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Online Bookings now available at Total Physiocare!

Booking Online

Finding it hard to book an appointment after hours or during business hours? We’ve listened to your feedback and have setup an easy way for you to book your appointment!

Online bookings are now live! You can book your physiotherapy appointment via the below link. You can book an initial or a subsequent physiotherapy consultation at any of our practices. You will still have to call for any cancellations or to change appointment times. For myotherapy, Womens health and other forms of services, you will need to contact your clinics directly.

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Lateral Epicondylitis “Tennis Elbow” by Ryan Fuller (Physiotherapist)

What is it?

Lateral Epicondylitis or more commonly known as “Tennis Elbow” is the most common cause of pain in the elbow. It is a tendinopathy which involves the extensor muscles of the forearm which originate from the lateral side of the arm.

Interestingly, only 5% of people affected with “tennis elbow” relate the injury directly to tennis. It is more commonly caused by overuse or work-related activities involving a lot of gripping than playing tennis. People with repetitive one-sided movement in their jobs such as electricians, carpenters and gardeners are all at higher risk of developing “tennis elbow”.

Symptoms

Patients typically present with lateral elbow pain which is reproduced by palpation to the extensor muscles origin from the bony part on the outside of the elbow. Pain can occasionally radiate upwards along the upper arm and downwards along the outside of the forearm and in rare cases even to the third and fourth fingers. Additionally, there may be weakness in the muscles around the forearm and wrist resulting in difficulty with simple tasks such as gripping and turning objects including; opening a door, turning on/off a tap and shaking someone’s hand. Symptoms can last on average between 2 weeks to 2 years.

Risk Factors

– “Tennis elbow” affects 1-3% of the population with individuals between 35-50 years old most commonly affected.
– The injury is often work-related with individuals completing high levels of wrist extension, pronation or supination during manual work
– Handling tools heavier than 1kg, handling loads heavier than 20kg at least 10 times per day and repetitive movements for more than 2 hours per day.
– Other risk factors: Training errors and misalignments, flexibility issues, poor circulation, strength deficits or muscle imbalances (Van Rijin et al., 2009)

Diagnosis

A thorough subjective assessment from a Physiotherapist encompassing the activity levels, occupational risk factors as well as an in depth physical assessment will determine the likelihood of “tennis elbow”.
Investigations are usually not performed for straightforward cases of lateral elbow pain, however, ultrasound examination can be useful in determining the degree of tendon damage as well as the presence of a bursa.
– X-rays: May be taken to rule out arthritis of the elbow
– Magnetic Resonance Imaging (MRI): if symptoms are perceived to be related to a neck problem
– Electromyography (EMG): Can be useful in ruling out nerve compression

Treatment

Non-operative medical management will typically aim to relieve pain and symptoms and to control any inflammation present. Once this has occurred a strengthening program will be guided by your Physiotherapist gradually increasing load to enable you to return to sport or activities of your desire.

If there is onset of pain after an injury or provocative task, then applying the P.O.L.I.C.E protocol within the first 72 hours is important.

Protection– Wearing a specialised elbow brace or support can help reduce strain on the tendon
Optimal Loading– Only completing tasks/activities that are pain-free. Gentle motion should be started as soon as tolerated
Ice– Applying ice may help with the swelling around your injured site as well as decrease some of the acute pain that you may have. 15 minutes every 2 hours is the advised duration
Compression– Apply a bandage to the area to help compress the injury and maintain swelling.
Elevation– Elevate your entire arm on a pillow where able

Physiotherapy treatments may include massage, electrotherapy, acupuncture, bracing and taping followed by a strengthening to regain strength and range of movement.

Other treatments can include ultrasound, corticosteroid injection, nitric oxide donor therapy, Botox injections and platelet-rich plasma injection’s which all have confounding research to support their use.

In severe cases, surgery is the last line treatment only considered in individuals who have had the condition for more than 6 months and have attempted other treatments with no success.

Prognosis

Overall, 90-95% of patients with “tennis elbow” will improve and recover with treatment listed above. 89% of patients will recover within 1 year without any treatment except perhaps avoidance of the painful movements (Wright, 2008).

At Total Physiocare Heidelberg, Reservoir, Camberwell and Footscray we treat many musculoskeletal conditions like the elbow.

Book an appointment today for your assessment!

Blog by Ryan Fuller (Physiotherapist)

Osgood Schlatter’s Disease

What it is

Osgood Schlatter’s Disease, or “tibial tuberosity apophysitis”, is a common condition affecting children and teenagers where the bone at the site of the tibial tuberosity growth plate is inflamed. It is characterised by a gradual, non-traumatic onset of knee pain that worsens rapidly. It most commonly affects physically active children, particularly boys, but any child can develop the condition.

It is a fairly common condition, with estimates that 15-20% of athletic children will experience it at some point, and up to 5% of non-athletic children. Despite this, many parents are unaware of the signs and symptoms, the management on the condition and the long term prognosis for their child. This blog will help explain the nature of the condition and management strategies used by physiotherapists.

 

What causes it

Osgood Schlatter’s Disease is an inflammation and subsequent pain in the growth plate or “epiphyseal plate” in the tibial tuberosity, which is a bony prominence at the front of the shinbone. Growth plates are found at the ends of developing bones and contain cartilage cells that form into adult bone. This process occurs during a growth spurt in children and is how their bones grow and usually occurs in “spurts” over a two-year period.

When this process is occurring the growth plates are weaker as they have not fully formed into adult bones. In this period of rapid growth, a child’s bones grow faster than their muscles causing them to be become tight. In the instance of Osgood Schlatter’s disease the quadriceps muscles and patellar tendon are pulled tight, resulting in pain and inflammation where it attaches to the weakened tibial tuberosity.

Signs and Symptoms:

The most common symptom is intense pain just below the front part of the knee, which presents on activities such as jumping, squatting, running, kicking, climbing stairs and kneeling. The pain tends to start off relatively mild and then increase in intensity until the patient is unable to effectively complete the task due to pain. In addition to pain on activity, the tibial tuberosity may be swollen and tender, even at rest.

In 20-30% of cases, children will experience these symptoms in both knees. In later stages, the growth plate itself may enlarge which tends to look like a bump on the tibial tuberosity. This will often stay even after the condition resolves.

Risk factors

The largest risk factor for developing a patella tendinopathy includes acute changes in load for jumping based tasks. Often such load changes include competing in a tournament, increased playing/training frequency, alterations in shoe-wear or alternations in playing surfaces. Weight gain can also be a contributing factor as this places extra load onto the joints. Patella tendinopathy is a highly prevalent condition in younger, jumping athletes, less than 30 years old.

Factors that can contribute to it

  • Active boys from 11-15 years old are the most likely to experience Osgood Schlatter’s Disease, but girls aged 8-13 years can also be affected. If a child plays multiple sports, they are more likely to experience OSD.
  • Having chronically tight thigh muscles can also make you more likely to experience Osgood-Schlatter’s Disease.
  • Activities involving repetitive, strong quadriceps contractions produce the highest risk. Children who participate in jumping, running, and kicking sports such as football, netball, basketball, soccer etc. are most at risk.

Diagnosis

An accurate diagnosis can usually be made based on the symptoms by a physiotherapist, imaging often won’t be required. An X-ray may or may not show bony fragments at the site of attachment from the patellar tendon to the tibial tuberosity. It is important to see a qualified practitioner for diagnosis, however, as there are several alternative diagnoses that you may be experiencing, including:

  • Sinding-Larson-Johansson syndrome (a similar condition affecting the bottom of the kneecap as opposed to the tibial tuberosity)
  • Patellar tendinopathy
  • Patellofemoral pain
  • Infrapatellar bursitis
  • Fat pad injury
  • Fracture of tibial tuberosity
  • Slipped capital femoral epiphysis

Treatment

The treatment will depend on the findings of the physical assessment, but will likely include pain relief, activity modification, supervised exercise and stretching.

Perhaps the most important treatment we can provide is activity modification. Osgood Schlatter’s is a self-limiting condition, which usually means that the pain experienced during activity is directly related to the amount of inflammation at the tibial tuberosity, rather than a sign of ongoing damage being caused. Activity modification involves modifying the duration, intensity, frequency or type of activity the patient undergoes in order to “manage” symptoms. If the pain is quite severe then rest from strenuous activity may be recommended for a short period of time.

Other treatments may involve strengthening of the muscles surrounding the knee, icing, low intensity activity such as walking and swimming. Stretching, massaging and foam rollers may be used to help to lengthen the tight quadriceps muscles.

Prognosis

As previously mentioned, Osgood Schlatter’s, while painful, is a mostly self-limiting condition. The typical lifespan of the condition lasts for a few weeks to a few months, however in some scenarios people experience symptoms for up to two years.

Once the condition has resolved, most people will not have any ongoing effects, however a small portion of patients will experience an enlargement of the tibial tuberosity, and some will have ongoing discomfort while kneeling on the affected leg.

 

 

At Total Physiocare Heidelberg, Reservoir, Camberwell and Footscray we treat many knee and overuse sporting injuries.

Book an appointment today for your assessment!

Blog by Nicholas Musso (Physiotherapist)

Carpal Tunnel Syndrome

What is it?

Carpal Tunnel Syndrome (CTS) is a painful condition involving the nerve that travels through the wrist to supply the hand and fingers (the median nerve). This nerve is compressed where it passes over the carpal bones through a passage on the palm side of the wrist due to a narrowing of the tunnel, enlargement of the tunnel contents or swelling of the wrist.

Symptoms

The onset of carpal tunnel syndrome is usually gradual and is characterised by tingling or numbness in the palm, thumb and first 2 and a half fingers. As symptoms progress a burning pain may become present and then finally weakness and muscle atrophy in the hands. This often causes a feeling of clumsiness as loss of grip and pinch strength results in frequently dropping objects.
Symptoms are generally aggravated by gripping objects such as phones and steering wheels and improve with shaking or flicking of the hand.

Risk factors

The onset of CTS occurs more commonly with increasing age, during pregnancy and in conjunction with conditions such as wrist arthritis, wrist fracture, thickened tendons, tendon inflammation and hand trauma causing swelling.

Diagnosis

CTS is often diagnosed by a physiotherapist, general practitioner or hand therapists who will complete a clinical assessment including range of motion of the wrist, strength and sensation of the wrist and fingers and grip. Palpation over the palm side of the wrist may cause pain and/or reproduction of symptoms. This will be compared to the unaffected side to highlight any differences.
A positive Phalen’s or reverse Phalen’s test is highly diagnostic as it compresses the affected nerve as it runs through the carpal tunnel.
Occasionally a nerve conduction study is required.

Treatment

A range of interventions are available for the treatment of CTS. The most successful outcomes are achieved when management is commenced early as the condition can become chronic and debilitating if left untreated.

Physiotherapy management may involve:

• Avoidance of aggravating activities
• Splinting to relieve pressure off the nerve
Tendon and nerve exercises
• Swelling management
• Strengthening of hand muscles once symptoms have subsided

A small percentage of people with CTS will require surgery. This is indicated when there is a loss of sensation or inability to contract the muscles supplied by the affected nerve.

Below are some tips of what is good hand posture and some exercises that may assist with Carpal Tunnel Syndrome.

Correct Hand Posture

 

Carpal Tunnel Exercises

Book an appointment today for your assessment!

Blog by Deana Gheri (Physiotherapist)

Special 3 part blog series

Part 3 – What is the treatment for Lymphoedema?

Blog by Alyaa Mokh’ee (Lymphoedema Physiotherapist)

 

In this last part of the blog series, we will explore the treatment options offered by a certified therapists to manage your Lymphoedema.

The specific management of your Lymphoedema treatment will vary according to your goals, level of motivation for self-management, and the extent of your condition.  Working alongside your Lymphedema therapist, you will collaborate to establish a personalised management plan which you will be required to integrate into your daily routine to optimise the on-going relief of your symptoms.

During the early stages of Lymphoedema, management is largely focused on education, exercises and elevation to assist with the self-management of your Lymphoedema. A compression garment/sleeve may also be prescribed for air travel and for exercises if deemed appropriate.

Education topics covered (not exhaustive):

  • Lymphatic system and how they function
  • Risk factors impacting lymphoedema
  • Adopting a healthy lifestyle and encouraging exercises as tolerated
  • Skin care to limit the exacerbation of lymphoedema

 

COMPLEX LYMPHOEDEMA THERAPY

Patients with lymphoedema that has progressed will likely require Complex Lymphoedema Therapy (CLT) to assist with lymphoedema management. This is usually done in 2 stages; the treatment phase before progressing to the self-management/maintenance phase. The primary aim of the treatment phase is to reduce as much of the swelling as possible. This phase can take up to a few days to a couple of weeks depending on the severity of the lymphoedema.

TREATMENT PHASE

Education

All patients will be offered an education session surrounding the lymphatic system and how it functions. The education session will also emphasise on the importance of healthy weight management and regular exercise.

Skin Care

Good skin care is paramount to the prevention of skin infections as they could aggravate your lymphoedema. Good skin involves ensuring that the skin is adequately moisturised and that you practise appropriate sun care in the warmer months. It is also recommended to regularly check for any skin breaks and/or monitor for any fungal infections that could increase your risk of infections.

Manual Lymphatic Drainage (MLD)

Manual lymphatic drainage is a specific massage that only a trained lymphoedema therapist can provide. It involves the strategic application of light pressure to stimulate specific lymph nodes to encourage lymph flow. Each MLD session will be tailored to the area and stage of swelling.

Self-Lymphatic Drainage (SLD)

Self-Lymphatic Drainage is usually a simplified version of the MLD, given to you to complete at home. It is recommended that you complete SLD to get the most benefit in between sessions with your lymphoedema therapist.

Compression Bandaging

Compression therapy via bandages is aimed at reducing the extent of swelling. It assists with improving lymphatic flow out of the affected area. Whilst compression is helpful to assist with the management/reduction of swelling, if implemented by an un-trained person, could lead to increased swelling in other areas of the body. Your lymphoedema therapist will discuss with you what is appropriate in your Complex Lymphoedema Therapy regime.

SELF-MANAGEMENT/MAINTENANCE PHASE

Once the swelling has reduced and is stable with minimal fluctuations, you will enter the self-management/maintenance phase. As the self-management/maintenance phase is lifelong, adherence is essential to ensure that the swelling does not return.

Education, skin care and SLD is encouraged in the maintenance phase as a tool for self-management.

Other options offered during the maintenance phase include:

Compression Garments

Compression garments may be prescribed to you to ensure maintenance of swelling reduction. Your lymphoedema

therapist will discuss with you what type and style of garment will suit your condition.

Wraps

Wraps can be prescribed as an alternative in instances where patients might not be able to tolerate or put on a compression garment. They aim to provide the same level of compression that compression garments do.

 

EMERGING TREATMENT OPTIONS

Pneumatic Pumps

This device provides pressure to the affected limb via a compression pump which mimics the principles of MLD and is usually used as an adjunct to SLD or MLD. It can be hired for home treatment or used in clinic (if available).

Low level Laser Therapy

At present time, there is some research suggesting that low level laser therapy could reduce any thickening of tissue, therefore improving lymphatic flow. This is usually used alongside lymphatic drainage and compression therapy. As it is an emerging therapy, with more research to be done, this option may not be available in all clinics.

While these treatments are offered by your lymphoedema therapist, there may be other surgical options that your doctor might suggest. In these cases, it is always best to consult with the appropriate specialist in order to determine what the best options is for your situation.

 

Back to Lymphoedema

PART 1 – What is Lymphoedema?

PART 2 – How is Lymphoedema diagnosed?

 

Book an appointment today for your assessment!

Blog by Alyaa Mokh’ee (Lymphoedema Physiotherapist)

Special 3 part blog series

Part 2 – How is Lymphoedema diagnosed?

Blog by Alyaa Mokh’ee (Lymphoedema Physiotherapist)

 

In Part 1 we learnt about our lymphatic system and how it works. In Part 2, we will be exploring how Lymphoedema gets diagnosed.

Confirmation of  Diagnosis

It may be suspected by family, friends, yourself or your medical practitioner as a potential diagnosis. It could also be discussed when you go for routine Specialists’ appointments after or during cancer treatment.

Most doctors and specialists will refer you to a certified Lymphoedema Therapist for a thorough assessment and confirmation of the diagnosis.

A majority of sufferers will have had significant swelling prior to seeing a therapist, although, there is a significant number of cases where swelling may not be as obvious but other symptoms may be present.

Lymphoedema Therapists will:

  • Explore your swelling history and changes in its presentation over the course of time.
  • Request specific tests from your medical practitioner to exclude other causes of swelling; for example Cellulitis or Deep Vein Thrombosis (DVT)
  • Complete a Bioimpedance Measure (if available) to calculate how much fluid is present in affected versus un-affected limbs
  • Undergo a Volume Assessment to construct a baseline and to monitor fluid changes over time
  • A Full Body Assessment which includes establishing the location of swelling, skin changes and potential limitations present. Photos may be taken to track progress and stability of your condition.

In some cases, your Specialist or Medical Practitioner might arrange for you to have further imaging procedures to examine the capacity and functionality of your lymphatic system.

With this comprehensive assessment model, your certified Therapist will be able to determine if it is actual Lymphoedema or a condition that only presents like the condition.

 

Before we go on to how it would be managed, it is also important to note that there are 2 types of Lymphoedema – Primary and Secondary Lymphoedema.

Primary Lymphoedema is caused by a congenital defect in the development of lymphatic vessels and is usually present from a young age. This could include an abnormal number of lymphatic vessels with impaired function.

Secondary Lymphoedema is caused by any potential damage to your lymphatic system.

Your lymphatic system can potentially be damaged by:

  • Radiation / Radiotherapy and associated scarring
  • Removal of lymph nodes
  • Surgery around sites of lymph nodes and/or major lymph vessels, and associated scarring
  • Side effects from cancer treatment
  • Cancer itself (invasion into lymph nodes or encroaching onto lymph vessels)
  • Recurrent infections like Cellulitis
  • Trauma/ Extensive injury
  • Lack of movement

 

 

Back to Lymphoedema

PART 1 – What is Lymphoedema?

PART 3 –What is the treatment for Lymphoedema?

 

Book an appointment today for your assessment!

Blog by Alyaa Mokh’ee (Lymphoedema Physiotherapist)