Post-Surgery Rehab

Joint Replacement | Fractures | Ligament Repairs | Tendon Repairs

After orthopaedic surgery, Physiotherapy plays a crucial role in restoring function and mobility to the affected body part. There are two main categories of post-surgical orthopaedic rehabilitation, each with its own approach and timeline for recovery.

1. Repair to Damaged / Torn / Broken Structures

Following procedures like ligament repair, bone fracture correction, or toe realignment, the rehabilitation process typically involves a longer period of immobilization and a more conservative treatment approach in the initial 10-12 weeks post-surgery.

2. “Clean Up” Procedure for Frayed or Degenerative Structures

Procedures such as arthroscopic debridement involve removing damaged tissue or debris from a joint. Rehabilitation for these cases usually requires a shorter period of immobilization and a more accelerated treatment progression over the first 4-6 weeks following surgery.

Expectations After Surgery

After surgery, your body enters a protective mode to facilitate healing. This often leads to stiffness and discomfort in the operated area due to factors like swelling, inflammation, and muscle tension. Pain and stiffness serve as natural mechanisms to prevent overexertion and promote healing.

Three Phases of Rehabilitation

Phase 1: Calm the System Down: In this phase, the focus is on reducing muscle guarding and secondary protective responses following surgery. Manual and movement therapy techniques are employed to unload the injured tissues and desensitize nerve endings, gradually easing the body out of its protective mode.

Phase 2: Explore Range of Motion

The next phase involves passive and active exploration of movement to decrease stiffness, tightness, and pain. Passive movements are performed by the physiotherapist, while active movements are carried out by the patient under supervision. This phase prepares the patient for coordination and strengthening exercises.

Phase 3: Restore Coordination & Strength: Once mobility is restored, the emphasis shifts to rebuilding coordination and strength. Basic exercises are introduced early on to build confidence and gradually progress as the healing tissues can tolerate loading. Graded exposure principles guide the intensity, duration, and frequency of exercises to facilitate a return to normal activities.

Summary: Rehabilitation after orthopaedic surgery involves three key phases: calming protective responses, safely exploring movement, and gradually restoring strength and coordination. It's important to recognize that post-surgery symptoms like pain and limited mobility are often normal parts of the healing process, not indicators of failure. Communication with your physiotherapist is essential for monitoring progress and addressing any concerns throughout your rehabilitation journey. If you have questions or concerns about your rehabilitation, don't hesitate to reach out for assistance.

The process for rehabilitating after surgery can be broken down into 3 phases:

• Calm the protective responses

• Safely explore movement

• Safely restore strength and coordination

If you have any queries or concerns about your rehab or prospective rehab, please don’t hesitate to contact us on 02 9665 9667.

Knee Problems?

Back Pain

Acute | Chronic | Lower Back | Upper Back | Sciatica

Got a back problem? You’re not alone. Did you know that 80% of Aussies report having had a back problem at some stage of their life! That’s a huge stat. For most people, their back problem is temporary and resolves with minimal treatment. For others though, a back injury turns out to be a life-changing event that negatively impacts employment capacity, recreational activities, basic activities of daily living and mental health.

Back problems are less visible than a broken leg or arm, and there can exist an unfair stigma whereby sufferers aren’t spared much sympathy. Some people are explicitly accused of faking or malingering!

Back problems also tend to evoke more fear for the future than other injuries. I don’t meet many patients with a sprained ankle who are worried about their long term future. There is an insidious idea in our culture that a back problem might easily become a chronic, lifelong problem. Fortunately, as our knowledge continues to be updated and expanded, we are much better placed to understand and better treat back problems.

It might surprise you to learn that most back problems, despite often being intensely painful and debilitating, recover rapidly, such that normal activities are resumed within a few weeks. It never ceases to amaze me how quickly the vast majority of acute episode of back pain emerge and resolve. There are however, people who present to our clinic who have been dealing with persistent symptoms for months or even years.

Our goal, with respect to treating back problems is two pronged;

1. Ensure that those with an acute/recent back problem achieve a rapid resolution of symptoms while acquiring the skills, knowledge and strategies to achieve a sustained return to valued activities

2. Ensure that those with a longstanding back problem build a greater capacity to address symptoms and engage in occupational, recreational and other valued activities

Back problems are our specialty. If you’d like to learn more, please call us on 0296659667

Workplace Injury?

If you’re employed in NSW, and you sustain an injury at work, your return to pre-injury health and work capacity is facilitated by the NSW worker’s compensation system. The worker’s compensation system aims:

• to assist in securing the health, safety and welfare of workers and, in particular, preventing work-related injury

• to provide:

  • prompt treatment of injuries, and

  • effective and proactive management of injuries, and

  • necessary medical and vocational rehabilitation following injuries,

  in order to assist injured workers and to promote their return to work as soon as possible,

• to provide injured workers and their dependants with income support during incapacity, payment for permanent impairment or death, and payment for reasonable treatment and other related expenses

• to be fair, affordable, and financially viable

• to ensure contributions by employers are commensurate with the risks faced, taking into account strategies and performance in injury prevention, injury management, and return to work

• to deliver the above objectives efficiently and effectively

Interacting with the worker’s compensation system and insurance companies can be confusing and overwhelming. In order to commence Physiotherapy treatment for a workplace injury, the key piece of information you require is your insurance claim number. Once you have your claim number, things tend to fall into place. The worker’s compensation legislation is set up such that you are granted eight sessions of Physiotherapy on a pre-approval basis so as to facilitate a timely commencement of treatment.

What this means is that we can get started on your rehabilitation immediately, for up to eight consultations. After eight consultations, we, as your treating Physiotherapy provider, complete what is known as an Allied Health Recovery Request (AHRR). This is a form that outlines our clinical assessment of your injury, treatment received and outcomes achieved to date. It also includes our plan for future treatment, short term and long term prognosis. The AHRR is submitted to your insurance company for assessment and approval. Each AHRR we submit includes a request for a maximum of eight additional treatment consultations. We continue a cycle of requesting treatment approval in blocks of eight consultations until your return to work and health goals are achieved.

Some workplace injuries are simple and require only a few weeks of Physiotherapy treatment in order to achieve your return to work goals. Other workplace injuries are complex and it may be many months before your return to normal employment and your claim is wound up. It really helps to choose a support team (GP, Physio, Specialist etc) that is well versed in handling worker’s compensation claims. Doing so will help ensure that your recovery is hassle free. Your focus should be solely on getting well again, and your time and energy shoudn’t be wasted on administrative red tape.

At Coogee Bay Physio, we ensure that;

• You receive a thorough and accurate physical assessment with your goals at the forefront of any management plans.

• We liaise closely with all the stakeholders involved in your care plan, whether that be your GP, insurer or other medical professionals – to take the stress out of your hands and let you focus on your recovery.

• Early on, our main focus is to get you out of pain and moving freely as quickly as possible. This can be achieved through a combination of hands on techniques and gentle exercise therapy. Once this has been achieved, our main aim is to get you reconditioned back stronger than you were before, utilising our purpose built rehabilitation gym.

If your situation changes whether that be for the better or worse, we communicate this quickly to the appropriate people to ensure that your care plan is constantly updated. We also utilise a large battery of objective tools to support our in house assessment.

If you’re a Coogee or Eastern Suburbs local and you have a question about your workplace injury and our Physiotherapy services, please don’t hesitate to give us a call on 029665 9667.

Neck Problems?

Bulging or Herniated Disc

A herniated or bulging disc would by far be the most common answer I receive when I ask patients the question- “what do you understand to be the cause of your neck or back pain?” When we are discussing disc related neck or back pain, it is really important that we place the herniated or bulging disc within the broader physiological context from which symptoms emerge. Put simply, the presence of a disc bulge or disc herniation is only part of the story of neck or back pain. It may be a big part of the story, or a small part of story… as time goes by, the bulging or herniated disc generally becomes a smaller part of the story.

We know from some good research that a disc bulge or herniation doesn’t correlate well with the presence of pain i.e. MRI studies of people without any pain repeatedly reveal the presence of degenerative changes in the intervertebral discs. And MRI studies of people who are suffering from back pain do not always reveal a bulging or herniated disc. This is not to say that an injury to the disc won’t be painful- the intervertebral disc is highly innervated, so your nervous system is capable of detecting injury to the disc and mounting a protective response in the form of pain.

What it does mean is that the presence of a bulging or herniated disc, as revealed by an MRI is not a fait accompli with respect to a life of neck or back back pain. Essentially, it is normal to have structural changes to the discs occur… they simply occur as we age. We don’t really know why some people have discs that wear out more quickly or injure more easily than others. It is likely a product of differing genetics and differing environmental factors.

The missing element in this conversation, up until the last 10-15 years has been the concept of neural sensitivity. Our nerve endings and pathways have a capacity to increase or decrease their sensitivity to mechanical and chemical activation. Broadly speaking I would argue that most people with ongoing pain who attribute their pain to a bulging or herniated disc, would probably get a great deal of improvement and perhaps resolution of their pain with education that tidies up their understanding of how pain works, and treatment that addresses the defensive motor patterns that are (probably) sustaining a good portion of their symptoms. Once the muscular guarding and neural sensitivity reduces, the spine is generally able to move more easily and symptoms tend to diminish. There are of course, a population for whom their disc pathology is the primary driver of their symptoms. Typically though, these patients present with a specific set of symptoms that indicate the need for surgical intervention.

I think it helps to keep in mind that generally, our spines are inherently strong structures… they are tough as nails. An acute injury to the disc, or wear and tear of the disc doesn’t compromise the structural integrity of our spines. Our spines are wrapped in layers of thick ligaments and muscles. A disc injury or wear and tear to the disc doesn’t make your spine unstable. If you’re dealing with recent or acute pain that you understand to be related to a disc problem, you need a good plan to work through the process of getting back to normal without getting to caught up on the popularly held belief that a disc injury necessarily means long terms problems. Similarly, if you have longstanding pain that you attribute to a disc problem, you might benefit from some conceptual re-framing of your problem and complementary treatment.

For more information feel free to call us on 9665 9667.

Shoulder Problems?

Getting active again

Getting active again after an injury can be difficult. It’s easy to lose confidence in your capacity to do the things you use to do. And it’s not just recovering from a recent injury that is tricky. There are many people who have been avoiding certain activities for months or even years for fear of re-injury. For some, it’s not fear so much as it is an insidious slide to a more sedentary lifestyle i.e. “I used to love jogging but I don’t do it anymore… I have a bad back”.

“re-engage in activities you’ve been avoiding”

Are there any activities you used to love doing that you don’t do anymore? What’s stopping you from doing them again? Perhaps you’ve got an old injury holding you back? Perhaps we can help you get back to it again?

If this sounds like you, give us a call on 0296659667 to learn about how we can give you a boost… and re-engage in activities you’ve been avoiding or unable to do the way you’d like to.

Sub-Acromial Bursitis

The sub-acromial bursa is a containment of fluid that serve the purpose of buffering regions within the shoulder complex that are subject to a lot of rubbing or sliding of tissues such as tendons and fascia against each other or bony prominences. Typically, the sub-acromial bursa buffers the supraspinatus tendon against irritating friction against the overlying acromion process, particularly with overhead activities. Unfortunately, the bursa itself may become irritated and inflamed when subjected to longstanding friction or mechanical irritation. The sub-acromial bursa, once inflamed and irritated typically restricts a person’s ability to perform overhead activities such as throwing or swimming. In more severe cases, even simple movements such as reaching overhead, or reaching forward to grasp a door handle may be limited by pain.

Although it is often dispensed as a specific diagnosis, I think it is probably rare that a shoulder pain is driven solely, or even predominantly by an inflamed bursa. More common, I would argue, would be the scenario where there is elevated nerve ending sensitivity in and around the shoulder joint, which has arisen secondary to an acute trauma/injury or an accumulative irritation of joint structures from occupational or sporting activities. The reason I point this out is that treatment of “bursitis” should not focus solely on a specific effort to treat the bursa itself. Rather, the initial goal is to desensitize the shoulder so that there is less protective muscle guarding present, and more tolerance to movement.

We achieve this through activity modification, joint mobilisation, massage and occasionally a referral out for a cortisone injection. Once the shoulder is, let’s say “calmer”, the concentration of inflammatory mediators in and around the shoulder generally, and sub-acromial space specifically, is likely to reduce and symptoms should track towards resolution. As movement becomes easier and less symptomatic, we can shift attention towards graded strengthening and conditioning.

If the primary problem is one of ramped up nerve ending sensitivity, we should see a very positive response to treatment and full recovery over a 6-8 weeks period. If there is a very slow response, or if symptoms do not improve, we need to consider what else might be sustaining your symptoms. It might be that there is a degree of contributory structural wear and tear. In more intractible cases, a surgeon may choose to carry out a “subacromial decompression”. In this procedure, some of the bursa is removed surgically. A surgeon may also perform an “acromioplasty” whereby extra space is created for the supraspinatus tendon by removing a small section from the acromion process.

The need for surgery, in my experience is low. Most cases of sub-acromial bursitis respond well to non-surgical interventions including activity modification, mobilisation and stretching of the shoulder, massage and a graded strengthening program. The key to getting better is finding a Physio who can guide you through the recovery process. Call us on 0296659667 to discuss your shoulder symptoms.

Ankle Problems

Jogging & Running

People who love to run, hate it when they can't run... So it is very common for me to hear the following three questions from an injured runner- Why did I get injured? How do I fix it? When can I start running again? Answering the first of these questions is often very difficult. The reasons for why any type of injury occur are many and most often, I would argue that we can't ever know for sure why an injury happens. The good news is that such uncertainty doesn't prevent us from building well reasoned hypotheses to explain an injury. And from there we can piece together useful strategies for treatment and rehabilitation. Importantly, if managed well, you shouldn't need to stop running. Very often we can simply change aspects of your training. Occasionally however, symptoms are severe enough to warrant a short break from running. We need to consider five key parameters to reach a hypothesis for the cause of an injury. Those parameters are technique, baseline level of strength, flexibility and fitness, task intensity, task duration and task frequency. That is to say-

1. how you run

2. how strong, flexible and fit you are

3. how hard you push yourself when running

4. how long you run for

5. how often you run

All of these factors will influence the adaptive potential of your muscles, joints, nerves and other body tissues. Your adaptive potential describes your body's capacity to withstand and adapt to load, in this case, the load of your running routine. So if you are a regular runner and have no injuries or problems to speak of, we can say that you are operating within your adaptive potential. We can say that you have reached your adaptive threshold when an injury occurs (e.g. muscle tear, cartilage tear) or the onset of symptoms occurs (e.g. pain). Usually pain will accompany an injury, but pain is also likely to emerge as a kind of warning signal before a gross structural injury occurs. So although we could argue that the presence of a structural injury is a sign that the adaptive threshold has been breached, the presence of performance limiting symptoms such as pain, stiffness or tightness are perhaps a more useful indicator of whether or not you are operating within your body's adaptive potential. So if your adaptive potential is being breached, which load parameter is to blame?

Is running technique the Problem?

The most tempting one of these five parameters to blame for your running injury or symptoms is the first one- technique. If there was a technical adjustment that could be made that would make an injury or symptoms go away and allow you to keep running it would be great, right? It's attractive because if it were true, there would be no need to alter the other parameters i.e. there would be no need to think about changing for example, how often or far or hard you run. Unfortunately, I very rarely see a treatment plan pan out this way. For most people, and when I say people, I am referring to the novice, average joe, recreational running population that I tend to see, running technique is not the problem. For those who do appear to have an "unusual" looking technique, making a judgment about whether or not that unusual technique is the cause of an injury is fraught with potential for error, as we don't have good research or data that establishes exactly what a "normal" or "optimal" technique for running is. Complicating issues is the fact that if you have pain you probably aren't using your "normal" running pattern anyway. Pain tends to muck around with our motor patterns and outputs, so it is difficult to know if your running style is a cause or a product of your symptoms.

I prefer not to jump to conclusions about the role of running style or technique when assessing a running injury. Doing so creates a massive burden of proof on me as a Physio, one that I simply cannot meet with evidence. We do have options for adjusting or altering aspects of running technique, and very often these bring about a reduction in symptoms. But generally, it is an error to frame these changes to technique and observed reductions in symptoms as a technique "correction", since no one knows what "correct" running looks like. A more reasonable explanation is that by adjusting or changing an aspect of how one runs, we have unloaded tissues that were otherwise being irritated. So is "technique" the cause of running injuries? I would argue that the answer is no, but with the caveat that some changes to how you run, for example, altering stride length or attempting to run more "softly" might have a positive impact on symptoms. Such changes alone however, are unlikely to help in the long term if the other parameters are not considered.

Is Strength or Flexibility the Problem?

The next most tempting parameter to blame your running injury on is your strength and flexibility. If only there was stretch you could do that could sort out your symptoms so that you could run pain free again. If only you were stronger through the glutes or hamstrings, then maybe you wouldn't have had that calf strain. Again, these are attractive propositions because it means avoiding making changes to how often, far or hard you run. And it isn't necessarily wishful thinking. Increasing your strength and flexibility may well increase your adaptive potential for your running routine such that you can overcome an injury or pain without having change anything else. I would argue though that this occurs infrequently. Usually, if someone has symptoms that are prominent enough for them to take the step to see me in the clinic, there is enough of an injury or irritation of tissues to warrant some sort of adjusting of the remaining parameters on the list above- those being load frequency, load duration and load intensity. This could be as drastic as stopping all running altogether for a period of time, or it could be a selective reduction in how far, fast or often you run.

Strength and flexibility training probably also helps from an injury prevention perspective, in that both can increase the adaptive potential of your tissues such that an injury is less likely. This is speculative however, as it is very difficult to test these ideas in controlled research settings. Incorporating a lot of prescriptive strengthening exercises into the treatment plans for injured runners is probably unnecessary- at least in the early stages anyway. In my view, the initial focus should be on reducing sensitivity to load and regaining any losses in mobility and capacity for performance of everyday activities. This means that it is nearly always more useful to direct treatment towards activity modification as the first line treatment option, and to follow up with strength interventions and stretching once you are approaching a symptom free baseline. Depending on the severity of symptoms, I think it is reasonable to commence strengthening activities in parallel with activity modifications, but I don't think it is reasonable to skip past a consideration of running load parameters and assume that you will be able to simply stretch or strengthen your way out of a running injury. We need to make sure we look at how far, often and hard you are running, and how these factors might be influencing your symptoms.

Altering Load Parameters

We don't have a solid research data to direct us when it comes to deciding which load parameters to alter. Should we attempt to restore normal sensitivity to load by first reducing frequency, duration or intensity? In my experience the simplest way to make a positive impact is to reduce intensity first. Basically, this means asking a runner to reduce how hard they push themselves when they run... to run within themselves as opposed to working near a maximum effort. I think it is reasonable to argue that maximum, or near maximum running efforts are more likely to lead to symptoms than sub-maximal efforts. Runners who try to reduce overall load by reducing running distance or frequency while maintaining intensity, in my experience, eventually end having to reduce intensity anyway. So I tend to suggest a reduction in intensity first.

If reducing the intensity of your running efforts does not bring about a reduction in symptoms, I suggest reducing the duration (distance) next. This means shortening how far you run. That one is pretty simple. The next option, if symptoms are still hanging around is to reduce how often you are running. Generally, those who run 5-6 times per week have a higher risk of injury than those exercising less than four times per week. Some runners prefer to reduce the frequency before reducing distance, which I think is reasonable, provided there has already been an attempt to reduce intensity. Really, the adjusting of these load parameters is trial and error. I can't provide solid data to say that one way is better than the other. I can only offer my opinion based on my experience as a Physio and the argument that a sensitized system is not likely to calm down if we keep making it work at high intensity for sustained periods of time.

Building Up Again

Once we have struck the right balance of adjustments to load parameters, and symptoms have resolved to a steady baseline, we can begin to increase load parameters again, with a view to returning to your preferred running routine. There are hundreds of approaches for progressing a return to running, and if you examine the ones that tend to be successful, the common feature between them is the application of the graded exposure principle. It's my view that this phase of a recovery from a running injury can very easily be over-complicated, especially for novice, average and recreational runners. The temptation is to replicate training programs designed for elite athletes, which have very specific progression pathways and are designed to get a runner back to training / performing as quickly as possible. They are designed to push the athlete as much as they can be pushed, without causing re-injury or a flare up in symptoms. These programs are structured this way because for elite athletes, time is of the essence- they need to get back to performing. If these programs could be described in terms of a risk-benefit analysis, there is a leaning towards greater risk in order to get the benefit of a return to performing earlier.

For most of us however, who run for general health fitness, enjoyment and fun, there is no rush to get back to running. This extra risk is arguably unnecessary. This is an important point to consider as what I tend to see quite often is that recreational runners can lose sight of the reasons why they run, in favour of for example, a secondary goal such as hitting a personal best time for a 5km run. If the main purpose for running is enjoyment, health and fitness, it makes sense to me to shelve these secondary goals when injury strikes and simply take your time getting well again. And if there is no rush to get back to running, there is no need to design elaborate, periodized training programs. What is important, in my view is that the return to running involves a progression of loading that is;

• sub-maximal

• systematic

• progressive

There really are many many ways to progressively load up the key parameters of frequency, duration and intensity. Generally, I take the approach that we should begin by increasing duration first, followed by frequency and intensity. But there aren't really any hard and fast rules. Returning to running after an injury is all about gradually exposing your body to the load of running again, in a manner that at worst, stops short of re-sensitizing the injure area and at best, increases your adaptive potential so that you are less likely to get injured again. The programs I put together for the runners I see tend to be very collaborative. They always emerge from a negotiation of sorts with the runner so that they incorporate the runner's primary goal without unnecessarily risking re-injury. If you are a Eastern Suburbs local, and have a running injury, or symptoms that are affecting your running, feel free to call me on 9665 9667 to discuss your options for treatment and rehabilitation.

Hip Problems

Pain, discomfort or tightness in the hip and buttock region is very common. We see it across all adult age groups and across all sorts of levels of fitness and health. Patients who present with symptoms in this area are most often concerned that the problem is in the hip joint itself. However, what we tend to find is that symptoms in this region are most often relieved by treatment directed at the lumbar spine, sacrum and pelvis. Less common drivers of symptoms in this region are an irritated and sensitive greater trochanteric bursa or irritation (+/- an acute tear) of the acetabular labrum in the hip joint.

If you choose to see a health professional with a view to addressing symptoms in the hip and buttock region, the consultation should include an assessment of your lumbar spine, sacroiliac joints and the hip joints. My preference is to carry out a series of active movement and passive movement tests to help identify which regions of the lumbopelvic-hip region aren’t moving with the freedom we would expect for your age, fitness level, health status etc. When we marry up information gleaned from the clinical assessment with all your personal information (age, health status, history of injury, aggravating factors, easing factors), we can begin to see a clinical picture emerge that points towards a particular diagnosis. These diagnoses are necessarily tentative, since our main outcome measures are changes in the patient’s report of symptoms such as pain, and we know that the experience of pain is personal and variable.

So I tend to proceed from a provisional diagnosis, with a treatment plan that is low risk. We can use within session and between session changes in symptoms to guide the progress of manual therapy treatment, and the transition to exercise interventions and beyond. The response to treatment is also useful for identifying “red flags”. Red flags are an indicator that there might be something more sinister or pathological driving your symptoms. Although very rare, it is important that we remain vigilant and when we see a set of symptoms that aren’t behaving “as they should”, we liaise with your GP or other specialist to arrange a referral and testing if needs be.

If you’re dealing with pain in the hip and buttock region, and you’re not sure about what is causing it, or how to manage it, give us a call on 9665 9667. We can discuss your specific scenario over the phone and make some initial decisions about how best to proceed.

Scoliosis

Scoliosis was originally a Greek word meaning curved or bent. Today it is a word used to describe a common type of spinal curvature. Scoliosis is simply a descriptive term, like headache- it is not a precise diagnosis. In other words, if you have had some imaging like an x-ray, or some other form of assessment that indicates that you have a spine that curves laterally, the next step is to work out why your spine is curved in such a manner.

There is some useful information about the various “types” of scoliosis on www.scoliosis-australia.org.

Small lateral curves in the spine a common and are of no particular consequence to an individual. For most people, a mild scoliosis is not something that warrants any specific treatment. We (people in general) are not perfectly symmetrical beings. We are capable of adapting to a mild scoliosis and performing our preferred occupational and recreational activities over a lifetime.

There is however, a smaller group of the population who develop more pronounced or prominent curves in their spines. And since every pronounced or severe case of scoliosis starts off at some point as a mild case, it does make sense to take measures to identify those who might be at a higher risk, as this will provide the best opportunity to commence effective treatment. The population that benefits most from early detection of scoliosis are children and young adolescents, particularly girls. About 2% of girls have a curve which warrants medical observation throughout childhood and adolescence. Three girls per 1,000 will require treatment during the growth phase.

You can download the Self Detection Brochure for scoliosis here.

Treatment for scoliosis may include surgery, the fitting of a brace or plaster jacket, depending on the age of the patient. There are no other treatments that have been shown to improve or reverse the lateral curve of one’s spine. We can offer treatment for symptoms such as pain and stiffness which may be associated with a scoliosis.

For information on such treatment, or for questions about your spine, or child’s spine, please call us on 9665 9667.

Chronic Regional Pain Syndrome

Have you been diagnosed with “Chronic Regional Pain Syndrome (CRPS)”? The purpose of this page is to help you understand what this diagnosis means. As is the case with many medical diagnoses, a diagnosis of CRPS is not based on singular test with a crystal clear, black and white result. It is not as straight forward as it is to, for example, have a blood culture taken to test for and diagnose a bacterial infection. The diagnosis of CRPS is based on your medical history, an analysis of the events leading up to the onset of your pain and an analysis of your symptoms and symptom behaviour over time. Many CRPS signs and symptoms can exist independently from each other, and independently from the diagnosis of CRPS.

It’s worth stating all this because it is important to understand that a “diagnosis” of CRPS is always a little bit grey around the edges… there do exist a few “classical” clinical presentations that tick all the diagnostic criteria, but very often there is a great deal of overlap between chronic pain conditions that qualify as CRPS, and those that do not.

CRPS is basically a label used to describe a cluster of symptoms. Attaching diagnostic labels to clusters of symptoms is a tricky thing… it helps researchers to plan and carry out more studies so that we can learn more. But the downside is that a diagnostic label can be problematic for you, the patient. It is easy for the worst features of a diagnosis to become the most commonly known features. The corollary is that the popularly or widely held understanding of a prognosis for a given condition can become skewed towards the worst case scenario. Within the context of CRPS, the risk is that the prognosis is popularly understood as a condition for which a lifetime of pain and and intractable suffering is a fait accompli. We know that this is not the case.

We know that most young people who are diagnosed with CRPS completely recover, while patients of all ages do much better with early education and treatment, than those who do not receive early interventions. We also know that pessimism with regards to the prognosis of persistent pain, is associated with passive coping and higher pain scores. So there is value in taking steps to help sustain, and even improve your optimism with regards to your prognosis. I encourage you read widely and learn as much as you can about CRPS. This will help ensure that your level of optimism reflects what is most likely to happen you, as opposed to the worst case scenario, which less likely to applies to you.

In my view, the key features of the diagnosis of CRPS is the acknowledgement that you;

• are experiencing pain, usually in a single arm or leg, that was not initially associated with any obvious precipitating injury

• you are experiencing pain that is disproportionately high relative to what might be commonly described as “normal” for a given precipitating injury

• you are experiencing pain that has outlasted the expected healing time for a given injury

• you have increased sensitivity in the affected area, such that even light touch or contact can be painful

The “classical” symptoms and clinical features that tend to lead to a diagnosis of CRPS include;

• skin colour changes to blotchy, blue, purple, pale, or red colour

• swelling of the affected limb

• abnormal sweating pattern in the affected area or surrounding areas

• changes in nail and hair growth patterns of the affected limb

• pain in an entire arm or leg, even though any precipitating injury might have     been only to a finger or toe.

• pain that spreads over time to the opposite extremity

• decreased ability to move the affected body part

• abnormal movement in the affected limb- a fixated position, tremors in or jerking of the affected limb.

There are many people suffering from longstanding pain, whose symptoms do not fit neatly within the classical presentation of CRPS. The good news is that you don’t need a clearly defined diagnosis in order to take steps towards resolving, or at least coping better with your pain. For those of you who have been diagnosed with CRPS, I think it is important to keep in mind that the diagnosis doesn’t determine your outcome. It really is only a label used to describe a cluster of symptoms that tend to manifest when there is something amiss in your body’s nervous system physiology.

Exactly what it is amiss, is the question that many researchers are hard at work trying to answer. It does not appear that the symptoms of CRPS specifically, or persistent pain generally, are caused by a singular or discrete injury or damage to any particular part of your nervous system. Rather, it seem more likely that when such symptoms emerge, the “problem” is multifactorial and is associated with altered nerve cell signaling and sensitivity in brain, spinal cord and nerves. That is quite a mouthful of a sentence… Unfortunately, it is tricky to state it in simpler terms. We know that sometimes these changes are triggered by an injury, and that sometimes they occur in the absence of any identifiable trigger. We also know that improving one’s understanding of pain physiology is associated with improved pain outcomes. So, the first step to improving your pain and your coping capacity may lie in a decision to learn more about your condition. We can help you with that process and get you started on an effective course of treatment. Call us on 02 9665 9667.

Osteoarthritis

Arthritis is defined as “joint inflammation” i.e. the “arthr” denoting part of the latin term for joint, while the “itis” denotes the latin suffix for inflammation. The “osteo” in osteoarthritis denotes the latin term for bone. So the term osteoarthritis, technically describes bone + joint + inflammation. This is not particularly useful since, any form of arthritis will include elements of inflammation, and both “bone” and “joint”, since every joint is formed by the articulation of two bones.

Sounds confusing, right? Well it is. It shouldn’t be, but it is.

Unfortunately, many of the diagnostic terms used in modern medicine have their roots in language which does not do justice to our current understanding of the pathophysiology of the body’s various bits and pieces. If you’ve been told that you have “osteoarthritis”, it means that your doctor, or your physio, or someone, suspects (or has confirmed via x-rays) that the cartilage that lines the ends of the joint surfaces of, say your knee joint, has to some degree, worn away. We begin life with a nice thick layering of shock absorbing, slippery and padded cartilage. It is true that this cartilage layer, especially in our weightbearing joints is subjected to a great deal of compression and shear forces on a daily basis. It is normal for cartilage to wear out with age. For some people, this wearing process is faster than for other people. Researchers do not really understand why some people’s cartilage wears out faster than others.

In the past, the presumption has been that the more severe your loss (or wearing out) of cartilage, the more severe will your “arthritis” symptoms be. However, this presumption has been turned on its head in recent years, with research demonstrating only a very weak relationship between the degree of cartilage wear and tear, and the degree of pain or disability one might develop. This is good news for those with a diagnosis of osteoarthritis. It means that you no longer have to presume that a life of disabling pain is a fait accompli. We now understand that there are other factors, in addition to the degree of cartilage wear and tear, that influence the extent to which your “osteoarthritis” is painful or disabling.

Central to these factors is the notion that your body’s sensory pathways, the nerves, have a capacity for changeable sensitivity. That is, the nerve endings that are plugged into, say, your knee joint, can be in a very sensitive state or, let’s say, a less sensitive state. If we stick with the example of the knee joint, the job of your nerve endings is to tell your brain what is happening in your knee. When they (the nerve endings) are in a very sensitive state, they very rapidly, and very effectively transmit every little skerrick of information back up to your brain, bombarding it with a (potentially) distorted picture of what is going on in your knee. Basically, when you have a very sensitive bunch of nerve endings doing their thing, small, low load movements can to be very painful. Sustaining static positions tends to be painful. Getting moving after being still for 20 minutes or so is likely to be painful. And, although things tend to be less painful once your up and moving, extended or intense bouts of activity are likely to be painful.

This pattern of pain behaviour is classic for cases of “osteoarthritis”, but we can no longer attribute these patterns of symptoms solely to the wearing out of cartilage in your joints. We also have to consider that the more ramped up is the sensitivity of your nerve endings, the more amplified is the information (about the state of your knee) being transmitted to your brain. The more amplified the incoming information, the “louder” is the protective response from your brain. And the response from your brain, typically, is to protect your knee by making the muscles around your knee tight to “guard” the knee. Your brain will also protect the knee by sending out messages to make the nerve endings even more sensitive. We end up with a cycle of increased nerve sensitivity, and protective “guarding” of muscles… ultimately, the result of all that is ongoing pain in the knee, or shoulder, or hip, or whatever particular joint of yours has been diagnosed as osteoarthritic.

The important point here, is that this cycle of nerve sensitivity and muscle guarding, is capable of driving up and sustaining a pain state, regardless of the degree of cartilage wear and tear in your joints. It is possible then, that your osteoarthritis pain, is changeable. Consider this proposition: To the extent that most of your pain is a product of an interplay between nerve sensitivity and muscular guarding, the significance of cartilage wear and tear is potentially negligible. Of course, the truth is probably somewhere in the middle… it is likely that the wearing out of cartilage from your joint surfaces, is part of the reason for the ongoing sensitive state of the nerve endings plugged into your osteoarthritic knee or hip or shoulder etc.

So how does all this help you? Well, the most sensible application of all this information, lies in one’s ability to consider that there is at least some component of one’s “osteoarthritis” pain that is a product of the positive feedback loop between nerve sensitivity and muscular guarding… and to the extent that that cycle is broken, one’s pain can be relieved, perhaps even resolved. The next step, logically, would be to find out how this pain cycle might be broken.

To find out, call us on 9665 9667. We can discuss your symptoms and determine whether or not it would be useful for you to drop into the clinic for an assessment of your arthritic joint. If you already think we can help you, feel free to book an appointment online.