Articles in Category: Training and Performance

Red Flags

Written by Don Williams BSc, MChiro, ICSSD. on Wednesday, 23 September 2015. Posted in Massage, General Health, Acupuncture, Training and Performance, Chiropractic

Red Flags

Red Flags

By Don Williams

B.Sc., M.Chiro., ICSSD., PG Dip. NMS Rehabilitation Cert DNS. Memb: FICS, CEA

 

Health care practice is an interesting and ever changing profession. One of the challenges that keep us on our toes is the assessment and management of different injuries and ailments.

 

The first goal in assessment is (or certainly should be) to identify what the complaint is, whether it is a serious or potentially serious condition that requires urgent intervention.

 

Recently, we have had a number of quite serious cases which have left us a little baffled as to the management they had unfortunately NOT received.

 

So this month I thought I would write an article on important symptoms to watch out for so you are not feeling sore and sorry.

 

Red Flags; this is believe it or not, a technical term for signs and symptoms which may indicate serious underlying pathology. These flags are many and varied and their presence is merely a potential indicator of pathology. This means that just because you have a “Red Flag” doesn’t mean you have a problem.

 

In compiling this list, it is by no means exhaustive and is a reflection of some of the things that we see showing up in our clinic.

 

So regionally, what are the things you should watch out for and what can they mean?

 

Back Pain

If you have back pain with referral down the leg, total numbness or loss of muscle strength it may be important. Loss of bowel and bladder control is certainly something we would want to know about.

 

Chest Pain

Most people know that chest pain can be an indicator of a heart attack. Most people realise that this is more commonly on the left side, however, pain in the lower front of the neck, the left arm, the left upper back and the right side of the chest can also be indicators. This would be reinforced by an increase in pain with exercise and or shortness of breath.

 

Night pain

Pain that wakes you from sleep is a concern, additionally; if this pain is accompanied by night sweats we would be a little more concerned. Sudden loss or gain in weight for no apparent reason is also a concern.

 

Headaches

“The worst headache I have ever had” is not a great thing to hear. If this is in conjunction with vomiting and dizziness it is more of a concern. The feeling that the head is going to explode is more of a concern. Disturbances in any of your higher senses (vision, taste, hearing or smell) can also be a concern

 

Pain

Unremitting pain of 6 months or more of duration may be serious. If this is high intensity pain, then it is more of a concern. If the problem is not responding to conservative treatment then it is more concerning again.

 

If you have had a problem which won’t go away or you have some interesting symptoms that you are just not sure about, then get them checked out. Sometimes they may mean nothing, sometimes they may be important. My thought, always, if in doubt check it out.

Spot Reduction

on Friday, 18 January 2019. Posted in Newsletters, General Health, Training and Performance

How Many Sit Ups Do I Need to Do to Get a 6 Pack?

This is a very common question we get asked here at Institute of Sports and Spines. The truth is that there isn’t a specific number of sit ups that would give any of us a six pack. Seeing results isn’t that simple.

There are claims that performing certain exercises targeting specific areas of the body can reduce the amount of subcutaneous fat in that area. This is known as spot reduction and has been disproved by a significant amount of scientific research.

Focusing all of your attention on a ‘problem area’ of your body will not result in fat reduction. You can definitely see improvement in muscular strength and even size when working on specific areas of the body but the amount of fat under the skin would have minimal change.

So how can I get rid of my belly bulge/thunder thighs/tuck shop lady arms?

It has been found that performing a combination of cardiorespiratory and resistance training is the most efficient way to reduce subcutaneous fat. When performing cardiorespiratory exercise we expend large amounts of energy (dependent on type of exercise). With regular resistance training (weight lifting) our muscles get more efficient and even at rest will be taking in energy (burning more energy).

It is also very important to be mindful of what you are eating and drinking - eating more foods from the 5 food groups, eating wholegrains, eating less highly refined carbohydrates, and drinking less alcohol and soft drinks.

Seeing results takes time and hard work, not 1346 sit ups. Consistency is key in achieving your goals and keeping your motivation on track is essential. Rather than focusing on a specific part of your body or a specific exercise, focus on making healthy lifestyle changes and you will get closer to improving that ‘problem area’.

 

Written by Emily Holzberger

Qualifications: B. ExSS Majoring in Clinical ExPhys.   

The Knee

Written by Don Williams BSc, MChiro, ICSSD. on Wednesday, 23 September 2015. Posted in General Health, Sporting Injuries, Training and Performance, Chiropractic

The Knee

By Don Williams

B.Sc., M.Chiro., ICSSD., PG Dip. NMS Rehabilitation,

Cert. DNS.   Memb: CAA, FICS, CEA.

 

This month I thought I would write a brief article about the knee.

 

The Knee is such a fascinating joint and unfortunately, is a regularly injured joint, necessitating visits to our clinic for many people.  We regularly receive referrals to assess knee injuries to identify what is actually wrong and how to manage the problem. This often necessitates us referring out for MRI scans and in some cases on referral to some of the excellent orthopaedic surgeons that we deal with.

 

The Knee 1  

 

Types of Knee Injuries:

Knee injuries and pain associated with those injuries generally fall into 3 categories.

 

Firstly, degenerative problems:

This can be osteoarthritic change or general wear and tear due to age or overuse of the knee.

Often age correlated or a result of lots of aggressive sport in the younger years.

 

Secondarily, biomechanical overload injuries:

These are often the result of;  genetic mechanical issues such as pronation of the feet and ankles, “Knock knee”, “bow legged” posture of the knees,  inappropriate footwear, poor technique in running, walking and other fitness activities, poor setup on bike position or sporting equipment or weaknesses and imbalances of the supporting musculature.

 

Thirdly, the pathological or traumatic injuries:

These are things like anterior cruciate ruptures (ACL), Meniscal tears (often referred to as the cartilage), fractures, and collateral ligament tears and issues. Bursitis and tendonitis issues are sometimes grouped into this category but are often more accurately grouped into the second category.

 

But what makes the knee so susceptible to injury:

Several factors really. The knee can be thought of as a force transducer. When we are walking, running, turning and jumping, our knee is subjected to high forces or loads in a multitude of directions.

 

The mechanics of the knee are complex and this article will be far from exhaustive in the description of the knee. But in basic terms the knee is a rolling/gliding hinge joint. Thinking simply, the knee is not a simple hinge (like a door), as the knee straightens, the femur glides across the tibia as it rolls towards the straightened position. This is why the end of the femur has a lengthened cam-like shape, in contrast to the relatively flat shape of the top of tibia. This means that the contact point and force vectors through the joint constantly change as the knee bends and straightens, combine this with the fact that the knee also pivots slightly right at the end of the straightening process make the knee a regularly injured joint.

 

Many health practitioners are taught at university that for the knee to have a pathological or major injury, there must be a large impact or nasty injury mechanism occurs to cause the damage. However, this is very clearly not the case with many of the patients we see at Institute of Sports and Spines.

 

In fact, the 2 worst knee injuries I have seen this year came from very low force activities; one from standing up after sitting on the ground and one from walking along the ground at work and turning to speak to someone. In fact, my own knee injury was not the result of a twist, fall or accident, but purely jogging along a flat footpath, the articular cartilage got caught and tore and it has been a problem ever since.

 

Scans and Imaging for the knee:

Depending on the injury or suspected injury, a range of scanning options are used.

Xrays and pretty good for looking at fractures of and around the knee, gross degenerative change and biomechanical position, they are not good at assessing soft tissue and ligament issues.

Ultrasounds are used to look at tendonitis and bursitis issues and muscle tears around the knee.

MRI scans are generally the image of choice for the knee and are the only means to effectively view meniscal tears, cruciate ligament injuries, collateral ligament injuries and articular cartilage defects.

I have included a couple of images below for interest.

 

Image 1                                                                                             Image 2

The Knee  2  The Knee 3 

The Knee 4

                                                                                              

Image 1 above, the green oval shows reasonable articular cartilage with some thinning. The red circle shows a tear or defect in the cartilage (the white area), the end of the bone has a light area which is bone swelling.

 

Image 2 The blue circle shows good articular cartilage and a healthy meniscus in the correct position (black triangle on the right side).

The red circle shows the lateral meniscus in the wrong place (this is bad ;)) and the green arrow shows us where it should be.

 

 Image 3 to the left shows a vertical tear in the meniscus and a little bit of swelling to the left of the arrow.

 

Management of Knee Pain:

When you have knee pain, correct assessment and diagnosis of the problem is critical. We have unfortunately seen many patients who have had a lot of treatment for the wrong diagnosis, resulting in poor outcomes.  A comprehensive physical and orthopaedic examination should give a working diagnosis which may then indicate treatment direction or relevant investigations to confirm the suspected diagnosis.

 

At IOSAS, we generally start our assessment with gait analysis, looking at joggers, work shoes etc, analysis of movement patterns and muscle strength to look for weakness and imbalances, followed by an orthopaedic joint assessment. This then directs how we will manage the presentation to move you towards the outcome you desire.

 

Most biomechanical issues of the knee and overload syndromes can be managed conservatively and don’t progress to surgery.  Advanced degenerative change of the knee will often require joint replacements and ruptures of ligaments and meniscal tears which catch or lock will usually require surgery with a degree of urgency.

 

Treatment options:

For many overload / degenerative and biomechanical issues, addressing mechanical issues and contributing factors can be a big part of the solution. Acupuncture, Massage and Chiropractic and other physical therapy interventions can be useful to address the current pain presentation. Progression towards rehabilitation and retraining may be indicated to prevent recurrence.

 

Due to the nature of the cases that we see, some patients require surgical intervention to help resolve their issues. It is vital in the post-operative phase to focus on rehabilitation and strengthening to make sure there is relatively good balance or symmetry in the strength and control of the knees to hopefully prevent future recurrences.

 

Generally, effective assessment and management of knees gives a greater probability of a good outcome.

 

If you have a new or ongoing issue with your knee, come in and see us, we might be able to help you get a better outcome.