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  • Sciatica physiotherapy treatment - Latest research!

    WHAT IS SCIATICA? Sciatica is a term that tends to get thrown around quite a lot especially in reference to any nerve related pain in the lower extremity. Yet despite its common diagnosis, there are many misconceptions surrounding what it really is. It is a vague term used to describe pain that is associated with the compression or irritation of a nerve root located in the lumbosacral region of the spine (lower back). Now grasping that this pain originates from the lower back can be a touch more complicated, especially when factoring in that most symptoms are felt down the leg. However, this begins to make more sense when looking into the major anatomical structures involved. Sciatica derives its name from the condition’s involvement of the sciatic nerve which is the largest and longest nerve in the human body. Starting in the buttock and travelling down to the lower leg, this nerve is formed by a cluster of smaller nerve roots that can be traced back to the sacral plexus within the lower back. If these nerve roots are irritated in any way it can manifest in referring pain down the nerves pathway which can include the buttock, thigh, calf, and foot. HOW CAN THESE NERVE ROOTS BE IRRITATED? To understand how the nerve roots can be irritated we need to look at where these nerve roots are and what structures can influence them. As can be seen in the image below, the nerve roots are the yellow cords exiting either side of the spinal cord. These nerves send and receive information from the brain all the way down to the tips of the toes and are therefore a very important travel route for sensory (feeling) and motor (muscular) control. Another important structure to consider is the discs, depicted as the blue semi-circles. When it comes to nerve root pain there are two primary types: mechanical pressure and chemical irritation. The concept of mechanical pressure is relatively straightforward. It postulates that when a nerve root experiences compression, as can be seen in the image above on the right, this can limit the amount of blood flow to the nerve. Without the appropriate blood flow there is reduced oxygen being delivered meaning the nerve will not be able to perform its functions properly. Furthermore, if this reduced blood supply is prolonged it can lead to nerve degeneration and the development of abnormal impulses within the nerve. This is what can often be experienced as the burning, pins and needles or electric shock type of sensations down the leg. The chemical irritation system is slightly more complicated and has two additional schools of thought. The first is that the discs contain powerful chemicals that when spilled onto the nerve can lead to inflammation making the nerve angry and dysfunctional. Discs are very active tissues within the body. They are constantly laying down new cells and breaking down the old ones to ensure they are always healthy and functional. For the discs to be able to break down old cells they need to have powerful enzymes that can damage and discard them. Therefore, if a disc herniates and some of the chemicals spill onto the nerve roots, they can irritate the nerve and start an inflammatory response from the body. The second is that the disc can cause an autoimmune response which will often catch the nerve in the crossfire. Whilst it is very rare that a tissue in the human body has no nerve or blood supply, this is the case for the discs after the first few months of life (like the inside of the eyeballs!). As a result, the discs are quite foreign to the body’s immune system, to the point where it is unrecognizable. Therefore, when a disc herniates the immune system reacts to this as it would a foreign body, such as an infection or a virus. This means it attacks the disc tissue resulting in an inflammatory reaction which will end up affecting the nerve root given its proximity to the disc. WHAT ARE THE SYMPTOMS OF SCIATICA, WHO DOES IT AFFECT AND FOR HOW LONG? The most common symptoms associated with Sciatica is pain travelling down the back of the leg. Key areas include the buttocks, back of the thigh, calf, and foot. Some people can experience a burning, electric shock or pins and needles type pain or in rare cases a sensation of cold water running down the leg that may be associated with numbness or muscle weakness. The intensity of the symptoms can be quite broad ranging from mild, barely noticeable pain to severe pain, likened in some cases to childbirth. Sciatica can affect people of every age however it is mostly seen in the forties and fifties. Expected timeframes for recovery from a sciatica diagnosis can vary greatly however the pain is generally the worst for the first 2-4 weeks. At the 12-week mark 50% of those with sciatica will have nearly a complete resolution of initial symptoms. For a small group of people, pain may not improve at the rate normally expected however by the 12-month milestone over 75% of patients are asymptomatic. HOW TO MANAGE SCIATICA? When it comes to the management of Sciatica there are a range of treatment options available, including physiotherapy. The most important factor in most of these is allowing the appropriate amount of time for recovery. Other common non-surgical treatments include adjusting lifestyle factors such as smoking cessation and weight loss as well as introducing general exercises or specific spinal/ nerve movements targeted at mobilising the sciatic nerve. In extreme cases medications, specialist nerve injections or surgery may be used as a last resort however for most this is certainly avoidable! If you are unsure about what may work best for you then book an appointment with your health professional who can provide you with an accurate diagnosis and a suitable treatment plan that is built around you and your lifestyle! References Dower, A., Davies, M., & Ghahreman, A. (2019). Pathologic Basis of Lumbar Radicular Pain. World Neurosurgery, 128, 114-121. doi: 10.1016/j.wneu.2019.04.147 Goldsmith, R., Williams, N., & Wood, F. (2019). Understanding sciatica: illness and treatment beliefs in a lumbar radicular pain population. A qualitative interview study. BJGP Open, 3(3), bjgpopen19X101654. doi: 10.3399/bjgpopen19x101654 Jesson, T., Runge, N., & Schmid, A. (2020). Physiotherapy for people with painful peripheral neuropathies: a narrative review of its efficacy and safety. PAIN Reports, 5(5), 1-e834. doi: 10.1097/pr9.0000000000000834 Schmid, A., Hailey, L., & Tampin, B. (2018). Entrapment Neuropathies: Challenging Common Beliefs With Novel Evidence. Journal Of Orthopaedic & Sports Physical Therapy, 48(2), 58-62. doi: 10.2519/jospt.2018.0603. Background photo created by jcomp -

  • IT Band syndrome: how to [effectively] get rid of your knee pain?

    Have you ever had recurring knee pain when walking, running or squatting? You're not alone: Thousands of people are suffering from the dreaded IT Band syndrome. We see and treat people with this kind of knee pain all the time, and have been able to get them back to the activities they love. In this article we'll guide you with the information you need to get rid of this annoying pain. What is an IT Band? ITB is short for iliotibial band. It's a thick band of fascia structure on the outside of your upper leg. It originates from a muscle on the side of your pelvis (the TFL or Tensor Fasciae Latae and some fibres of the gluteus maximus) and inserts just below your knee. It flexes and extends the hip and helps with rotation of the leg as well, and plays an important role in knee stabilisation. One of the most common and dreaded injuries associated with the ITB is called IT band syndrome What causes ITB tightness - what causes pain on the outside of the knee? IT band syndrome occurs when the IT band becomes painful due to irritation and overuse: flexing and bending the knee repetitively. When we repeatedly engage in a movement; like bending and extending the knee, this can cause friction and irritation of the area. This almost always happens when the IT band is too tight and causes friction on the outside of your knee. This can result in pain and / or inflammation and is very common in active people. When will you experience the most pain? The discomfort, irritation or pain from this issue will most likely be when moving: running, walking or squatting (with or without weights) will usually offset the symptoms due to the friction on the outside of the knee. Resting will normally ease these symptoms, although it may take a while before this annoying feeling disappears. Why does the IT band get tight? This is the most important question to answer in order to get the right treatment in place. In many cases, we see a biomechanical issue that's a big contributing part. It could be an issue with foot mechanics or lower leg dysfunction; where one of the bones in the lower leg isn't moving well. It could also be higher up the leg, or even in the lower back. When one of the lower vertebrae in your spine is stiff or when there is tightness in one of the muscles in the pelvis, this can cause the pelvis to tilt. Even if this tilt is slight, it will result in more tension in the IT band. The discomfort, irritation or pain from this issue will most likely be when moving. Running, walking or squatting (with or without weights) will usually offset the symptoms due to the friction on the outside of the knee. Resting will normally ease these symptoms, though it may take a while before this annoying feeling disappears. You’ll need one of these if you want to roll your IT band! :-) How to treat ITB pain? Let's start with explaining what will NOT resolve your problem. Many health practitioners focus on the symptoms and will give treatment on the painful spot: somewhere around the knee. This is unlikely to solve your issue because although this is the spot where your pain or tightness is, it is not necessarily the cause of the problem. Another unhelpful treatment option: foam rolling your ITB! We see so many active people foam rolling their ITB in the gym. Let me tell you: you cannot release your IT band with a foam roller. Whilst a foam roller is an amazing tool that can be used to release muscle tightness all over your body, the IT band is not one of them. Because the IT band is very strong connective tissue and not muscle, you would require far more pressure than you could generate with a foam roller to make the necessary impact. Foam rolling the gluteus maximus and the TFL muscle to ease IT band tightness The clue with treatment is finding out what is moving well in the body and what is not moving well. Foam rolling your glutes and TFL muscle can be a good start (find out how to do this correctly here ), but a proper assessment of the biomechanics at play is needed to address the underlying cause of your pain. At Physio K, we are experienced in finding and addressing the root cause of your problem and guiding you in your rehab, so you can get back to doing what you love. To book an appointment with one of our experienced practitioners: click here

  • Rotator cuff related shoulder pain: “Subacromial impingement”

    Subacromial impingement syndrome. It’s quite a mouthful and a diagnosis that will make you fearful of ever using your shoulder and arm again. But what is it and what does it mean? Subacromial impingement is considered to be the most common musculoskeletal condition affecting the shoulder and is estimated to affect at least one in four people at some point in their lifetime. It is based upon the idea of tissues within the shoulder joint undergoing compression during certain functional movements, especially ones that involve the arm being raised above shoulder height. In essence this theory suggests that one of the muscles that contributes to the rotator cuff (supraspinatus) gets pinched underneath the bony roof of your shoulder blade (acromion process) resulting in pain and inflammation of the tendon and its surrounding tissues such as the bursa (a sac of fluid that protects the tendon from abrasion). But is this really the cause of your shoulder pain? After all, up until this point in your life you’ve never had an issue with this bone or this tendon so what’s changed? To answer this, we first must understand what tendons are and how they operate. Tendons are the connective tissues that help connect a muscle to a bone. It is made up of collagen fibres which are closely packed to give a tendon the strength it needs to transmit the forces produced by our muscles into the bones they attach to. In fact, tendons are so robust that gram for gram these tightly packed fibres are stronger than steel! If that’s the case, then you may be wondering how do they get damaged? Well, there are several lifestyle factors that contribute to tendon health and regeneration. Avoiding modifiable factors such as smoking, obesity, high intakes of fatty or processed foods and high cholesterol levels all contribute to maintaining healthy tendons. However, by far the most notable risk factor for tendon injury is SUDDEN CHANGES IN ACTIVTY LEVELS! Tendons do not like a sudden change in activity. If they go through a period of unaccustomed loading, especially above shoulder height, they will end up getting irritated and unhappy. When we work a tendon to fatigue (which happens quite easily when we first start moving after a period of inactivity) it induces swelling within that tendon. This is especially true in the case of the supraspinatus tendon, which is the main tissue implicated in this diagnosis. As a result of this fatigue and swelling there is a decrease in activation of the supraspinatus muscle which plays an important roll in stabilising the shoulder joint and preventing the unwanted rise of the humeral head (top of the arm bone). Therefore, the issue is not actually subacromial impingement but rather tilting more towards an irritation of the tendon due to overuse, also referred to as overuse tendinopathy or as rotator cuff related shoulder pain. So, what can you expect from physiotherapy management? Well typically when dealing with rotator cuff related shoulder pain there should be physiotherapy rehabilitation for the first 12 weeks, followed by self-management or independent rehabilitation from week 12 to 24. After week 24 you can then return to normal activity. Physiotherapy management may often include some manual therapy techniques in addition to a targeted home exercise program or work-related activity program. It is important to note that some of the exercises you will be asked to complete may bring on some discomfort or result in you working through pain. This is completely normal, but it should be tolerable and settle quickly upon completion of the exercise. The reality of the situation is that this theory of shoulder impingement is now considered outdated. The evidence now shows us that decompression surgery, which was and still is the surgical procedure for this injury to date, does not outperform either placebo surgery or physiotherapy treatment in the short-, medium- or long-term outcomes. So, we have to ask, why risk taking the surgical route if in 6-12 months-time the result will be the same with physiotherapy treatment. References Cuff, A., & Littlewood, C. (2018). Subacromial impingement syndrome – What does this mean to and for the patient? A qualitative study. Musculoskeletal Science And Practice, 33, 24-28. doi: 10.1016/j.msksp.2017.10.008 Lewis, J. (2009). Rotator cuff tendinopathy/subacromial impingement syndrome: is it time for a new method of assessment?. British Journal Of Sports Medicine, 43(4), 259-264. doi: 10.1136/bjsm.2008.052183 Lewis, J. (2011). Subacromial impingement syndrome: a musculoskeletal condition or a clinical illusion?. Physical Therapy Reviews, 16(5), 388-398. doi: 10.1179/1743288x11y.0000000027 Lewis, J. (2016). Rotator cuff related shoulder pain: Assessment, management and uncertainties. Manual Therapy, 23, 57-68. doi: 10.1016/j.math.2016.03.009 Lewis, J., McCreesh, K., Roy, J., & Ginn, K. (2015). Rotator Cuff Tendinopathy: Navigating the Diagnosis-Management Conundrum. Journal Of Orthopaedic & Sports Physical Therapy, 45(11), 923-937. doi: 10.2519/jospt.2015.5941 Löscher, S. (2018). 2013 Neer Award: Prädiktoren für das Versagen von nicht operativer Therapie bei chronischen, symptomatischen Rupturen der Rotatorenmanschette. Manuelletherapie, 22(04), 157-159. doi: 10.1055/a-0658-8975

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  • Treatments: Physiotherapy | Manual Therapy | Dry Needling

    PHYSIOTHERAPY TREATMENTS Bondi Junction, Eastern suburbs, Sydney WE BLEND TRADITIONAL WITH INNOVATIVE TECHNIQUES OF PHYSIOTHERAPY At Physio K, our physiotherapists take the time to understand the pain you are experiencing and get to the underlying heart of the problem. Our approach is based on hands-on treatment, using our systematic and scientific process, we make sure the right technique is applied. We are experts in manual therapy, sports and remedial massage techniques. We are also advanced in the innovative technique of dry needling, having taught this technique to other physiotherapists, we have advanced skills in this area and know the appropriate times and situations when this technique should be used. ​ We believe a combination of old and new techniques to speed up recovery and get you back into action. Physiotherapy treatments is dealing with conditions that cause joint and muscle pain, movement or mobility disorders, sports injuries, work related injuries and musculoskeletal dysfunctions. We are in the business of treating and prevention. Sports and Remedial Massage Post-operative Rehabilitation Treatment Manual manipulation techniques Dry Needling

  • Most Effective Dry needling | Physio K | Bondi Junction

    WHAT IS DRY NEEDLING? Dry needling is a fast and effective treatment proven to relieve pain and advance recovery. It involves inserting and advancing a fine filament needle into the muscle in the region of a “Trigger Point’. The aim of Dry Needling is to achieve a local twitch response to release muscle tension and pain. Dry needling is an effective treatment for chronic pain of neuropathic origin with very few side effects. This technique is unequalled in finding and eliminating neuromuscular dysfunction that leads to pain and functional deficits. The needle used is very thin and normally you won’t even feel it penetrating the skin. Healthy muscles won’t feel much or any discomfort when inserting this needle. However, when the muscle is sensitive and shortened or has active trigger points within it, the patient may feel a sensation like a muscle cramp -‘the twitch response’, and that’s exactly what we’re looking for. Deactivating these trigger points results in reducing your pain and restoring normal muscle function. WHAT CAN BE ACHIEVED WITH DRY NEEDLING? ​ Dry needling can be very beneficial to reduce neck pain, back pain, shoulder issues, knee pain, tennis elbow or any sports injuries. Strained muscles react very well to dry needling and it can significantly reduce the time of rehabilitation. In combination with other forms of physiotherapy, dry needling can be very effective in treating these conditions. DRY NEEDLING TREATMENT Bondi Junction, Eastern suburbs, Sydney HOW DOES OUR DRY NEEDLING DIFFER FROM MOST OTHER PRACTICES? ​ ​ 1. We don’t leave needles in the body and walk away. At Physio K, we always combine manual treatment, exercise prescription, education, assessment and any other form of treatment that could be of benefit for you with dry needling. When we do dry needling, we will insert the needle and do some movements (up to 10 seconds) and then take the needle out. The whole process of needling normally doesn’t take longer than a couple of minutes. 2. We make sure our patients respond to our manual intervention. We will do a thorough clinical assessment, followed by the intervention of dry needling and then reassess to see how much you have responded to the needling. We will work with you to find the cause of the problem and not just do some needling in the area where you feel the symptoms. 3. We are trained with GEMt, which is one of the leading global dry needling companies. We value high standards and make safety our top priority. The management team at Physio K is involved in teaching dry needling with this company to other manual therapists across the globe. DIFFERENCE BETWEEN DRY NEEDLING AND ACUPUNCTURE ​ Both acupuncture and dry needling use a fine filament needle which is inserted into the skin in order to treat pain, but that is where the similarity stops. Acupuncture is Chinese medicine, which focuses on energy levels (meridians). It is a more superficial treatment and the needles are inserted into specific parts of the body in order to focus on restoring energy or “Qi”. With dry needling, we are focussing on trigger points (a term which was first described in 1942 by Dr. Janet Travell). These are painful spots in the body that can cause local and / or referred pain. The aim with dry needling is to deactivate and desensitise a myofascial trigger point which should stimulate a healing response in that tissue and reduce the biomechanical stress of the muscle treated. FAST AND EFFECTIVE TREATMENT ​ Treatment outcomes can be achieved faster, allowing the practitioner to do more in the same session. RESEARCHED BENEFITS ​ The research has proven that the ‘twitch’ response in the muscle during dry needling is associated with muscle relaxing. This will be beneficial to muscles, tendons and joints in the body! PROVEN TECHNIQUES Dry needling treatment is an extremely effective method for treating acute and chronic pain, and it has very few side effects. As well as standard physiotherapy and manual therapy, Physio K also offers dry needling treatments to patients we believe would benefit from it. In combination with other forms of treatment, trigger point dry needling is a quick and effective way to treat neuromuscular dysfunction to greatly reduce pain and discomfort. Our practice provides sports physio in our clinic, located in the Eastern suburbs of Sydney. Our studio is located in Bondi Junction. Physio K services the surrounding suburbs as well, such as Bondi Beach, Waverley, Tamarama, Bronte, Clovelly, Randwick, Woollahra, Paddington, Darlinghurst, Bellevue Hill, Double Bay, Rose Bay, Dover Heights and Vaucluse.

  • Physio K: Quality Holistic Physiotherapy | Bondi Junction

    Going beyond your symptoms with physiotherapy that is driven by results. BOOK AN APPOINTMENT OUR PHYSIO TREATMENTS PROCESS When you visit Physio K at our clinic in Bondi Junction, you are in safe hands. Our depth of expertise is matched by our ability to understand your pain. We take the time to assess your unique situation so that we can first get to the root cause of the pain and then tailor the treatment to suit your needs ​ FIND THE PROBLEM ​ We deep dive into the diagnosis of the problem and apply our anatomical knowledge, and clinical reasoning and experience to get to the root cause of the pain. ​ TREAT THE CAUSE ​ We treat the cause, not the symptom. Our thorough approach aims to set you on the path to recovery. We provide ongoing support plans to ensure you stay on track with your recovery. ​ INNOVATIVE TECHNIQUES ​ We are highly skilled and experienced practitioners and use innovative techniques such as dry needling alongside traditional hands-on manual therapy. OUR SERVICES QUALITY TREATMENT At Physio K, we have a simple but fundamental philosophy; to provide you with the very best of care. The aim is to give you elite level treatment in a professional and welcoming environment. We tailor all treatments to your individual needs and pride ourselves on a high level of care, a wealth of knowledge and quality results without overtreatment. Read More SPORTS AND REMEDIAL MASSAGE Sports and remedial massage: Massage and fascia techniques are often used to release tight muscles and free up areas of the musculoskeletal system. When these are used in combination with other techniques in the movement system, they will almost always give better results than only massage. MANUAL THERAPY The therapists at Physio K will use their extensive knowledge and expertise in the musculoskeletal system to get you pain free again. A combination of hands-on treatment with specific exercises will be used to get you back to the things you love. Read More HOLISTIC TREATMENT At Physio K, symptoms are never seen as isolated issues, but as a part of a dysfunction in a physiological chain. We believe in holistic physiotherapy and will identify and address the underlying cause of your pain rather than just treating the symptoms. DRY NEEDLING The management team at Physio K is teaching at GEMt (global education of manual therapists), where the skill of dry needling is taught to manual therapists across the globe. Read More POST-OPERATIVE REHABILITATION TREATMENT Post operative rehabilitation treatment: To regain your strength, flexibility and functional fitness after an orthopaedic surgery, it will be essential to get specific physiotherapy treatment. To ensure optimal recovery and to avoid compensation patterns in the future, a tailored treatment plan will be offered to you. At Physio K, we are experienced in post operative rehabilitation to get you back to what you love. Did you know... Using our HICAPS system, we can swipe your health fund card at the time of your appointment. This means you only have to pay the gap and won't have to make any further claims to your health fund. Contact We’re here for you when you need us! Book in online, call us to schedule an appointment, or send us an email and we’ll get back to you as soon as possible. Address: Suite 801 / 3 Waverley St, Bondi Junction NSW 2022 NEW LOCATION Email: Phone: 02 7902 1408

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