RHP Physiotherapy Blog
The latest from RHP Physiotherapy
RHP Physiotherapy is one of Brisbane’s premier physiotherapy practices. We’ve started this blog in order to provide an informed and authoritative discourse on a range of health related topics.
Our hope is that we can provide you with up to date information and events associated with a range of health topics not limited to sports injuries and musculoskeletal problems as may be associated with traditional ‘physio’ or physiotherapy.
Our sports physiotherapists are amongst the country’s elite but we have worked hard to establish a culture of excellence across a range of health related issues. Many of these topics we hope to discuss in coming blogs.
Post by Sam Donaldson (M.PhtySt, BAppSci(HMS), Physiotherapist APAM SMAM)
Justifying the physical approach to therapy in rehabilitation and performance.
Every fortnight at RHP Physiotherapy, we are fortunate to have implemented an in-service program, through which our therapists are afforded the opportunity to learn as a team and collaborate in the care of our patients.
This fortnight we took on the science behind Mechanotherapy.
Mechanotherapy is a term used to describe the therapeutic use of any modality that provides a mechanical stimulus to the tissue, which is directed towards rehabilitating or developing the body to return to, or improve activity. My personal favourite definition (from Huang et al 2013) is the “Therapeutic interventions that reduce and reverse injury to damaged tissues or promote the homeostasis of healthy tissues by mechanical means at the molecular, cellular or tissue level.”
What this whittles down to is that when a force is applied to any bodily tissue, that force stimulates a change. When jumping up and down, the muscles must stretch and contract; tension pulls and recoils in the tendons, the bones absorb vertical compression which also bends and twists them (ever so slightly). The cells in these tissues must deform under that force, which will stimulate a cascade of events within the cell, as well as between the cells. Ultimately, the cells of those muscles, tendons and bone, will stimulate DNA transcription (the building blocks of our bodies) and create new muscle, tendon and bone.
What is most interesting to us, is that each tissue type will respond to different types of forces. Not only that, but the cells of these tissues will respond at various amounts depending on how much force, the rate of repetition of that force and the recovery period between those forces that are applied. This means that we can potentially find an optimum amount of that mechanical force, that will stimulate change: with far too much being detrimental, a little too much being no better than the optimum, and too little not being effective enough to make the necessary adaptations.
Without going too much further into the dry science of it all, it is these cellular mechanisms that underpins every aspect of our physical approach to therapy; be it massage therapy, stretches, exercise therapy or even something like shock-wave therapy or low intensity pulsed ultrasound.
So, if you have ever wondered why you have been asked to do certain exercises or walking or running with explicit repetitions, sets and recovery times, this cellular response to that exercise is one justification for the specificity of that prescription.
Without a doubt, there is more at play than just the biological responses at a cellular level when we are considering how we might rehabilitate an injury. Pain and the nervous system is a whole other kettle of fish! However, the way the body can physically adapt to whatever it is we ask it to do, it seems we can achieve the most when we do just the right amount at just the right intensity, and allow certain rest times. Sometimes less is more, and more is less!
The human body is an amazing organism and one we are continually amazed by. Treat yours well and it will reward you!
If you would like to learn more or have any physical barriers to doing what you would like to be doing (injury, pain or other), then get in touch with our physiotherapists on 07 3856 5566.
- Warden, S. J., & Thompson, W. R. (2017). Become one with the force: optimising mechanotherapy through an understanding of mechanobiology.
- Khan, K. M., & Scott, A. (2009). Mechanotherapy: how physical therapists’ prescription of exercise promotes tissue repair. British journal of sports medicine, 43(4), 247-252.
- Huang, C., Holfeld, J., Schaden, W., Orgill, D., & Ogawa, R. (2013). Mechanotherapy: revisiting physical therapy and recruiting mechanobiology for a new era in medicine. Trends in molecular medicine, 19(9), 555-564.
Sit – Stand Workplace Tips
Workstations that allow computer workers to vary their position between sitting and standing are becoming more common, and the costs involved in setting up a sit – stand workstation are becoming more affordable for all.
Our guidelines for how best to incorporate sit-stand technology into your day include
- Prepare your body for sitting
- Prepare our lumbar intervertebral discs for sitting by going for a walk in the morning. Our discs compress at the start of the day after lying/sleeping. A walk will help the disc start the day in an ideal state. Perhaps > 20 minutes.
- To enable our bodies to be able to sit with the ideal posture outlined in various ergonomic guidelines, we need to be
- flexible in the hamstrings and back of the hips to help maintain a neutral lower back curve (lordosis)
- flexible in our chest muscles to help maintain upright trunk posture
- Prepare your body for standing
- After sitting for a while the muscles at the front of your hips will have tightened a bit. Thus, stretch them out before your standing stint so the lower back position will be optimised. Tight muscles at the front of your hips can drag the arch in the small of your back into a shape that is too deep, and this can compress the joints in your lower spine.
- Maintain strength of your abdominal, pelvic floor, gluteal, and spinal muscles. These need to be gently active and supporting your skeleton whilst standing.
- Prepare your workstation
- For standing ensure a cushioned surface and shoes that provide stability and some shock absorption.
- Invest in a sit-stand workstation that meets all your requirements e.g adequate space for monitor(s), keyboard, documents, phone, drinks etc.
- The sit-stand workstation needs to be easily moved from the sitting position to standing and vice versa. Supported lifting hydraulics and durable mechanisms are recommended, as well as non-pinching hinges.
- Sit-Stand workstation guidelines
- Stand with your breast bone positioned over the front of your pelvis. A common mistake is to allow your pelvis/hips to slide forwards during standing.
- Don’t cock your hips to one side whilst standing.
- Only stand for 20-40 minutes. If you are uncomfortable or can no longer maintain good posture, then it is time to sit again.
- Change position whilst standing. For short periods, it may be useful to place one foot up on a small stool.
Sit – stand work stations can be a helpful addition to the workplace if utilised correctly, and if your body and workstation are appropriately organised.
If you are experiencing pain associated with your computer work, RHP Physio’s are able to help identify the physical contributors, and provide remedies specifically for your body or work environment.
Why would I see a Physiotherapist?
Post by Kerry Staples (MPhysio (Sports) BPhysio (Hons) B HMS (Ex Sci) Sports Physiotherapist APAM)
Physiotherapists are highly qualified health professionals who work in partnership with their patients to help people get better and stay well.
Physiotherapists also work closely with GPs and other health professionals to plan and manage treatment. GPs refer more patients to physiotherapists than any other healthcare profession.
Using advanced techniques and evidence-based care, physiotherapists assess, diagnose, treat and prevent a wide range of health conditions and movement disorders. Physiotherapy helps repair damage, reduce stiffness and pain, increase mobility and improve quality of life.
Physiotherapy extends from health promotion to injury prevention, acute care, rehabilitation, maintenance of functional mobility, chronic disease management, patient and carer education and occupational health.
Common reasons people seek help
All Australians can benefit from physiotherapy at some point in their lives. While it is well-known that physiotherapists treat injuries, increasing numbers of Australians are coming to physiotherapists when they want to take control of their health and stay well. Some of the needs physiotherapists address include:
- Cardiorespiratory – prevent, rehabilitate and support people living with, or at risk of diseases and injuries affecting the heart and lungs, such as heart disease or asthma.
- Cancer, palliative care and lymphoedema – address a range of patient needs, including treating, managing or preventing fatigue, pain, muscle and joint stiffness, and deconditioning.
- Continence, men’s and women’s health – manages and prevents incontinence and pelvic floor dysfunction in men, women and children. Physiotherapists work in areas including pregnancy, birth, post-partum care, breastfeeding, menopause, loss of bladder or bowel control, and with men living with or recovering from prostate cancer.
- Supporting older Australians – using evidence-based care to promote healthy and active ageing among older Australians, including falls prevention.
- Musculoskeletal – prevents and treats clients with musculoskeletal conditions such as neck, back and joint pain. Techniques include addressing underlying problems, preventing further injury, and prescribing exercises and other interventions to promote mobility.
- Neurology – promotes movement and quality of life in patients who have had severe brain or spinal cord damage from trauma, or who suffer from neurological diseases such as stroke, Parkinson’s disease and multiple sclerosis.
- Orthopaedic – helps patients prevent or manage acute or chronic orthopaedic conditions such as osteoarthritis, rheumatoid arthritis and amputations. Physiotherapists also help patients prepare for or rehabilitate from orthopaedic surgery, or another orthopaedic hospital admissions.
- Occupational health – supports the health and wellbeing of workers, reduces safety risks in the workplace, prevents and manages injuries and diseases, and support workers in returning to work.
- Paediatric (supporting infants and children) – aims to prevent conditions such as plagiocephally (misshapen head) or support a child’s development such as addressing milestone delays with sitting and walking, clumsiness, or hyperactivity.
- Pain – manages or prevents pain and its impact on function in patients using a psychologically informed and interdisciplinary approach. Physiotherapists work with other health and social-care professionals to manage pain at the acute stage of an injury or condition, including through identifying psychosocial risk factors that may lead to chronicity.
- Sports – prevents, diagnoses and treats musculoskeletal and sporting injuries among all types of people, from professional athletes to everyday Australians.
- Acupuncture and dry needling – which helps to manage both chronic and acute conditions such as sprains and strains, spinal dysfunction, arthritis and neurological conditions.
- Aquatic – using a pool, physiotherapists treat patients with a multitude of conditions using hydrotherapy including sports injuries, post-operative and orthopaedic conditions, spinal pain and/or injuries and arthritis.
About a typical physiotherapy session
A typical session with a RHP physiotherapist is unique to a patient’s needs and their health condition. RHP Physiotherapists are all expert clinicians with a wide range of interests and experiences.
A‘typical’ initial physio session would usually involve:
- Assessing and diagnosing your condition and needs. A careful explanation of the condition is a key focus at RHP Physiotherapy.
- Working with you, the patient, to set and attain goals—whether that’s maintaining mobility and independence in aged care to running a marathon.
- Developing a treatment or prevention plan with you that will take into account your lifestyle, activities and general health. At RHP Physiotherapy, we take the extra time needed to carefully design a treatment plan with you.
- Prescribing exercise, maintenance strategies, and physical aides if required. These are often simple strategies that are effective and time efficient.
Book in today and get some answers to your questions. Recommend someone to RHP Physiotherapy and we will thank you with a massage voucher.
If you have any questions, please do not hesitate to contact us on Book in today and get some answers to your questions firstname.lastname@example.org
Adapted from https://www.physiotherapy.asn.au/APAWCM/Physio_and_You/physio/APAWCM/Physio_and_You/physio.aspx?hkey=25ad06f0-e004-47e5-b894-e0ede69e0fff [accessed 21 Jun 2017]
We walk who we are!
The way we walk often reflects who we are as an individual personality. Laid back and free? Hustle and bustle? Stomping and full of purpose? Slouched and succumbed?
We are how we walk!
In turn, the way we walk determines which muscles in the body are being engaged on a daily basis, or what shape our spine is held in, and how much load is transmitted through our joints. These factors all contribute to our physical wellbeing.
A good walking pattern helps to maintain physical health through activation of our stabilising muscles. These include the important gluteal, abdominal, and back muscles, among many others.
A good pattern will absorb and dissipate what we call ground reaction forces. These are the jarring loads that occur when we land on the ground. Excessive jarring will overload and contribute to joint stress, particularly in the feet, knees, hips, and lower back.
A good walking pattern will help to maintain ideal posture, which is crucial for optimal spinal health.
A poor walking pattern can bypass these stabilising muscles, and encourage overuse of the wrong muscles. This often leads to tightness and muscle imbalance problems, which in turn loads up our joints and promotes injury. These injuries can include low back pain, hip joint degeneration, gluteal tendinosis, and knee pain.
Image from Professor Vladimir Janda
Walking utilises the whole body, and becomes a firmly fixed motor memory in the brain. Learning to walk well and over time reshaping the brains gait memory can have a massive effect on our joint and muscle health, and help eliminate ongoing or recurring pain conditions.
At RHP Physiotherapy we have expertise in movement analysis including walking and running. We can propose exercises and strategies to mould your walk into a smooth, co-ordinated and cohesive pattern. So perhaps it is time to ask yourself “how do I walk?”
Post by Sam Donaldson (M.PhtySt, BAppSci(HMS), Physiotherapist APAM SMAM)
Recently, a patient presented with a lengthy (>3 month) history of lower back pain. This individual’s pain wouldn’t behave as typical lower back pain. There was also a complaint of some discomfort in other body regions that didn’t fit a typical spinal pain presentation. Upon being made aware of some recent illness, it became apparent that we might be dealing with something systemic or auto-immune.
Fortunately, these suspicions were justified once this patient attended a Rheumatologist, with a Spondyloarthropathy diagnosis being made and subsequent treatment being positive.
What was interesting in this case is the rarity of these patients and the challenge for the health professional that this type of patient presents from a diagnostic perspective.
It is, among other things, one of the Physiotherapists primary roles… ensuring that Physiotherapy treatment is appropriate for the patient in front of them. Through thorough questioning and examination of the patient in their initial appointment, we are essentially deciding whether we can help, and if not, what health professional might.
Fortunately, there are strong guidelines for the appropriate referral of a patient that we might suspect is suffering a Spondyloarthropathy. A recent “NICE Guideline” presented a number of clinical features of a patient’s presentation and at what point should a referral to a Rheumatologist be made. Bearing in mind (for any Physiotherapists reading), this might mean a phone call to the patient’s GP to discuss the possibility and for the referral to be made via the appropriate pathways.
One of the first decision for us to make is: is this patient suffering “Inflammatory Low Back Pain?” This is generally described as:
- Lower back pain lasting >3 months
- Better with movement and worse with rest
- Pain at night, improves upon getting up in morning
- Alternating buttock pain
- Insidious onset
Following the recognition of inflammatory lower back pain, a range of clinical features might also be present (see infographic). If 3 or more criteria are present, it is reasonable to be suspicious of a Spondyloarthropathy. Particularly since the average time between symptom onset and diagnosis is 8.5 years. This is a significant amount of time losing quality of life and suffering pain.
So, if this is the case for yourself or a loved one, a discussion with a primary health care provider such as your GP or Physiotherapist is certainly appropriate. For the Physiotherapists, hopefully some greater awareness and interest is sparked and further reading performed. We have a great role in assisting in musculoskeletal management of various spondyloarthropathies and the impact on our patient’s life can be astounding!
McAllister, K., Goodson, N., Warburton, L., & Rogers, G. (2017). Spondyloarthritis: diagnosis and management: summary of NICE guidance. BMJ, 356, j839.
Akgul, O., & Ozgocmen, S. (2011). Classification criteria for spondyloarthropathies. World J Orthop, 2(12), 107-15.