Author: Michael Ranger

Chronic Regional Pain Syndrome – CRPS

Posted on November 24, 2021 by - Category One

What is CRPS?

Complex regional pain syndrome (CRPS) is a term characterised by chronic
persistent pain. CRPS can affect any part of the body, but mainly occurs in the arm
or leg following injury and often involves certain changes to the area including
extremely sensitive skin, reduced function in the hand or foot, redness, warmth,
swelling, and changes to the way nails and hair grow. The onset is mostly
associated with a trauma, surgery or immobilisation however there is no link
between the severity of injury and subsequent CRPS.

What causes CRPS?

It is not clear what causes CRPS however once triggered changes occur in the way
the nerves function. Nerves that carry motor information (nerves that drive
movement), sensory information (nerves that drive feeling and touch) and those
that play a role in other functions including blood flow, which affects temperature
and colour changes within the skin can be affected. This can often lead to weakness
and stiffness.

Who gets CRPS?

CRPS affects approximately 5 out of every 100,000 people with a female to male
ratio of 3.5:1. The lower limbs are generally more affected than upper limbs with
the leg affected in 60% of cases and the arm in 40%.

CRPS symptoms

The diagnosis of CRPS is not based on a single test with a black and white result
however there are a range of symptoms that may lead to the diagnosis of CRPS.
● Constant pain, higher than the normally perceived pain
● Extremely sensitive skin eg painful to gentle touch or numbness
● Temperature changes eg sweating or extremely cold
● Skin colour changes eg blotchy, pale, red, blue
● Reduced or painful range of motion
● Changes in hair and nails
● Swelling

Treatment for CRPS

There is no simple treatment for CRPS and treatment will often involve a number of
different modalities with the aim to restore movement and function of the affected
limb and reduce pain. Some common treatment approaches include:
● Physiotherapy – often involves patient education surrounding pain, manual
therapy techniques to improve range of motion and most importantly
exercises to improve the strength and functioning of the affected limb.
● Pain relieving medications.
● Psychological support – to help cope with stress, sleep disturbances and
chronic pain.

Reducing injury risk post lockdown – Michael Freeman

Posted on November 10, 2021 by - Category One

Top 4 tips to reduce injury risk when returning to exercise post-lockdown

Have you recently returned to sport or the gym since coming out of lockdown and found you could barely move the next day? Don’t worry – me too! This general soreness is completely normal and is a sign your body is responding to a new exercise stimulus and needs to adapt.

 

Different to this general soreness however is an actual injury (more on this in an upcoming post). With the excitement of Victoria opening up and returning to a “Covid-normal”, we have seen a number of injuries in people returning to sport and the gym.

Here are my Top 4 tips to reduce your injury risk during this time!

1) Ease your way back in!

You could be forgiven in all the excitement to start exactly where you left off, and you may get away with it, but unfortunately going from “zero to hero” and the “all or nothing” approach may also bring you unstuck.

A gradual build back towards your pre-lockdown activity levels will greatly reduce your injury risk and can be broken down into four key areas:

– Intensity: how hard are you working? How much are you puffing and sweating?
– Duration: how long are you exercising for?
– Frequency: how many times per week?
– Type: is the activity or skill new or different?

If you can avoid a big spike in these areas you’ll greatly reduce your risk of injury. There are simple and effective ways of monitoring your exercise workload, which I’ll cover in an upcoming post.

2) Warm-up!

Getting your body moving before exercise is a quick and easy way to reduce your injury risk. Aim for a more active warm-up rather than static stretches (i.e. sitting down touching your toes). Think squats, leg swings, windmills etc. It doesn’t have to take long and whatever you can do to get your body moving and feeling warm will help prepare the body for what’s to come!

3) Recover! Recover! Recover!

The importance of recovery cannot be understated during this time.

 

This can come in many forms, but by far the most important one is sleep! Of course we all sleep, but how well do we sleep? Do you go to bed quite late or wake up really tired? During sleep is where a lot of our body’s natural recovery and healing occurs, and so good sleep hygiene will help your body to recover in time for the next exercise session. A day in between exercise sessions is in a lot of cases a good idea to help reduce your injury risk.

There are many other recovery strategies that you could utilise and they include:

– Stretching
– Foam rolling/spiky ball use
– Hot/cold showers
– Beach recovery (if you’re game to brave Victoria’s chilly water!)

– Good nutrition

4) Listen to your body!

Last but not least is listen to your body! Sometimes for no apparent reason we feel really great and better than expected during an exercise session, and sometimes we feel really lousy and worse than expected. This is normal. So listen to your body, and if you’re feeling fantastic push yourself a little harder, and if you’re feeling a bit off then look after yourself and consider doing a little less.

So there you have it…

 

My top 4 tips to reducing your risk of injury post-lockdown. I hope you’ve found them useful and help you make a successful return to whichever form of exercise you enjoy! If you’ve succumbed to a post-lockdown injury or have a niggle and feel like you might be on the verge of one, go and visit your physiotherapist today and they can help you get back on track and fit and firing!

Men’s Health – Movember facts

Posted on November 5, 2021 by - Category One

MEN’S HEALTH

Globally, men die on average 5 years earlier than women, and for reasons that are largely preventable. Which means that it doesn’t have to be that way: we can all take action to live healthier, happier and longer lives.

5 tips for men or the men in your lives from the Movember foundation to improve their health:

  • Spend time with people that make you feel good.
  • Talk, more.
  • Know the numbers.
  • Know thy nuts. Simple.
  • Move, move.

More details on the above can be found at the Movember website.

Asthma

Posted on October 27, 2021 by - Category One

Chest

ASTHMA

Asthma is a chronic disease affecting the airways of the lung. In people with asthma, the airways are sensitive to stimuli. Therefore, those who have asthma experience recurrent and reversible flare-ups (attacks) of airway narrowing and inflammation. Asthma usually begins in childhood but can affect people of any age. During a flare-up of asthma, the symptoms can include wheeze, breathlessness, cough and chest tightness.

What causes asthma?

The actual cause and pathology behind asthma is not well-understood, but it is thought that a trigger causes airway inflammation, airway narrowing and mucous secretions. A person who has asthma will experience recurrent flare-ups (attacks) that are reversible. These flare-ups are usually triggered by exposure to some sort of stimuli or allergen, such as dust, dog or cat hair, pollen, mould, chemicals, tobacco smoke, air pollution, exercise in the cold and some types of food or drink. The symptoms of a flare-up are usually reversed by taking reliever medication, a blue or grey ‘puffer’).

How do I know if I have asthma?

During an asthma attack, common symptoms are wheeze, breathlessness, cough and chest tightness. Asthma Australia recommends that during an asthma attack, it is important to stop and rest, sit upright in a chair, and take four puffs of your asthma medication, with a spacer if you have one. If the symptoms are not relieved after four minutes, take the puffer four times again. If there is still no improvement, call 0-0-0. People with asthma who have the disease under control may not experience any symptoms normally outside of flare-ups. Refer to Asthma Australia for more information.

A GP will help diagnose asthma. They may do a variety of breathing tests to try to determine if you have asthma and how severe it is, and may then send you to a specialist medical doctor (respiratory physician) for assessment and treatment. Asthma is diagnosed based on a history of recurrent flare-ups (especially if the flare-ups occur after exposure to an allergen), reversal of symptoms and improvement in breathing immediately after taking asthma-relief medication. Because asthma cannot be cured, the treatment is focused on managing the condition and preventing flare-ups. The main component of treatment for asthma is medication (preventers and relievers) prescribed by a medical doctor.

How can physiotherapy help with asthma?

Physiotherapy is important in the management of asthma. Your physiotherapist will help educate you about your condition. They will teach you to use and clean your asthma medication devices correctly to ensure you are getting the correct dose. There are many different types of devices, such as puffers, Turbuhalers, Autohalers and tablet devices. They each work slightly differently.

Your physiotherapist can also help prescribe and supervise exercise training for you. Sometimes exercise can induce an asthma attack, so your physiotherapist will help to assess your exercise ability, your breathing and the presence of any wheeze before you commence. They can develop an appropriate exercise program for you to do at home or in a group setting, and will teach you what to do before and during exercise sessions to prevent a flare-up induced by exercise. Your physiotherapist may also teach you breathing exercises to help with your asthma.

How effective is physiotherapy for asthma?

There is growing evidence for exercise training and breathing techniques in the management of asthma. Exercise training, such as running, cycling, swimming, walking, gymnastics and weight training, can improve fitness levels and quality of life. Breathing techniques may also help reduce symptoms and improve quality of life. Both exercise training and breathing techniques are well-tolerated and safe for people with asthma when done correctly.

What can I do at home?

Managing your asthma at home is important. Discuss with your GP or physiotherapist about having an asthma action plan. This involves having a plan for what medication to take when you are stable, how to detect if your asthma is getting worse, and what medications to take if your asthma is getting worse. An important part of your management at home is measuring your ‘peak flow’ every morning. This measures how fast you can breathe air out of your lungs and helps you keep track of your asthma severity over time. Maintaining a physically active lifestyle is also important to keep you fit and healthy.

How long until I feel better?

The symptoms of asthma during a flare-up should be relieved within four to five minutes of taking relief medication. However, other longer-term ongoing benefits are slower to occur.

The effects of exercise training will be seen after at least one month of regular training. Evidence showing the beneficial effects of exercise training for people with asthma was seen in people exercising for a minimum of four weeks and training at least twice per week.

Rhabdomyolysis

Posted on October 8, 2021 by - Category One

Rhabdomyolysis
Rhabdomyolysis is a serious condition characterized by breakdown of skeletal muscle. In young
athletes it is most commonly caused due to overexerting the muscles. Extreme muscle overuse
can damage the muscle tissue, breaking it down, which causes the release of a muscle protein
called myoglobin into the bloodstream. A big influx of myoglobin is toxic to the kidneys which
can block it’s filtration system leading to kidney complications. The severe muscle damage can
also cause an extremely high level of electrolytes to accumulate into the bloodstream which can
cause serious complications to vital organs including the heart.
Common causes:
● Trauma or crush injuries eg car accident
● Extreme muscle exertion
● Prolonged immobility
● Infections
● Muscle hypoxia
● Genetic disorders
● Body-temperature changes
● Drug or alcohol abuse
● Metabolic and electrolyte disorders
Common signs and symptoms:
● Muscle pain – the most common muscle groups affected are the calves and lower back
● Muscle weakness or stiffness
● Dark coloured urine due to excessive myoglobin levels
● Flu-like symptoms
● Elevated creatine-kinase level
Management:
● Urgent medical management is recommended initially which may include treatment to
manage electrolyte imbalances and intravenous fluids to help maintain urine production
and prevent organ damage.
● It is important to adequately hydrate, retain range of motion and avoid overexertion to
prevent creating more muscle breakdown.
● Physiotherapy management will often include rehabilitation to regain range of motion,
muscle strength, and full function to assist in progressing back to physical activity.

 

Staff Profile – Matilda Wayte

Posted on October 1, 2021 by - Category One

Matilda Wayte

 

Matilda is a qualified Exercise Physiologist, who is passionate about improving people’s lives through movement and physical activity. Graduating from QUT in 2018, Matilda initially plied her trade in Brisbane before joining the Mackay team in Sep 2021.
Matilda’s love for human movement came from 15 years as a Gymnast where she competed at a national level on a twice. Nowadays Matilda stays active by playing team sports or exploring the beautiful local Queensland mountains and beaches.
Believing that everyone should be able to enjoy the benefits of physical activity no matter their age, gender, or condition, Matilda works with all her patients to tailor an exercise program specific to their goals. Matilda is also currently studying Neurological rehabilitation at ECU and has a particular interest in Clinical Pilates, Hydrotherapy, Mental health, Women’s health, and Chronic disease management.

Exercise Physiologist Matilda Wayte

Wrist injury series – Scapholunate dissociation

Posted on September 10, 2021 by - Category One

Scapholunate dissociation

What is it

An injury involving a stretch or tear of the scapholunate ligament which can affect the way the
scaphoid and lunate bones interact.

Mechanism

Often occurs when a person experiences a fall onto an outstretched hand where the wrist is
forced into a position of hyperextension and ulnar deviation which causes a stretching or tearing
of the ligaments between the scaphoid and lunate. Distal radius fractures are often associated
with scapholunate dissociation.

Clinical presentation

● History of a fall onto an outstretched hand
● Pain/clicking on the dorso-radial aspect of the wrist
● Reduced grip strength
● Tenderness 2cm distal to Lister’s tubercle on the radial side of the lunate
● Tenderness in the proximal end of the anatomical snuffbox
● Watson test: either painful or reveals dorsal movement of the scaphoid
● X-ray while gripping an object is useful for diagnosis

Management

● For incomplete tears where there is no instability of the scapholunate joint,
splinting/casting to immobilise the joint may be required
● Taping to improve stability
● Avoiding aggravating activities
● Regaining pain-free movement and strength through joint mobilisation and strengthening
exercises
● For complete tears specialist opinion is recommended as surgical intervention may be
required

Wrist injury series – TFCC injury

Posted on September 8, 2021 by - Category One

TFCC irritation

What is it?

Triangular Fibrocartilage Complex (TFCC) is a cartilage structure that lies between the ulna and
carpus. The function of the TFCC is to act as the main stabiliser of the distal radioulnar joint.

TFCC anatomy

Mechanism

Often injured in forced ulnar deviation or falling on an outstretched hand. Common in racquet or
stick sports and those that create repetitive ulnar and compressive loading including
gymnastics, weight lifting, boxing and surfing. TFCC injury should be investigated following a
distal radius fracture and wherever distal radioulnar joint (DRUJ) instability exists.

Clinical presentation

● Ulnar sided pain that worsens with grip, rotation and weight bearing
● Clicking sensation on wrist movement
● Point tenderness between the pisiform and the ulnar head
● Reduced grip strength
● Pain on resisted wrist extension and ulnar deviation
● Positive foveal sign = sharp pain with deep palpation
● Positive press test = reproduction of pain when lifting own weight up off a chair using the
affected wrist
● MRI imaging is useful for diagnosis of these injuries

Management

● Avoiding aggravating activities
● Avoiding repetitive wrist movements and trying to keep wrist in a neutral position where
possible
● Short period of splinting
● Tape to offload the TFCC
● Stabilisation exercises particularly involving ECU and pronator quadratus instability as a result of a complete ligamentous rupture often requires surgery as soon as possible.