Up to date Database
At Balgowlah Physio, we endeavour to stay up to date with the latest research and treatment options. We are continuously refreshing our database - we have summarised some interesting new developments below.
return to sport decisions after lateral ankle sprain requires a thorough, multifactorial assessment
Smith et al. (2021) compiled a consensus of opinion among 155 globally diverse health professionals, predominately physiotherapists and sports physicians working in elite field or court sports with postgraduate qualifications. Three rounds of surveys were completed to establish which assessment items should be included to inform return to sport decisions after an acute lateral ankle spain injury.
5 domains which encapsulate 16 items were agreed upon (see graphic below). A range of tests can be used to assess each item in the context of other elements such as tissue health, tissue stresses and risk modifiders.
Once a fracture is excluded by XR or Ottawa Ankle Rules, individualised physiotherapy must begin. Addressing each of these assessment items is vital to return to full function, unrestricted participation and to minimise the risk of recurring injury.
At Balgowlah Physio, we work through each assessment item one by one with every patient. Every rehabilitation is different, focusing on the impairment found to be in deficit. Each patient needs to demonstrate normal values before return to sport clearance can be given.
foot orthoses & hip strengthening are equally BENEFICIAL in managing patellofemoral pain
Matthews et al. (2020) compared the effectiveness of foot orthoses in those with mid-foot mobility greater than 11mm and those with mid-foot mobility less than 11mm in managing patellofemoral pain over 12 weeks.
Across 218 participants, there was no significant difference, as well as no clear benefit of foot orthoses over hip strengthening exercises.
At Balgowlah Physio, we will assess both mid-foot mobility and hip strength in multiple directions to construct a comprehensive assessment of all contributing factors to patellofemoral pain including movement strategies, quadricep strength and lumbopelvic stability.
exercise benefits far outweigh the risk of cartilage wear in osteoarthritis
Bricca et al. (2019) reviewed the impact of exercise on articular cartilage in people at risk of, or with established, knee osteoarthritis.
Knee joint loading exercise seems to not be harmful for articular cartilage. Knee joint loading exercise interventions at a dose sufficient to improve cartilage health need to be investigated further.
reduced neck muscle endurance in those with migraines
Florencio et al. (2019) compared neck flexor and neck extensor muscle endurance in 26 women with migraine and 26 age-matched women without migraine or headache.
In this cross-sectional, controlled study, patients with migraine exhibited a lower holding time for both neck extensor endurance (166.5 seconds vs. 290 seconds) and neck flexor endurance (35 seconds vs. 60.5 seconds) than the controls. The author suggests a possible association between migraine and reduced performance of the neck muscles.
At Balgowlah Physio, we can help diagnose headaches into cervicogenic, migraine and tension-type categories, use hands-on therapy for short-term pain relief and tailor a neck strengthening program to help minimise deficits in cervical spine muscle endurance.
hamstring injury risk & running
Physiotherapy as effective as surgery for tendon pain
Challoumas et al. (2019) evaluated 12 current research papers that compared the effectiveness of surgery on all tendinopathies to no treatment, sham surgery and exercise-based therapies for both mid-term (12 months) and long-term (>12 months) outcomes.
Physiotherapy was as effective as surgery for both mid-term and long term for pain, function, ROM and tendon force, and pain, treatment success and quality of life, respectively.
At Balgowlah Physio, we can prescribe individualised loading programs to best treat tendinopathy without the need for surgery. This is combined with manual therapy to offer immediate relief and slowly improve tissue resilience to maximise loading thresholds.
immediate referral to sports physio is paramount post acl injury
Culvernor et al. (2019) randomised 121 adults after ACL injury into either a structured exercise program plus early reconstructive surgery (62 participants) or a similarly structured exercise program, with the option of having a delayed ACLR if symptomatically unstable or if requested (59 participants).
Patellofemoral cartilage thickness was assessed via MRI at baseline, 2 and 5 year follow up. Each participant performed the same goal-oriented, progressive physiotherapist supervised exercise therapy program.
Early ACL reconstruction was associated with greater patellofemoral cartilage thickness loss seen when MRI reviewed at 2 and 5 years compared with optional delayed ACLR.
At Balgowlah Physio, immediately after ACL injury, we commence our 12-week World Best Practice ACL rehabilitation protocol. The protocol consists of swelling management, strengthening and restoring function. After 12 weeks, an orthopaedic review is held where an informed decision regarding reconstructive surgery can be made.
Plantarflexor strength is critical to mid-portion achilles tendinopathy
O’Neill et al. (2019) constructed a case control trial with 39 runners with mid-portion Achilles tendinopathy and 38 healthy runners. The mid-portion zone refers to 2-6cm proximal to the distal insertion.
Subjects with Achilles tendinopathy produced statistically less torque and endurance capacity of plantar flexors that there healthy counterparts. This included when tested concentrically, eccentrically and isokinetically.
Surprisingly, deficits are bilateral in nature - meaning the subject with Achilles tendinopathy on the left shows poor strength and endurance in both left and right plantar flexors compared to healthy subjects.
At Balgowlah Physio, we have a systematic strength program to offload acute and longstanding Achilles tendinopathy in the short term and make the tendon more resilient in the medium to long term.
exercise therapy is the treatment of choice for meniscal tears
Thorlund et al. (2019) describes treatment of degenerative meniscal lesions should be non-surgical, with exercise therapy as the core component.
At Balgowlah Physio, we design programs to help stimulate growth factors of the meniscus safely and in line with MRI scan results.
TAKE CONTROL OF YOUR OSTEOARTHRITIS!
Skou & Roos (2017) analysed data from 9,825 participants with hip or knee osteoarthritis who underwent 6-weeks of supervised exercise and education delivered by trained physiotherapists. At 3-month & 12-month follow-up, participants reported reduced pain & reliance on painkillers, improved physical function & quality of life, as well as comparatively faster results post-operatively.
At Balgowlah Physio, we run the program one-on-one so it can be individualised to you.
Hip pain? an injection may not be for you
Meoller et al. (2018) compared a program of physiotherapy over 8 weeks to an corticosteroid injection to a 'wait and see' approach in 204 people with lateral hip pain for more than 3 months.
After 8 weeks, 77% of those involved with physiotherapy were "moderately better" compared to 58% after a corticosteroid injection and 29% with a 'wait and see' approach.
At Balgowlah Physio, we can diagnose your hip pain and design a specific exercise program for you. Listen below to leading clinical researcher Bill Vicenzino summarise his research into the effectiveness of cortisone injections.
PHYSIOTHERAPY IS THE FIRST STEP TO ELIMINATE LOW BACK PAIN, not surgery
Furunes et al. (2017) randomised 173 patients aged between 25 and 55 years old with 12 month history or more of low back pain and localised degenerative changes at L4-5 or L5-S1 or both to either surgery (total disc replacement) or 5 weeks of "hands-off" multidisciplinary rehabilitation (MDR).
At 8 year follow up, while there were subtle differences, these were not found to be clinically significant.
Imagine the results if the MDR included 10 weeks of hands-on physiotherapy!
“Considering the risk of surgical complications and the significant number of patients who achieve a clinically important improvement after rehabilitation, the first choice of treatment should be multidisciplinary rehabilitation.”
It is hard to believe that one-third of patients attending orthopaedic review in Australia had not had a trial of non-pharmacological management (such as physiotherapy) (Haskins et al. 2013).
1-page summary (PDF) Full text (PDF)
As a sports physio in Balgowlah, we have extensive experience in combining hands-on treatment and individualised exercises to minimise the likelihood for surgery.
knee osteoarthritis? Rotator cuff tear? don't stop moving!
Chakravarty et al. (2008) investigated knee XR changes and signs of osteoarthritis (OA) in 45 long distance runners versus 53 sedentary individuals over 12 years with a mean age of 58. Long distance running (average of 214 mins a week) was not associated with accelerated incidence or severity of radiographic OA.
20% of runners had OA compared to 32% of controls
2.2% of runners had severe OA compared to 9.4% of controls (not statistically significant)
As a sports physio in Balgowlah we stand by…
"Long-distance running or other routine vigorous activities should not be discouraged among healthy older adults out of concern for progression of knee OA."
1-page summary (PDF) Full text (PDF)
Gumina et al. (2018) critiqued bilateral shoulder MRI of 25 people with mean age of 57 with an old (>20 year) unilateral arm amputation. A partial or a full thickness tear was found in only 20% of the cuffs on the healthy side, 32% on the amputee side.
The authors suggest shoulder non-use as a risk factor for rotator cuff tear. However, we cannot say for certain, as this would require more strict research methodologies.
At Balgowlah Physio, we advocate appropriate strengthening to help joints move freely and make tendons more resilient.
INJURY PREVENTION IN SYDNEY GRADE CRICKETERS
Soomro et al. (2018) conduct injury surveillance across all teams playing in the Sydney Grade Cricket competition during the 2015/2016 season. Lower back injuries (20%) were the most common injuries followed by foot (14%), hand (13.75%), knee (7.5%) and calf (7.5%).
High workloads or inadequate physical conditioning may contribute to such injuries. The study suggests that coaches and administrators must develop and implement cricket-specific injury prevention programmes.
As a sports physio in Balgowlah, we perform pre-season screening tests for fast bowlers and prescribe individualised strength and flexibility programmes to target identified at-risk areas.
Check out this article that highlights the importance of adequate load monitoring, strengthening and working with the up-to-date Sports & Exercise Physios at Balgowlah Physio. We can maximise training effectiveness and minimise injury risks.
stop your achilles tendinitis & plantar fasciitis
Chan et al. (2018) analysed 320 novice runners on a treadmill at 8km/h and 12km/h. Half were given 2 weeks of gait retraining and real-time visual feedback, while the other half were not given feedback. Based on vertical ground-reaction force signals, participants were asked to "run softer".
At 12-month follow-up, the occurrence of running-related musculoskeletal injury was 62% lower in the gait retraining group. Achilles tendinitis and calf strains were reported in the gait retraining group, whereas plantar fasciitis and patellofemoral pain were most commonly reported injuries in the control group.
As a sports physio in Balgowlah, we can critically examine your gait pattern and implement strategies to minimise calf, Achilles and plantarfascia stress when walking and running.
Pilates can improve chronic neck pain
Cazotti et al. (2018) randomised 64 patients with 3-month or more history of mechanical neck pain into either a Pilates exercise group or control group. Pilates consisted of 60 min sessions, twice a week for 12 weeks run by a certified instructor.
The Pilates group showed high adherence (91%) and pain reduced by 45% (compared to 7.5% in control group) over 90 days.
Pilates can be a low risk, effective tool in managing chronic neck pain. It is a powerful method when “direct pathoanatomical cause of mechanical neck pain is rarely identifiable”. Pilates principles can all positively assist with self-management strategies for pain including entering, concentration, control, precision, flow and breathing.
At Balgowlah Physio, we can individualise a Pilates program to mimic and enhance the results of this study in combination with hands-on therapy.
reduce pain prior to back surgery with physio
Lindbäck et al. (2018) randomised 197 people (mean 59 years old) who were scheduled for surgery because of disc herniation, spinal stenosis, spondylolithesis or degenerative disc disease to either pre-surgery physiotherapy or standardised information pre-surgery. Patients were seen twice a week for 9 weeks for hands-on therapy combined with supervised exercise and cognitive approach therapy.
The pre-surgery physiotherapy group significantly reduced back and leg pain, anxiety, depression & fear-avoidance, as well as improved self-efficacy and higher physical activity levels.
There were minimal differences between the groups at 1-year post surgery follow-up, except for a higher activity level in the physiotherapy group.
1-page summary (PDF) Full text (PDF)
At Balgowlah Physio, we can implement an individualised hands-on and exercise program to reduce your back pain and potentially shrink the need for surgery.