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Lower Back Pain

Lower Back Pain

by | Dec 3, 2019 | Lower Back, Pain

Sharp catch of pain? Ongoing aches? Trouble getting out of bed or with long car rides? Stiff and sore when you are bending over to pick things up? Referred pain into you legs?

If you’ve experienced any of these symptoms recently you are not alone. Lower back pain is a common ailment affecting people of all ages and lifestyles with up to 80% of us experiencing various symptoms in our lifetime. Lower back pain can be caused by various factors such as poor posture, muscle strain, joint pain or underlying medical conditions.

Back pain is complex. These aches and pains are usually a sign that your spine are not tolerating loads well and are more sensitive than usual. Symptoms could arise from a subtle change in muscle balance and biomechanics, altered postures, novel or increases in training intensity or even your thoughts arounds the fragility of your spine. Physiotherapy offers effective solutions for managing and alleviating lower back pain by assessing the root cause of the pain, educating you on what is happening and develop personalised treatment plans. We also employ techniques like manual therapy, exercises, and stretches to strengthen you, improve flexibility, return you to activity and desensitise the painful area. Physiotherapy also includes education on proper body mechanics and ergonomics to prevent future episodes in activities such as lifting, sports or activitities of daily living.

Mid Potion Achilles Tendinopathy Location

Whatever the cause, our highly trained Praxis physiotherapists have expertise in this area and will help identify the problem and work with you so that you will feel empowered to fix the problem. At Praxis Physio, this is our point of difference. We promise to take the time to fix you using a range of modalities including advice, hands on manual therapies, reformer pilates and of course strength and conditioning programming.

No need to accept back pain as ‘normal’ call us now on (07) 3102 3337 or book online to have one of our physios get you back on track before your pain becomes any worse.

Team Praxis,

PREVENT | PREPARE | PERFORM

Sporting Injuries

Sporting Injuries

by | Dec 3, 2019 | Pain, Return to Sport, Sports Injury

Are you a weekend warrior who is plagued by injury or an aspiring athlete trying to find that extra 1% or somewhere in between? We know how frustrating it can sitting on the side lines and not being able to be involved in the things that make you happy. All the Praxis team have (or still do) play sport of some description and understand the anguish that goes hand in hand with injuries. That is why we do what we do!

 

Praxis has an expert team who have been fortunate to travel the country and even the world with various sporting teams. Whether it is Stephen with Cricket Australia teams, Cam with the ICONZ Rugby, Zac with Netball or Emma with AFL Praxis has you covered.
Mid Potion Achilles Tendinopathy Location

We separate ourselves from other therapist because we know that specific, personalised and evidence based physiotherapy is the most effective and efficient method to getting you back to what you love doing quicker and better. Combine that with our years of experience in treating all athletes from the elite to the weekend warrior, and there is no sport we can’t help with!

In summary, we believe that specific, personalised and evidence based physiotherapy is the most effective and efficient method in

If you are looking to Prevent future dysfunction, Prepare for your activity and Perform at your best, the Praxis Team has you covered and will get you achieving your goals sooner! See one of expert team members today by giving us a call on (07) 3102 3337  emailing admin@praxisphysio.com.au or booking online.

Team Praxis

PREVENT | PREPARE | PERFORM

Chronic Groin Pain (Athletic Pubalgia)

Chronic Groin Pain (Athletic Pubalgia)

by | Oct 26, 2019 | Gym and Strength, Hip, Pain, Return to Sport, Sports Injury

GROIN PAIN

Groin pain, referred to also as athletic pubalgia, is a common problem for a number of athletes, particularly those who engage in sports that require specific use (or overuse) of lower abdominal muscles and the proximal muscles of the thigh. Predominantly, these activities centre around kicking sports such as AFL and soccer, as well as long distance running. Ice hockey is also a well renowned sport in which chronic groin pain occurs. All these sports involve repetitive energetic kicking, twisting, turning or cutting movements, which are all risk factors for causing pubalgia.

SUMMARY:

  • Four structures are commonly implicated in the causes of groin pain
  • Adductor muscles
  • Pubic bone
  • Abdominal wall
  • Iliopsoas
  • Understanding which of these four structures is causing your pain is key in effective management
  • Exercise therapy and activity modifications should be the mainstay of treatment
  • Absolute rest has been shown to be ineffective
  • Steady gradual progressions through strength and function, tailored to your goals, is key to successful management
Mid Potion Achilles Tendinopathy Location

ROLE OF HIP ADDUCTORS (groin muscles)

Similar to other joints in the body, the hip relies on muscular control for stability and movement. At the hip, there are five key planes of movement; flexion, extension, abduction, adduction and rotation.

The adductor muscles are a large group of muscles located on the inner side of the thigh, attaching from below the knee, along the shaft of the femur and into the pubic bone of the pelvis.

While acute tears of the adductor muscle is common, more long standing pain is usually the result of an overload of the adductor tendon that attach to the pelvis. This is called an adductor tendinopathy. Adductor enthesopathy is common disorder which effects the bony attachment point of the tendon, with a slight structural difference from tendinopathy, however, management is similar in both cases

MANAGEMENT OPTIONS

Exercise:

Strength and functional based exercise are the core management strategies for adductor tendinopathy, and have been shown to increase function, decrease pain and reduce likelihood of injury [4].

Activity Modification:

Activity modification, especially in the acute phase or when symptoms are significantly affecting function, is key in reducing load on the affected structures and allowing tissues to adapt. [1]

Rest:

While activity modification is important, absolute rest has been shown to be ineffective in the management of adductor tendinopathy, and does not promote adequate tissue repair. [1,2]

Other:

Other conservative measures such as manual therapy, electrotherapy and stretching have been [1] explored, with reduced effect compared exercise prescription. Surgical management is also a potential option, with some positive results emerging for groin pain, though specific evidence [10] around adductor tendinopathy is limited. [10]

WHY IS EXERCISE IMPORTANT?

Exercise has been shown to increase tendon turnover, meaning in the first 24-36 hours there is a reduction in tendon integrity, but after that there is an overall increase in integrity and strength. Other benefits include: increased blood flow, increase in growth factors, and a reduction in altered pain processes in the brain [14].

WHAT’S THE BEST EXERCISE?

Isometric exercise has been shown to be effective in short term pain relief. Current evidence is unclear as to the best long term exercise strategies, with evidence supporting both eccentric and heavy-slow isotonic exercise. [12]

EXERCISE PLAN

The Copenhagen Adductor Program [9], with the below dosage, has been shown to significantly improve adductor strength, as well as being effective in groin injury prevention. It is important to note that though the program is eight weeks long, most effective tendon[12] adaptations take ≥ 12 weeks, and a tailored dosage should be discussed with your physiotherapist towards the end stage of rehabilitation.

Depending on how the symptoms affect your function, a reduction in training, running and kicking may also be required. Example progressions are noted below in the running program, in order of loading on adductors.

ADDITIONAL STRENGTH AND PROGRAMS

While targeted strengthening to the adductors is key, global strengthening around the hip may also aid in a reduction of loading to the tendon. Thorough assessment of your strength through all five movements noted previously is needed, as well as a tailored training program to resolve any discrepancies.

As symptoms reduce and function improves, part practice of painful activities, can be beneficial to reload structures, for example, banded kicking movements in preparation for return to soccer.

SUMMARY

In chronic adductor tendinopathy, tendon adaptations take time. It is important to understand this as you begin your rehab journey and not progress more than your body can tolerate. Steady gradual progressions through strength and function, tailored to your goals, is key to successful management.

As always, if you have a history of groin pain or are concerned about performance in your chosen sport, contact us today and chat to one of our friendly and knowledgeable physiotherapist to ensure you can Prevent. Prepare. Perform. Alternatively you can book online here

Till next time, Praxis what you Preach

📍 Clinics in Teneriffe, Buranda, and Carseldine

💪 Trusted by athletes. Backed by evidence. Here for everyone.

References: 

  1.  Almeida, M.O., et al., Conservative interventions for treating exercise‐related musculotendinous, ligamentous and osseous groin pain. Cochrane Database of Systematic Reviews, 2013(6).
  2. Bohm, S., F. Mersmann, and A. Arampatzis, Human tendon adaptation in response to mechanical loading: a systematic review and meta-analysis of exercise intervention studies on healthy adults. Sports Medicine – Open, 2015. 1(1): p. 7.
  3.  Brukner, P., Brukner & Khan’s clinical sports medicine / Peter Brukner … [et al.]. Sports medicine series, ed. K. Khan. 2012, North Ryde, N.S.W: McGraw-Hill Australia.
  4. Charlton, P.C., et al., Exercise Interventions for the Prevention and Treatment of Groin Pain and Injury in Athletes: A Critical and Systematic Review. Sports Med, 2017. 47(10): p. 2011-2026.
  5. Frizziero, A., et al., The role of eccentric exercise in sport injuries rehabilitation. Br Med Bull, 2014. 110(1): p. 47-75.
  6. Griffin, V.C., T. Everett, and I.G. Horsley, A comparison of hip adduction to abduction strength ratios, in the dominant and non-dominant limb, of elite academy football players. Journal of Biomedical Engineering and Informatics, 2015. 2(1): p. 109.
  7. Haroy, J., et al., The Adductor Strengthening Programme prevents groin problems among male football players: a cluster-randomised controlled trial. Br J Sports Med, 2019. 53(3): p. 150-157.
  8. Harøy, J., et al., Infographic. The Adductor Strengthening Programme prevents groin problems among male football players. British Journal of Sports Medicine, 2019. 53(1): p. 45.
  9. Haroy, J., et al., Including the Copenhagen Adduction Exercise in the FIFA 11+ Provides Missing Eccentric Hip Adduction Strength Effect in Male Soccer Players: A Randomized Controlled Trial. Am J Sports Med, 2017. 45(13): p. 3052-3059.
  10. Jorgensen, S.G., S. Oberg, and J. Rosenberg, Treatment of longstanding groin pain: a systematic review. Hernia, 2019.
  11. Kohavi, B., et al., Effectiveness of Field-Based Resistance Training Protocols on Hip Muscle Strength Among Young Elite Football Players. Clin J Sport Med, 2018.
  12. Lim, H.Y. and S.H. Wong, Effects of isometric, eccentric, or heavy slow resistance exercises on pain and function in individuals with patellar tendinopathy: A systematic review. Physiother Res Int, 2018. 23(4): p. e1721.
  13. Machotka, Z., S. Kumar, and L.G. Perraton, A systematic review of the literature on the effectiveness of exercise therapy for groin pain in athletes. Sports Med Arthrosc Rehabil Ther Technol, 2009. 1(1): p. 5.
  14. Magnusson, S.P., H. Langberg, and M. Kjaer, The pathogenesis of tendinopathy: balancing the response to loading. Nat Rev Rheumatol, 2010. 6(5): p. 262-8.
  15. Rio, E., et al., Tendon neuroplastic training: changing the way we think about tendon rehabilitation: a narrative review. British Journal of Sports Medicine, 2016. 50(4): p. 209.
  16. Thorborg, K., et al., The Copenhagen Hip and Groin Outcome Score (HAGOS): development and validation according to the COSMIN checklist. Br J Sports Med, 2011. 45(6): p. 478-91.
  17. Wei, A.S., et al., The effect of corticosteroid on collagen expression in injured rotator cuff tendon. The Journal of bone and joint surgery. American volume, 2006. 88(6): p. 1331-1338.

Podcast

Podcast

by | Oct 17, 2019 | Pain, Team Praxis

PODCAST

Something a little different for Praxis Physio recently with our principal physio Stephen, having a chat with Matt from Back Yourself fitness.

The latest episode is all about rehab, recovery, Praxis Pilates and physio assessments.

Some interesting stories about all things Praxis, footy with Aspley Hornets and cricket all done on location at our Club Coops clinic.

If you think Stephen is the physio to help you navigate your aches and pains, feel free to give us a call on (07) 3102 3337 or book online today

The BACK YOURSELF PODCAST is available on all podcast platforms 🔥🎧.

ROTATOR CUFF TEARS || Do I Need Surgery?

ROTATOR CUFF TEARS || Do I Need Surgery?

by | Sep 14, 2019 | Pain, Shoulder, Surgery

That age old question in which the answers seems to be becoming increasingly more difficult to answer. We have looked over the research and tried to simply things for those who are unsure about what to do with their shoulder.

SUMMARY:

  • A rotator cuff (RC) tear is a common cause of pain and disability among adults.
  • There are multiple risk factors for RC tears, but most are down to overactivity of the shoulder joint decreased conditioning of the shoulder complex, which comes with age.
  • Most common in individuals over the age of 40 with linear increase in incidence as we get older.
  • A well-constructed strength program and active lifestyle is pivotal for preventing RC tears.
  • Diagnosis of a RC tear is done through first a physical examination, which is then followed by a positive finding on medical imaging.
  • To two main ways of treating a RC tear is either through conservative management with your physiotherapist or down the surgical route, which is also then followed by physiotherapy rehabilitation.
  • There is evidence for both choices and the decision between the two is down to many factors and the well-trained and experienced physiotherapists at Praxis Physiotherapy can greatly assist you in making the decision!

ANATOMY

The rotator cuff (RC) muscles are a group of four muscles that act as rotators and stabilisers of the shoulder. These are supraspinatus, infraspinatus, subscapularis and teres minor. Supraspinatus is the most frequently torn of this group.

These muscles work to help raise and rotate your arm for everyday activities such as putting on a t-shirt, combing your hair or putting away dishes on a high shelf. In sport the cuff works as a dynamic stabilisers of the shoulder to help cope with the forces associated with overhead activities such as swimming, tennis serving, throwing or weight lifting. Simply put, the cuff aids in keeping the ball (head) of your upper-arm bone (humerus) in your shoulder socket with movement.

CAUSES, SYMPTOMS & RISK FACTORS

The cause of RC tears is multifactorial. Degeneration (which comes with age), impingement and overload, may all contribute in varying degrees to the development of rotator cuff tears.

Mid Potion Achilles Tendinopathy Location

This disease is primarily of middle aged and older patients with observational data reveals a nearly linear increase in the frequency of rotator cuff tears with age. Pain with movement and function is one of the biggest symptoms of a rotator cuff tear. However, it is important to know that a sizeable portion of rotator cuff tears are actually asymptomatic and don’t cause the person any pain or discomfort! A study by Minagawa and Yamamoto in 2013 found that in a screening of 664 village residents, 147 subjects had RC tears on a medical imaging screening. Surprisingly 65% of them had no symptoms at all and didn’t have any shoulder complaints.

Why is this important? Well if you end up going to a GP and he/she send you for a scan and finds a torn RC, most will assume that it is the cause of them pain, but as seen in the study this is definitely not always the case. Before it can be decided whether the RC tear is the causes of the pain there are numerous structures in and around the shoulder that have to be examined and “crossed off the list” of possible causes of the pain. This can only be done by a physical examination of the shoulder which can be done by an experienced physiotherapist.

TREATMENT: CONSERVATIVE OR SURGICAL

The decision of treatment for rotator cuff tears is dependent on many factors. The current literature on the topic states three main modalities of treatment for a symptomatic RC tear; these being:

  • Use of a corticosteroid injection
  • Physiotherapy intervention
  • Surgical management

The use of corticosteroid injections is commonly recommended by GP’s for treatment of pain in RC tears. They may provide pain reduction in some patients but is important that you talk to your GP about both the pro’s and con’s of these injections as the current evidence does support that these injections do in fact have a detrimental effect on tendon health and strength.

In addressing whether a surgical or conservative route should be taken, there is currently very limited literature and evidence to support one modality over the other. A study by Lambers and van Raay in 2015 looked at comparing the effectiveness of surgical versus conservative management of 56 patients with rotator cuff repairs. They followed up over a year and the results showed no significant difference in pain and disability in favour of either modality.

However, a study by Moosymayer and colleagues collected data from 103 patients with RC tears, with half having surgical repairs and half being treated conservatively with physiotherapy. They were followed up over 10 years at 6 months, 1, 2, 5 and 10 year marks. The first three follow up saw no difference in results between both modalities. However at the 5 and 10 year follow ups they found preferable outcomes for surgical repair over conservative treatment, with a small proportion of the conservative management patients opting for surgical treatment at the 5 and 10 year marks due to decreased satisfaction in results from conservative management.

The big answer for the whether conservative management or surgical management is best for a rotator cuff tear………….

As always – it is a case by case decision!! There is no definitive evidence for supporting one over the other generally speaking! However, it is vitally important to note that each option comes with their own pros and cons. Furthermore, it is important to remember that just as every person is different, each case of rotator cuff tear is different. Young vs old, acute vs degenerative RC tear, current and desired future function, pain levels, radiographic findings, previous history of shoulder trauma and the patient’s wishes are only some of the questions that aid in the decision process. The best way to decide would be to contact your physiotherapist and have chat about both options and what the goals of rehab are so that a tailored plan can be developed WITH you.

We here at Praxis Physiotherapy pride ourselves on providing the best possible treatment and advice on all things musculoskeletal and are more than happy to assist, and advise you on your decision regarding rotator cuff tears. We also work closely with a number of excellent orthopedic surgeons specialising in shoulders in Brisbane to ensure you get the best possible advice and intervention if you require it. So stop waiting and suffering, give us a ring and book an appointment on (07) 3102 3337 or simply book online

Till Next Time, Praxis What You Preach

The Praxis Team

PREVENT | PREPARE | PERFORM

FACT OR FICTION – I’m in pain, I’m damaging something

FACT OR FICTION – I’m in pain, I’m damaging something

by | Sep 7, 2019 | Pain

FICTION! Stay with me on this one as it can be confusing.

Pain = An unpleasant sensory and emotional experience associated with actual or potential tissue damage.

The best way to sum it up is the above photo.

This unlucky gent stuck a nail through his shoe. He was in agony. Off in the ambulance he went, straight to hospital. First thing they did was get him an X-Ray. Now this view doesn’t look too good, but from the top they found something interesting…the nail had gone straight between his toes – not through his foot!!

Pain is an unpleasant sensory and emotional experience, controlled by the brain. If your brain deems something to be harmful (whether it actually is or not), it provides a pain response to remove you from perceived “harm”.

Pain isn’t a life sentence. If you are in pain, understanding this is the first step in changing your pain. To discuss how to manage and help your pain, let the Praxis team help you.

Give us a call today on (07) 3102 3337 or book online 

Till next time, PREVENT | PREPARE | PERFORM

Team Praxis

Reference:

IASP. (14/12/17). International Association for the Study of Pain. Pain Terms: A Current List with Definitions and Notes on Usage.