NEWS

Pain on the side of the hip from bursitis or gluteal tendon inflammation is an annoying problem often more so at night because lying on it frequently disturbs people’s sleep. It is a reasonably common problem for me to see. Tendons and bursae degenerate as we age and weakness in hip musculature can be a cause. But it can happen to anyone. Guided steroid injections can help, but most people respond well to soft tissue manipulation. The lower back should definitely be assessed and (usually) treated manually as related spinal joint stiffness frequently contributes to the issue. The hip joint should also be assessed and treated if necessary. Exercises can be helpful but need to match the pathology so an Ultrasound image might be needed give a diagnosis.

Interstate visitor Client D came in two days before the Melbourne Ironman. Despite treatment interstate he had persisting leg soreness which had stopped him running for a week and had serious doubts on finishing, let alone doing well enough to earn him what he entered for: a qualifying position in the Hawaiian Ironman. He had some back joint stiffness and lateral hamstring trigger point muscle spasm and after loosening these up he felt better. However running a full marathon after the 3.8 kilometre swim and 180 kilometre cycle would be a massive test! The news post race was that he had got though the event and even with a puncture on the cycle grabbed a spot in Hawaii!  Well done to him! (And a bit to me too!)

There are many good studies which indicate glucosamine is more effective than a placebo in decreasing pain and / or increasing function for people with chronic joint conditions. (See Research) In my experience it does not work for everyone but it is worth trying. My advice is to give your sore area a score out of 10 every day for a week before you you start taking Glucosamine. Hide the scores!  Commence the recommended dose for three months and then repeat the scoring process. Most people know if Glucosamine is helping but sometimes the average score is lowered surprisingly. If there is no change in your scores then you may as well not buy it. Good luck!

This tape is relatively new. It is a semi rigid tape which, when correctly appied, can "unload" a muscle which is injured or sore. This can assist in healing time or in sporting performance (you may have seen athletes wearing this tape - often with a "tribal" pattern). Recently Patient A presented the day of her netball Grand Final with a sore back and calves which she felt was from over-training. Her back was loosened up easily via Physiotherapy treatment although she still had soreness in both calves when springing on her toes.  She had no other indication of muscle damage so I appied Dymamic Tape, hoping to get her through her Grand Final. Once taped she was pain free and wih a very pleasing end result: Another flag! (Her sister actually reported Patient A was "the game changer"!)

Recent studies have confirmed specific Physiotherapy techniques to be very successful in treating most types of headache. If your headache can be reproduced by careful assessment of your neck by Brendan, it is extremely likely your headache will be treated effectively. Treatment involves specific guided pressure type techniques on the spinal joints of your upper neck. True manipulation (cracking the neck) is NOT and should not be used. Exercises specific to helping prevent reoccurrence will be advised. Studies also indicate increased release of serotonin (a natural chemical in the blood stream) is helpful in decreasing the severity of headache. Serotonin can be increased by general physical exercise and by eating foods containing tryptophan (an amino acid) which the body uses to build serotonin. Foods include eggs, most dairy, soy and some seafood, especially cod.

Tendonitis, tendonosis, tendonothapthy? These are common conditions in the shoulder, elbow, wrist, hip, knee and ankle. Tendon injuries usually are due to overload. This might be too much load for too long or it might be a change in what load your tendon is used to (eg: sudden change in exercise routine). Microdamage in the tendon occurs due to the overload stress with resulting local inflammation and swelling. Managed early and properly tendons will often settle quickly. Remember though, tendons are tough and take a long time to complain to the point where we notice them. In the same way they can take a long time to settle down after flaring up. They need to be managed carefully through this period. In addition to examining the tendon and joint close to it, proper assessment should include examination of the neck or back (depending on the tendon) to define any nerve contribution to the tendon problem. Subsequent treatment may involve mobilization of the spine as well as local treatment of the tendon.  While they don't like being overloaded, they love being loaded properly, so exercises which include progressive isometric and eccentic programs are vital. Again, these exercises need to be advised and managed correctly!

Sydney shoulder Surgeon Professor George Murrell reported some interesting findings at a conference I attended where he had called back all his patients 8 years after reconstructive surgery to assess how their shoulders had lasted via ultrasound and MRI. Amazingly, 80% of them had RE-TORN their tendon! What was interesting? Nearly all of these people were pain free, without any movement problems! This little piece of news reinforces what I've thought for many years now: Radiology is helpful sometimes but it's not everything. Although these people looked bad on ultrasound, their shoulders were doing fine for them. I'm sure many people that come in to me with a sore shoulder and resolve quickly would have tears if investigated. Effective Physiotherapy, by increasing range of movement via manual therapy, will almost certainly decrease someone's pain, in this case in the shoulder. Of course, with structural damage this is not always possible and that's where injections and/or surgery should be considered. But Physiotherapy's worth a try! I saw an old bloke last year who hadn't moved his arm for twelve months after a failed reconstruction. In his rotator cuff he had ruptured supraspinatus, ruptured subscapularis and partial tear to infraspinatus. That is, he only had 1 and a 1/2 muscles out of four!  His GP referred him in desperation for pain relief but after a few months he had 150 degrees of active flexion (to a high shelf) and virtually no pain. To be honest, I was as surprised as he was!

"I've got arthritis, there's nothing you can do about it" If I had a dollar for every time someone.......... As long as I didn't have to fork out a dollar for my response: "how long have you been like this for?" Osteoarthritis/degeneration/wear and tear (as distinct from inflammatory arthritic diseases) is part of the ageing process and in some people and some joints it happens faster than in others, sometimes for a reason, but often for no reason. The only way any of us will avoid getting it in every joint is if we die before it happens! It doesn't necessarily mean you can't be helped via Physiotherapy. Sure, we're pushing uphill in someone who has central canal stenosis and has had gradually increasing leg pain over years. Or someone with no chondral cartilage in their knee. But what if their pain level has spiked only recently? Maybe via an incident or not but if they've only been adversely affected for a month or less I start to get interested. The injury almost certainly looked the same on x-ray, CT or MRI three months before. If they weren't too bad before they flared up, then it's not just their radiology or, logically, they should have been crummy back then! There's a good chance joint stiffness and/or weakness for whatever reason is now contributing to their increase in symptoms. Joint stiffness we can change. And of course muscular/proprioceptive support via increased strength around a joint will always have value in the patient prepared to put in, as instructed!

At least weekly I see a new client who says to me: “I’ve never had this type of treatment before”, despite having seen one or more Physios previously. My treatment always involves manual therapy of various methods, principally aimed at increasing the range of movement the body joint involved with the problem. In my opinion this is a very simple Physiotherapy approach and is very effective. I’m perplexed at the propensity, especially of more recently trained Physiotherapists, to concentrate their efforts (and treatment time) on demonstrating and instructing exercises to their clients without physically changing a joint with restricted movement. Now I agree exercises have great value in assisting people to improve and maintain a condition but when a joint is not moving properly manual therapy is faster and more effective in addressing the problem in my view.  If your treatment involves lots of exercises and you’re struggling to get better maybe you should call!