of mobility is only achievable by sacrificing stability, and this is where the shoulder and rotator cuff sometimes come unstuck.

Common conditions

Here is a brief overview of some common rotator cuff disorders:

• Rotator cuff tendon injury: Who remembers what tendons do? We’ll give you a clue… They attach muscles to bones. A tendon may become injured acutely (known as tendinitis) or in a chronic way through degeneration (known as tendinopathy). This commonly occurs due to impact to the shoulder or through repetitive movements as seen with throwing sports in the initial stages. If the movements continue over a long period of time and healing doesn’t occur fully, the tendon tissue can degenerate, leading to tendinopathy.
• Rotator cuff tear: If the above process continues over an even longer time period, the tendon will degenerate more and eventually it may reach a point where the tendon tears. This can cause significant loss of movement and pain with shoulder movements.
• Subacromial impingement: Between the ball of the arm bone and the tip of the shoulder (a.k.a The acromion) sits a small space called the subacromial space. Several structures run through this very small space, including the tendon of the supraspinatus and part of the biceps muscle. There is also a fluid filled sac called the subacromial bursa which helps to keep movement smooth in the shoulder joint. Repetitive movements can lead to any of these structures becoming irritated and inflamed, making an already small space even smaller. The shoulder then cannot function to its full movement capability and movement becomes painful. Rotator cuff tendinitis is one cause of subacromial impingement.

All of the above conditions share some common signs and symptoms. The main symptom experienced is pain with shoulder movement, particularly when raising the arm above the head, in front or out to the side of the body. Acute tendinitis, chronic tendinopathy and a tear can all lead to weakness during shoulder movements, although weakness associated with a tear is usually more severe. You may also experience pain when lying on the affected shoulder at night-time. Sometimes it can be difficult to determine from the outset what condition is developing, but we will make an informed decision based on the information you give us and what signs and symptoms you have when we assess you.

Treatment

All of the above conditions can be managed well with manual treatment and exercise. With the exception of severe tears, which may need a shoulder specialist/surgical opinion if the injury doesn’t respond well to conservative treatment, rotator cuff injury is commonly managed from start to finish by us here at Philip Wood Physiotherapy, so always come to us as a first port of call.

Acute injuries will always need time for the body to deal with the inflammation that has occurred. Then a combination of massage, shoulder and spinal joint mobilisation and mobility and strengthening exercises are what is required to get over these painful conditions. The exercise program will start simple and gradually progress over time; it aims to return the muscle and tendon to full strength, as well as re-train efficient shoulder and spinal movements that may have been lost during the injury process.

We may decide to use other treatment techniques including taping, therapeutic ultrasound and treatments to aid in the healing process.

Most rotator cuff injuries respond very well to manual treatment. Even small tears can be well managed this way. If you have shoulder pain and need some help, please get in touch today, so we can get you back on the dancefloor, shimmying to your heart’s content!

We would like to update you on the precautions we are taking to address the current COVID-19 situation at Philip Wood Physiotherapy.

Firstly, we are closely monitoring all available information provided by the Australian Department of Health and the World Health Organisation (WHO) in relation to the current Pandemic. We are using this information, and its regular updates to inform the management strategies we develop to prioritise the safety of our patients and employees.

Secondly, we have implemented the following immediate measures;

• Staff have been instructed not to come to work if they are experiencing flu-like symptoms, have recently returned from overseas, or have been in close contact with a confirmed case of COVID-19.
• Staff have been retrained in safe handwashing procedures, and gloves will be worn during all cleaning processes to protect both patients and employees.
• We are working to ensure hand sanitiser is available to patients and will provide information throughout our practices about safe hygiene practices.
• We are encouraging the use of card payments wherever possible to limit the handling of cash for both our patients and employees.

Increased cleaning coverage

Our primary goal is to increase the frequency of cleaning for high touchpoints in common areas, such as bathrooms, handrails, doors, point of sale equipment and admin areas. We have also withdrawn the use of paper/disposable sheets on treatment beds in favour of a wipeable service that will be disinfected between each patient use and allowed to dry. We will continue to use disposable face masks per patient.

We have also removed handtowels in the bathroom and provided paper wipes accordingly.

Thank you for your patience and understanding during these difficult times.

Philip Wood Physiotherapy
March 2020

Do you love the outdoors? Fresh air, sunshine, wind, rain, wildlife and nature… Blissful! We don’t know about you, but we absolutely love to get outside and immerse ourselves in the natural environment. Just you, a backpack, some energy food, a water bottle and for the organised ones, a compass and a map. Oh, and don’t forget those hiking boots.

If you’ve never considered hiking before, but like the thought of immersing yourself in nature while getting some great exercise, then maybe you need to. With technology leading the way these days, it’s easy to get bogged down with binging on TV shows and playing your favourite video games after a long week at work. We’ve all felt it before, the urge to just put our feet up for the weekend and chill. That’s okay every now and then, but we as humans need to move more, and hiking is a great way to do that. Other than a few initial costs with getting yourself a decent pair of walking boots and a backpack for all of your supplies, it’s basically a free activity. And, it comes with a heap of benefits. Read on to find out more.

The advantages

The benefits of hiking include:

• Increased muscle strength: Hiking is essentially walking, but tends to involve walking over different terrain which may range from flat forest pathways to rocky mountainous passes. Either way, getting yourself out and about is going to get those trunk and lower limb muscles engaged and pumping. This type of exercise will help to improve strength in your glutes, quads, hamstrings, calves and trunk muscles which will provide stability to your skeleton and joints, and help keep away potential joint problems like osteoarthritis.
• Improved cardiovascular health: The planet is becoming more obese as each year passes, which is seeing an increase in heart-related disease. A great reason to try hiking as it could help you to control or lose weight, reducing stress on the cardiovascular system. Regular exercise of this type has been shown to lower blood pressure and blood-sugar levels, reducing the risk of developing heart disease and conditions like type-2 diabetes. Challenging yourself to walk up and down difficult terrain is a fantastic way to improve your aerobic fitness and keep everything in check.
• Improved core stability and balance: Walking over rocky and uneven terrain is a great way to challenge those core stabilising muscles and work at improving your balance. Walking on flat, even surfaces doesn’t provide the body with that side to side component of movement that walking on an uneven surface can do.
• Improved mental well-being: There is evidence that spending time in green, natural environments away from urban jungles can help to reduce stress levels in people. The outdoor, rural landscape can provide you with a sense of peace and quietness, calming the mind of all of life’s worries. This is something you just don’t realise when you are constantly in the hustle and bustle of city life where noise and pollution are rife throughout.
• A chance to socialise: Humans are social beings. We like to engage with others (there are always exceptions to this rule!) and be with them to really enjoy the benefits of living. If family time is short mid-week because of work, school and other engagements, hiking gives you the perfect opportunity to be with the ones you love. You can talk, move and have fun together in a beautiful environment. What else do you need?!

Suggestions for hiking

If we’ve said enough to get you on board (hooray!), there are a few little pointers we want to bring to your attention before you get going.

1. Get equipped: Ensure you get fitted with a good pair of walking boots, grab a backpack and if you are just starting out, a hiking stick or pole may be of benefit to help you through trickier terrain (especially if you have any knee issues).
2. Pack water and food: Have enough with you to keep your energy and hydration levels up throughout your hike.
3. Find a route that fits your abilities: If you are just beginning, we suggest you don’t go straight for the most mountainous route out there. Try an easy track or nature reserve walk before attempting K2 or Everest (you need extra training for these by the way!).
4. Take a friend or family member: It’s sometimes good to get out on your own for ‘you’ time, but hiking is great when done with someone else. Having more than one person means that if you get injured or help is needed, you are not stranded alone with nowhere to turn to. Keeping in mind, some hikes may be in areas with little cellular reception.
5. Let someone know you are going: It is safer to tell someone at home or a neighbour that you are heading out. The outdoors is sometimes unpredictable so letting someone know where you are going and when to expect you back is another safety measure worth having in place.

So what are you waiting for? Get out there and really enjoy what the world has to offer. We live on a beautiful planet, so make sure you get to experience it and improve your health whilst doing so.

Ready. Set. HIKE! (You can reward yourself with an episode of your favourite show when you get back!)

Have you ever rolled your ankle? Plenty of us have, especially when we partake in sports such as netball, basketball, volleyball, football and soccer. These sports all involve pivoting, quick changes of direction, jumping and landing. The classic ankle injury involves rolling your ankle during landing on an uneven surface from a jump, or lunging for a ball during a tackle, where your foot rolls inwards and your leg outwards upon contact with the ground.

About ligaments

Our ankles are stabilised either side by an outside and inside ligament (tissues that attach bone to bone). The inside (medial) ligament is much stronger than the outside (lateral) one, therefore injuries to these ligaments where you roll your foot outwards, are much less common. The outside ligament is made up of three parts – front, middle and back. The front part of the ligament is the weakest and is usually the most affected in ‘rolling’ injuries. With more severe injuries, it is possible to affect the other parts too.

What happens when I roll my ankle?

When you roll your ankle, forces placed on the outside ligaments may be too great, and the ligament will sprain. A sprain is broadly categorised into three grades:

• Grade 1 – the ligament is overstretched but not torn
• Grade 2 – the ligament is partially torn with some ligament fibres still intact
• Grade 3 – the ligament is completely torn (also known as a ‘complete rupture’)

Signs & symptoms

As with most ligament injuries, it starts with a moment where too much strain or force is put through the joint/ligaments, and you feel something give. This is usually painful and may or may not be accompanied by a ‘pop’, which usually signifies that something has torn. Depending on the severity of the injury, you may start to see swelling and bruising appear quickly, or it may take time to develop. Either way, bruising is another sign something has torn and bleeding has occurred under the skin.

Whether you can put weight through the joint and walk straight after injury is an important part of the process. If you can, this tends to indicate a less severe injury. If you can’t and require help to move off the field or court, this may mean something more serious has happened, like a fracture alongside a sprain. If this is suspected by your physio, you may be sent off for x-rays to confirm.

Immediate treatment

It is important that the injury is managed well from the beginning to ensure a speedy and hassle-free recovery. The first goal is to protect the joint from further injury. Depending on severity, this may require you to be off your feet for a short period, so crutches may be needed. After this, it is recommended to start putting weight through the joint to help reduce swelling and increase movement. Ice, compression and elevation are also recommended in these early stages. If it turns out you have a fracture too, there will be a short period of immobilisation in a boot to allow the fracture to heal.

Further treatment and return to play

After the acute period is over and your swelling and pain are controlled, your physio will get to work on your ankle. You would have lost range of motion of the joints, so they will mobilise them and give you exercises to keep mobilising at home between treatments. You would have lost some strength as well, so you will need to strengthen the surrounding muscles, as well as work on other aspects of fitness including balance.

During this period, you will get back to full weight bearing activities starting with walking and moving through to jogging, running, jumping and landing, adding agility exercises to retrain the ankles’ ability to pivot and change direction without giving out on you again. You’ll need to complete some rigorous training before your physio clears you to return to the field of play to compete. The time it takes you to get back playing will depend on the severity of your injury, with a simple low-grade sprain taking anywhere from 2-4 weeks to heal, and a severe sprain and fracture taking months.

If you have rolled your ankle and need some help to get back to the field or court, then look no further. Call us today on 9838 3030 to book your appointment, and we’ll have you hopping, skipping and jumping in no time at all!

With most of the winter sports coming to a close, we may start to see a few less sports injuries coming through the door. But far out, we have been busy treating all kinds of injuries this season! There are thousands of really active kids in Australia and across the world – and active kids are bound to pick up a few injuries here and there. Being young comes with its advantages, but it also comes with its hurdles. Growing being one of them.

Active adolescents are particularly susceptible to developing a knee condition called Osgood-Schlatter disease. This problem usually arises around the time when a child goes through a big growth spurt when rapid changes are occurring in the bones and muscles. Does your child play lots of sport and sometimes has pain around the front of their knee? Are they currently in the middle of a growth spurt? Then read on…

What is Osgood-Schlatter disease?

Osgood-Schlatter disease is a condition which is characterised by inflammation and pain on and around a bony prominence on the lower part of the knee joint. As your quad muscles run down your thigh to your knee, they merge to form the patella tendon which then inserts into the shin bone or tibia. Where the patella tendon inserts into the tibia is called the tibial tuberosity (you should be able to feel the small bump at the top of your shin bone). Inside this part of the bone is a growth plate, a highly active part of the bone where put simply, growth of the bone takes place. Now, because kids these days play a hundred different sports and activities, the quad muscles repeatedly contract, especially during running and jumping (footy and netball are classics for this type of injury). This can lead to the pulling, softening and irritation of the growth plate underneath where the patella tendon inserts. This leads to inflammation and ultimately, pain which is aggravated by exercise.

Who does it affect?

Boys are generally more affected than girls, and usually at slightly different ages due to the differences in age when the growth spurt occurs in each gender. Once activity at the growth plate slows and eventually closes, the pain relating to this condition generally goes away. This is usually around the age of 16 in boys and 14 in girls. Depending on how severe the problem is, the end result may be having to live with a slightly enlarged tibial tuberosity.

Can treatment help?

The simple answer is yes! And treatment is pretty simple too. After consulting your physio for   diagnosis and advice, the most important aspect of treatment for this condition is activity modification. If the child can modify the amount of activity they are doing, it can greatly reduce the amount of pull on the bone and therefore less irritation to the growth plate. Because it is a developmental condition, children and parents should be informed from the beginning that symptoms may come and go, but may last right up until the child reaches the age where the growth plate closes. So, play when you feel good, and rest when you are in pain. Your physio will likely release excess tension in the quads and provide you with some light stretching to perform at home. Some people also respond well to strengthening and this is usually implemented when pain allows.

Icing when pain is high may help to reduce pain and control inflammation and swelling. There are also some handy patella tendon de-loading taping techniques which your physio may well make use of to control pain and keep your child playing longer.

We hope you found this an interesting and educational read. If you are young and reading this, or if you have a child with knee pain that is aggravated by exercise, please call Philip Wood Physiotherapy on 9838 3030 to book an appointment or talk about treatment options.