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Lower back pain

Why is Early Intervention so important for the Treatment of Acute Lower Back Injuries?

As most of us know and have heard early intervention is always best when it comes to the rehabilitation for acute injuries. But why is this so important and what can we improve to ensure the best outcome for an injured individual?

As an exercise physiologist specialising in the workers compensation system, it is very common to be referred an injured worker months after their injury. This could mean that the worker has had no active treatment, may have poor coping strategies, a lack of education about their injury and the recovery timeframes, have had little assistance navigating the workers compensation system, and could have commenced no return to work to assist with a return to function.

Studies have shown that with acute lower back injuries early intervention is more effective in the short term than advice on staying active, leading to more rapid involvement in function, mood, quality of life, and general health. An additional and highly important point found was that the timing of intervention affects the development of psychosocial features, which are very common in the workers compensation system. If treatment is provided later, the same psychosocial benefits are not achieved. Therefore, early intervention is a necessity for improving an individual’s function, mood, quality of life, general health and decreasing the development of biopsychosocial features that can hinder an injured workers engagement in a return-to-work plan, treatment compliance, and their return to pre-injury function.

At Absolute Balance we understand that during the initial assessment with an individual it is crucial to focus on explaining the cause of pain and instructions to stay active, which studies show can promote long-lasting physical and mental health in individuals with acute lower back pain. Returning to work is a part of returning to function and research indicates that not implementing early intervention for acute work-related back pain can lead to high pain and disability, low recovery expectations, and fears that work may increase pain or cause harm which are risk factors for chronic work disability.

If you would like more information on individualised client-focused goal setting and how to build stronger rapport with your clients, please do not hesitate to contact us at info@absolutebalance.com.au.

Jason

Jason Peschke

Accredited Exercise Physiologist (AEP) (ESSAM)

 

References

Turner, Judith A. Et al. Worker Recovery Expectations and Fear-Avoidance Predict Work Disability in a Population-Based Workers’ Compensation Back Pain Sample, Spine: March 15, 2006 – Volume 31 – Issue 6 – p 682-689.

Wand, M Benedict et al. Early Intervention for the Management of Acute Low Back Pain, Spine: November 1, 2004 – Volume 29 – Issue 21 – p 2350-2356.

Whitfill, T., Haggard, R., Bierner, S.M. et al. Early Intervention Options for Acute Low Back Pain Patients: A Randomized Clinical Trial with One-Year Follow-Up O

Collagen

Collagen and its role in Rehabilitation from an Injury

The recommendations for diet, exercise, supplementation, and our health are changing on a regular basis, with new research and scientific studies delving deeper than ever before into how to best sustain the health of the human body. An up-and-coming area of research, specifically for athletic populations and rehabilitation, is the use of Collagen supplementation to treat injuries to muscles, tendons, ligaments, cartilage, and connective tissues.

To start with, I will answer the question ‘What is Collagen?’

Collagen is an abundant protein within the human body, found in all connective tissues, the skin, muscles, and bones, and is often referred to as the scaffold or glue that provides strength and structure to these tissues. Collagen is comprised of amino acids, once ingested Collagen is broken down to its amino acid form, transported through the blood and to the tissues where the amino acids are used to synthesise new tissue and rebuild damaged tissues.

So, what does this mean for rehabilitation from an injury?

The evidence suggests that supplementation of Hydrolysed Collagen is useful in the treatment of all injuries to the connective tissues or cartilage, with most current research being conducted specifically with tendinous injuries. The most recent research suggests that when collagen is supplemented into the diet while recovering from an injury, collagen synthesis can be increased up to 20%, particularly when taken 1 hour prior to completing exercises (Lis and Baar, 2019), this has a positive impact on the body’s ability to heal, repair and build Collagen containing tissues. The consensus of the available research supports that Collagen supplementation could very likely reduce the time it takes to recover from an injury, which is an amazing concept!

Although the research demonstrates supplementation of Hydrolysed Collagen to have the most promising responses, it is possible to consume high amounts of good quality Collagen in our diets to also assist with the recovery process. The good news – Collagen is easily found in animal products, with the highest bioavailable amounts found in cartilage, bone marrow, tendons, and gristle. If you are the adventurous type, the best sources of Collagen are in chicken feet and pig skin, and marine collagen including fish skin, scales, and bones! If none of these foods sound appealing, the good news is that Collagen can be easily added into your diet through consuming bone broth and gelatin.

The only downside to dietary consumption of Collagen is that you cannot specifically measure and predict accurate dosages for yourself or others, however the health benefits of consuming Collagen rich foods in your diet still far exceed other types of supplementation when recovering from an injury. The only other factor to consider is that your Collagen needs to be consumed with Vitamin C as this is vital for Collagen Synthesis. The specific dosages for Vitamin C vary, however the RDI of 45mg/day combined with 15-25g of Hydrolysed Collagen or Gelatin seems to be a winning combination.

The information above is of course evidence-based and supported by the latest scientific research, however, each injury is different, and each patient should speak to their treating medial practitioner regarding what would benefit them the most with their recovery. If you are interested in knowing more on the topic, get in touch with the team at Absolute Balance through the website www.absolutebalance.com.au or email info@absolutebalance.com.au.

 

Alixe Marion

Alixe Marion (BSc – Exercise Physiology)

Workers Compensation Specialist

Senior Accredited Exercise Physiologist

 

 

References

Lis, D. and Baar, K., 2019. Effects of Different Vitamin C–Enriched Collagen Derivatives on Collagen Synthesis. International Journal of Sport Nutrition and Exercise Metabolism, 29(5), pp.526-531.

 

Tend to Your Forearm Tendonitis!

Have you ever experienced a burning sensation in the small tendons and muscles in your forearms? Do you encounter this feeling after strain, overuse or too much exercising involving your forearms? You may be suffering from forearm tendonitis.

Forearm tendinopathy and tendonitis are some of the most frequent encountered disorders of the upper extremity. With forearm tendonitis individuals present with progressively increased pain in their forearms over a subacute or chronic period. Although forearm tendonitis can be caused by a sudden injury, such as a motor vehicle accident, it most commonly occurs through repetition of a particular movement over time. The importance of proper technique in work duties and hobbies is crucial to reduce the stress put on the forearm tendons and musculature. Other infrequent causes include nerve entrapment in the forearm or arthritis.

The main symptom of forearm tendonitis is inflammation of the forearm tendons. This can cause pain, redness, and swelling around the elbow, wrist, and hand. Secondary symptoms of inflammation including warmth, weakness, throbbing, burning, stiffness, numbness, or the development of a lump on the forearm. Compromised forearm tendons and musculature intrinsically effects range of everyday arm or hand movements.

R.I.C.E:

Rest – Although it can be difficult to stop using your forearm muscles in everyday tasks, constricting movement in a brace or splint will reduce the overall healing time of the inflamed tendons.

Ice – Applying ice to the affected area for 10-minutes a day is an immediate effective treatment after the forearm has been heavily used or inactive for a long period of time. Applying ice to the area will temporarily reduce blood flow and significantly reduce inflammation, swelling and pain.

Compression – Different sleeves and wraps are designed to compress either the full area or segments of it. Applying pressure will also reduce swelling by restricting the flow of blood and other fluids.

Elevation – Keep the forearm raised at a level above the heart to reduce the blood flow to the affected area. This intern will reduce swelling and other symptoms.

Exercise Rehabilitation:

Stretching and strengthening exercises of the forearm and surrounding musculature have been shown to assist in reducing the symptoms of inflamed and injured tendons. Targeted forearm stretching exercises including wrist extension, elbow extension and wrist rotations will help rehabilitation and strengthen the forearm slowly, as well as improve blood circulation through the forearm and into the wrist. Localised strengthening exercises including wrist curls, reverse curls and forearm pronation/supination can help build lost forearm strength and help prevent forearm pain from reoccurring.

Ergonomic Assessments:

By using biomechanical principles, adjustments can be made to your workstation to reduce the risk of overuse/repetitive movements that increase the risk of developing forearm tendonitis. This includes observing force, repetition, volume, and exertion on certain muscle groups to complete daily work tasks. Simple adaptations including using an ergonomic keyboard and adjusting your desk to an appropriate height can reduce the repetitive strain on your forearms.

James McNally

James McNally (BSc – GradDipClin Exercise Physiology)

Workers’ Compensation Specialist (AEP ESSAM)

 

References:

Eric Wagner, Michael Gottschalk. (2019). Tendinopathies of the Forearm, Wrist and Hand. Clinics in Plastic Surgery, 46 (3), 317-327.

What Is Forearm Tendonitis, and How’s It Treated? (2021) Healthline. Retrieved from: https://www.healthline.com/health/forearm-tendonitis#home-remedies

What are the causes of forearm pain? (2018) Medical News Today. Retrieved from: https://www.medicalnewstoday.com/articles/320782

 

Rotator Cuff Repair and Exercise Rehabilitation Programme

I would like to share one of my success stories of my recent patient who sustained a left shoulder injury at work in February 2020. An MRI showed a full-thickness tear of the supraspinatus tendon, moderate subscapularis tendinopathy and complete long head of biceps tendon tear. My patient had a left shoulder arthroscopy and open rotator cuff repair March 2020 and commended his exercise rehabilitation programme in July 2020. The individualised exercise rehabilitation programme was implemented to facilitate a return to pre-injury duties as a Groundsmen.

 

Job Specific Programme

The patient was completing pre-injury hours with a lifting restriction of 5kg and working below shoulder height. The patient’s pre-injury duties involved maintenance of irrigation around the school grounds including digging, repair and replacement of sprinklers and checking underground electronics. The physical critical demands of the patient’s job role are sustained bent over postures, combined with predominately repetitive hand-arm movements between waist and shoulder height. He is required to lift and carry 20L buckets of sand.

The exercise rehabilitation programme initially focused on increasing pain-free range of movement, joint mobility and stability through his left shoulder. The patient’s programme quickly progressed to addressing recruitment patterns of the left shoulder and supporting musculature with a focus on a variety of positions and postures. The final stage of his programme was to increase upper limb strength in a variety of postures with a focus on correct manual handling and repetitive movements with lifting load away from the midline of his body. The programme included eccentric strengthening exercises for the rotator cuff, concentric and eccentric strengthening for the scapular stabilisers. The focus was external rotator cuff strengthening due to an imbalance between the over strengthen internal rotators and weakened external rotators.

 

Outcome of Exercise Rehabilitation

The patient is now at 100% functional capacity in the gym for his pre-injury role. The patient was compliant to his exercise rehabilitation programme and return to work plan. He initially completed one supervised session per week for the first eight weeks combined with two to three unsupervised sessions per week. The supervised session was reduced to once per fortnight, which allowed the patient to progress to self-management. At the end of the exercise programme, the patient showed significant improvements in his range of movements and mobility through his left shoulder. The patient has gained strength with lifting load away from the midline of his body and lifting load in various postures necessary for his pre-injury duties, which allowed for job hardening, giving him the confidence to perform his work duties pain-free. As a result, the patient was certified fit for pre-injury duties and due to obtain a final medical certificate at his next specialist review.

 

 

Daniel Nguyen (B.Sc. Exercise Physiology)

Senior Accredited Exercise Physiologist (AES, AEP)(ESSAM)

 

 

Reference

Byram IR. American Orthopaedic Society for Sports Medicine (AOSSM) 35th Annual Meeting Abstract 8363. Presented July 10, 2009.

A day in trade with Mr Daniel Meyerkort – Orthopaedic surgeon

As an Exercise Physiologist we normally see our patients in the sub-acute to chronic stages of post-operative rehabilitation. I recently had the pleasure of observing Mr Daniel Meyerkort from Perth Orthopaedic and Sports Medicine Centre in theatre at Hollywood Hospital in Perth. I was lucky enough to witness three procedures during the afternoon observations, two of which will assist with understanding the process of post-operative exercise prescription for my patients in the workers compensation system who have undergone these surgeries. I was able to witness a lateral ankle ligament and tendon repair, chronic exercise-induced compartment syndrome fasciotomy and an ACL reconstruction with meniscal root repair.

It was humbling to see the professionalism of the team in the room from wheeling the patient in and going through pre-op procedures to wheeling the patient out for post-operative recovery. The team run like clockwork whilst still taking the time to ensure every patient is safe. It was amazing to see the differences in skills required from delicate stitching through to pulling through new ACL grafts that are required with some force! It is easier to appreciate why some patients pull up with more pain than others due to the invasiveness and force of some of these procedures. I have quickly learnt over my time that two patients will not recover from the same surgery in the same way. I also learnt that a lot of the patients will present quite sore not only from the surgery but also the tourniquet applied above the surgical site.

Mr Meyerkort explained that despite patients presenting with the same injuries, advice will change depending on the patient themselves. Not only the amount of injury sustained is taken into account but their age, associated risks and comorbidities, the occupation of the person as well as their standpoint on having surgery. This is always why I encourage my patients not to “Dr Google” as the advice is never going to be the same for every person. Every person’s rehab journey post-surgery is never going to be the same either. It was also great to hear the amount of education that is given to the patient’s surrounding their surgery.

It was surprising to see that even with viewing the imaging of the patient’s knee prior to surgery it is sometimes never fully clear to see the extent of what is going on until you are in the surgery. Mr Meyerkort kindly talked through each of the surgeries whilst able to repair on the go. During the ACL reconstruction he was able to go through the knee and find out the exact parts of the meniscus that needed repairing and his team where able to demonstrate and explain the thread work required and the importance of positioning and precise drilling required through the tibia and femur. The ACL procedure was the longest and most technical of the three with the aim of restoring stability to the knee. Mr Meyerkort demonstrated the extraction of the hamstring graft first using a long instrument to take the semitendinosus and gracilis to use for the graft. Careful inspections of the tendons is a must to make sure the thickness is of exact amount to provide stability. While Mr Meyerkort was repairing the meniscal damage and clearing the fat pad of the knee, the hamstring graft was being meticulously prepared. Throughout the surgery the knee was regularly tested through flexion and extension to ensure everything was on track. This is something that as an exercise physiologist I can draw on, as functional testing should be intermittently performed on the patient to ensure treatment is effective. Through fine and technical threadwork along with some brute strength, the ACL graft was pulled through the knee and secured in a tight position to restore the patient’s stability with the entire surgery lasting approximately two hours.

It was fabulous to see the acute stages of injury repair and the start of a patient’s rehab journey. I was able to draw comparisons in Mr Meyerkort’s work which rings true in the exercise physiology world.

1. You always have to consider the patient as an individual and no one treatment will have the same effect on that patient.

2. No person will have the exact same outcome and it is important to consistently test and check along the way

3. To always have respect and care for the patient and listen to their needs and concerns and be able to adapt in your approach where possible.

It is important to empower the patient through their recovery. If you have a question surrounding pre or post-operative rehabilitation, you can contact an Accredited Exercise Physiologist.

Taylor Downes

Accredited Exercise Physiologist

BSc/GradDipClinExPhys | B.Ed. Human Movement | (ESSAM, AEP)

Mirror Box Therapy

Mirror box therapy is derived from the use of a mirror to reflect the use of a normal functioning limb to trick the brain to reinforce movement without pain. It involves placing the affected limb inside a box or covered with the reflective side displaying the “working limb” back to the person. From their perspective, they see two fully functional limbs. This type of therapy has been widely used for people with amputated limbs who experience phantom limb pain, complex regional pain syndrome and people recovering from stroke.

Phantom limb pain is where a person feels painful sensations from a limb that is no longer there. The mechanisms of phantom limb pain are not widely understood; however it is thought to be due to peripheral mechanisms due to the injury-causing disrupted input from afferent nerves back to the spinal cord and changed in central neural mechanisms. Mirror box therapy can assist people with phantom limb pain by using the mirror to assist with visual feedback making it real for the patient to see movement and move the “phantom limb”. They receive feedback through vision and proprioception which assist the person to see real movement and that this can occur without pain. The idea is to trick the brain to remodel the cortical systems that may provide relief through visual dominance of the motor-sensory process and activation of mirror neurons through visual movement.

There are some limitations to the use of mirror therapy in rehabilitation with restrictions to the location of injury as well as the extent of injury and the variety of pathologies that induce pain. Mirror box therapy can be easily added into exercise-based routines using active or passive range of motion movements and other exercises for patients based on their level of ability. It is best to consult an accredited exercise physiologist prior to undertaking treatment.

Taylor Downes |B. HM. | GradDipClinExPhys|

Accredited Exercise Physiologist (AEP) (ESSAM)

 

Najiha, A., Alagesan, J., Rathod, VJ., Paranthaman, P. Mirror Therapy: A review of evidences. IntJ Physiother Res 2015;3(3):1086-1090. DOI: 10.16965/ijpr.2015.148

Subedi, B., & Grossberg, G. T. (2011). Phantom limb pain: mechanisms and treatment approaches. Pain research and treatment, 2011, 864605. https://doi.org/10.1155/2011/864605

O’Connell  NE, Wand  BM, McAuley  JH, Marston  L, Moseley  GL. Interventions for treating pain and disability in adults with complex regional pain syndrome‐ an overview of systematic reviews. Cochrane Database of Systematic Reviews 2013, Issue 4. Art. No.: CD009416. DOI: 10.1002/14651858.CD009416.pub2.

Exercise and Back Pain

Almost everyone has experienced a degree of back pain throughout their lifetime, preventing them from completing activities of daily living and leisure activities. Most often than not a vast majority of people will completely cease involvement in exercise or sporting activities after experiencing a bout of back pain as they are fearful it will cause more harm than good. However, this is a common misconception and in most cases exercise and movement are the natural stimuli to begin the healing process.

It is recommended that no more than one- or two-days rest at the onset of back pain is needed, as inactivity protracts the likelihood of prolonged pain. Increased periods of inactivity cause deconditioning of the lower back leading towards increased stiffness, weakness, and decreased mobility. As the old saying goes use it or lose it.

Exercise plays a dual role of both treating and preventing lower back pain. Regular stretching and exercise help by nourishing and repairing spinal cord structures which will help solve pre-existing issues. Whilst continued movement will help prevent future exacerbations by ensuring the lower back is strong and mobile.

Exercise is known to have many benefits in the process of treating lower back pain and when completed in a controlled and sensible manner these benefits may include:

  1. Strengthens the muscles which support the spine, alleviating pressure on facet joints
  2. Reducing stiffness and promoting mobility
  3. Improving circulation to better distribute nutrients to the discs
  4. Increased release of endorphins, which may help with pain.

The key to a successful gym programme to aid in the reduction of lower back pain is adherence. Exercise is one of the most important factors long term pain relief, even small bouts of 10 minutes a day is enough to notice benefits. Start small and progress slowly, remember some movement is better than none. Below are 5 easy exercises to get you started on you pain free journey!

5 Exercise to Help with Lower Back Pain

  1. Cat Camel
  2. Lumber Rocking
  3. Lumber Roll Down
  4. Glute Stretch
  5. Glute Bridge

 

Cameron Galati

Accredited Exercise Physiologist (AEP, AES) (ESSAM)

Hochschuler, S. (2020). Exercise and Fitness to help your back. Journal of Spine Health.

Gopez, J. (2017). Exercise and Back Pain. Journal of Spine Health.

Whiplash

Whiplash and Whiplash Associated Disorders

Whiplash associated disorder (WAD) is a term used to describe the collection of symptoms associated with an injury of the neck usually sustained in an accident. Whiplash and whiplash associated disorder are often terms used with the intention of equivalent meaning, however whiplash refers to the mechanism of the injury instead of symptoms present whereas WAD is a range of neck-related clinical symptoms which are usually chronic in nature.  Both conditions are common and are usually the result of sudden acceleration-deceleration movements most commonly following the involvement in a motor vehicle or sporting accident.

Whiplash is one of the most controversial musculoskeletal conditions as a precise anatomical diagnosis is usually unachievable. There are 4 grades of whiplash depending on the severity, pathology, signs and symptoms present. Neck pain is the most common indicator of a whiplash injury, other symptoms include stiffness of the neck, headache, visual disturbances, shoulder pain and pain, numbness, tingling or weakness in one or both arms. For some whiplash patients their symptoms become debilitating and progressively worse, for these patients their condition develops into a whiplash-associated disorder. Psychosocial symptoms such as depression, anxiety and fear can also be seen in patients with a whiplash injury as well as psychological factors surrounding the accident itself. Anyone who has already sustained a neck-related injury in the past is more susceptible to whiplash.

For many reasons whiplash injuries can be difficult to treat. Factors such as severity and presence of pain symptoms, interactions of psychological, legal, and physical factors can impact the time to recovery and the effectiveness of treatment methods. Most recent studies suggest active treatment, early mobilization and a gradual exercise programme lead to improved outcomes compared to treatment options which include motion restriction and rest. An exercise programme incorporating specific neck range of motion, strengthening, and stretching exercises can assist with recovery of a whiplash injury. Studies also suggest an early intervention and exercise can reduce pain intensity, improve functional capacity, reduce absences from work and improve range of motion of the neck to pre-injury levels. In patients with chronic whiplash and whiplash-associated disorders exercise, early mobilisation and returning to activity improved long-term outcomes. Overall, recovery times can vary due to the interactions of many factors, however early intervention and exercise can offer the best chance for recovery.

Katie Lintott 

Accredited Exercise Physiologist (AEP) (ESSAM)

 

References

Michele Sterling (2011) Whiplash-associated disorder: musculoskeletal pain and related clinical findings, Journal of Manual & Manipulative Therapy, 19:4, 194-200, DOI: 10.1179/106698111X13129729551949

Yadla, S., Ratliff, J. K., & Harrop, J. S. (2008). Whiplash: diagnosis, treatment, and associated injuries. Current reviews in musculoskeletal medicine1(1), 65-68.

 

 

 

 

Joints Click

My Joints Click, Is There an Issue?

Do your joints click and pop when you are active? I would be surprised if you did not. The technical term for the noises coming from our audible joints is “crepitus” and people of all ages experience it. Personally, my knees “click”, my right hip “clunks” and when I roll my shoulders there’s an internal “thud” sound that accompanies the movement. I have a lot of clients who are initially worried about such noises, associating the crackles and pops with further damage to the joint.

The good news is it really is quite normal to experience crepitus and most of the time has no sinister affect on the body. As we age, of course our joints are aging with us, leading to general wear and tear to the structures of the joint, most notably the cartilage. Crepitus can then occur from these rougher surfaces rubbing together as you complete a movement, such as a click in your knee as you stand up from your chair or a pop in your ankle as you shift your weight on your foot.

In regard to exercise, it is also quite normal to hear repetitive clicking as you complete each repetition of a given movement. This could be caused by a tight muscle which is causing some friction around the bone. Some gentle, targeted stretching may be all that is required to sort that snapping out. Overall, exercise is a great way of maintaining your joint health, the more your body moves, the more your joints will lubricate themselves.  – “Motion is Lotion” as they say.

One caveat, if the crepitus is accompanied with pain then there is the possibility of an underlying injury and a review with a healthcare professional would be the best course of action to mitigate any risk of damage as you go about your day to day life. For further information please contact Absolute Balance through info@absolutebalance.com.au.

Callan Smith (B.Sc. Exercise & Sport Science, B.Sc. Exercise Science & Rehabilitation)

Senior Accredited Exercise Physiologist (AEP) (ESSAM)

 

 

References

 

Robertson, C., Hurley, M., & Jones, F. (2017). People’s beliefs about the meaning of crepitus in patellofemoral pain and the impact of these beliefs on their behaviour: A qualitative study. Musculoskeletal Science And Practice28, 59-64. doi: 10.1016/j.msksp.2017.01.012

Client Feedback – Callan Smith

“I recently suffered a work injury and was referred to Callan Smith for aid in my recovery. I’m back to pre-injury fitness and probably a bit better, due in great extent to Callan’s assistance.

From the beginning he was realistic, friendly and thoughtful. He actually listened to my symptoms and (for which I was particularly grateful) never made it all about my weight.

He has given me a doable workout which doesn’t hurt, and has extended it as my symptoms have improved. I am actually enthusiastic about my gym visits as I know they will make me feel better instead of worse.

Thank you very much, Callan”