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Introducing the GLAD program to Total Physiocare – Blog by Christian Bonello

GLA:D program for hip and knee arthritis – What is it?

The GLA:D® program (Good Life with Arthritis: Denmark) is an education and exercise program developed by researchers in Denmark for people with hip or knee osteoarthritis (OA) symptoms.

OA is the most common lifestyle condition affecting individuals 65 year of age and older, but can also affect those as young as 30.

Current national and international clinical guidelines recommend patient education, exercise and weight loss as first line treatment for osteoarthritis. In Australia however, treatment usually focuses on surgery and the GLA:D Australia program offers a better and safer alternative.

Background of the GLA:D program

Research from the GLA:D® Denmark found that patient reported symptoms reduced by 32% after partaking in the program. Other favourable outcomes included less pain, reduced use of pain killers, and less sick leave or absenteeism. GLA:D® participants also reported high levels of satisfaction with the program and increased their levels of physical activity 12 months after starting the program. Similar results have also occurred via the GLA:D Canada Program.

This program is unique in that the education and exercises provided can be applied to everyday activities. By strengthening and correcting daily movement patterns, participants will train their bodies to move efficiently, prevent symptom progression and reduce their pain.

What does GLA:D involve?

The GLA:D program is an eight week intervention and includes education and exercise, based on the latest evidence in osteoarthritis research. The program is supervised by a certified GLA:D physiotherapist, with the aim to help patients manage their OA symptoms.

GLA:D® Australia training consists of:

  • An initial appointment with a GLA:D certified physiotherapist explaining the program and collecting data on baseline functional ability
  • Two education sessions where you will learn about OA, how the GLA:D intervention improves joint stability and can reduce symptoms, and ongoing management following the program
  • Group neuromuscular training sessions which occur twice a week for six weeks to improve muscle control of the joint.

GLA:D® Australia is being unveiled in private and public hospitals and physiotherapy clinics.

Can I participate in GLA:D Australia ?

GLA:D® Australia is a program for all individuals who experience any hip and/or knee osteoarthritis symptoms, regardless of severity or x-ray reports. You may participate in the GLA:D® Australia program if you have a hip or knee joint problem that resulted in visiting a health care provider.

You may not be eligible to participate in the GLA:D® Australia program if you have

  • Other sources of knee pain including; tumor, inflammatory joint disease, result of hip fracture, soft tissue or connective tissue problems
  • Inflammatory conditions that are more pronounced than osteoarthritis problems (for example chronic generalized pain or fibromyalgia)
  • are not able to understand english

If you have queries in regards to the eligibility criteria please feel free to contact us.

You do not need a referral from your Doctor to partake in the GLA:D program. However you may be eligible for a rebate from Medicare for some of the cost of the program, if deemed appropriate by your GP.

FIND OUT MORE:

The GLA:D program will commence across Total Physiocare sites in May 2017. Please contact you closest clinic via phone or email for further information or to register your interest.

Why not give it try today and book an appointment today for your assessment! 

Blog by Christian Bonello (Physiotherapist)

Meniscus Tear

What is the Meniscus? – Blog By Ryan Harris

The meniscus is a crescent shaped disc of fibrocartilage that is located in the knee joint. The role of it is to distribute the weight of the body and absorb shock within the knee during movement. Each knee has two meniscus, one laterally and the other medially.

Mechanism of Injury

There are two main reasons for tearing this structure.

Traumatic

A Traumatic meniscus tear is more likely seen in the younger, more active population. It most commonly occurs when the foot is planted on the ground and a twisting force is applied upon the knee. This twisting force is often caused by another person.

Degenerative

In the older adult, a degenerative tear is most likely to occur. This may be due to the natural age related changes of the meniscus or arthritic changes of the femur tearing into the meniscus.

Signs and Symptoms

  • An incident of a painful twist of the knee,
  • Some people may describe a tearing sensation,
  • Clicking, popping, or locking of the knee,
  • Minimal immediate swelling which increases of the next 24hours
  • Tenderness of the knee joint line.

Healing

The location of the meniscus tear will determine its capacity of healing. 

The outer rim of the meniscus has a blood supply from the synovial capsule. This allows it to have a capacity to heal overtime with conservative treatment, depending on the size and type of the tear.

The central part of the meniscus has no blood supply, instead gaining its nutrients from the synovial fluid. Injuries to this area of the meniscus do not usually heal overtime and often require surgery.

Assessment

Your Physiotherapist will perform a comprehensive physical examination and perform special test to diagnose your injury

It is important to undergo a thorough physiotherapy assessment as other knee injuries such as an ACL tear and/or medial and lateral collateral ligament tears may be present.

If a meniscus tear is suspected, your physiotherapist, doctor or surgeon may refer you for a MRI. This will aid in determining the location and type of tear and will help guide the appropriate treatment pathway.

Conservative Rehabilitation

Small tears and tears that occur in the outer ring that have no restriction of movement can be treated conservatively. Conservative treatment consists of:

  • Eliminating swelling
  • Restoring full range of motion
  • Strengthening of the knee and lower limb,
  • Enhancing pelvic stability
  • Improving lower limb proprioception and jumping/landing strategies
  • Sport specific activities, 
  • Gradual return to sport.

Surgical Management

Meniscectomy

Surgical intervention may be required

Following a period of conservative treatment, surgical intervention may be required. This is performed arthroscopically (keyhole). During the surgery, the surgeon will inspect the meniscus and surrounding structures via a small camera. Once the tear is identified, the surgeon will remove the affected tissues and clean up the surrounding area. The aim of surgery is to protect as much of the meniscus as possible, although it may be necessary to have a complete removal of the meniscus. 

Meniscal Repair

The surgeon may decide to repair the tear in younger patients with a recent tear in the outer rim as these tears have a chance to heal over time. Rehabilitation for meniscal repairs are greater as time is needed to get the meniscus a chance to heal.

Rehabilitation

It is important to commence rehabilitation prior to surgery. “Prehabilitation” can increase the recovery speed post operatively and in some cases, the patient can avoid surgery all together.

Monitoring of the knee is crucial during rehabilitation as the remaining meniscus and underlying articular cartilage need to adapt to the new load that is being placed upon them. Your physiotherapist will continue to reassess your knee after each progression of exercises to ensure your knee is coping with the new stresses. If an increase in pain or swelling is seen, the rehabilitation program will be altered as a result. 

The same rehabilitation principles apply for both, conservation and post surgical care. The principles are outline above. The exception being a meniscal repair which requires an initial period of rest to allow for healing to occur before commencing rehabilitation.

At Total Physiocare Heidelberg, Camberwell, Reservoir & Footscray, we have seen many knee arthroscopy surgeries due to the close hospital affiliations we have.

Book an appointment today for your assessment!

Post by Ryan Harris(Physiotherapist)

Total Hip Joint Replacement (THJR)

What is a Total Hip Joint Replacement? – Blog By Christian Bonello

A Total Hip Replacement (THJR) is one of the most common operations in orthopaedic surgery.  It is a surgical procedure whereby the diseased hip joint is replaced with an artificial prosthesis. As the hip is classified as a ball-and-socket joint; the ‘socket’ is formed by the acetabulum, which is part of the pelvis bone, and the ‘ball’ is the head of the femur or thigh bone. The bone surfaces of the ball and socket are covered with articular cartilage which cushions the joint and enables smooth movement. Overtime the joint may become degenerated causing reduced movement and increased pain especially in activities such as walking.

A THR is therefore performed to relieve pain of degenerative diseases affecting the hip joint. The procedure is performed by replacing the diseased head of the femoral (thigh) bone with a metal stem that is placed into the hollow center of the femur. The femoral stem may be either cemented or “press fit” into the bone. A metal or ceramic ball is then placed on the upper part of the stem and this ball replaces the damaged femoral head that was removed. The damaged cartilage surface of the socket (acetabulum) is removed and replaced with a metal socket. Screws or cement are sometimes used to hold the socket in place. A plastic, ceramic, or metal spacer is then inserted between the new ball and the socket to allow for a smooth gliding surface.

Type of Incisions

Depending on the patients age, fitness level, hip presentation and the orthopaedic surgeon’s preference; two incisions are commonly utilised for patients undergoing a Total Hip Replacement:

  • Posterolateral approach: Incision is made via the rear and side of the hip joint. Due to the muscles that are separated, limitations of hip movement are advised in the first six weeks following surgery. These include keeping the height of the knee below that of the hip, no twisting the lower limb inwards and no bringing the leg past the middle of the body. Special equipment such as an over-the-toilet chair, higher chair and a pick-up stick are usually recommended during the first six weeks following surgery.
  • Anterior approach: the incision is made through the front of the thigh and offers a potential for an accelerated recovery time as key muscles are not detached during the operation.

Who requires a hip replacement?

A total hip replacement is considered for patients whose hip joints have been severely damaged by either progressive arthritis, trauma or other joint pathology.

  • The most common type of arthritis occurs where there is gradual loss of articular cartilage causing bone remodelling, joint inflammation and loss of normal joint function. It mainly affects people over the age of 50 and usually affects people with family history of osteoarthritis and may cause significant pain.
  • Rheumatoid Arthritis: This autoimmune condition involves chemical changes in the synovial membrane surrounding the joint (within the capsule), causing it to become thick and inflamed. This causes the breakdown of the cartilage and joint degeneration over-time.
  • Post-Traumatic Arthritis: Trauma to the hip joint either via serious hip injury or fracture can cause the bone and the cartilage to not heal correctly. This can mean that the hip joint may develop arthritis. Alternatively a THR may be the intervention of choice for orthopaedic surgeons managing a hip fracture in older populations.
  • Avascular necrosis:An injury to the hip, such as a dislocation or fracture, may limit the blood supply to the femoral head.  The lack of blood may cause cell death to the bone tissue resulting in tiny bone breaks and the bones eventual collapse. Some diseases can also cause avascular necrosis.
  • Childhood hip diseases: Some infants and children are born with hip pathology. Even though many of these conditions are successfully treated during childhood, they may cause arthritis later on in life if the hip joint does not grow in optimal alignment and the joint surfaces are affected.

How can I prepare for Surgery?

  • Commence exercising

It is recommended prior to your surgery that you attend a physiotherapy class where you will be taught a series of exercises that will help to strengthen the muscles in your legs. To physically prepare for the surgery you will be given a home exercise program designed by a physiotherapist or exercise physiologist. This will focus on increasing the strength of the muscles in your legs, your abdominal muscles and your arms. This improved strength will help you to mobilise more easily following your surgery. The physiotherapy information will also help you to know what will be expected of you after your surgery.

  • Reduce alcohol intake

It is always recommended that you decrease your alcohol intake prior to surgery. Some of the drugs given to you either during or after your operation can interact with any alcohol that is in your system.

  • Lose Weight (for patients who are overweight)

By losing weight prior to your surgery, it will help reduce the stress on your new hip joint and help you mobilise more freely. Being over-weight can increase your risks of a raised blood pressure and therefore complicate your post-operative period.

  • Stop Smoking

Cigarette smoking has been proven to increase the time it takes you and your joint to heal. It’s a good idea to stop smoking at any stage, but this is a perfect opportunity.

Rehabilitation

Rehabilitation exercises following a Total Hip Replacement will start on the evening of or the day following your procedure depending on the surgeon’s protocol. This will be guided by your physiotherapist and will include hip range of motion exercises, muscle activation and strengthening exercises and early mobilisation. Following a Total Hip Replacement, you can usually put as much weight on the knee as you feel comfortable, however this will be guided by your surgeon.

If a rehabilitation hospital is not required, it is recommended to start outpatient (private) physiotherapy a week following discharge from hospital and arriving home. This will incorporate manual therapy and progression of exercises to optimise the outcome of surgery. If required, hydrotherapy may also be of benefit during this period.

It is essential during this time to manage both the normal post-operative responses – such and swelling, joint stiffness, bleeding and muscular tension – at the same time as you push to improve muscular strength and joint range of motion. Finding the right balance with the aid of your physiotherapist will ensure an optimal post-operative outcome.

 

Expected recovery

It may take up to 12 months to experience a full recovery from THJR surgery. Our team expect that you graduate from 1:1 physiotherapy into a self-managed exercise routine or group class during your rehabilitation. It is vital to maintain half an hour of daily exercise throughout your life and return to activities that are important to you. Ideally such exercises should incorporate a mix of aerobic exercise that elevate your heart rate and strength-based training.

At Total Physiocare we are responsible for the orthopaedic care of patients at both Warringal Private and Western Private Hospital. We also offer pre-habilitation exercise programs with our team of physiotherapists or exercise physiologist and hydrotherapy services to assist in the recovery plan following a Total Hip Replacement. 

Book an appointment today for your assessment!

Post by Christian Bonello (Physiotherapist)

Total Knee Joint Replacement (TKJR)

What is a Total Knee Replacement? – Blog By Stephen Lee

A Total knee replacement is a surgical procedure whereby the diseased knee joint is replaced with an artificial prosthesis. The procedure is performed by separating the muscles and ligaments around the knee. The end of the thigh bone (femur) is removed and is replaced with a metal shell. The lower leg bone (the tibia) is also removed and replaced with a metal T piece with a plastic top. Depending on the condition of the kneecap, a plastic ‘button’ may also be added under the kneecap to improve the surface.

tkjr

Who requires a knee replacement?

A total knee replacement is considered for patients whose knee joints have been severely damaged by either progressive arthritis, trauma or other destructive diseases of the joint.

  • The most common type of arthritis and occurs where there is gradual loss of articular cartilage causing bone remodeling, joint inflammation and loss of normal joint function. It mainly affects people over the age of 50 and those with family history of osteoarthritis.
  • Rheumatoid Arthritis. This condition involves chemical changes in the synovial membrane surrounding the joint (within the capsule), causing it to become thick and inflamed. This causes the breakdown of the cartilage and degeneration which worsens over time.
  • Trauma to the joint can cause the bone and the cartilage to not heal correctly. This can mean that the knee joint may develop osteoarthritis.

tkjr2

How to prepare for Surgery?

  • Pre-habilitation exercises: Evidence supports the implementation of a pre-operational exercise program to strengthen the muscles in your lower leg. Principally this entails strengthening the quadriceps muscle complex. It is recommend commencing and performing pre-habilitation exercise a minimum of six weeks prior to surgery. Research supports that an exercise program designed by a physiotherapist improve post-operational outcomes.

tkjr3tkjr4

  • Lose Weight (for patients who are overweight). By losing weight prior to surgery, it will help reduce the stress on the knee joint and permit easier mobilisation in the period post surgery. Being overweight can increase your risks of raised blood pressure and therefore complicate your post-operative period.
  • Stop Smoking: cigarette smoking has been proven to increase the time for tissue and joint healing and recovery.

Rehabilitation

Rehabilitation exercises following a Total Knee Replacement will start the day following your procedure and will be guided by your physiotherapist in hospital. This will include knee range of motion exercises, muscle activation and strengthening exercises and early mobilisation. Following a Total Knee Replacement, you can usually put as much weight on the knee as you feel comfortable, however this will be guided by your surgeon.

If a rehabilitation hospital is not required, it is recommended to start outpatient (private) physiotherapy a week following discharge from hospital and arriving home. This will incorporate manual therapy and progression of exercises to optimise the outcome of surgery. If required, hydrotherapy may also be of benefit during this period.

It is essential during this time to manage both the normal post-operative responses – such and swelling, joint stiffness, bleeding and muscular tension – at the same time as you push to improve muscular strength and joint range of motion. Finding the right balance with the aid of your physiotherapist will ensure an optimal post operative outcome.

tkjr5tkjr6

Expected recovery

It may take 12 months to experience a full recovery from a TKJR surgery. Our team expect that you graduate from 1:1 physiotherapy into a self-managed exercise routine or group class during your rehabilitation. It is vital to maintain half an hour of daily exercise throughout your life and return to activities that are important to you. Ideally such exercises should incorporate a mix of aerobic exercise that elevate your heart rate and strength-based training.

tkjr7 tkjr8 tkjr9

At Total Physiocare we specialise in orthopaedic for care of patients at both Warringal Private and Western Private Hospital. We also offer pre-habilitation exercise programs with our team of physiotherapist or exercise physiologist and hydrotherapy services to assist in the recovery plan following a Total knee replacement. 

Book an appointment today for your assessment!

Blog by Stephen Lee (Director, Physiotherapist)

What is Hydrotherapy and what are the benefits?

Hydrotherapy involves therapeutic exercise in warm water to treat different health conditions and is conducted by a qualified health professional.

The pool is heated to around 35 degrees Celsius to promote relaxation and pain relief, whilst the hydrostatic pressure assists in promoting circulation. Exercising in water has all the same additional benefits of exercising on land, but the principles of water can be used to effect exercise intensity. For example, buoyancy makes the body feel lighter and enables patients to do exercises that they are unable to do on land. Alternatively, water turbulence and equipment (such as noodles, floats and kickboards) can be used to increase the difficulty level of exercises. Because of these factors, patients are able to exercise, build muscle strength and improve function, without flaring up their pain levels.

hydro1

Who can benefit from Hydrotherapy?

Common conditions that benefit from hydrotherapy include:

  • Arthritis
  • Back pain
  • Post-surgery (e.g. knee/hip replacements, ACL reconstructions, shoulder reconstructions, spinal surgery, Achilles repair)
  • Chronic pain & Fibromyalgia
  • Neurological conditions
  • Frail/deconditioned and clients who are prone to falls

Hydrotherapy exercise programs through Total Physiocare are individually prescribed and tailored specifically for our clients to assist with their condition.

hydro4

How do I go about joining Hydrotherapy?
If you are a new client to Total Physiocare, we require that you attend an assessment at one of our clinics prior to commencing the class. This ensures that we are aware of the details of your injury or condition, as well as your medical history, water confidence level and rehabilitation goals.

If you are a current client of Total Physiocare, your Physiotherapist can hand these details over to their colleague who will be taking the class.

hydro2

I’ve recently had surgery, when can I commence Hydrotherapy?

You can start hydrotherapy once your dressings are removed and the wound has closed over with no signs of infection. Generally, this occurs by the 2 to 3 week post-operative mark. Since you’ve had surgery, it is likely that you will already be attending physiotherapy for your rehabilitation, and your Physiotherapist will be able to let you know when it is safe to go in the pool.

Our group hydrotherapy classes are conducted at Reservoir Leisure Centre on Tuesdays and Fridays from 12-1pm.

Please contact our Reservoir clinic on 9469 3157 to organise an assessment or for more details.

 

hydromap

 

Blog Post by Emily Shortal