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Am I covered for Physiotherapy under Workcover?

Workcover (WorkSafe Victoria) is a compensation scheme for all Victorian employees in the unfortunate event of a workplace injury. There are similar insurance schemes within each state. These allow you to receive medical services, compensation and rehabilitation while recovering from your workplace injury. Access to these medical services is vital, as the vast majority (89%) of workplace claims are due to injuries and musculoskeletal disorders. Of these, the common causes are traumatic injury to the joint, ligament or tendon; wounds, musculoskeletal and connective tissue disease; and fractures.

Fortunately, there is a wide range of medical services that you may be able to access with a workcover injury, including Physiotherapy.

What to do with a workcover injury?

First, don’t panic!

If it is a serious incident, your employer will report this to Workcover and complete an incident form with details of your injury. This will ensure you are eligible for any rehabilitation and medical services that are included as part of the compensation scheme. Your employer may need to pay what is known as the Employer Liability. This is equivalent to $744 (current excess) of reasonable medical and related expenses. While your employer is paying for the excess, you may be required to pay for the medical appointments upfront and have your employer reimburse you afterward, or your service provider may be able to bill your employer directly.

Medical treatment is an essential component of recovery after your injury. It is important that you access healthcare services early on to fast-track your recovery and return to work. This early intervention is key in preventing the injury from deteriorating or having a lasting effect on your life.

You may need to take some time off work due to your injury. In this case, you will need a Certificate of Capacity. This details what sorts of activities you are able to complete at the workplace, and what activities should be avoided at this stage. You must go to your GP to receive your first Certificate. Another key function of this certificate is to determine the suitability of tasks and duties at your workplace, and whether things like reduced hours or extra assistance are needed. Your Physiotherapist may complete subsequent Certificates. We are well placed to do so as you will likely see us most frequently during your recovery, and we can modify your certificates as needed.

How can I claim?

1. Complete a Worker’s Injury Claim Form with all injuries related to your compensation claim. This may be found on the Workcover website, and is submitted to your employer.

2. Expect a decision from the Workcover Agent within 28 days of receiving the claim from your employer. Your health is the most important thing, so you are allowed to go see your GP or a Physiotherapist while waiting for claim approval. While this is in progress, your employer is liable for the first $744 (current) of your medical services.

Who is Involved?

  1. You may have a Return to Work Co-ordinator at your workplace: They will assist you and your employer in returning to your previous duties as safely as possible. This will involve consulting with all involved parties and monitoring your recovery.
  2.  Case Manager: This person will be the primary contact for all involved parties, and will work alongside Workcover Victoria to manage your claim and entitlement to any medical entitlements
  3. Your health practitioner: You are able to choose which health practitioners you would like to work with to facilitate your recovery and return to work. Physiotherapists are well trained in assessing and treating workplace injuries.Physiotherapy

So where does Physiotherapy fall into with all this?

As outlined above, you are encouraged to see a GP as well as a Physiotherapist for any musculoskeletal or physical injuries. Your employer may cover initial medical expenses during this time. There is no referral required to start seeing a Physiotherapist for rehabilitation, so you may be able to see both concurrently. This early intervention immediately after your injury may reduce the likelihood of further complications down the track, and speed up your recovery.

Your first Physiotherapy appointment.:

  • Bring your claim details – your Physiotherapist will need your claim number, date of injury, insurer and case managers details. These ensure a Physiotherapy Management Plan can be sent to your insurer once they have thoroughly assessed you and decided on a course of action.
  •  Discuss your workplace duties. Your Physiotherapist will tailor a comprehensive rehabilitation program for you in order to achieve your goals. Understanding these duties is essential in developing your program. This will also be useful in completing the Certificate of Capacity that you will need prior to returning to work.
  • Do your homework! You will only see your health practitioners for a few hours a week at most. Therefore, the rehabilitation program will include a home exercise plan. This ensures you are making the most of your visits, and results in quicker return to your full duties.

If you have had a workplace injury that requires Physiotherapy services, make an appointment with us at Total Physiocare Heidelberg, Reservoir, Footscray, Kew and Brunswick. We offer fast-stream access to orthopaedic surgeons should you require any surgical consultation, as well as access to a wide range of services like Exercise Physiology and Hydrotherapy. These services are beneficial in reducing your recovery time, enabling you to return to work as soon as safe to do so.

Book an appointment today for your assessment!

Lumbar Fusion by Thomas Andrews (Physiotherapist)

lumbar fusion diagram
lumbar fusion diagram

What is it?

In people with severe back pain or nerve referral down the leg, a lumbar fusion may be recommended. A lumbar fusion is a surgery that permanently connects two or more vertebrae of your spine together.  This is done with metal plates, screws and rods in the vertebrae. This technique holds the two vertebrae still and stops any movement at this area of the spine. Often during this surgery, the surgeon may release or trim areas that are compressing nerve structures to relieve pain.

When is it indicated?

Lumbar fusions are usually indicated for those people who have persistent high levels of pain despite trialling conservative treatment. For example; Physiotherapy, medication and injection therapies. Usually this occurs in people who have the following conditions:

    • disc herniations (disc bulge)
    • spinal scoliosis (irregular curves in the spine)
    • sciatica or nerve irritation
    • severe arthritis of the back (stenosis)
log roll
log roll

What to expect in the hospital:

After the surgery, you will be in hospital for at least the next 4 days to allow time to recover. During this period, physiotherapists and nursing staff in the hospital will assist you getting out of bed, walking and completing daily tasks.  Your surgeon will likely recommend that you do not to bend or twist following surgery for a number of weeks.

Getting out of bed after lumbar fusion or with severe back pain can be difficult. It is recommended that you use the log roll manoeuvre as shown in the diagram.  This reduces movement at the spine, which may help reduce pain and protect the area.

What to expect once your home:

After discharge from hospital, the first six weeks post surgery includes basic exercise, walking, and other light activities. It is not recommended that you avoid heavy house-hold duties during this time. After surgical review at 6 weeks, your surgeon may recommend Physiotherapy. Due to the screws and plates and the pain in your back, you are likely be stiffer in that region, making simple tasks such as putting on shoes and socks difficult. Physiotherapy following a lumbar fusion is recommended to assist in activating muscles in the back, core and legs and to support the injury area.  Treatment may also include nerve stretching, Clinical Pilates and manual therapies.

How can we help you:

Physiotherapists can use hands-on techniques to help improve movement of your back, reduce pain and facilitate muscle activation. Physios can also develop a tailored exercise program dedicated to your needs, to assist you in getting back to activities that you want to do.

Below are some exercises that we often give patients immediately after lumbar fusion to help get you started.

Transversus abdominus muscle activation.

The transversus abdominus is a deep core muscle that helps support the both the abdomen and the spine. After lumbar fusion surgery, this muscle has some difficulty working and supporting the spine. This exercise is aiming to jump start this muscle again to get it working. This may help to decrease pain after lumbar fusion and help to ensure the spine is supported.

To complete this exercise, you slowly draw your lower abdomen in, hold it for 3-5 seconds and then release.

Hip abduction

This exercise aims to build up the strength in the hip muscles to create a stable and strong foundation for the back.

To complete this, bring one leg to the side whilst standing upright. Hold this position for up to 3 seconds and then bring it back in.

Chair squats

This exercise is aimed at improving leg and hip strength. It also works on coordination of the lower back muscles.

To complete this, stand whilst holding onto a back of a sturdy chair or kitchen bench, keeping your back straight, bend your knees making sure they don’t go past your toes. Make sure you don’t squat down too low and return back. You can progress this exercise by removing the chair and completing a squat to the same height.

Book an appointment today for your assessment!

Rotator Cuff Injury by Evan Yang (Physiotherapist)

Overview of the shoulder

The shoulder is the most mobile joint in our body. Whilst this beneficially allows for multidirectional use, it also means that the shoulder is the least stable of all joints in the human body. Due to the lax nature of the shoulder joint, it becomes more reliant on the surrounding structures to provide stability, namely the muscles, ligaments and tendons.

 

The Rotator Cuff Muscles

There are four rotator cuff muscles that surround the shoulder joint. The primary purpose of these muscles is to stabilise the shoulder, keeping the ball of your humerus in the shoulder socket. Each muscle of the rotator cuff contributes largely to the multidimensional movement of the shoulder.

The supraspinatus, infraspinatus and teres minor muscles all attach to the back of your shoulder.  This is where they are involved in outwards rotational movements and moving the arm away from the body. The subscapularis muscle is the largest of the four rotator cuff muscles. It attaches to the front of the shoulder blade and is important for inwards rotational movements.

There is a lot of evidence that highlights how dysfunction of the rotator cuff can result in reduced ability to use shoulder in functional tasks.  This includes shoulder pain and impaired quality of life. If you do end up with shoulder pain or reduced shoulder movements, it is important to get this assessed by a Physiotherapist.  They are the best person to determine the type of injury and the best treatment plan.

 

What is a Rotator Cuff Tear?

rotator cuff repair

One of the most frequent injuries that occur in the shoulder is a rotator cuff tear. It is important to determine whether the tear is partial or a full-thickness tear. Symptoms that can identify a rotator cuff tear include shoulder pain, difficulty using the arm for functional tasks, reduced strength in the shoulder, increased stiffness in the shoulder, pain that worsens at night, or an audible sound when moving the arm that sounds like cracking or popping. It is important to recognise that pain is not always present. A study conducted by Itor (2013) highlighted how only one-third of individuals have pain with a rotator cuff tear.

The size of the rotator cuff tear is important to consider when determining whether to have surgery on your shoulder or not. Partial and even full-thickness tears are often

managed conservatively. Intrinsic and extrinsic factors such as the patient’s age, their medical history and their current shoulder pain, movement and strength are all important to consider when calculating the best treatment approach (Edwards et al., 2016).

 

Treatment:

 

Surgical Management:

Some rotator cuff injuries are most suitable for surgical management. There are three surgical techniques that are most common.

Open Rotator Cuff Repair:

This technique is the most invasive.  It involves a large incision (usually several centimetres long) conducted to separate and reattach a larger shoulder muscle (the deltoid) to repair the tear. This surgical approach is primarily used for individuals who have complicated rotator cuff injuries.

Arthroscopic Rotator Cuff Repair

This technique is the least invasive of the three procedures. They are generally conducted on individuals with smaller tears (equal or less than 3 centimetres).  People who undergo arthroscopic surgery generally have lessrotator cuff pain and a shorter recovery time period.

Mini-Open Rotator Cuff Repair

This is a newer surgical technique that involves an keyhole (arthroscopic) incision to evaluate the rotator cuff tear and remove loose cartilage. A further incision (around 4 to 6 centimetres) is then conducted to repair the injury.

In nearly all cases, all three surgical approaches require a period of time in a sling. The open rotator cuff repair often requires individuals to have their shoulder immobile in a sling for more than a month. Whilst unlikely, some surgical cases can take up to 2 years to properly rehabilitate. Thus it is crucial to see a physiotherapist as soon as appropriate to prevent stiffness, regain movement, improve strength, improve quality of life and recover movement automatism.

 

Conservative Treatment:

 Most rotator cuff injuries are recommended to undergo conservative treatment. Physiotherapy will be aimed at increasing strength and movement of the shoulder,  improving the quality of life and reducing pain. Physiotherapy will also be involved in realigning the shoulder structures and recovering movement automatism. A physiotherapist will involve a combination of manual therapy techniques and exercise to maximise these outcomes.

Other forms of conservative management include rest, thermotherapy (use of heat or cold) and NSAIDs (non-steroidal anti-inflammatory drugs). Corticosteroid injections are also a common practice, however  caution  should be taken if you are considering this management route.

Recent studies have highlighted how conservative treatment has a high likelihood of improving functional use and reducing pain.  It is important to have your shoulder assessed by a physiotherapist and orthopaedic surgeon before deciding on taking the surgical route.

If you have had recent shoulder pain or a recent shoulder operation make an appointment below at one of our clinics at Total Physiocare Heidelberg, Reservoir, Footscray and Kew.

 

 

Book an appointment today for your assessment!

Blog by Evan Yang (Physiotherapist)

Adenomyosis written by Claire De Vos (Physiotherapist)

What is Adenomyosis?

Adenomyosis is a condition that affects up to 1 in 10 women yet is rarely spoken about. It occurs when cells similar to those that line the uterus (womb) grow into the muscle wall of the uterus. The extra tissue can cause the uterus to enlarge and with each menstrual cycle it thickens, breaks down and bleeds which can lead to cramping, pain, and heavy periods. Adenomyosis most commonly occurs in women aged 35-50 years who have had children, although it can occur in young women and teenagers as well. The cause of adenomyosis is largely unknown, although it is believed that childbirth or previous surgeries can increase the risk of developing it.

Uterus model showing Adenomyosis

Adenomyosis differs from endometriosis (another common pelvic pain condition), although many women have both adenomyosis and endometriosis. Endometriosis occurs where cells similar to those that line the uterus grow on other parts of the body, commonly the fallopian tubes, ovaries, bladder and bowel

Adenomyosis Symptoms

Diagram showing a healthy and a uterus with Adenomyosis

Adenomyosis can vary greatly from woman to woman. For some women, symptoms can be severe and extremely debilitating. However, up to 30% of women with adenomyosis experience no symptoms at all. The correlation between the severity of symptoms and the amount of adenomyosis is also poor so it is difficult to predict who will experience symptoms.

Symptoms of adenomyosis can vary between women but may include:

  • Heavy, painful periods
  • Menstrual cramping
  • Pain in lower limb and lumbar spine
  • Pressure in pelvis and/or bloating
  • Chronic pelvic pain
  • Pain with sexual intercourse

How is it diagnosed?

Adenomyosis can be difficult to diagnose. If a medical practitioner suspects you have adenomyosis they will likely refer you for a transvaginal (internal) pelvic ultrasound.
MRI is also a useful tool for diagnosing adenomyosis and is non-invasive.

How is it treated?

There are medical, surgical, and conservative management strategies. Although the only definitive cure is hysterectomy, there are many lifestyle and medical interventions that can decrease pain and improve quality of life.

Conservative management

Uterine model Adenomyosis

The good news is physiotherapy can help! Physiotherapy management may include lifestyle modification advice and pain management strategies including heat, ice, pacing and gentle movement. Physiotherapy management may also include; soft tissue release, pelvic floor muscle down-training, biofeedback, and retraining good bladder and bowel habits. Your pelvic health physiotherapist will conduct a comprehensive assessment and work together with you to identify your goals and create a tailored management plan.

Exercise is an important part of managing any persistent pain condition and working with an exercise physiologist who specialises in managing pelvic pain conditions is a great way to incorporate regular movement and activity into your daily routine.

Medical Management:

  • Pain management and analgesia
  • Hormonal therapies. These may be either oral medications or an intrauterine device can help such as the Mirena.

Surgical Management:

  • Laparoscopy
  • High intensity ultrasound
  • uterine artery embolization
  • Endometrial ablation

If you experience any of the above symptoms, get in touch today to discuss the role of Pelvic Floor Physiotherapy and Exercise Physiology.

 

Book an appointment today for your assessment!

Blog by Claire De Vos (Physiotherapist)

Runners Knee by Marco Cheung (Physiotherapist)

Coming into 2021, I’m sure the new “COVID-normal” has many people brainstorming ideas to keep fit. One way that has increased in popularity over the past year is recreational running. There are numerous health benefits to running, most commonly stronger bones, stronger muscles and improved endurance.

As with any sport, a balance needs to be struck between keeping active and over-training. One common consequence of overuse in running is pain around the knee. This is broadly defined as “Runner’s Knee”, otherwise known as Patellofemoral Pain Syndrome (PFPS).

What is Runner’s Knee?

Runner’s Knee is commonly classified as an overuse injury. Despite its name, it can also occur in athletes that need to bend and straighten their knee frequently. This means cyclists and soccer players are also frequently affected. Pain can come about from irritation of the kneecap on the thigh bone (femur). It can be caused by many things, like increasing your running distance too fast, uneven running surfaces or even improper training and footwear. The pain experienced can vary, from a dull ache all the way to a sharp shooting pain.  Pain generally arises around or underneath the patella (kneecap) with this injury, and can get worse with knee bending, climbing stairs or walking on uneven surfaces. Other common signs noted are swelling and crunching within the knee joint. Patellar tracking (how your kneecap moves) can be one of the contributors towards this.

What should you do?

If you encounter this, the best way to manage an acute flare-up of knee pain is to follow these steps over the first week:

Rest: It is important to avoid repetitive overuse and stressing of the knee. This can be completed with relative rest – you may reduce the running distance to one where there is no flare-up of knee pain after the session. Additionally, reducing exercises with significant knee bending like lunges and deep squats can reduce the stress placed on your knee joint.

Ice: This helps reduce localised pain and swelling, Apply an ice pack onto your knee for 30 minutes at a time, and ensure it is wrapped with a towel to avoid ice burns.

See a Physio!

Physiotherapists can assess and get to the bottom of what exactly is causing this knee pain. Due to its nature, risk factors that affect patellar tracking and load bearing around the area can increase the incidence rate of Runner’s Knee.

Some common risk factors are:

  • Weak Quads: Your thigh muscles are responsible for straightening the knee, and are an essential muscle group to help load the knee appropriately. Weakness, particularly of the inside quads, can also cause the kneecap to track along the outside of your knee. This further contributes to knee pain.
  • Tight Iliotibial Band: The ITB is a thick fibrous layer of fascia that runs along the outside of your thigh, attaching onto the lateral aspect of your knee. It normally assists in knee stabilisation and movement of the lower extremity. However, if it gets too tight, it can pull the knee cap laterally, thereby influencing knee pain.
  • Loading changes: Sometimes, changes to intensity and volume of your training can contribute to knee pain, especially when combined with insufficient recovery. The best thing to do with loading changes is to only change one variable (eg. Speed, duration or frequency), and ensure a gradual change instead of a rapid increase.
  • Knee Cap position: Patellar positioning is different on each individual. Some are more predisposed to knee problems due to where it sits. If it sits to far to the side, this can increase contact with the groove, and hence knee pain. A good method to counter this is to train the muscles around the knee and optimise the patellar positioning.

How can we treat it?

Physiotherapy is an evidence-based, effective treatment for Runner’s knee. There are many ways we approach treatment and prevention of this:

  1. Education: Discussing the nature of your injury and how to prevent recurrence is a crucial component of your treatment. Reflecting on your training and loading is the first step in reducing your pain.
  2. Taping: Taping or bracing can help relieve pain in the short term, and may allow a continuation of running. This is because the tape helps the patella track more on the inside, helping reduce its contact with bony grooves and therefore reducing pain on running.
  3. Exercise: Targeted strength and activation training is needed, given the dynamic nature of running. This will likely involve work with the glutes and quads. A common example of an activation exercise is VMO activation. The VMO is the inside quad muscle, and plays a role in keeping the kneecap in place. A common sign in people with Runner’s Knee is weaker VMOs, so strengthening this muscle may help improve pain and biomechanics of running as well. Other exercises can target different muscles, movement patterns or muscle activation. These include single leg squats and lunges. It is important to ensure you work within a tolerable threshold, as pain can be a big barrier to training.
  4. Soft tissue work: Many people present with tightness in their major muscle groups in their legs. This can be worked on with stretching or soft-tissue work. Additionally, foam rolling or kneecap and ankle mobilisations may be of some benefit. However, the main contributing factors are more likely to be related to strength and motor control. Therefore, soft tissue work is considered a short-term form of treatment, and unlikely to resolve your Runner’s Knee for long.

If you are pulling up with increased soreness, and it is interfering with your everyday life, book an appointment with our expert practitioners. Most of the time, one or more of the above causes can contribute to your Runner’s Knee, so we can help tailor an appropriate treatment plan for you to  achieve your goals.

 

Book an appointment today for your assessment!

Brachial Plexus by Marco Cheung (Physiotherapist)

Introduction:

The brachial plexus is a network of nerve fibres that allows movement and sensation in our arms. It forms five major branches as shown in the image pictured.

Occasionally, these nerves may be compressed by muscles or bony structures around it. This can cause symptoms like numbness and tingling to occur, so a Physio can help assess and understand what’s going on in the arm.

When you book in with a Physio, they will complete a series of assessments on you. Upper Limb Tension Tests (ULTTs) are ones that evaluate your nervous system. They are performed by placing tension on your arms or legs. This blog will look at neural assessment for your arms, and outline their use in assessing neurological structures like the Brachial Plexus within it.

 

Why use these tests?

Use of the ULTTs are indicated when :

  • Neural symptoms (tingling and numbness) are around the head, neck, thoracic spine and arms
  • Symptoms are not severe and not easily provoked

The tests are valid for detecting peripheral neuropathic pain (PNP), and can detect neural sensitivity associated with this (Née et al., 2012). Common PNP conditions include cervical radiculopathy and carpal tunnel syndrome.

What are they?

ULTTs are split into 3 common types: Median nerve, Radial nerve and Ulnar nerve. They are completed on the unaffected side first, applying pressure from the shoulders to the fingers, or until pain is replicated.

An outline of each step for the 3 ULTTs, as well as a video, is available for reference. Video: https://youtu.be/rir6x6Iiqc4 (Physiotutors)

What a positive result looks like

You will feel a stretching and tingling sensation when your arm is put on stretch. At this point, stretch on the hand will be reduced. If a reduction in symptoms is experienced, then this is a positive result, and treatment techniques called sliders and tensioners may be used.

Treatment Options

Tensioners and sliders are effective techniques in treating conditions like neck and back pain.  They can reduce the sensitivity of the neural tissue by allowing more movement within. Tensioners are used more commonly, and involve stretching the nerves more. Sliders work by moving the nerve forwards and backwards. Sliders are less forceful than tensioners, and may be more useful in acute and post-operative management. Meanwhile, tensioners may improve intraneural pressure and improve circulation by pumping the nerve.

To perform them, first complete the relevant test to place the nerve on stretch. For tensioners, add lateral neck bending towards the opposite side. For sliders, add lateral neck bending towards the opposite side and offload the nerve at the fingers.

The video below demonstrates how to complete the tensioners and sliders of the median, ulnar and radial nerves.

https://youtu.be/Fv_EJV8q2E0

 

References

Basson, A., Olivier, B., Ellis, R., Coppieters, M., Stewart, A. & Muniz, W. (2017). The Effectiveness of Neural Mobilization for Neuromusculoskeletal Conditions: A Systematic Review and Meta- analysis. Journal of Orthopaedic & Sports Physical Therapy, 47(9), pp. 593-615.

Coppieters, MW. & Butler, DS. (2008). Do ‘sliders’ slide and ‘tensioners’ tension? An analysis of neurodynamic techniques and considerations regarding their application. Manual Therapy, 13(3), pp. 213-221.

Nee, RJ, Vicenzino, B, Jull, GA, Cleland, JA & Coppieters, MW (2011). A novel protocol to develop a prediction model that identifies patients with nerve-related neck and arm pain who benefit from the early introduction of neural tissue management. Contemporary Clinical Trials, 32(5):760–770. doi: 10.1016/j.cct.2011.05.018

Nee, RJ., Jull, GA., Vicenzino, B. & Coppieters, MW. (2012). The Validity of Upper-Limb Neurodynamic Tests for Detecting Peripheral Neuropathic Pain. Journal of Orthopaedic & Sports Therapy, 42(5), 413-424.

 

Book an appointment today for your assessment!