Shoulder instability and recurrent shoulder dislocations are the cause of a lot of visits to Dee Why physiotherapists and shoulder surgeons.
The root cause of shoulder instability can be a number of different conditions, and the most commonly injured structure following a shoulder dislocation is the anterior labrum, AKA Bankart lesion.
What is a bankart lesion?
The Bankart lesion is named after English orthopaedic surgeon Arthur Sydney Blundell Bankart.
The shoulder socket, or glenoid is covered with a layer of cartilage called the labrum that cushions and deepens the socket to help stabilise the joint. During anterior shoulder dislocations (when the humeral head is displaced towards the front) the labrum may be torn. Labral tears and other lesions are also common in athletes and workers that use repetitive overhead activities.
After a dislocation in young patients, instability recurrence rate has been reported to be up to 90%.
Occasionally a bony piece of the socket will fracture off with the labrum; this is imaginatively called a “bony Bankart” lesion.
Symptoms of a Bankart lesion can include:
- Pain when reaching overhead, to put the seatbelt on and daily activities.
- Instability and weakness that causes apprehension about moving the shoulder into certain positions away from the body. Low energy movements, like rolling over in bed commonly mentioned as times when their shoulders can ‘slip’.
- Limited range of motion.
- Grinding, catching, locking in place, or popping
Bankart lesions are commonly treated using conservative methods such as rest, immobilisation, and a physiotherapy program, particularly in older patients.
However, many cases require surgery to reattach the torn labrum to the socket of the shoulder performed through arthroscopy.
As with any surgical procedure, there are risks associated with arthroscopic Bankart repair that may include:
- Blood clots
- Shoulder stiffness
- Blood vessel or nerve injury
- Post traumatic arthritis.
Early physio rehab goals after bankart repair surgery
After arthroscopic Bankart repair, you will generally be required to keep your arm immobilized in a sling for approximately one month but physio will usually start within the week.
Once you have had surgery to repair your bankart lesion, Early goals for your surgery rehab will be to:
- Protect surgical repair
- Reduce swelling, minimise pain
- Maintain range of motion in the elbow, hand and wrist
- Minimise muscle inhibition
- Educate you on your injury and ways to minimise recurrence
After surgery it is important to
- Not overstress healing tissue
- Gradually return to full functional activities
- Do your rehab exercises
- Listen to your physio
Be sure to follow your bespoke treatment plan. Although recovering from shoulder surgery can be a slow process, your commitment to physiotherapy is the most important factor in returning to all the activities you enjoy without pain or fear of instability.
 Bankart ASB. Recurrent or habitual dislocation of the shoulder- joint. Br Med J. 1923;2(3285):1132-1133. doi:10.1136/bmj.2.3285.1132.
 Taylor DC, Arciero RA. Pathologic changes associated with shoulder dislocations. Arthroscopic and physical examination findings in first- time, traumatic anterior dislocations. Am J Sports Med. 1997;25(3):306-311. doi:10.1177/036354659702500306.
Osteoarthritis and rheumatoid arthritis are very different diseases managed very differently, but are often confused when people come in to my Northern Beaches office to talk about their sore joints.
Although both cause pain and damage to joints, the damage occurs for different reasons.
How are rheumatoid and osteoarthritis different?
Rheumatoid arthritis differs from osteoarthritis because in rheumatoid arthritis it is the faulty immune system that causes inflammation, while in osteoarthritis the joints become damaged through wear and tear.
Your immune system is an intricate mechanism that enables your body to defend itself against bacteria, viruses and other organisms that want to invade it. A healthy immune system knows which of these are foreign to the body and which ones belong, the rheumatoid arthritis sufferer’s does not. If you have rheumatoid arthritis, your immune system sends antibodies to the lining of your joints, where instead of attacking harmful bacteria, they attack the tissue surrounding the joint.
Osteoarthritis normally starts later in life than rheumatoid arthritis and along with joint pain, some rheumatoid arthritis sufferers feel tired or generally unwell when inflammation occurs. In rheumatoid arthritis it is also possible to have inflammation in other organs as well as the joints, for example, the lungs and blood vessels, but usually it is the joints that are affected.
Having rheumatoid arthritis means that your joints are much more vulnerable to damage than other people’s joints are.
If you have been diagnosed, it is important to start rheumatoid arthritis treatment ASAP
The word pain is derived from the word poena, which means punishment. And that’s exactly how many rheumatoid arthritis sufferers describe their pain.
Even though rheumatoid arthritis can’t be prevented, there are a number of strategies that can minimise its impact on your life. Early treatment of Rheumatoid arthritis has been shown to slow the progression of joint damage in most patients, helping to prevent irreversible disability.
Before starting treatment, your Fixio physio will determine your needs based on any current incapacity, disability, and handicaps.
One of the key issues for anyone who has rheumatoid arthritis is dealing with pain, stiffness and discomfort. Many people with rheumatoid arthritis rank pain as the most important symptom to be treated.
Your physio will ask you a number of questions about your:
- limitations in daily functioning,
- morning stiffness,
- muscle strength,
- joint range of motion,
- joint stability,
- limitations in leisure activities,
- aerobic capacity and
- limitations in work situations
Your joints will likely be checked for the presence of swelling, tenderness, loss of motion, and deformity.
Your physiotherapy treatment may include:
- The application of heat or cold to relieve pain
- Rest and splinting during rest to reduce pain and improve function
- Education on safe exercising for your needs
- Relaxation techniques to relieve secondary muscle spasm
Staying active with rheumatoid arthritis is a balancing act
Too much heavy weight bearing exercise such as jogging, jumping, lifting can overload already painful eroded joints. But people who have rheumatoid arthritis need strong muscles to support their joints, particularly if they are damaged due to cartilage erosion.
Pain and stiffness from not keeping active can often lead patients to avoid using the affected joints. This lack of use can result in loss of joint motion and muscle atrophy, decreasing joint stability and producing a further increase in fatigue and weaker muscles.
This is where an expert physio can guide you through a bespoke exercise program.
Objectives of physio treatment of rheumatoid arthritis are to
- prevent disability,
- to increase functional capacity,
- to provide pain relief,
- and to provide patient education.
If you have been diagnosed with rheumatoid arthritis or would like more information regarding your specific pain, give us a call to book an appointment with one of our Fixio experts.
Your brain is fed by blood carrying oxygen and nutrients through blood vessels called arteries.
Stroke is the term doctors use when blood cannot get to your brain because of a blocked or burst artery, causing your brain cells to die due to a lack of oxygen and nutrients.
Up to 1.9 million brain cells may die every minute when they do not get enough blood.
What is a stroke?
There are two main types of stroke:
Ischemic strokes are caused by a blockage in one of the blood vessels that supply oxygen and other important nutrients to the brain. The majority of strokes are ischemic.
Haemorrhagic strokes occur when blood vessels in the brain leak or rupture, causing bleeding in or around the brain. This can lead to pressure within the head, which can cause damage to the brain.
Strokes can cause long-lasting disability or even death. However, early treatment and preventive measures can reduce the brain damage that occurs because of stroke.
What are the symptoms of stroke?
Every stroke is different. How a stroke affects someone depends on where it happens in the brain, and on how big the stroke is. Signs and symptoms of a stroke may be similar to other conditions; the only way to know for sure is to be seen as soon as possible by an experienced doctor or nurse.
The symptoms of a stroke usually begin suddenly but sometimes develop over hours or days, depending upon the type of stroke.
In both ischemic and haemorrhagic stroke, depending upon the area affected, a person may lose the ability to move one side of their body, the ability to speak, or a number of other functions.
Knowing the signs and symptoms of a stroke can be lifesaving.
Classic stroke symptoms can be recalled with the acronym FAST, or BE-FAST with each letter standing for one of the things you should watch for:
- Balance – Is the person having trouble standing or walking?
- Eyes – Is the person having trouble with their vision?
- Face – Sudden weakness or droopiness of the face, or problems with vision
- Arm – Sudden weakness or numbness of one or both arms
- Speech – Difficulty speaking, slurred speech
- Time – Time is very important in stroke treatment. The sooner treatment begins, the better the chances are for recovery. Call an ambulance right away.
What are the risk factors for stroke?
There are a number of risk factors for stroke; some of these factors increase the risk of one type of stroke, while others increase the risk of both types.
Ischemic stroke risk factors include the following:
- Heart disease
- High blood pressure
- High blood cholesterol levels
- Inactive lifestyle and lack of exercise
- Current or past history of blood clots
- Family history of cardiac disease and/or stroke
Haemorrhagic stroke risk factors include the following:
- High blood pressure
- Illegal drug use
- Use of warfarin or other blood thinning medicines
Following a stroke, you should be assessed by a physiotherapist as soon as possible
After a stroke, our brains cannot grow new cells to replace the ones that have been damaged, but the brain has the ability to reorganise its undamaged cells and make up for what has been lost. This is called neuroplasticity. This process can be guided by the rehabilitation you receive following your stroke, and your physio will provide expert guidance on how to relearn movement and regain function.
Physiotherapists specialise in treating issues related to motor and sensory impairments; helping to restore physical functioning by evaluating and treating problems with movement, balance, and coordination exercises.
A physiotherapy program for stroke rehabilitation may include exercises to strengthen muscles, improve coordination, and regain range of motion.
During physiotherapy you may do exercises to strengthen weak muscles and build up your stamina. Stretching exercises can reduce muscle and joint stiffness. You may also work on specific skills that you need to improve. For example, if you are having difficulty keeping your balance, you may be asked to stand up a lot. If you have difficulty lifting your arm, you will need to do activities that make you lift and use your arm. If you are having difficulty walking you need to walk as much as possible.
You may work on a one-to-one basis with a physiotherapist, particularly on the tasks and the movements you are re-learning to do. You will also have home-based activities to do on your own outside of therapy sessions.
Most people recover quickly in the first weeks after their stroke and when you start physiotherapy, your physio will plan and set goals and exercises with you.
You should have physiotherapy for as long as you need it, ending when you have reached your goals, such as walking or improving your balance.
Blood pressure is the measure of how strongly your blood presses against the walls of your arteries as your heart pumps it around your body.
This number is split into systolic blood pressure and diastolic blood pressure.
- Systolic pressure refers to the maximum pressure within the large arteries when the heart muscle contracts to propel blood through the body.
- Diastolic pressure describes the lowest pressure within the large arteries during heart muscle relaxation between beating.
If your blood pressure is too high, it may put a strain on your arteries and heart, increasing your risk of a heart attack, stroke and kidney problems.
The good news is that your blood pressure can be brought down to, and maintained at a normal level with lifestyle changes that physiotherapy can help with.
What is hypertension?
Borderline hypertension or high blood pressure is for the adult, a systolic blood pressure between 140 and 159 mmHg or a diastolic blood pressure between 90 and 95 mmHg. While a systolic and diastolic pressure of 160 and 96 mmHg respectively or greater is considered to be absolute hypertension.
Hypertension and its complications (stroke, congestive heart failure, kidney failure and heart attack) are major medical problems all over the world.
High blood pressure can have several causes
Modifiable risk factors include:
- unhealthy diets (excessive salt, a diet high in saturated fat, low intake of fruits and vegetables)
- physical inactivity
- consumption of tobacco and alcohol, and
- being overweight or obese.
Non-modifiable risk factors include:
- a family history of hypertension
- age over 65 years and
- co-existing diseases such as diabetes or kidney disease.
What will happen when I see a physiotherapist?
Your physiotherapist will work with you to identify what changes in your lifestyle are necessary and achievable. In particular, they will develop a programme of exercise to increase your physical activity safely and effectively.
How can physiotherapy help manage high blood pressure?
Your physiotherapist can advise you about how to lower your risk of developing high blood pressure and also about how to reduce your risk of health problems once you have been diagnosed.
A well-being review delivered by a physiotherapist with knowledge of pulmonary hypertension can identify simple lifestyle changes that can help prevent you having to take medication.
Supervised exercise training has been shown to be beneficial in patients with pulmonary hypertension. exercise in patients with pulmonary hypertension is safe and leads to improvements in functional ability and quality of life.
In particular, your physio can tell you which exercise programmes are suitable for you, depending on how high your blood pressure is, how fit you are and how any other health conditions or disabilities you may have will affect your ability to exercise.
How can I help lower blood pressure myself?
The main advice is to have your blood pressure checked regularly, take regular exercise and eat a healthy diet.
- Go for a walk every day. Start with short distances and build up gradually.
- Get advice from your physiotherapist or GP before you start doing more energetic and exercise
- Stop smoking
- Lose weight if you need to
- Eat a balanced diet with plenty of fresh fruit and vegetables and oily fish
- Reduce the amount of alcohol, salt and animal fat in your diet
- Take your medication as prescribed.
 Guidelines Committee (2003) European society of hypertension European society of cardiology guidelines for the management of arterial hypertension. J Hypertens. 21-1011-53.
Leggio M, Fusco A, Armeni M, et al. Pulmonary hypertension and exercise training: a synopsis on the more recent evidences. Ann Med 2018; 50(3): 226–233.
Spinal stenosis is a condition that can cause pain, numbness, or tingling in the back or down the legs. Spinal stenosis is a narrowing of the spinal canal or of the spaces between the vertebrae where spinal nerves pass through. This narrowing is usually caused by arthritis or injury, and can cause symptoms for different reasons.
Your back is made up of bones, muscles, nerves, and other tissues that work together to help you stand and bend
There are four main regions of the back;
The cervical, thoracic, lumbar, and sacral zones.
- There are 7 cervical vertebrae located in the neck
- There are 12 thoracic vertebrae located in the upper back
- There are 5 lumbar vertebrae located in the lower back
- The sacrum and coccyx are fused bones, found at the base of the spinal column
The vertebrae are stacked on top of one another with the spinal cord passing through openings in the back of the vertebrae, and small nerves exiting from the spinal cord and passing through spaces on the sides of the vertebrae. The vertebrae are held together by ligaments and tendons, allowing the vertebrae to move together as the spinal column bends forwards, backwards, and side to side.
The spinal cord is the highway of nerves running through the vertebrae that connects the brain to the rest of the body (this is why problems in the back can cause leg pain or bladder and bowel problems.)
Between each stacked pair of vertebrae in the spinal column is a disc made of a tough outer tissue and a gel-like inner pulp. These discs protect the bones, acting like cushions or shock absorbers.
The vertebrae can form bone spurs – small growths that pinch the spinal cord or the nerves branching from the spinal cord and discs can shrink and make the space between the vertebrae smaller. This can cause the vertebrae to pinch the nerves that pass through them.
What are the symptoms of spinal stenosis?
Spinal stenosis does not always cause obvious symptoms, when it does they are usually worse when the person is walking or standing upright, getting better if they sit down or bend forward at the waist.
Other common symptoms are back pain and tingling or numbness that spreads down the legs. Severe spinal stenosis can cause leg weakness or even trouble controlling your bowels or bladder.
How is spinal stenosis diagnosed?
Imaging tests, such as an X-ray, MRI, or CT scan, can show what’s going on inside your back.
How is spinal stenosis treated?
A small number of people end up needing surgery to treat a spinal stenosis. But most people do well with a combination of physiotherapy to teach you special exercises and stretches to improve your strength and flexibility, hands-on massage and pain medication for flare-ups.
What can I can do on my own to feel better?
People instinctively think that bedrest is the best treatment for a bad back. The truth is, bedrest can actually make back problems worse because the back can get weak and stiff with too much rest.
Even if you have some pain or discomfort, stay as active as possible. One of the most important things not to do is to stay in bed or rest too long.
Find physical activities you like to do and slowly do more. While working with your physio to avoid any activities, such as bending or lifting, that you shouldn’t do for a while.
The shoulder joint has evolved to give us mobility, sacrificing some stability along the way and volleyballers, footy players and plenty of others (myself included) in my Dee Why office have felt the effects of that.
Dislocation and subluxation of the glenohumeral joint occurs relatively frequently in active populations, with 9 out of 10 first-time shoulder dislocations resulting from forceful collisions, falling on an outstretched arm, or a sudden wrenching movement.
In populations under 25 it has been estimated that the recurrence of dislocation after an initial injury could be up to 90%. This means that the treatment of a dislocation and focus on rehabilitation could save you plenty of pain down the road.
When the shoulder is moving normally, the ball stays centred against the socket. With chronic shoulder instability this mechanism goes wrong.
What is chronic shoulder instability?
Shoulder instability occurs when the ligaments and muscles providing stability and mobility to the joint are unable to keep the humeral head in the glenoid fossa.
This is where your shoulder can feel ‘loose’ and dislocate or subluxate with little or no force applied. You might even dislocate your shoulder by reaching across your body to pull the blankets over you!
Poor posture, weak core stability and dysfunctional motor control of the rotator cuff muscles or surrounding shoulder muscles can all effect stability.
People with shoulder instability will often notice a clicking or popping sensation in the shoulder during certain movements, a loss of power in the affected shoulder and a feeling of weakness during certain activities.
There are several factors that can contribute to the development of shoulder instability.
Some of these factors may include:
- history of previous shoulder subluxation or dislocation
- inadequate rehabilitation following a shoulder dislocation
- intensive participation in sports or activities placing the shoulder at risk of developing instability
- muscle weakness (particularly of the scapular stabilizers and rotator cuff)
- muscle imbalances
- poor posture
- abnormal biomechanics or sporting technique
- thoracic spine stiffness
- poor posture
- inadequate warm up
People who have chronic shoulder instability commonly experience:
- Pain when reaching backward or above shoulder height
- Glenohumeral joint pain
- Shoulder stiffness
- Tingling or burning in the lower arm and hand or localised numbness of the skin overlying the deltoid muscle
- Rotator cuff weakness
How can physiotherapy treat shoulder instability?
Physiotherapy treatment for shoulder instability is vital for the healing process and ensuring the best outcome for you. Anxiety, fear and avoidance of movement are all common emotional reactions to shoulder instability, and physiotherapy can help to minimise their impacts.
Physiotherapy looks to strengthen stabilising muscles like the trapezius, rhomboids, and serratus anterior, and increase scapular stability which is required for proper rotator cuff function.
We may use a combination of the below to treat shoulder instability:
- Short term use of a sling for pain relief only
- Postural re-education
- Soft tissue therapy
- Dry needling
- Joint mobilisations
- Motor control training of specific muscles and
- Manual therapy
- protective shoulder taping
- progressive exercises to improve rotator cuff strength, shoulder blade stability, shoulder strength, posture and core stability
- activity modification advice
- biomechanical correction (correction of throwing technique, swimming stroke, volleyball serve)
- clinical Pilates
Be sure to follow your bespoke treatment plan. Although it is a slow process, your commitment to physiotherapy is the most important factor in returning to all the activities you enjoy without pain or fear of instability.
 Hovelius L, Eriksson K, Fredin H, et al. Recurrences after initial dislocation of the shoulder. Results of a prospective study of treatment. J Bone Joint Surg Am 1983;65:343-9.
 Kibler WB, Sciascia A. The role of the scapula in preventing and treating shoulder instability. Knee Surg Sports Traumatol Arthrosc 2016; 24:390.
Has your head recently been jolted backwards and forwards in a whip-like movement? It might have been in the classic rear-ender car accident, falling down the stairs or in a forceful rugby tackle, but all cause similar stress to the neck joints, ligaments, muscles and discs.
Whiplash is effectively a sprain of the joints in the neck and occurs when an acceleration-deceleration event causes sudden extension and flexion of the neck. Whiplash injuries are also commonly referred to as cervical strains or sprains.
Whiplash neck sprains are common, with about 2 in 3 people involved in car accidents developing neck pain. But the good news is that physiotherapy treatment is very effective in the treatment of whiplash.
How do I know if I have whiplash?
Whiplash symptoms can vary between individuals, but the most common symptoms include:
- Neck pain
- Muscle tightness or spasm
- Being unable to move your neck or turn your head
- A headache, especially in the back of the head
- Shoulder pain
Whiplash injuries are classified according to the associated signs and symptoms
The extension-flexion mechanism may have injured intervertebral joints, discs, and ligaments; cervical muscles; and nerve roots. Injury to the zygapophyseal joint, commonly referred to as the facet joint, is likely the most common cause of whiplash-related upper neck pain and headaches.
- Grade 1 – Complaint of neck pain or stiffness only; no physical signs
- Grade 2 – Complaint of neck pain or stiffness with associated musculoskeletal signs (eg, decreased range of motion, point tenderness)
- Grade 3 – Complaint of neck pain or stiffness with associated neurologic signs (eg, decreased or absent deep tendon reflexes, weakness, sensory deficits)
- Grade 4 – Complaint of neck pain or stiffness with associated fracture or dislocation
Physiotherapy treatment of whiplash
Research shows the most effective way to treat your injury is with a combination of treatment options which are tailored to your individual needs. Physiotherapy management of whiplash is extremely effective when started rapidly after the injury occurs.
Early treatment consists of reducing pain and inflammation and stabilizing your neck to prevent further damage. Ice is the best natural anti-inflammatory and it is also very soothing when your neck is painful.
Most whiplash patients will start to feel better within a few weeks of the injury. Your physiotherapy treatment will aim to:
- Reduce neck pain, headaches and inflammation.
- Normalise joint range of motion.
- Strengthen your neck muscles.
- Strengthen your upper back muscles.
- Improve your neck posture.
- Normalise your muscle lengths and resting muscle tension.
- Minimise your chance of future neck pain or disability.
If you are able to support your head and neck, it is important to keep your neck mobile rather than immobilizing it in a soft cervical collar. Studies have shown that you are more likely to make a quicker recovery if you do regular neck exercises, and keep your neck active rather than resting it for long periods in a collar.
Due to traumatic nature of a whiplash injury; there is a risk of more sinister injuries which need to be ruled out before undergoing treatment. Please notify a health professional if you have (or develop) any of the following:
- Bilateral pins and needles
- Gait disturbances
- Progressively worsening weakness or sensation problems
- Pins and needles or numbness in the face
- Difficulty speaking or swallowing
- Drop attacks/fainting
- Bladder or bowel problems
Because whiplash injuries are complex and require time to heal and rehab, don’t waste time before you seek treatment. Whiplash is one of those injuries that can hang around for years if not treated properly.
 Spitzer WO, Skovron ML, Salmi LR, et al. Scientific monograph of the Quebec Task Force on Whiplash-Associated Disorders: redefining “whiplash” and its management. Spine (Phila Pa 1976) 1995; 20:1S.
 Lord SM, Barnsley L, Wallis BJ, Bogduk N. Chronic cervical zygapophysial joint pain after whiplash. A placebo-controlled prevalence study. Spine (Phila Pa 1976). 1996 Aug 1;21(15):1737-44; discussion 1744-5. doi: 10.1097/00007632-199608010-00005. PMID: 8855458.
With winter sports like Rugby league, Rugby Union, and Soccer now in full swing, it’s the time of year that a potentially dangerous condition becomes more prevalent in the offices of Northern Beaches physiotherapists, doctors and emergency rooms – Concussion.
What is a concussion?
Put simply, a concussion is a mild brain injury that can happen after a person has suffered an injury to the head from a collision, falling, or being hit in the head with an object.
Thankfully our soft gooey brains are protected by a hard skull casing, but when the head or body encounters a hard impact, the brain can bounce up against the hard skull wall, and injure it.
How do I know if I have a concussion?
After a head knock in the NRL, you’ll see the doctor asking the player about their symptoms, their state of mind and performing a quick physical exam.
An incorrect response to any question on the tests such as the Westmead posttraumatic amnesia scale is considered a positive for cognitive impairment after head injury:
- What is your name?
- What is the name of this place?
- Why are you here?
- What month are we in?
- What year are we in?
- What town/suburb are you in?
- How old are you?
- What is your date of birth?
- What time of day is it? (morning, afternoon, evening)
What are the symptoms of a concussion?
The symptoms immediately after and in the days and weeks following a concussion can be complex and vary between person to person.
The most common symptoms that can happen immediately after a concussion include:
- Memory loss – People sometimes forget what caused their injury, as well as what happened right before and after the injury.
- Dizziness or trouble with balance
- Nausea or vomiting
- Feeling very tired and acting cranky, irritable, or not like themselves
Symptoms that can happen hours to days after a concussion include:
- Trouble walking or talking
- Memory problems or problems paying attention
- Trouble sleeping
- Mood or behaviour changes
- Vision changes
How do I know if my concussion is actually something worse?
Because head injuries and concussions can be potentially life-threatening, they should be taken very seriously from the moment they occur.
You, or the person with you, should seek immediate medical attention if:
- You vomit more than 3 times
- You have a severe headache, or a headache that gets worse
- You have a seizure
- You have trouble walking or talking
- Your vision changes
- You feel weak or numb in part of your body
- You lose control over your bladder or bowels
How is a concussion treated?
A concussion does not usually need treatment. Most concussions get better on their own, but it can take time. Some people’s symptoms go away within minutes to hours. Other people have symptoms for weeks to months.
When symptoms last a long time, doctors call it “postconcussion syndrome.”
After a concussion, it is important to:
- Not drink alcohol while you are still having any symptoms of concussion
- Rest your brain – Avoid doing activities that need concentration or a lot of attention if they make you feel worse.
- Rest your body – Make sure to get plenty of sleep.
When can I play sports or do my usual activities again?
Prematurely returning to sports after a concussion is putting your health at risk.
It’s important to let your brain heal completely after a concussion. Getting another concussion before your brain has healed may lead to serious brain problems.
Do not go back to playing on the same day as your injury
With each concussion you suffer, the risk of future concussions increases.
For more information on concussions, how to treat them and how to return safely back to sport and work, give us a call to book an appointment.
Should I use heat or ice for…?
It’s one of the most common questions I’m asked in the office at Physio Dee Why or out and about at sports events on the Northern Beaches.
Ever since the invention of the frozen bag of peas, most people have wondered whether heat or cold would help ease their pain for a number of injuries and ailments. You might have even tried both in an effort to scientifically prove which one is the best.
Knowing the benefits of heat and cold for injuries, along with understanding the proper duration for each can help you manage your injury from the outset and speed up your recovery in the process.
How do ice and heat therapy work?
Using ice on an injury works by lowering the local temperature of the surrounding tissue, resulting in decreased blood flow, nerve activity and swelling. Ice can also make your pain worse if your body is already cold, causing muscles to tighten and contract more, rather than relaxing and easing the tightness that’s causing the pain.
Whereas heat raises the local temperature of the surrounding tissue; increasing blood flow to the area, metabolic rate and muscle elasticity. Because muscle tension can spiral into many other problems, including headaches, which cause more pain; so many people swear by a relaxing hot bath or a stint in a sauna to improve their overall health and well-being.
So, heat therapy works to relax injured muscles, heal damaged tissues and improve flexibility and ice temporarily reduces nerve activity, reduces swelling, bruising and slows circulation to the affected area.
Because they work so differently, it’s important to see why both treatments need to be used properly. For instance, heat does not go well with swelling. Using heat therapy when you are hot and have a new swollen injury is a recipe for more pain. Crack out the ice pack instead.
When should I use ice on an injury?
- Musculoskeletal trauma
- Acute or chronic pain
- Acute inflammation
- Muscle spasms
When should I use heat?
- Decreased range of motion
- Muscle guarding
- Muscle spasms
- Myofascial trigger points
- Subacute or chronic pain
- Chronic inflammatory conditions
After looking at the benefits of using ice and heat for injuries and how each works, as a general rule:
- If the injury is new or has occurred within the last few days – Ice it
- If there is noticeable swelling with your pain – Ice it
- If you have decreased range of motion with no swelling – Use heat
- If you have muscle tightness, spasms, or trouble relaxing – Useheat
- If you have had chronic pain with no range of motion loss and significant swelling – Ice it first, then use heat
Heat and cold therapies are excellent ways to ease pain and relax muscles. However, neither is a substitute for an expert physio.
If you find yourself relying on ice or heat over a long period without decreases in your pain levels, consult with your Fixio physio for more in depth and permanent treatment options.
Do you have pain on the outside of your hip?
Does it get worse when you:
- Sit down for a while and then stand up
- Walk up or down stairs
- Stand for a long time
- Get in and out of your car
- Lay on the side that is painful
You may have Greater Trochanteric Pain Syndrome (GTPS), also commonly referred to as hip bursitis or gluteal tendinopathy. GTPS occurs when the tendons, muscles or bursae that lie over the greater trochanter at the top of your thigh bone become irritated.
The good news is that this common condition can be managed well by an expert musculoskeletal physio and here on the Northern Beaches, we see a lot of it.
What causes Greater Trochanteric Pain Syndrome?
The exact causes of GTPS are many and not always well understood. Because GTPS can affect many parts of your life, it is important for your physio to identify what factors are exacerbating your cycle of pain. Once your physio has done this, they can get stuck into providing short term pain relief, education around activity modifications and exercises you can do so that you can get back to doing activities you enjoy.
Lateral hip pain causes include:
- A recent increase or change in your exercise routine and loading
- Gluteal muscle weakness
- Iliotibial band tightness
- Tightness of adductor muscles
- An imbalance of muscles in the greater trochanteric region
Who is most at risk of suffering from lateral hip pain?
If you are a female between 40 and 60, you are more at risk of developing GTPS. You may also be more likely to develop GTPS if you:
- Have a previous/current history of back pain
- Are overweight
- Run more than 30km per week
- Have knee arthritis
How can physiotherapy treat GTPS?
GTPS is often a vicious cycle of pain which causes patients to avoid many activities, leading to further muscle weakness around the hips and in turn, more pain.
Our Fixio physiotherapists are up to date with the latest evidence and base our management of GTPS on evidence based principles so we can make sure we are always giving parents the best care and advice.
At Fixio we may use different types of treatments to control and reduce your pain and swelling, including ice, heat, taping, exercises, massage and manual therapy.
Your Fixio physio will work with you to:
- Reduce Pain and Swelling
- Improve Motion
- Improve Flexibility
- Improve Balance
- Learn a Home-Exercise Program
To help prevent a recurrence of GTPS, your physio may advise you to:
- Follow a bespoke flexibility and strengthening exercise program
- Always warm up before going for a run or playing sport
- Gradually increase any physical activity, rather than suddenly increasing the amount or intensity
- Learn and focus on maintaining correct posture
Is dry needling recommended for lateral hip pain?
Studies have actually shown that dry needling is at least as effective as a cortisone shot for the treatment of a number of injuries, Greater trochanteric pain syndrome (GTPS) included.
“Cortisone injections for GTPS did not provide greater pain relief or reduction in functional limitations than DN (dry needling). Our data suggest that DN is a non-inferior treatment alternative to cortisone injections in this patient population”.
Is there anything I can I do now to reduce my hip pain?
- Avoid sitting with your legs crossed
- Avoid sleeping on the irritated side
- Avoid bearing more weight on one leg than the other
If you are experiencing lateral hip pain, contact our team today. Call us or book online.
 Lin CY, Fredericson M. Greater Trochanteric Pain Syndrome: An Update on Diagnosis and Management. Curr Phys Med Rehabil Rep. 2015;3(1);60-66.
 Brennan KL, Allen BC, Maldonado YM. Dry Needling Versus Cortisone Injection in the Treatment of Greater Trochanteric Pain Syndrome: A Noninferiority Randomized Clinical Trial. J Orthop Sports Phys Ther. 2017;47(4):232-239. doi:10.2519/jospt.2017.6994