Mental health in Sports Rehab

As a player goes down with injury, we as physiotherapists are all well equipped to assess the pathology and initially manage the physical pain, but how much do we consider the mental anguish that is associated?

I am sure we are all aware of the 5 stages of grief (or the Kubler-Ross model): Denial, Anger, Bargaining, Depression and Acceptance. With the hard work that our players put into their  training, for it to be taken away from them in an instant, you would think the player would enter a grieving process immediately. 

As the person who is often first on the scene, I think it is important we consider this. When trying to gain as much information as possible out of our subjective questioning, if the player is in the denial or anger phase, the information we receive may be skewed or limited. 

Particularly if prognosis is poor and the player is set for an extended stint on the sidelines, I think it is also vital that physiotherapists and other fitness staff involved consider the athlete’s mental health throughout rehab for better outcomes. 

Often longer term injuries mean the athlete is limited in the amount of high intensity exercise they can do. For people who are so conditioned to push themselves to the edge physically, this can sometimes lead to a bit of a hole in their daily routines and affect their mental wellbeing as a result. 

A study by Gulliver, et al 2015, titled “The mental health of Australian elite athletes” showed that injured athletes had higher levels of symptoms of both depression and generalised anxiety disorder. 

Further studies have also shown that higher intensity exercise leads to decreased stress and depressive type symptoms (Gerber, et al 2014). It was also shown that increased exercise intensity leads to decreased pain levels and improved sleep patterns, which can lead to direct benefit for the athlete whilst in rehab. 

Obviously there are others in the medical profession who are better equipped than us to deal with some of these mental health disorders, however this shows that we can play a role in reducing the incidence of these mental health issues throughout our rehab programming. 

These ideas may also be important to consider in relation to injury prevention also. It has been found that questionnaires related to stress and sleep quality could help predict future injury in elite sportspeople (Laux et al, 2015). Again, as physiotherapists and strength and conditioning staff often have first contact with these players, and may have access to these screening questionnaires, it is important to consider the role that mental health stressors play on injury and be able to investigate further if required. 

Hopefully this can all act as a reminder that when we are dealing with our athletes/patients, we are rehabilitating the person as a whole, not just the physical being. 

References:

Kubler-Ross, E. 1969. On Death and Dying. 

Gerber, M. Brand, S. Herrmann, C. Colledge, F. Holsboer-Trachsler, E. Puhse, U. Increased objectively assessed vigorous-intensity exercise is associated with reduced stress, increased mental health and good objective and subjective sleep in young adults. Physiology & Behaviour, 2014.

Putukian, M. The psychological response to injury in student athletes: a narrative review with a focus on mental health. British Journal of Sports Medicine, 2018. 

Laux, P. Krumm, B. Diers, M. Flor, H. Recovery–stress balance and injury risk in professional football players: a prospective study. Journal of Sports Sciences, 2015. 

“It’s just a rolled ankle”

We, as physiotherapists, hear this all the time; Ankle sprains are one of the most common injuries amongst the sporting and general populations.  Because of the common presentation and often quick resolution of symptoms, many people think of ankle sprains as a relatively minor injury.

However, ankle sprains can leave people with increased laxity of the ankle ligaments, pain, and instability of the joint.  In fact, up to 70% of people who sprain their ankles will do it again.

The good news is that rehabilitation programs have been shown to significantly reduce the recurrence of ankle sprains.

The term “ankle sprain” means that a ligament (or ligaments) in the ankle has been injured.  Ligaments are dense fibrous tissue that connects bone-to-bone providing strength and stability to the joint.  When the ligaments are injured, the stability and strength of the joint are compromised leaving the surrounding muscles to provide stability.

This is where physiotherapy and rehabilitation comes in. After a detailed assessment, your physio will provide you with advice for the management of your acute ankle injury, as well as a rehabilitation program aimed at restoring the stability of your ankle joint through strength, coordination, and proprioception training.

With the winter sport season well underway and ankle sprains being such a common injury on the sporting field, don’t leave this type of injury unattended.

To book an appointment, call 08 9335 7733

Written by: Keri Meyers, Physiotherapist

References:

 

Gribble PA, Bleakley CM, Caufield BM, Docherty CL, et al. 2016 consensus statement of the International Ankle Consortium: prevalence, impact and long-term consequences of lateral ankle sprains. Br J Sports Med 2016;50:1493–1495.

 

Brukner, P., Clarsen, B., Cook, J., Cools, A., Crossley, K., & Hutchinson, M. et al. Brukner & Khan's clinical sports medicine (1st ed.).

 

Using Your Time in Rehab To Improve Athletic Performance

Speaking to some of the sporting population I deal with on a regular basis, there biggest fear after an injury is the idea that they may not be able to ever reach the same level of performance once they return to their chosen sport.

 

The number one priority for physiotherapists are to return their clients to sport safely (see my previous blog“When Is It Safe To Return To Play”), however there are many injured athletes out there who cannot be bothered with the massive amount of effort a rehabilitation program takes, if they can’t return to their desired level of performance.

 

Speaking from personal experience and a long list of previous injuries related to playing Australian Rules football, I now feel as though I can’t run as fast, jump as high, or kick as long as I previously could.

 

Previous to becoming a physio and knowing what I do now, I was more worried about getting back on the park ASAP, rather than ensuring I was able to perform at the same level I could pre-injury.

 

Now, I understand the importance of not just rehabilitating the injury, but rehabilitating the athlete as a whole to help achieve their ultimate goal, to be the best player they can be.

 

For longer term injuries in particular, maintenance of strength, flexibility and power in regions away from the injured area are extremely important to ensure future injury risk is decreased and athletic performance is maintained.

 

For example, consider a young 18 year old footballer who has suffered a stress fracture in his foot. Quite possibly, the player could return to the football field after a period of complete rest from running allowing the fracture to heal.

 

However, if the player does not maintain their global lower limb strength, flexibility and power, as well as aerobic conditioning, they are much more likely to sustain another injury (not necessarily in the same region), and return to play with a lower level of performance.

 

This is where physio can play a massive role in ensuring all baseline objective values (strength etc.) are met at the very least, before returning to play. Unfortunately, unless you are working with an elite sporting team, you are unlikely to have these baseline values at your disposal, but you can always compare to the uninjured side!

And I believe a shift of thinking to returning the athlete to baseline athletic performance, rather than just treating the injury itself, can make the journey to return to sport a much more enjoyable one for all involved.

 

There is scientific evidence to support this idea also. An injury prevention program set up by soccer’s world governing body FIFA, called the “FIFA 11+ Injury Prevention program” not only helped to reduce future injury, but was also found to significantly improve balance, jumping and sprinting measures.

 

This is an example of how more athletic movement based exercises (not just exercises specific to a previous injury) can lead to better athletic performance, whilst also keeping the player out on the park for longer.

 

So rather than dreading your inevitable rehab once an injury occurs, try looking at it as an opportunity to work on your athletic weaknesses, and return the field stronger, fitter and faster than you ever have before.

 

 

Research Link:

https://www.ncbi.nlm.nih.gov/pubmed/28192831

Is Taping the way to go?

With the local winter sports season well and truly underway, we as physiotherapists often get asked the question, should I use tape?

The use of tape has been part of a physiotherapist's toolkit for a number of years. Throughout this time there have been a number of changes to the materials, techniques and even 'styles' involved in taping, and with elite athletes often wearing tape that is clearly visible to the weekend warrior's amongst us, the question of whether to use tape or not, has only increased.

So, should we be taping?

The question of whether to tape an area or not comes down to consideration of a few key principles.

Tape will not prevent an injury. This point is key. A lot of people expect that if they tape an injured or susceptible area, it will rid them of the risk of injury. This is not the case. Tape may reduce the severity of an injury, but does not eliminate the risk. So for example, a taped ankle can still sprain, but it may reduce the severity of the sprain. This is evident in elite sport. A lot of elite athletes, such as AFL footballers, will prophylactically tape. Meaning they tape a body part, ankles being a common example, despite never having a serious ankle injury. There are still ankle sprains in the AFL, so the tape doesn't stop injury. But the tape is there to attempt to reduce the severity of the injury and hopefully reduce the number of matches missed.

Another important point is that tape should never be substituted for a proper rehabilitation program. If you know you have a weakness in a certain area that makes you susceptible to an injury, taping is fine, but do yourself a favour and consider seeking the advice and guidance from a health care professional, to address the weakness.  An exercise program that helps reduce the risk of injury is often of benefit and can be used in conjunction with taping. But rarely do we recommend the use of tape in isolation.

This flows into the next question that we get asked. Will taping make my joint weak? My advice. Regular taping is fine, as long as there is the counterbalance of some other strength, balance or conditioning work. To understand this point further we need to understand what tape does.

Amongst other things, taping helps provide proprioception to a joint. What this means is that tape helps enhance the feedback loop that naturally occurs in our body. When we walk or run, the tissues within out lower limb give feedback to our brain on what they are doing. To take the ankle for example again, when we step on an uneven surface the tissues in our ankle send messages to the brain saying where they are. The brain then interprets the information and sends signals back down to muscles and tendons around the ankle, instructing what to do, so that we don't lose our balance. Tape gives more sensation around the ankle, so helps provide more feedback to the brain and can enhance our proprioception. If we were to tape our ankle all the time and didn't exercise it without tape on, the feedback loop can become reliant on the tape itself. We could then feel 'weak' in everyday activities.

This applies for taping of all joints and isn't ideal. So, if you do tape regularly for matches or training, it's best that you do something that works on the tissues around the joint, without tape on and help maintain the natural feedback loop within the body. This could be specific physiotherapy exercises or simply doing some sports specific training without tape on.

The last point to consider is tissue healing and the risk of re-injury. If you have had an injury to an area but by taping the joint, you feel you can return to play quicker, make sure you seek professional advice before simply doing so. It's important that you know the risks before stepping out onto the playing field and a health professional will be able to give you guidance on whether it's a good idea or not. There are some circumstances where a physiotherapists will allow a person to return to play, if taping allows them to function better, but this decision is made with careful, professional consideration to how well the tissue has healed and what the risk of further injury is. 

So should we tape? Of course! But make sure it's done in consideration of the principles mentioned above. Realise that it won't prevent an injury from occurring, you do need to do something else to help with your recovery or injury prevention and that seeking advice when you are unsure is probably the best thing to do.

Tape is a wonderful tool and there's a place for it in all levels of sport and recreation. Be sensible about when you use it and it certainly can be the way to go.

 

 

 

 

 

When Is It Safe To Return To Play?

 

After all the countless hours you’ve spent in the gym and on the track, the thirst to get back out there with your teammates or back into individual competition would be high. I’m sure you’ve wondered why your physio has held you back from getting that important tick of approval to return to play (RTP).

 

Well let me give you an insight into our decision making process when it gets to this stage of your rehab plan.

 

Firstly and possibly most importantly, we ensure that the injured area has healed appropriately based on standard healing times. For example, we know a broken bone usually takes around 6 weeks to heal, so RTP would definitely not be safe before this timeframe.

 

Next, we look at the body symmetry of important objective measures. Strength, flexibility and joint control are all important factors that should be as close to pre-injury baseline as possible. When a physio doesn’t have the information to your baseline measurements, they will often compare to your uninjured side to get a rough idea.

 

Thirdly, the physical requirements of your sport must match up to your current physical capacity. For example, AFL football requires components such as high speed and endurance running, agility, jumping and landing and power when being tackled or knocked off the ball. It is important that all components have been ticked off in training without any increase in symptoms and at pre-injury level prior to RTP.

 

Training load is also a very important part in returning to play with as little risk of future injury as possible. There has been a lot of scientific research published recently in relation to making sure training load is built up safely to reduce risk of future injury.  This is an important part in making the decision in RTP, in relation to whether the current training load compared to playing load is too high.

 

Finally, the psychological nature of RTP is also a very important consideration. If a player is not confident in returning to their chosen sport, they are likely to compete differently which can also put them at increased risk of injury.

 

Hopefully this overview can give you an idea of the aspects of your rehab plan you must tick off before helping you to achieve returning to your chosen sport at your best.

Rottnest Channel Swim

http://rottnestchannelswim.com.au/

http://rottnestchannelswim.com.au/

It's that time of the year again! One of Western Australia's most iconic events, the Rottnest Channel Swim brings together groups of people to either participate in this gruelling physical challenge or support friends and family who are doing the swim. 

Even if this 19.7km open water swim is not on your bucket list, swimming is a great sport. If you read our previous blog post you can find all the benefits of being in the water. However, swimmers can frequently present with shoulder problems- in elite swimmers the prevalence of pain can be as high as 91%. 

The repetitive nature of this sport can cause injuries and micro trauma to the shoulder joint which can hinder your performance and at times cause you to cease your training. There are things that physiotherapists can do to assist you getting back on track, including assessment of:

- your shoulder joint movement, strength and stability

- your shoulder blade movement

- your neck and upper back rotation 

- your hip mobility

- your core strength 

- your flexibility 

- your training regime

Come down and watch the swim if you can! The team at LifeCare Fremantle will be cheering on one of our physiotherapists, Chris Basile. 

If you have any questions do not hesitate to get in touch with us. Please contact us on 08 9335 7733 if you would like to book an appointment or find out more information. 

Summer is coming!

http://www.clipartkid.com/girl-swimming-cliparts/

http://www.clipartkid.com/girl-swimming-cliparts/

And what better way to refresh yourself than getting in the pool. Whether you are swimming, walking or performing hydrotherapy exercises, being in the pool can provide a variety of different benefits.

Exercising in the pool:

-       Allows for a low impact workout

-       Builds endurance but also works on strengthening

-       Helps you to maintain healthy lungs and heart

-       Provides a full body workout by using many different muscles- this will improve your performance with other exercises such as running and cycling

-       Relieves you of stress

-       Cools you down when the temperatures outside get too hot!

If you have any questions of how to improve your swimming technique or what hydrotherapy exercises you can perform in the pool get in touch with us. Please contact us on 08 9335 7733 if you would like to book an appointment or find out more information. 

Managing calf tears

Calf tears are a common injury in athletes but fortunately for us they respond well to treatment. A traumatic injury to the calf will usually occur when there is a sudden movement whereby the ankle is in dorsiflexion (bent up) and the body weight is placed on the limb, for example, during rapid lunging or running. People who have experienced a calf tear will describe a feeling of being hit on the back of the calf and this will lead to pain, swelling and sometimes the inability to walk. 

Management of calf tears will largely depend on each patient and will also be determined by the severity of the injury. Nevertheless, the following principles of treatment can be outlined as rough guidelines to the management of these:

  1. Relative rest. At this point it may be indicated to use ice and elevate the limb. If swelling is present you may find compression can help to reduce this. 
  2. Use aids to assist you if needed. If the injury is severe crutches can help you to mobilise. If placing the foot down is too sore you may find that a heel wedge helps your symptoms. 
  3. Exercise within your pain limits. Once you are ready to perform some exercises to maintain your strength and flexibility, make sure you are not in pain. 
  4. Progress the exercises as able, increasing the load through the limb as tolerated. 
  5. Once you are no longer in pain in your day to day activities, you may still need to rehabilitate certain aspects in order to return to sport. 

As per most injuries, have it looked at by your physiotherapist if you are in doubt. With calf pain it is important to clear serious conditions such as Deep Vein Thrombosis (DVT) as they can present similar to tears but can be life threatening. Please contact us on 08 9335 7733 if you would like to book an appointment or find out more information.

Headaches

Most people will have experienced a headache in their lifetime, but if you suffer with them on a regular basis you know how much of a nuisance they can be. With millions of people across Australia experiencing the same problem, you can be sure you are not alone and there are things out there you can do to try and relieve your symptoms.

What is causing my headache?

Headaches can be caused due to a variety of reasons, these being the most common:

Tension-type headache
Tension headaches are what we would call the normal “everyday” headaches and they are the most common type. They can last anywhere between thirty minutes to several days, and are usually resolved with painkillers. They can also be made better with keeping hydrated, changing your posture, stress management and a balanced diet. If you suffer these types of headaches regularly, talk to you physiotherapists about ways to help manage your symptoms.

Cervicogenic headache
These headaches originate from the neck or the soft tissues surrounding it, as identified by the Australian Physiotherapy Association (APA). They can be caused due to a variety of reasons including whiplash, muscle imbalances, stiffness of the spinal joints, poor sleeping positions or posture. Physiotherapy can help you with cervicogenic headaches.

Migraine headache
Migraines are usually far more severe in nature than a usual headache. When they come on they can last hours before they settle and are usually associated with increased sensitivity to light and sound. Although they can sometimes be managed with usual painkillers, the more severe types may require stronger prescribed medication.

Cluster headache
Cluster headaches are characterised by one sided excruciating pain and can often occur with variety of other symptoms such as runny or blocked nose and watering of the eye. It is a rare type of headache that occurs in clusters for a couple of months usually around the same time every year.  

What can I do if I have a headache?

If your headache is severe enough to stop you from carrying out your daily activities it may be a good idea to see your GP so they can identify the cause of these. Some headaches can be serious and you need to have them checked. 

Nevertheless, physiotherapy has been shown to help with patients suffering from headaches bought on by some of the reasons mentioned above. Several different techniques can be used such as

-joint mobilisations

-soft tissue release

-acupuncture/dry needling

-advice on how to improve you posture

-taping

-exercises to improve flexibility and strength

Please contact us on 08 9335 7733 if you would like to book an appointment or find out more information.

K-Tape and the Olympic Games

With the 2016 Rio Olympics right around the corner, it is likely we will be seeing a lot of athletes sporting brightly coloured strips of tape. Although Kinesiology Tape (K-tape) has been around for nearly 40 years, there has been a noticeable increase in the number of athletes using the tape in recent years. 

So what is K-Tape?

K-tape is an elastic sports tape that is characterised by its ability to stretch up to 140% and identifiable by the wide range of neon colours available.  K-tape was conceptualized by Dr Kenzo Kase in the 1970’s with the goal of relieving pain and promoting healing.  K-tape exploded in popularity after the 2008 Beijing Olympics where the tape was seen on athletes such as beach volleyball gold medallist Kerri Walsh Jennings. It is now widely used by professional teams such as the Socceroos, the Wallabies, and AFL clubs.

What is it used for?

K-Tape proposed benefits include:

·         Reduce pain

·         Decreased swelling

·         Improve posture

·         Expedite recovery of injured muscles

·         Aid performance

Does it work?

In terms of the research – the jury is still out. For every paper that supports the use of K-tape, there is another that finds no effect.

Physiotherapists strive to provide their patients with the best evidence based practice. This takes into consideration the research, clinical expertise and patient values and preference.

So while there is limited evidence supporting the use of K-tape, there are many clinicians and patients who have seen promising effects.

A few things to keep in mind

·         K-tape doesn’t replace the rest of your rehabilitation

·         K-tape is not suitable for all people or injuries

·         Athletes seen sporting this bright tape may be sponsored by the tape manufacturers

If you think you may benefit from K-tape or have any questions come into the clinic or call us on (08)9335 7733.

 

TherEx- the fun exercise class for over 65's

LifeCare Fremantle offers exercise classes on a weekly basis to clients who want to improve their mobility. 

Run by Sam O'neill, one of our great physiotherapists, the class includes a variety of cardiovascular, flexibility, strength and balance exercises. 

Please contact us on 08 9335 7733 to obtain more information.

Working on balance, flexibility and step up exercises

Working on balance, flexibility and step up exercises

Running Injuries

High injury rates in the running population is an unfortunate scenario that cannot be ignored. Whether you are an experienced runner or a novice, you may fall into the 70-80% of runners that experience some sort of niggle or pain during their training. What are the most common injuries and why do they happen?

Common running injuries

Running injuries will more frequently affect the lower limb (leg). This can vary between the hip, ankle and more frequently the knee. In people that have recently started running we may see injuries such as shin splints or medial tibial stress syndrome which causes pain at the front of your shin. Irritation near the knee cap (patello-femoral pain) is also very common.

For those that have been running for over a year, we may encounter problems that are more frequently associated with tendons- patellar tendon at the knee, achilles tendon near the heel or even iliotibial band syndrome down the side of the thigh.

Why are running injuries so common?

It is difficult to generalise this answer to every runner out there. Everyone is different and the cause of each individual injury will vary greatly. However, there are some common patterns that as physiotherapists we tend to come across.

Many runners do too much too soon- remember that when you run your lower limb joints are taking on three times your body weight! Gradually increase your mileage to avoid overuse injuries.

Have you recently changed your shoes? Or have you changed your running surface? All these can have an impact on your symptoms.

Finally, it is important to incorporate different exercise in your routine besides running itself. Try strengthening exercises as well as cross training (cycling, swimming, etc) and having at least two rest days per week.

Should I be running with pain?

It is normal to feel muscle soreness after exercising, but if the pain you feel is more intense and potentially injury related, it can be detrimental. Not only can it hinder your running performance but it can also cause more serious injuries elsewhere in the body. In these instances it may be advisable to seek health professional advice to assess your symptoms and treat as able. 

The old fashion cork

Recent injury to Brownlow favourite Nat Fyfe, has reminded me of the importance of managing an old fashion cork. It’s been widely reported that Fyfe received a knee to the quad in a controversial incident with Sam Mitchell when the Dockers played the reigning premier three weeks ago. Fyfe, soldiered on for two weeks before missing Freo’s most recent clash with GWS due to a documented groin injury. We can only speculate whether there is a relationship between the two injuries but nevertheless it’s reminds me of the common perception that, ‘it’s a corkie… it’ll be alright’.

Most people know that a cork is the result of direct contact to the muscle by an external force. Whether this is an errant elbow or knee or landing awkwardly on the ground, a lot of us can relate to that numbing moment when you’ve received a cork. As a result of the trauma, the muscle bleeds and a haematoma develops within the tissue. (For ease, I will refer to the haematoma as a cork for the rest of this blog.) Bruising develops, often within the hours and days following and the feeling of a very stiff muscle to touch is there for days and sometimes weeks.

I’m sure many of us have heard the stories of how corks used to be managed. Heck I’m sure there are many of you that as your reading this, are getting flashbacks to the time when you were on the bench, digging your fingernails into the rickety old physio table, as the trainer did their best to inflict as much pain as physically possible, lathering the decorub and stripping the muscle to within an inch of it’s life, attempting to rid you of the dreaded ‘corkie’. I’ve been told many a time in the past to ‘run it out’ and push through, but my more recent experiences with corks, have made me realise the management of these type of injuries has changed and for the better.

I’ve seen some horror stories. Players that have thought it would be best to self manage their cork, failing to report to me until they have already returned to the training track. I remember on one occasion a footballer reported feeling a strain after they went back to training too soon without consulting anyone first. Even after a strain was diagnosed they failed to follow instruction. A week later I was sending them for an ultrasound of their quad, which revealed a cavity a cool 22cm long. The cork had bled again after the strain, essentially splitting the muscle, leaving a long cavity full of fluid to collect. In the case of corks this is a train wreck and extremely rare. And although my aim is not to scare readers, it highlights the importance of at least getting it checked by a trainer or health care professional.

So how is a cork best managed? Should we be continuing to run? In some cases this is ok but in the interest of preventing further injury, always get an opinion first. In general, ice should be applied immediately and can be repeated every two hours, for 20 mins. How long you use ice for is still under conjecture, but using ice for 72 hours post injury is generally accepted. Compression can be applied but be sure to remove it overnight.  Elevate the leg when possible to help remove swelling and keep the area moving in the most pain free way. Avoid stretching the muscle until you’ve sought the advice of a trainer or physiotherapist and have a confirmed diagnosis. Avoid massage in the early stage as this will make the muscle bleed more and hold yourself back from heading out on the town and getting on the drink.

Returning to training or playing depends on many factors such as your strength and muscle length, so have these tested before getting back into it. If you come back too early, running around with a muscle that is not functioning properly, could predispose you to overload in other areas and muscles. Is this the case with Fyfe? Unfortunately we can’t say it is because we don’t have the inside word and the reality is he would have received the best standard of care, so there is every chance his groin injury is completely separate. But it has reminded me of times when it has been the case so again make sure the muscle is working well before returning to play.

As always, my advice would be to seek professional advice and treatment to make sure your dealing with a ‘cork’ and not something else such as an intermuscular haemotoma, which is a little different to a cork, whereby the bleed happens between the layers of muscles instead of within the muscle itself. Remember good management in the early stage will help prevent further injury.

 

 

 

Don't Be Scared of Needles

Have you ever wondered how people managed their aches and pains thousands of years ago, without the use of modern day medications and fancy physio modalities we so often take for granted?  Surely those Chinese Warriors must have done something right to get themselves up for battle back in the day?

 

It turns out that traditional acupuncture, used widely to treat these warriors for their sore bits, is coming back into fashion in the physiotherapy world some 2000 years later, and for good reason too.

 

Now slightly reformed, and termed “dry needling”, the use of solid, filament needles are used predominately to be inserted into muscle and the thin wrapping around it to try and release its “myofascial trigger point”. In simple terms, a myofascial trigger point can be thought of as a small contraction knot in a muscle. So whenever you are feeling a bit sore at the back of your neck, and feel as though your muscles are all knotted up when you reach back there, there is a high chance you may have developed a myofascial trigger point.

 

But before we get to how these little (often 30-50mm in length depending on the area involved)  needles can help, I am sure you are all wondering how these annoying trigger points can develop in the first place (if not, I’m going to tell you anyway!)

 

Even though there is still much controversy around how exactly these trigger points form and their true prescence, we understand that they can occur in a muscle for a multitude of reasons, including an acute muscular strain, a fall, a sprain or fracture, or excessive or unusual exercise. However, trigger points can also develop over a less acute period, and are often the result of chronic overload of a muscle due to poor sitting/standing posture, sleeping habits and repetitive work tasks. Stress can also be closely linked to the prescence of trigger points due to the person holding increased tension through their muscles throughout their whole body.

 

A myofascial trigger point can present as a localised hyperirritable spot of a muscle. It can also cause referred pain to another area of the body, and there seem to be common referral areas for trigger points found in certain muscles around the body. Compression of a myofascial trigger point can also elicit a localised twitch of a muscle. 

 

Now lets get down to business and talk about how we can get rid of these annoying things.

 

Dry needling is thought to work in a number of different ways. The first mechanism, can be thought of as fighting pain with pain. By inserting a sharp object such as a needle in to the body, this causes the brain to focus on this pain (transmitted to the brain by slightly different pain fibres) and blocks onward pain transmission of another type of pain fibres responsible for the dull ache often associated with myofascial trigger points. Evidence has also shown that by stimulating a trigger point, a chemical called cortisol increases in the body, which is a chemical which eventually leads to an anti-inflammatory and pain numbing effect in the body (acknowledgment to Acupuncture, Muscles and Pain course- Glenn Ruscoe).  

 

Physiotherapists are well placed to practice dry needling, as we are competent in assessing for the presence of myofascial trigger points and assessing why these trigger points may be present.

 

Even though I’m sure you all cant wait to get some needles put into you to alleviate all your aches and pains after reading this, it is important you take some responsibility for your pain to get the most optimal effect from dry needling. As effective as dry needling is, supported by medical studies done in the past (Effectiveness of dry needling on the lower trapezius in patients with mechanical neck pain: a randomized controlled trial., Pecos-Martin et. al is just one example), it is important the correction of posture, alleviation of stress and muscle stretching is all completed to ensure your pain does not come back!

 

So even though our understanding of pain and the way we treat it has come a long way since the days of ancient Chinese Medicine, it seems that some things don’t need to change.

The battle against concussion

It seems the more we learn about concussion, the more questions are raised. Should we be wearing helmets? Should we be playing contact sports? I often wonder what runs through the head of those that are on the frontline in regards to researching head injuries. Surely amongst them there has to be someone that loves to watch a cheeky game of football from time to time. Do they too fear that we will one-day lose contact sport to concussion?

In recent times there has been an increase in the amount of information available regarding the long-term effects of multiple concussions. Post-concussion syndrome has been identified as a possible long-term effect of a severe or concurrent head injury and comes with various undesirable symptoms. But could the way we handle a concussion also affect the likelihood of longer-term problems?

In our profession, we are passionate about handling injuries with the upmost care. For me, the way you manage a concussion is the most important. Remember, concussion is a brain injury, an injury to our most vital organ.

We saw on the weekend a sickening head-clash between two Sydney Swans. We saw one of them, Buddy Franklin, lose consciousness from a knock to his cheek. He’s out cold well before he hits the ground. You wouldn’t be silly to be surprised that the result was a concussion rather than a fractured cheekbone. But it’s what we don’t see, which explains why Buddy was left laying there the way he was.

Buddy’s brain, had rattled within his head, hitting his skull, most likely once at the front and once at the back, much like how a pin ball bounces quickly from a nearby barricade and then ricochets back to where it came. The brain suffers trauma and Buddy loses consciousness.

The way we manage someone like this is important. Obviously professional sports people have professional support, but in the general community we don’t necessarily have this on hand. So what should we do?

Anyone that loses consciousness, no matter how short a time that may be, should be removed from the ground and should not be allowed to return to play. This topic is well debated amongst those in professional sport and still to this day many players return later in the match. The AFL introduced the concussion rule a few years back to allow the highly trained staff extra time to assess a player thoroughly and ensure they were not at risk of returning to play. This is still being debated as best practice within media circles. But I think it’s safe to say that if people are still discussing it at the highest level with the highest professional support, we can say it’s best to keep people off the ground at community level.

Allow the player to rest. Just like when you tear a hamstring, that initial stage requires a level of relative rest to allow tissue healing. This means avoid vigorous exercise and anything that stimulates the mind. So put away the Suduko’s and cross words for a while and let the mind recover.

Avoid alcohol; it is a vasodilator of your blood vessels, which means it will increase your blood vessels diameter. When you suffer a concussion the body is already pumping blood to the brain to help with healing. This is normal and healthy. If you add alcohol to the equation, more blood will be pumped to the brain then is required for healing and it will ultimately impede recovery.

Importantly keep the patient safe and monitor their symptoms. Make sure they don’t drive, they have someone that can stay with them at home and look for signs that they maybe deteriorating. Any headache, dizziness, nausea or vomiting and vision impairments that are becoming gradually worse should all be taken as a sign to be checked out immediately. Remember if they fall asleep you can’t monitor this so don’t allow them to go to bed until around their usual bedtime. Don’t be cruel and keep them awake all night, remember the brain needs rest. And as always, the safest bet is to have them checked by a healthcare professional.

In regards to returning to play, most local competitions these days have imposed a policy of having a concussed player assessed by a GP and obtaining a medical clearance before returning to sport and I think this is a fantastic initiative.

Please treat brain injuries the right way. Hopefully the better we become at managing concussion, the more often a patient will completely recover, the fewer the incidence of long-term symptoms will occur and the less likely we will lose contact sport to concussion.