Health

Compare Private Health Insurance

Private Health compared for Osteo

At Infinity, one of the questions we frequently get is about private health insurance: Should we get it? How much cover should I get? Which one is best? 

When considering getting private health insurance there are many things that need to be considered on an individual level, for example: 

  • I’m already getting charged a medicare levy, how much does getting private health reduce this and is this cost worth it for me? 
  • What extras do I need (for example dental and optical) and how much do these cost? 
  • What is their customer service experience? What do their customer reviews look like?

 

When getting healthcare it is important to do your own research and find out which companies best suit your needs. Whilst we can’t definitively say which health care is best for you, we have done some research into which health care providers can provide the best coverage for osteopathic treatments. 

You can also visit the Government website: https://www.privatehealth.gov.au/dynamic/Search/

We’ve assessed in depth healthcare providers with regards to two aspects – most dollar based coverage, and best percentage back at Infinity. 

 

Best total dollar coverage:
  1. Health partners – Best extras: covers $1200 combined osteo, physio and chiro
  2. Latrobe Health Services – Premier: covers $1000 osteo
  3. HBF – Flex 60: covers $1000 combined osteo, dental, pharmaceuticals, physio, chiro and other health care
  4. ACA – Health benefits fund: covers $850 combined osteo, physio, chiro and other health care
  5. HBF – Flex 50: covers $800 combined osteo, dental, pharmaceuticals, physio, chiro and other health care
  6. HIF – Vital options: covers $800 combined osteo, dental, chiro, physio and ambulance 
  7. Defence Health – Premier Extras: covers $750 combined osteo and chiro 
  8. Bupa – Top Extras 90: covers $700 combined osteo and chiro, with $1400 per membership 
  9. Police Health – Rolling Extras: covers $700 combined osteo, chiro, acupuncture and complementary therapies, rolling over to a max of $1400
  10. Aus Unity – Advanced 80%: covers $500 combined osteo and chiro
  11. NIB – Top: covers $500 combined osteo and chiro 
  12. Medibank – Top Extras 90: covers $500 combined osteo and chiro
  13. AIA – Enhanced extras: covers $400 combined osteo and chiro 

 

Best percentage returned per appointment at Infinity:
  1. Aus Unity – Advanced 80%: covers 80%
  2. ACA – Health benefits fund: covers 80% 
  3. Police Health – Rolling Extras: covers 80%
  4. NIB – Top: covers 75%
  5. Medibank – Top Extras 90: covers $63.60 initial (~72%), $44 subsequent 
  6. AIA – Enhanced extras: covers 70%
  7. Defence Health – Premier Extras: covers $54 initial (~61%), $40 subsequent 
  8. HBF – Flex 60: covers 60%
  9. Health Partners – Best Extras: covers $50 initial (~56%), $40 subsequent 
  10. Bupa – Top Extras 90: covers $50 for the first 10 appointments (~56%), $35 for the following 10 
  11. Latrobe Health Services – Premier: covers $45 (~51%)
  12. HBF – Flex 50: covers 50%
  13. HIF – Vital options: covers 50% 

 

Overall winners:

  • Health partners 
    • Best extras: covers $1200 combined osteo, physio and chiro
    • Best Extras: covers $50 initial (~56%), $40 subsequent 
  • ACA
    • Health benefits fund: covers $850 combined osteo, physio, chiro and other health care
    • Health benefits fund: covers 80%
  • HBF 
    • Flex 60: 
      • covers $1000 combined osteo, dental, pharmaceuticals, physio, chiro
      • covers 60%
    • Flex 50: 
      • covers $800 combined osteo, dental, pharmaceuticals, physio, chiro
      • covers 50%
  • Latrobe Health Services 
    • Premier: covers $1000 osteo
    • Premier: covers $45 (~51%)
  • Bupa
    • Top Extras 90: covers $700 combined osteo and chiro, with $1400 per membership
    • Top Extras 90: covers $50 for the first 10 appointments (~56%), $35 for the following 10

 

I really hope your company is on that list, because they were head and shoulders above the others! It’s time to evaluate your health cover, there are tax benefits, but you also need to be aware if extras cover is worth it for you.

 

Worst coverage (the shame list!)

  1. Latrobe – Core Essentials: $200 combined osteo, physio and chiro, 34% cover
  2. HCF: $150-300 combined osteo, chiro, chinese medicine and other services, ~50% cover
  3. CUA: $300 combined osteo and chiro, 60% extras cover 
  4. GMHBA: $350 combined osteo and chiro, 75% cover 
  5. Frank: $400 combined osteo and chiro, 50-80% cover 

 

Disclaimer  
These rankings do not take into consideration the cost of each package and some may include other services such as dental, physio and other health services. As such, it is important to do your own research to find out which company will best suit you and your families needs. As a general rule, good coverage should have an annual limit towards or in the vicinity of $800. Lower coverages around $250 per annum are not as good and may fall short of your healthcare needs. 

*All information in this article correct at 1st July 2021

 

Exercise Health Injury

Pain in the…knee

Knee pain in the middle to late decades of life is a common complaint amongst patients presenting to osteopathic clinics across the globe. Osteoarthritis (OA) is a common cause of knee pain in this age group of people. Research suggests approximately 654 million people aged 40 years and over were living with knee OA in 2020 around the world. This comes at an incredible cost to healthcare services worldwide, with figures in the billions of dollars! 

 

What is osteoarthritis?

Osteoarthritis is just one of a number of forms of arthritis… Essentially a disease which affects the joints in our body. OA is the most common form of arthritis, with Rheumatoid Arthritis (RA) being the second most common form. This blog will focus on OA, a potentially debilitating disease that most commonly affects the weight-bearing joints of the body (i.e. the knees, hips and lumbar spine), but can affect any joint in the body where the joint surfaces are covered in cartilage.

The characteristics of OA include loss of the cartilage that covers the ends of bones that come together to form joints. The underlying and surrounding bone, as well as other joint structures (including joint capsules and other tissues) are also susceptible to degenerative changes that ultimately lead to poor functioning of a joint. The process usually occurs over a long period of time, often starting early in life (interestingly with little to no symptoms at all) and progressing into the latter years. The severity of the disease varies from person to person with some people only experiencing mild symptoms throughout their life. Other people experience more severe symptoms and may require joint replacement surgery as a last port of call to ensure they can continue to live their life as pain-free as possible.

Osteoarthritis of the knee can affect either of the two main joint components of the knee… The joint between the ends of the thigh bone and the shin-bone (called the tibiofemoral joint), and the joint between the thigh-bone and the knee-cap (called the patella-femoral joint).

 

Risk factors

There are certain factors associated with higher rates of knee OA. These include:

  • Age: Rates of knee OA increase in the elderly
  • Gender: Females slightly out-do the males with this one, being approximately 1.5 times more likely to develop OA
  • Trauma: A trauma to the knee can increase your likelihood of developing knee OA
  • Obesity: Rates of knee OA increase with higher levels of obesity
  • Smoking: Smoking is associated with higher rates of knee OA

 

Signs and symptoms

The signs and symptoms of knee OA include:

  • Pain
  • Stiffness
  • Swelling
  • Reduced range of motion
  • Difficulty performing functional movements including squatting and kneeling

Pain associated with tibiofemoral OA commonly affects the inside region of the knee first, where the two bones meet at the joint line. Patella-femoral related pain is often felt deep behind the kneecap. Pain will vary from one person to another, and the severity of pain does not necessarily relate to the severity of degeneration. Although if you speak to a person who is about to have a joint replacement surgery (i.e. their joint has degenerated to the point of needing a surgical intervention to keep the person functioning well), they will likely tell you that the pain is extremely debilitating.

Pain and stiffness are regularly felt first thing in the morning and late at night. OA tends to respond well to movement of the joints, and so people often find their pain and stiffness improves once they are up and moving, for it to return once their day has finished and they are relaxing at night.

 

Treatment

So, you’ve been diagnosed with knee OA. What to do? Call your osteo… Ta-dah!!!! Given we love teaching you how the human body moves (we study human biomechanics at uni), we’re good at picking up how the body should and shouldn’t move. There are no magic pills for treating OA of the knee, and no practitioner can claim to treat the disease itself, as there is unfortunately no cure for OA. It is a progressive, degenerative disease, but there are ways of stunting the progression of this condition if the risk factors leading to its presence are attacked head on.

Poor movement resulting from daily postural repetitive strain, or an old injury that wasn’t resolved are major factors in the maintenance and development of OA in the knee. Poor movement or dysfunction occurring in the low back, hip or ankle can all lead to excessive load being placed through the knee joints, which can exacerbate the disease process. This is where we come in.

We can assess how you move and work out what is causing the excessive loads through the knee and then develop a plan to improve range of motion and flexibility, strengthen muscles and return you to (hopefully) pain-free daily activities. We will use a combination of education, soft tissue manipulation, joint mobilisation and progressive exercise programs to restore life to your body. Returning to efficient movement patterns after years of neglect, poor movement and a deconditioned body part will take time, but with determination from both you and your practitioner, it can happen.

As previously mentioned, some cases of knee OA can end up requiring surgical intervention to replace either part of or the whole joint. The good news is, if you do have to go through this process, we have your back (well… in this case, your knee) and can help you through rehab and recovery. Many people who have a knee replacement return to full daily activities and live a long and pain-free life.

Knee pain? What are you waiting for? Call us today on 9846 2800 to book your appointment.
Health

Eat. Rest. Digest. Repeat.

Eat. Rest. Digest. Repeat.

Have you ever wondered about the inner workings of your body? We regularly talk about muscles, bones and joints, but this month we switched focus to our digestive system. Without this system working properly, the rest of the body can really struggle… which is why us osteos like to keep a close eye on it.

Often people will mention they are taking supplements, or ‘low in iron’, ‘Vitamin D deficiency’ – but there are more important habits to sort out first.

 

What is the digestive system and what does it do? 

The digestive system is the system that is responsible for breaking down all of the food and drink we consume into useful stuff for the body to use. It is essentially one long tube which starts at the mouth and ends at the back passage. In-between, the tube is divided into different sections, all of which have their own job in the process of food breakdown. On the journey from mouth to back passage, the tube is joined by a few assistants (called organs), which feed the tube with juices that help to mulch up the food.

The tube (or ‘gut’) is broken down into the following sections:

  • Mouth: Food goes in, we chew, and the process of digestion begins with the mixture of food and saliva.
  • Oesophagus (aka ‘food-pipe’): This is the connecting tube between the mouth and stomach. The food-pipe is able to push food towards the stomach using muscles in the wall of the tube. Interesting fact… We do not voluntarily control this movement, and we also cannot feel it happening!
  • Stomach: An expanded section of the tube where the food is stored for a short while. Muscles of the stomach contract to mix the food with digestive juices and turn the solid food into a liquid.
  • Small intestine: Juices from our liver / gallbladder and pancreas enter the tube at the beginning of the small intestine to mix and breakdown the food from the stomach to make it suitable for the body to begin to absorb. Absorption of many nutrients (including broken down carbs, proteins and fats) happens in the small intestine.
  • Large intestine: This section is responsible for removing any remaining water from the food and putting it into the bloodstream, as well as forming the stool we eventually pass through our back passage. What we pass is the left-over material the body has no use for.
  • Anus: The final part of the digestive system. We all know what happens here.

In a nutshell, it’s a long and winding road from food in, to stool out. The digestive system breaks down the food we eat, absorbs all of the good stuff and leaves all of the unwanted stuff for us to get rid of.

 

You’re asking me questions about the food I eat… all I want is help with my low back pain!

You might be thinking to yourself, why is my osteo so interested in what food I eat when I have come asking for help with pain?! It’s a fair question, and you wouldn’t be the only person to ask it. The old phrase, “you get out what you put in” is very relevant when it comes to the body. And it’s pretty simple when it’s broken down (excuse the pun!) in front of you. Our bodies require a wide range of nutrients in order to function, repair and grow. For example, we need to be able to break down carbohydrates in pasta to provide the body with glucose to use as energy, so our muscles can contract and move us around.

If we don’t feed the body with the right amount and quality of nutrients it needs, then the body can start to feel sluggish, disease can take hold, and you might not feel like you can do simple things like run or jump as easily as you used to. Our point is, your body is only as healthy as the food and drink you consume. Many of the sugary and nutrient-poor foods modern day society consumes can even lead to higher levels of inflammation in the body which can play a major role in how someone experiences pain.

This is why we are so interested in what you eat each day. Yes, as osteopaths we primarily treat the musculoskeletal system using hands-on techniques, but always remember the body is a whole. It is a maze of interlocking systems. If one system falters, it can affect the whole body until balance is restored. Dietary changes and treatment of the digestive system can have a huge impact on a person’s pain. So, the next time you are wondering why we go so deep into our questioning, this is the reason why.

 

Ways you can help your digestive system

If you want to get the most out of your guts, follow some of these simple rules:

  • Drink plenty of fresh water every day: We need constant replenishment of water because the body cannot produce it on its own.
  • Eat a diet high in fibre: Your gut will love you. Diets poor in fibre result in digestive dysfunction including constipation.
  • Keep your diet varied and full of fresh vegetables and fruits: This will help to cover you for fibre intake, as well as provide the body with important energy, vitamins and minerals.
  • Give the system a rest every now and then: Our digestive system is constantly on the go. Be kind to it by not over-eating and bingeing regularly.

If you have any questions on how you can make your digestive system work better for you, speak to your osteopath during your next appointment. Don’t yet have a next appointment? Calls us today on 03 9846 2800

 

References
  1. Chila, AG. et al. 2011. Foundations of Osteopathic Medicine. 3rd ed. Lippincott, Williams & Wilkins: Philadelphia
  2. National Institute of Diabetes and Digestive and Kidney Diseases. 2017. Your Digestive System & How it Works. [Online]. Available from: https://www.niddk.nih.gov/health-information/digestive-diseases/digestive-system-how-it-works. [Accessed 08 May 2021]
Health

Vertigo: symptoms and treatment

This month we are switching focus to the head, and specifically a condition which causes a person to feel dizzy. We welcome you to the world of Benign Paroxysmal Positional Vertigo (BPPV). In simple terms, a non-serious sudden attack of dizziness brought on by a change in head position.

 

What is vertigo?

Vertigo is a type of dizziness where a person experiences the sensation of whirling, spinning or swaying. A person will usually feel that they, or objects around them are moving when they are not. There are several causes of vertigo, with the most common cause being BPPV. Other common causes include Ménière’s disease (vertigo with hearing loss and ringing in the ears) and labyrinthitis (inflammation of the inner ear).

The ear is made up of an outer, middle and inner section. The outer ear is the ear that we see on the head and the opening that leads into the head itself. This connects to the middle ear — a small area inside the head which houses the ear bones, connects to the inner mouth and also the inner ear. The inner ear is the section which houses our hearing and balance organs — the cochlea and the vestibular system. It is this inner section which is involved with BPPV.

 

What causes BPPV?

The structure of the inner ear is quite complicated. It is a maze of hollow chambers and canals all connected together and filled with fluid. There are three semi-circular canals which are expertly positioned to detect movement in the 3 planes that our head can move (nodding up and down, tilting left and right, and looking left and right). Inside the chambers live tiny crystals which, when movement of the head occurs, move and send important information to the brain about what type of movement is occurring. Sometimes these crystals become detached from the chamber and move into the canals where they can play havoc.

Basically, the crystals move through the fluid which stimulates nerve endings in the canal. The nerves then send a message to the brain which the brain perceives as movement, even though the head isn’t actually moving. Because this information doesn’t match with what the eyes are seeing and the ears are detecting, we experience vertigo. It is one big mismatch of information which is tricking the brain, and can make it think you have been poisoned. And the effect is quite unpleasant!

An attack of BPPV can be brought on by a quick change in head position relating to gravity, when rolling over in bed, sitting up from lying down, or when looking up to the sky. A recent head injury or degeneration of the inner ear system can precede episodes of BPPV.

 

Signs and symptoms

As discussed, the main symptoms include a sensation of spinning or swaying. People may also experience feelings of light-headedness, imbalance and nausea. Attacks will usually only last a period of a few minutes and may come and go. It is not unusual for a person to have a period of symptoms followed by a period of no symptoms for months at a time. If symptoms persist for longer than a few minutes at a time, then it is likely the vertigo is from a different cause.

Some conditions that cause vertigo can also give symptoms of headache, hearing loss, numbness, pins and needles, difficulty speaking, and difficulty coordinating movements. Episodes of vertigo may also be much longer or constant. If you experience any of these symptoms they should be reported immediately as they could be signs of more serious issues, which will need to be investigated. 

 

Can it be treated?

BPPV is very treatable. Many people with dizziness end up seeing their GP first, but it is common for a GP to refer these cases to us here at Infinity for assessment and management. After a thorough session of questioning and assessment, if we are happy with our diagnosis of BPPV, then we can get to work right away. Unfortunately that assessment may involve a Dix-Hallpike’s test which aggravates the symptoms, but we are careful with explanation and consent is crucial!

BPPV can affect any of the semi-circular canals mentioned above. For treatment, we need to first bring on the symptoms. It sounds sadistic, but it is necessary to ensure we resolve the symptoms for you. Treatment for BPPV consists of a series of head and body movements where you start seated, move into a lying down position and end sitting upright again. This series of movements is known as the Epley Manoeuvre and is used to treat the most common form of BPPV. If the source of the problem is coming from a different canal, then the treatment will be slightly different.

We then send you away with some general do’s and don’ts. You may have to keep your head relatively still for the rest of the day (sorry, heavy exercise is not recommended at this stage) and to try not to let your head fight with gravity after treatment. We will then organise for you to come back in within a few days to reassess and if necessary continue with another treatment.

 

Final comments…

Interestingly, we often get patients come in who think they have vertigo, but in fact, it’s other structural issues contributing to their dizziness (which we diagnose and treat). That’s why it’s so important that we have a thorough consultation, to ensure we develop the right treatment plan for you. If you think you are experiencing vertigo, please come in and speak to us. Osteopaths are highly trained medical practitioners who can help treat more than you think.

Health

How to incorporate mindfulness into your daily life

What is mindfulness?

Mindfulness is simply paying focused attention to the present moment in a curious and nonjudgmental way. The need for an empty mind during meditation is a common misconception and often leads to a feeling of failure, causing people to give up. The great thing about mindfulness is that you can’t really fail! When your mind starts wandering off again, you can always bring it back to the present moment, observe your own thoughts, feelings and sensations.

How does mindfulness work?

Some experts believe that mindfulness works by helping people to accept their experiences-including painful emotions, rather than avoiding them.

What are the benefits of mindfulness?

  • Reduces stress
  • Decreases anxiety
  • Improves memory
  • Reduces overthinking
  • Experience fewer depressive symptoms
  • Increase in focus and attention
  • Decreases emotional reactivity
  • Can help with chronic pain

Simple mindfulness techniques:

  1. Basic mindfulness meditation – Sit quietly and focus on your breathing. Allow thoughts to come and go without judgment and return to your focus on breath.
  2. Body sensations – Notice body sensations such as warmth or tingling without judgment and let them pass. Notice each part of your body from head to toe.
  3. Sensory – Notice sights, sounds, smells, tastes, and touches without judgment and let them go.
  4. Emotions – Practice naming emotions: “joy,” “anger,” “sadness.” Accept the presence of the emotions without judgment and let them go.
  5. You can choose any daily task or moment to practice mindfulness, such as eating, showering, walking, or relaxing.

 

Exercise Health Injury

Cycling pain or problems?

Don’t stop riding, but find a way to do it well and stay comfortable. You often hear how good cycling is for you, but you needn’t endure unnecessary pain or discomfort in your joints whilst doing it! 

What falls into this category?

  • Thoracic outlet syndrome
  • Neck/lumbar facet sprains
  • Headaches
  • Muscle strains
  • Shoulder, knee or hip injury
  • Bursitis 
  • Fractures (from falls)
  • Elbow or wrist sprain or injuries

What are the symptoms?

  • Tingling in arms
  • Pain or stiffness
  • Aching in lower back or hips
  • Catching or pinching sensation

When should I get treatment? 

If you are experiencing persistent or worsening pains for over a few weeks. It’s best to seek help earlier rather than later to avoid potentially making things harder for yourself in the long run! Even more so, it usually means less layoff time and we will try to avoid getting you off the bike as much as possible!

What treatments help?

It actually heavily depends on your issue for this, but it’s worth asking the question. Typically we’ll aim to reduce the load for your problem, and strengthen it to prevent it being an ongoing issue, but it may include some of the following:

  • Manual therapy (eg. massage, stretching etc)
  • Exercise prescription (better endurance, power or generalised core stability)
  • Plyometrics use for serious riders
  • Postural management
  • Bike setup for less strain through neck and shoulders
  • Stretches (for hip, hammy and Low back flexibility)
  • Yoga can be very beneficial too!

Book online to improve your performance or feel better

Reference: https://pubmed.ncbi.nlm.nih.gov/2011683/

Health

Injury blog: Shoulder impingement

Suffering from shoulder pain?

As osteopaths, shoulder pain is up there as one of the most common complaints we treat. Office workers, gym goers and overhead sports people such as basketballers and netballers are all regular victims of shoulder pain. Subcranial, or shoulder impingement is a common complaint we see. Say ‘shoulder’ and most people think of a ball and socket joint. This does indeed make up a large part of the shoulder, but there is much more to it than that. Above the ball and socket joint sits a bony ‘bridge’ which is made up of the collar bone. The shoulder blade (specifically the ‘acromion’ part of the shoulder blade). And finally a joint which connects the two (aptly named the ‘acromio-clavicular’ joint). Beneath the bridge and above the ball and socket joint is a small gap called the sub-acromial space (sub= underneath). It is within this space that impingement occurs and causes pain when moving the arm.

Why does impingement occur?
Well, there are quite a few soft tissues which run through this space that help keep the shoulder functioning. These parts include the tendons of the biceps and one of the rotator cuff muscles (a ligament and a fluid-filled sac called a ‘bursa’). Bursi allow smooth, frictionless movement around joints and can be found all over the body. Any of these body parts can be involved in shoulder impingement if they become inflamed. Repeated overhead arm use in throwing sports, or chronic poor positioning of the shoulder in desk workers can lead to these soft tissues becoming irritated and inflamed. For example, a cricketer who spends a large part of their career throwing a ball could experience increased stress placed on the rotator cuff tendon that passes through the space, leading to inflammation, wear and tear, and poor movement. This then has a direct effect on other surrounding structures, potentially causing an inflamed bursa too.
Signs and symptoms
When someone has shoulder impingement, they may experience any or all of the following:
– Pain when moving the arm
– Decreased range of motion in the shoulder
– Weakness when using the arm
– Reduced ability to perform everyday tasks such as reaching up high in a cupboard, doing up a bra, putting on a coat or holding/lifting a child
Get to the osteo!
If you want to get on top of your shoulder pain quickly, then we recommend a trip to see us here at Infinity. During a thorough assessment we will work out what lifestyle or movement factors are responsible for your pain. Using a combination of soft tissue massage, joint mobilising, and many other techniques, will help reduce your pain and get you moving. Those with shoulder problems often have issues related to neck or back movement, so don’t be surprised if we look further than the shoulder for answers to your problem. If you are a thrower, we may ask you to demonstrate a throw so we can see how you are moving (don’t worry, we won’t ask you to do this if you are in acute pain). Likewise, if you are a desk worker, we may ask to look at your desk set up and sitting posture. Getting you to take a photo of yourself at your desk is often helpful for us to see if you need to make postural changes. When it comes to lifestyle advice, whether it’s the hobbies you have or the way you sleep, we’ve got you covered!We pride ourselves on awesome treatment, but shoulders are often tricky to treat, and some cases may take longer than others. To ensure you get back on the right path as quickly as possible, always follow our advice between treatments, and please do your exercises! Weakness and instability (a possible cause of shoulder impingement) need strengthening, and strength takes time to build. Consistency is key with exercise. We will educate you on what you need to do, but you need to be the one to do it at the end of the day. It’s a team effort. We know it’s hard to keep motivated, but rest assured we will always be there on those days when you need a hand!

If you want to give pain the cold shoulder, book an appointment today at infinityosteo.com.au.

Clippings Health Injury

Let’s talk about TMJ dysfunction

The summer of 2021 is here and with that is often an  influx of social gatherings, work Christmas parties and family get-togethers coming your way. What do we do at these gatherings? We talk, eat, drink…! Therefore, it’s very important that you have a good functioning jaw right?! Do you get jaw pain or clicking? Do you also suffer from headaches or neck pain? This month we’re focusing on our jaw joints – what we use them for, how these joints can cause issues and what we can do to help.

A bit of anatomy…

The jawbone (or mandible) is the bone which hangs from your skull, creating the lower part of your head. It houses the lower teeth and attaches to either side of the head just in front of the ears. Put your fingers just in front your ears in line with the ear holes, gently open and close your mouth and you will be able to feel movement at these joints.

These joints are called the temporo-mandibular joints, or TMJ. Movement at these joints occur when we open and close our mouth during activities such as eating and talking. As well as opening and closing our jaw, we can move it side to side and forwards and backwards.

Movements of the jaw, such as chewing, are controlled by various muscles. Three main muscles close our mouth, and one main muscle aids with opening it. This makes sense when you think about the effect of gravity on the body- we need a bit more help to close our mouth and bite into our food than we do to open it and let it hang.

Problems with the TMJ

A common jaw condition Osteos treat is TMJ dysfunction, which affects women twice as much as men. Problems can arise from many structures in and around the joint, including the muscles, joint surfaces and a small disc which sits inside. Muscle imbalances are common and can lead to stiffness or pain (or both) when opening and closing our mouth.

Tightness in the surrounding muscles could be a result of trauma to the jaw (like with being punched or hitting your chin during a fall), clenching when sleeping (known as ‘Bruxism’), a neck dysfunction/restriction, or from dental problems such as having an uneven bite. People who are highly stressed will often clench their jaw in their sleep, which may lead to waking up with a sore jaw or headaches.

The small disc inside the TMJ slides and moves during jaw movements. Sometimes this disc can become ‘displaced’ and may not slide and move as smoothly as it should. This can often lead to a jaw that clicks or cracks when opening the mouth. For the most part, the click is painless, however some people may experience pain alongside a click. In some severe cases the jaw may temporarily lock, which as you can imagine would be quite distressing. Pain from the jaw joints can sometimes present as ear pain.

 

Osteopathic treatment for TMJ dysfunction

Treatment for TMJ dysfunction will depend on the cause of the dysfunction. A simple muscle imbalance may be corrected by soft tissue release of the jaw muscles, joint mobilisation, and corrective mobility and strengthening exercises. It is rarely that simple though. More often than not, a TMJ dysfunction will come hand in hand with a problem in the neck and shoulders, be it restriction of movement or poor stability and strength in the region.

An osteopathic approach to treating TMJ dysfunction will include a thorough assessment of the head, jaw, neck, shoulders and mid-back. Because of the proximity of the jaw and neck, you rarely get dysfunction in one without the other. Your osteo will ask you about your occupation, sleeping habits, hobbies, and current stress levels – all of which may be playing a part in your condition. If your osteo believes your TMJ issues stem from a dental issue, they may advise a visit to the dentist (Templestowe Dental Group) for a check-up as sometimes problems can be resolved with input from both professions. If clenching is an issue, you may find it useful to wear a gum shield or mouth guard to bed to alleviate pressure on the jaw and teeth.

We appreciate it’s not the best look in the world, but it can be a game changer! Stress management including breathing exercises, relaxation and mindfulness techniques can also be a great way to handle that stress in your life. Don’t worry, your osteo will have some tricks and tips up their sleeves for this too. Always let them know if you feel like you need help with this aspect of your life.

If you think you might have a jaw problem, don’t keep it tight-lipped. We’ll have you ready for copious amounts of food, drink (we say copious, but we mean in moderation, of course) and chin-wagging in the upcoming festive season. We hope you have a jaw-lly good Christmas!

Look after yourselves,

Evan

Health

The Lymphatic System

What is the lymphatic system?

One part of it is a collection of small tubes found right throughout the body, and you can think of these tubes as part of the circulatory system of the body. Say ‘circulatory’ and everyone thinks of blood, arteries and veins, but the buck doesn’t stop there. The lymphatic tubes are well and truly just as important as the tubes that carry blood around the body. The other part of the lymphatic system is a collection of larger tissues found in various areas of the body and you can think of these as part of the body’s defence system. So straight away, you can see it’s pretty important!

Let us take a look at these areas in a little more detail… A little recap for you on circulation…Arteries take blood from the heart to the body, and veins take blood from the body back to the heart. Where does the lymphatic system fit in to all of this? Well, the tubes (or vessels) of the lymphatic system roughly follow the pathway of the veins in the body (so back towards the heart). The pump of the heart creates pressure, which drives blood through the arteries where it gets distributed to all of the different tissues of the body (i.e. our skin, muscles, bones and organs). However, the pressure from the arteries causes some of the fluid and nutrients in blood to leak out into the surrounding areas. This is where the lymphatic tubes kick in. They pick up the excess fluid and nutrients (mainly proteins) and send it all back towards the heart to be re-used by the body. This ensures every valuable bit of fluid and nutrition in the body is not wasted. Very efficient right?! The fluid that travels through lymph vessels is simply called ‘lymph’.

The lymph is transported through the lymph vessels by a combination of muscle contractions in the vessel walls, and us moving our bodies (another reason why moving is so good for you!). Along the way back up to the heart, the fluid is passed through a filtering station called a lymph node. Here, any of the bacteria, viruses, or even cancer cells that are in the lymph are dealt with swiftly by our immune cells. The freshly cleaned lymph is then sent further along the chain until it reaches a vein close to the heart. Here, the lymph re-enters the blood and the cycle continues.

Before we forget, in the small intestines there are some very specialised lymph vessels which help the body to absorb fats from the foods we eat. This is another important function of the lymphatic system!

Defence, defence, defence!

On the defensive front, there are various tissues located around the body (called lymphoid tissues) where the production of the defence cells of our immune system occurs. The main tissues include the ‘thymus’ – which is found in the upper chest region, and the ‘spleen’ – found in the abdomen. If it wasn’t for these handy organs, we would be much more susceptible to infection and disease. We have a lot to be thankful for with the lymphatic system!

How to book an appointment

To book with one of our practitioners: For pure lymphatic drainage, I would suggest calling 03 9846 2800 and booking with Margit. If you’re not sure you can book with Margit or you might like to book with any practitioner that suits you so we can determine what will best help the flow of your lymphatic, and circulatory systems. To do this you can also call 03 9846 2800, or you can book online

We love lymphatic systems

So why are we so interested in this system? Well, at the heart of Osteopathy lies the principle of maintaining fluid balance throughout the body – we’re all about keeping the flow going. But sometimes, the flow of fluid in the body can become compromised, perhaps due to injury or disease. Congestion in the tissues then occurs and things start to stagnate. This can lead to a whole host of issues including reduction in mobility, pain, and imbalance throughout the body. A dysfunctional lymphatic system can lead to a type of swelling called lymphedema, which is essentially a backlog of lymph fluid. This often occurs in the hands, arms, feet and legs. Depending on the cause, this is something your trusty Osteo is skilled at dealing with, so always seek help if you notice swelling. Regardless of your issue, our treatment will aim to restore the flow of fluid through the body.

We hope this has been interesting and educational, and that you now have a newfound respect for the intricacies of the human body and the importance of looking after those bodies! Here’s to health!!

Clippings Exercise Health Injury Pregnancy

Lumbar Disc Injury

Lumbar disc prolapse: Symptoms and treatment

It’s moving day and you’ve been running around packing, unpacking and lifting boxes and awkward furniture all day. You can’t stop though, because there’s still more to do. It’s onwards and upwards with another load in the back of the ute. You bend down to pick up the umpteenth box of the day and bang! You’re hit with excruciating low back pain and a shooting pain down the back of your leg. It’s crippling and you’re struggling to catch your breath and stand up straight. It’s a scenario that a lot of us are familiar with, unfortunately, but what has caused this searing pain? One possible and relatively common cause for such pain is a lumbar disc prolapse. Sit back with a coffee and let us take you through the ins and outs.

What is a disc and what just happened when I bent down?

Your spine is made up of many vertebrae spanning from the neck all the way down to the tailbone. Between each vertebra sits an elastic-like structure called a disc. The disc is made up of a tough outer section called the ‘annulus fibrosus’ and a gel-like inner section called the ‘nucleus pulposus’. The discs separate the vertebrae to allow movement, and during movement they provide shock absorption to forces acting on the spine.

Common causes of disc prolapse include trauma, degeneration of the disc tissue as a result of poor posture (for example, lots of slouching or slumping) and repetitive bending movements. When we bend forward, particularly under load (like with our house mover above who had been repetitively picking up and putting down heavy boxes), the forces acting on the discs (especially the inner nucleus) increase drastically. Over time these repetitive movements may cause small micro-tears in the layers of the outer annulus, which weakens the overall structure of the disc. Slowly, the nucleus gets forced out and a small bulge may occur (there is often no pain at all at this stage). If these movements continue, or if you go to pick up that box which is just too heavy for you, the force is too much and the bulge can progress to a larger protrusion.

As with any injury, the initial response of the body is inflammation. The presence of inflammatory chemicals alone can cause irritation to the surrounding nerve tissue as it exits the spine, or you may get actual contact of the disc on the nerve itself, causing impingement. This process can be quite painful and you should be seeking medical advice if you feel pain.

 

‘What should I expect to feel when this happens?

The signs and symptoms of a disc prolapse can vary greatly depending on the type and severity of the prolapse and where the spine is affected. A prolapse may happen slightly out to one side of the disc, affecting only the nerves on that side of the body (this is most common). Or it may occur in a backwards direction, potentially affecting nerves on both sides of the body. A small bulge may only yield mild symptoms, whereas a large prolapse may cause more severe symptoms. However, this is not always the case.

 

Some of the symptoms you may experience include:

  • Low back pain
  • Pain running down the front, side or back of the leg
  • Pins and needles or tingling down the leg
  • Numbness down the leg
  • Muscle weakness (this may manifest as losing the ability to lift your foot)

The most common disc prolapse affects the L5/S1 disc (the lowest disc in the spine) and will give symptoms down the side and back of the leg. Your practitioner will ask you lots of questions and do a number of tests to determine exactly which area is being affected.

 

How do we treat disc prolapses?

Initially, you may be in a lot of pain and simple movements such as standing up straight can be very difficult to perform. This is because the body is trying to protect you from doing further damage. Once inflammation occurs, the body needs a few days to deal with what has happened. So, if you come to see your Osteo straight away, don’t expect to feel better after one visit. In fact, it is quite possible you will feel worse in the coming days before you start to feel better. The advantage of seeing your Osteo early is that they can educate you on the do’s and don’ts, tell you what to look out for and inform you of what to expect going forward. The unknown is often scary, but your Osteo will be able to ease your mind, even if not the pain immediately.

Early on, we’ll get you moving better. We will also give you breathing, relaxation and core activation exercises to help the body cope better with the pain. A disc will often prolapse because of poor core stability, so getting you on the path to rehabilitating your core is very important. When it is possible, we will relax the tight muscles and reinstate movement to joints that may have seized up and become restricted following injury.

Our focus is to ensure the fluids of the body (i.e. blood, joint fluid, and lymphatic fluid) are moving freely around the body. When injury occurs, these fluids can become congested and a bit stuck around the area of injury, and sometimes need a little help to get moving again. This will ensure a speedier recovery. The injury site will need lots of fresh blood to the area, while the lymphatic system will need to be flushed- ridding the area of all the bad stuff. Depending on the severity, discs generally take around 3-6 months to fully recover.

Your Osteo is trained to help you through the injury process, so you can rest assured that you are in safe hands. We know when and how to treat, and know what to look for to ensure you are seen by the right people if it’s required (this might include your GP or a specialist if necessary). If you think you have a disc prolapse or have previously been diagnosed with one and need help managing it, then look no further. Call us today to book your appointment.

Health

Stiff and painful neck? Facet joint injury explained

Treating stiff and sore necks has to be up there as one of the most common things we do for patients on a day-to-day basis. There are numerous causes for neck pain, the most common being muscle strain, joint restriction, underlying degeneration and disc-related injuries. We regularly see injuries relating to the facet joints of the neck. Facet joints are the small joints between two vertebrae in the spine.

What are facet joints there for?

Depending on their position, they restrict and allow certain movements based on how the joint surfaces are orientated. In the neck, the joints are orientated in such a way that allows for relatively large amounts of movement, through forward and backward bending (flexion and extension), side-to-side bending (lateral flexion), and some twisting (rotation) too. If you move your head around, you will notice your neck is the most mobile part of your spine. This can mean it is at higher risk of injury.

How do these joints get injured?

It could be something as silly as a quick glance over the shoulder to check your blind spot in the car, or spending an extended period looking up like when having to paint a ceiling in a house. There are usually underlying movement issues that lead you to this point, such as joint restrictions higher up in the neck or in the mid-back. That quick glance over the shoulder could be enough to sprain it (some patients call it a “crick”), or the long period spent looking up could over-compress the joint surfaces and lead them to lock up. Mums who spend hours looking down at their bubbas can also put these joints under strain, ending up with a very stiff and painful neck.

Can an Osteopath help?

Of course! In addition to our manual, hands-on treatments, there are many ways we can help. When you come into Infinity, we will sit down with you and have an in-depth chat to get a real understanding of your lifestyle and the issue you’re currently experiencing. We’ll scan through the risk factors and help you understand how to minimise them so that you can try to prevent those pesky sore neck issues. We’ll look into your home and work life, hobbies and sports and even how you spend your time relaxing and sleeping. These are all areas that can play a part in your health.

Initially, we will focus our attention on relieving your pain. Our treatment will be hands on to massage the muscles, mobilise the joints, and possible use of manipulation to achieve optimal joint motion and muscle relaxation. We’ll then give you some exercises and lifestyle advice so you can leave knowing how to manage the problem at home and continue to improve further.

A locked facet joint will typically take a few days to calm down following injury. Once the initial inflammation reduces, the pain will begin to decrease, movement will start to improve and you should start to feel back to normal again. We want you pain free and moving better than ever!

Look after yourselves,

Evan

Health

How it all started

I have loved sports from a young age. Dad grew up playing tennis and rugby, and watching motorsports. It definitely rubbed off on me, but my passion for sport was a little different. While I really liked sport and wanted to be involved, I knew I wasn’t athletically good at anything in particular (I tried everything). Oddly, what I really liked was watching replays of people injuring themselves. What did they do? Why is that different from that other thing? It clicked. I was fascinated by the human body.

My earliest memory of replaying an injury over and over again is the video below. It’s Darren Cresswell from Sydney whacking his kneecap back in after it dislocated. I didn’t really know what was happening but looking back, I now realise that this was the awakening of my obsession with rehab. My own knee injury a number of years ago resulted in physio, myo and osteo treatment. Call it recon, but I wanted to experience the different treatments and experience all the different aspects of therapy.

While the human body has been extensively researched and studied, our knowledge is still evolving and prior recommendations are now being altered, flipped and rewritten. Now the fun bit is following the updates and following that passion that still rumbles inside. We’re forever learning, changing and adapting, and I’m loving every second of it!

Look after yourselves,

Evan

 

Warning: Graphic kneecap dislocation video

Health Injury

How To Simplify A Shoulder

The shoulder consists of many different structures (tendons, bursa, capsules, ligaments and more) and each of these structures create different sensations when problematic. This can make treating shoulder issues seem complex and confusing from a patient’s perspective. The number of tests, yet lack of specificity, sensitivity and in some instances, unreliability of MRI scans are create some significant problems with the shoulder. To simplify things for the patient, we ask a couple of straightforward questions.

Is it torn, stiff or irritable?

To question the quality of pain you can simplify it to three terms – torn, stiff and irritable. Once we get an idea of what kind of pain and where you are suffering, the job of a therapist is to change that. Reduce the pain, improve the motion and ensure it’s unlikely to happen again. The practitioner will need to seek out the pain causing structure and determine the best cause for reducing the load. This can be as simple as removing an activity or altering a strengthening exercise.

 

Is it strong enough to do what it needs to do?

This second question enables us to determine how much and where we need to build the strength of the shoulder, to enable it to do the tasks you want it to. Those tasks can be simple day to day things like hanging clothes and cleaning, or as difficult as overhead lifting for roofing.

Yes, there can be an issue with being too simplistic when considering a complex joint. However here in lies the failure of the current understanding where often diagnosis of “impingement” or “rotator cuff” and prescribing exercises for “scapular stabilisation” are not helpful enough and does not provide sufficient information. As mentioned above, they all are unreliable on testing and MRI. A lot of therapists can over complicate a very difficult joint, but the easier it is for you as a patient to understand the more effective you can be with your exercise. Which is a brilliant thing for getting you back playing tennis, carrying little ones or serving pizza!

Exercise Health Kids

You Need to Start Walking

Man has spent centuries on packaging the world into a neat space with a roof, lights, and climate control. Because of this, we tell ourselves that we are advanced, evolved beings.

But we’ve got it wrong.

The modern fitness world has spent billions of dollars developing machines (and advertising them to you) in order to keep you fit and healthy.

But they’ve got it wrong, too.

Walking is the single most beneficial thing you can do for yourself after going to bed earlier and eating better.

Consider the following:

  • twelve-year study by Hakim et al. found that men who walked less than a mile per day died at a rate double that of those who walked at least two miles per day.
  • 2015 study by Zhao et al. found that for men without critical diseases found that walking over two hours per day was significantly associated with lower all-cause mortality. For men with critical diseases, walking one to two hours per day showed a protective effect on mortality compared with walking less than half an hour per day.
  • ten-year study published in 2015 by Dwyer et al. showed that increasing your step count to 10,000 steps per day (for me this amounts to roughly 5km of walking plus my normal back and forth in the gym) lowered risk of death by 46%.

In addition, a nearly ten-year study by Williams and Thompson published in 2013 found some amazing things relating to walking:

  • People who walked slower than 24.19 minutes-per-mile (equivalent to covering 400m during a six-minute walk test) showed the highest risk of death from cardiovascular disease, heart failure, and dementia.
  • The risk of dementia increased 6.6% with every extra minute per mile. That is to say, the slower you walk the more likely you are to develop dementia. During their test, researchers found the slowest walkers had a nearly three times more likely chance of developing dementia than the fastest walkers.
  • A slower minute-per-mile pace led to a 2.4% greater chance of cardiovascular disease, a 2.8% increase in risk for ischemic heart disease, a 6.5% greater risk for heart disease, and a 6.2% increased risk for hypertensive heart disease.

The Link Between Walking and Vitamin D

If you’re not sold on walking yet there’s another factor to consider. Vitamin D is an important hormone in our health. Low levels of Vitamin D can lead to:

  • Depression
  • Increased risk of bone fractures and osteoporosis
  • Muscle aches and weakness
  • Periodontitis (bone weakness relating to tooth loss)
  • Birth defects

Vitamin D deficiency has also been found to be highly associated with obesity.  That also means it can be a precursor to diseases that stem from obesity such as diabetes, hypertension, and heart disease.

Do you know what the number one source of Vitamin D is? It’s the sun.

This is one of those things where modern gyms have almost got things right, but then failed right when it counts. They provide a way for you to increase your walking daily by having treadmills available but those treadmills are inside and under a bunch of fluorescent lights that don’t help you get any vitamin D.

While I understand that sometimes a treadmill is useful — like if it’s cold, dark, snowing, or possibly unsafe to walk the streets — then it’s a great way to add some walking to your day. However, if it’s not cold, dark, snowing, or unsafe, then it’s probably best to walk outside so we can maximize the benefits and absorb as much vitamin D as possible.

The Science of Walking and Stress Relief

The benefits of walking don’t end at Vitamin D and mortality rates. On a short-term basis, walking can help to counter regular daily stress. And when paired with sleep, walking becomes a powerful one-two punch to allow you to turbo charge your recovery.

How can adding more movement to your day help, you ask? Surely everything has a recovery cost? In most cases that is true. Loaded walking, such as farmer walks or rucking, definitely has a recovery cost. However, unloaded walking has a recovery benefit. This kind of walking is like moving meditation when it comes to lowering stress hormones in the body and gently coaxing us back to a more recovered state.

For instance, a 2007 study by Morita et al. out of Japan found that walking in nature led to a decrease in stress response and emotions. They measured heart rate variability (HRV), blood pressure, pulse, and cortisol as well as subjective measurements of comfort, calm, and relaxation. They found a significant shift in HRV towards the relaxing (parasympathetic) side of the nervous system. Said simply: walking calmed the nervous system. In a world filled with stress, instant messaging, and lack of sleep, walking definitively calmed the body down.

This was backed up with a 2017 study by Di Blasio et al. that found that post-menopausal women experienced a significant lowering of cortisol provided they walked daily. Those who walked sporadically did not see any significant reduction.

But we’re still not done with walking…

Walking Improves Body Composition

One of the things I always do is benchmark. I make a practice of noticing what the most successful people do and emulate it. When it comes to being lean and muscular, bodybuilders have it right. Forget the excessive drug use and being as big as a house. At its core, bodybuilding is about having a lean and muscular physique — something I am sure many would want.

If you ever spend time with a bodybuilder, you will notice one thing when it comes to their cutting phase — there is never any high-intensity interval work. None. Zero Zip. Zilch. Nada. The reason is simple — it is too costly and can result in decreased muscle mass. Bodybuilders have intuitively grasped the elements of recovery necessary for muscle growth and, in an effort to always optimize that growth, they spend the rest of their time doing the minimum they can to get the best result. And that result comes from low impact, easy effort cardio.

In other words, they will go for a slow walk.

If you’re a 90kg male, then you’ll burn roughly 400cal/hour walking. That may not sound like much, and in relation to many other activities like running (~700-1000cal/hour) it isn’t. However, remember that walking lowers stress, allows you to absorb vitamin D, and helps you live longer — so maybe all exercise isn’t about the calorie count.

But even with all that taken into consideration, if you walk for an hour a day you’ll burn 2800 cal/week (400 calories x 7 days). One kilogram of fat has 9,000 calories. That means an hour of walking a day will help shave one kilogram (2.2 pounds) off your waistline over a three-week period. That amounts to 17lb or 8kg over the course of a year — and all with no actual food restriction to achieve it. Who wouldn’t like to lose that much fat over the next twelve months?

Make It a Year of Walking

If you haven’t figured it out yet, I am a huge fan of walking. There are just too many benefits to ignore. If you want to make this year your healthiest year ever, you need to start with a foundation of health first. Sleep, wholesome food choices, and walking are the cornerstones of building enormous fitness potential. With so many benefits you really have no reason not to lace up and get outside more often.

Written by Andrew Read and originally posted on Whole Life Challenge

Health Kids Pregnancy

How To Nurse A Baby Without Back And Neck Pain

With a large number of patients welcoming new children (or about to), there is a really well-timed series of articles called “Postpartum Pain Clinic”. We’ve copied this one straight from Lifehacker. We are fans of anything that gets you out of pain and this is a common one!

So far in our online clinic for new parents, we’ve covered how to hold a babyhow to change a baby’s nappyhow to push a stroller, and how to carry a nappy bag without hurting your neck, wrists or back (or at least making the problem worse). This week we’re covering another source of postpartum pain: Breastfeeding.

Now certainly the early days of breastfeeding can be brutal: Getting the baby to latch properly sometimes takes weeks or even months of effort, and many women endure significant breast and nipple damage while they and their baby are getting the hang of it. And even once that’s sorted out, mothers still endure neck and back pain that arises from nursing in hunched and awkward positions.

I spoke to Stephanie Leaf, a physical therapist specialising in postpartum issues and the director of New Leaf Physical Therapy, for her best advice on avoiding and treating the neck and back pain caused by breastfeeding a newborn.

Do:

“Sit with your back supported and upright to protect the lower back,” says Leaf. “Pull your shoulder blades back to support your neck and upper back.” Hold the baby with flat open hands to avoid tendonitis and wrist pain, and keep both feet supported on the floor. Bring the baby up to you, and do not slouch towards the baby.

A nursing pillow can be a lifesaver for breastfeeding comfortable (I myself used the appallingly named My Breast Friend pillow, and in the newborn days would sometimes shove an extra throw pillow under there for support.) Some women swear by a nursing stool to keep their feet and legs supported.

Don’t:

Leaf says, “Don’t sit hunched to the side with crossed legs. Don’t round your shoulders and drop your head.” Right before my second kid was born, I also snagged a free glider off a parents’ list, which made all the difference in avoiding the neck and upper back pain I’d had with my first son – I could lean my head back instead of hunching over the baby.

Also, if you have a newborn, know that it gets much easier once the baby grows a little and can actually reach the breast without major proppage. And if you haven’t yet, try nursing lying on your side, which, if you have proper support for your head, can be much more comfortable than sitting up.

 

Image: Tara Jacoby/GMG

Article: Lifehacker

Health Kids

Is Conservative Health Care worth the Investment?

Quite a good article about considering your options when surgery is a realistic consideration for your pain or condition. It’s come directly from Nick at Integrative Health and the original article is here.

You can’t cut out pain. – every *good* orthopaedic surgeon ever

Despite what we know about pain, many people are subjected to poor medical management for their pain on a daily basis.

From the recommendations of medications that don’t work for certain conditions (ahem, anti-inflammatory drugs and low back pain), to expensive courses of passive therapies that have extremely low effect sizes.

Not only do these treatments not work very well, they are is an enormous waste of everyone’s resources. To make matters worse, many of these management strategies are not benign, meaning they have the potential for negative side effects.

When it comes to poor medical management, over the counter medications and ineffective passive therapies are the (very small) tip of the iceberg. Many costly, and potentially dangerous drugs, invasive therapies like injections, nerve blocks and the “grand-daddy” of them all, surgery all carry high risk profiles and for very small benefit, especially over the long term.

It’s right about now that I should add some moderation to this post:

I’m not saying these treatments are completely worthless all the time. In fact, I have had many patients who have benefited from the right prescription or surgery over the years.

What I’m saying, is that these treatments often come with big costs and risks that are not fully disclosed when they are recommended (although nearly every surgeon does a better job at explaining the risks of their treatments to patients, many still overplay the benefits or don’t fully explain the alternatives).

With this in mind, the sleeping giant in the treatment of most painful problems, especially those involving the musculoskeletal system is good conservative health care.

I emphasise the good, because there is so much bad out there.

No, I’m not trying to be negative and put down other health professionals. I am simply stating, that based on my experiences with patients (and supported by research), many have not had adequate conservative care to begin with, which is how they’ve ended up with chronic conditions in the first place.

What Is Conservative Health Care?

Conservative health care is based around interventions designed to avoid radical medical therapeutic measures or operative procedures. 

They are typically lower in cost than more aggressive treatments, which a much safer risk profile.

The downside is that some conservative treatments don’t have a large effect size, and many work in general, not specific ways.

Some examples of conservative health care include:

  • Education, advice and reassurance
  • Lifestyle changes
  • Dietary changes, including supplementation
  • Exercise based interventions
  • Physical/manual therapy
  • Certain medications

When Should You Seek Out Conservative Health Care?

Conservative health care is not appropriate for all health problems.

Serious and life threatening conditions typically need more aggressive and/or invasive treatments. Examples of such conditions include major infections, cancer, organ diseases and major trauma (though there are many more).

When conservative health care is most optimal, is when a condition is chronic and stable, or progresses slowly, when the condition is self-limiting (i.e. it will resolve with time, and symptomatic management is all that is required) and when the condition is non-specific (it can’t be attributed to a single cause), like many low back pain presentations.

Usually, a general practitioner will be able to advise you when conservative options are suitable, so that’s often a good place to start.

Conservative Treatment For Pain

Pain is the number one reason people consult their GPs, however, a lot of pain is very poorly managed from the beginning, leading to the progression towards chronic and more debilitating pain.

This is where I feel that conservative management can really shine.

Almost every chronic condition will improve to some degree from improving your health generally.

Additionally, many chronic pain presentations will benefit just as much, if not more in the long run, from good conservative management.

Unfortunately, many people miss out on receiving good conservative care when they need it most, leading to them needing/wanting more aggressive treatment options when their condition has progressed.

The Benefits of Conservative Health Care

Conservative health care has a number of benefits for all parties involved: patients, practitioners and 3rd party payers (insurance companies, governments etc).

One of the biggest benefits is economic.

Let’s take chronic low back pain as an example, because it is so prevalent, and so widely researched.

The cost of these conditions to the Australian economy in 2012 was more than $A55 billion. Back pain and osteoarthritis, the most common of musculoskeletal conditions, accounted for 52% and 41% of cost respectively.

When we look at the costs, most people intuitively think of the cost of treatment (consultations, investigations like imaging, medication etc), however, the bigger cost is the indriect cost, that is the cost to society and the individual of lost income, productivity and quality of life as a result of their condition.

While the direct costs of chronic conditions is around A$9 billion annually, the indirect costs are a staggering A$54 billion annually!

With such high costs, you’d think that prioritising excellent conservative care from the outset would be high on the agenda for all involved.

Unfortunately, many clinicians do not follow the clinical care guidelines which are developed by compiling the best evidence from researchers around the world. In fact, only 20% of low back pain patients received care inline with the guidelines.

These guidelines are designed to ensure the best possible management of each condition, yet with only one in five people getting treatment based around them, many are missing out and going on to develop chronic pain, which ends up costing them in time, money and quality of life.

Other benefits of conservative health care include:

  • Safety – by definition, most conservative health care is low risk.
  • Availability – there are typically many more health professionals able to deliver conservative health care than specialists who deliver more invasive treatments.
  • Sustainability – conservative approaches can typically be maintained over the long term, which can help manage chronic conditions.

What stops people getting good conservative treatment?

I believe that most of the time, most people are doing the best they can. As a result, the lack of implementation of clinical guidelines for conservative care is not down to any one factor, but here are a few:

  • Market forces – funding for public health services is always stretched, so GPs cannot spend adequate time educating patients. Private practice clinicians are often limited in the number of times they can see someone due to a patient’s ability to afford treatment.
  • Expectations – patients often want to be “fixed”, not understanding, or wanting to participate in more active management for their conditions.
  • Practitioner knowledge and skill – most health practitioners are skilled in diagnosis and treatment, not in facilitating behavioural change. This makes it hard to create long term, empowered change.

With this in mind, we can see the challenges that need to be overcome to offer the best available conservative care.

What is needed to improve conservative treatment?

  1. Government and insurance companies need to appreciate the long term cost savings conservative care offers, and fund it accordingly. If a surgery costs $20,000 spread across direct and indirect costs, and that surgery could have been prevented by 2 years of physical/exercise therapy, then even at $100 per session, twice per week, you are coming out at break even. However once you add in the rehabilitation costs of surgery, and the costs of the increased risk, the physical therapy option is actually cheaper.
  2. Patients need to take responsibility for their thoughts and actions. Yes, circumstances can affect everyone, which can make life harder and less fair for some, however, taking 100% responsibility for how you respond and act will mean that you are in the best frame of mind to improve your situation and your condition.
  3. Educational institutions need to adapt to the changing demands on healthcare and focus more on communication and behaviour change. Simply increasing the awareness of this important skill will lead to those interested healthcare practitioners pursuing further education.
  4. Health practitioners must accept that they can always improve, and seek out ways to develop their skills to better serve their patients. This includes seeking out appropriate continuing education, but it also means enhancing their networks and their ability to utilise these networks to benefit their patients.

The Big Two

Of all these factors, the two most important are economic and cultural forces.

Money is always an influence on how we make decisions, and many people simply don’t have the financial freedom required to pursue optimal conservative care, especially privately.

While there are always those who are living on the edge, and literally have no room in their household budgets for anything about the essentials of living (housing, food, transport and utilities), there are many more who claim that health care is too expensive. Yet these people walk around with the latest iPhone on a high monthly plan, or drink/smoke/gamble regularly. For these people, who may be on average incomes, it is simply a matter of choice and priorities*.

This is where culture becomes important.

Our culture in Australian is heavily influenced by commercial interests.

Unfortunately, there is a lot of money to be made in selling treatments for conditions that offer a simple solution to a person’s health problem.

Whilst they appeal to our emotions, simple solutions are usually inadequate for complex problems.

So when you propose a long term course of conservative care, which involves active participation by patients, it is often a tough sell.

It is made even tougher by the massive marketing budgets pharmaceutical companies and medical device companies have. They use these to influence our culture.  Every night on TV there are commercials for different types of pain medications. Ironically, if most people spent just 30 minutes less watching TV, and decided to go for a walk instead, they probably wouldn’t need them anywhere near as much.

A Different Perspective

If instead of thinking in terms of expense (cost and time/energy), you changed focus to investment, then immediately you have changed your perspective on health.

When you invest in a term deposit, at the end of the term you have more money than when you started.

Conservative health care, done properly, is an investment.

Yes, you are spending time, money and energy to change your health, which has an initial up front cost. But, by the end of the treatment program, you should have improved health, reduced pain, better function and an overall better quality of life.

Get more years out of your life, and get more life out of your years.

These improvements can be thought of as your return on investment. Like a term deposit, conservative treatment is mostly safe, offers fairly predictable outcomes and is overall, low risk.

Once you have restored your health, the idea is to maintain it (just like you would with wealth). Usually this means you need to continue your healthy habits which you established during treatment.

A final word on perspective; if you are in debt, you must pay back your debt before you can invest. The bigger your debt, the more work and time it takes to repay. The same school of thought applies to health. While things can change quickly, true healing from chronic conditions, or even severe acute conditions, takes time.

If that puts you off, think about it like this: time will pass, regardless of what you do or don’t do. If you do nothing, you will be in the same, if not worse situation in a year or ten.

Conclusions

Conservative care is extremely important from both a public health and individual perspective. Delivered optimally, it saves money, improves outcomes and reduces the need for interventions with higher side effect or risk profiles.

There are some barriers to delivering good conservative health care at the population level. On an individual level, the two most important variables can usually be overcome.

If you are a patient: when you are seeking out a health care provider, discuss long term strategies and look for providers who will incorporate an active management plan.

If you are a practitioner, you should look to improve your communication and behavioural change skills. Telling someone what to do isn’t good healthcare. Guiding them through the process of how to do it is.

 

Originally published: Integrative Health

 

References

(1) Medibank: Chronic pain costs economy more than $22bn a year

(2) Pain drain: the economic and social costs of chronic pain

(3) The burden of musculoskeletal conditions in Australia: a detailed analysis of the Australian Burden of Disease Study 2011

Exercise Health Injury

My Achilles Hurts

Last night I played Futsal (form of indoor soccer) and this morning my achilles hurts. The first few steps to the kitchen feel like I’m walking in bricks. I know it will settle because this has happened before, and I know a trick or two!

Achilles tendons are the largest tendon in the body so that makes them solid things, and often pain like this doesn’t mean I am any more likely to tear my tendon like many people seem to fear. Oddly enough, that single sentence is the one I repeat the most. People are more scared of the “gunshot” achilles rupture than of any tendinopathy.

Cause

We’re not exactly sure what causes them, but we do know a few risk factors (58% are male; have reduced ankle motion, power or strength). More commonly, increasing load too quickly including returning from injury, training errors and footwear are common extrinsic factors. Achilles tendinopathy can be acute or chronic. They are most often seen in 15-25 year-olds (young athletes), and 45+ year-olds (desk workers) with limited activity.

Basic stats of achilles tendon pain sufferers: 58% male, risk factor = reduced ankle dorsiflexion (which can occur from previous ankle sprain)

Recovery

The journey can be tough because there is frustration with the management. The rupture fear factor in achilles patients can actually determine their recovery time, so you can imagine the importance of an accurate understanding and communication with your health care provider. McAuliffe et al (2017) demonstrated the psychosocial components where activities of daily life (up and down stairs, walking, etc) caused fear of further tendon damage and therefore significantly reduced all activities.  There can be a great deal of frustration with the management of achilles tendon for both clinicians and patients as it is slow to settle and quick to aggravate.

Silbernagel et al (2010) found only 65% of people with progressive strength programs were symptom-free at 5 years. 15% had new symptoms, 20% had ongoing issues.

What to do?
  • Understand your pain, the cause and what exercises are best for your stage of recovery
  • Manage fear/stress and assess other health issues including diet and sleep
  • Learn what isometric (pain relief) and eccentric (for strength) exercises are!
  • Reduce pain, build load tolerance and get you back to what you love!
Long-term management

Ongoing management relies on consistent self-management by the patient, which is both exercise and education based. Patients should find balance with training (avoid morning training, hills, back to back running). This requires an adequate understanding of what to do when certain pain or training changes happen.

 

Thanks to Clinical Edge, McAuliffe et al (2017), Silbernagel et al (2010), and tendon gurus – Tom Goom and Peter Malliaris

Exercise Health Injury

How to Fix 4 Common Running Injuries

I really enjoy reading articles about the body, exercise and tech. The point of this Clippings section is to uncover and make good articles easier to find! This one was found recently and is great for understanding a few common injuries that are perfectly normal and mostly associated with beginner runners! Check it out at self.com!

4 Beginner Running Injuries That Are Totally Normal and How to Fix Them

Running doesn’t always feel good, whether you’re dealing with running injuries or just the run-of-the-mill running aches and pains. Sure, those of us who run regularly say that it gives us life and makes us feel wonderful. But at the end of the day, running is a high-impact exercise, meaning your entire body take a bit of a beating when you pound pavement for a prolonged amount of time.

If you’re a beginner runner, your body isn’t accustomed to the repetitive motion, and you’re likely to end up with some aches and pains. That doesn’t always mean you’re injured, Reed Ferber, Ph.D., researcher at the University of Calgary and director of the Running Injury Clinic, tells SELF. “Running hurts, you need to prepare yourself for that,” he says. “But if the pain gets better, or goes away as the run goes on, that’s a good thing. That’s not really an injury.” It takes your body some time (maybe even a few months) to adapt to the new stress you’re exposing it to.

But if the pain persists, gets worse throughout your run, or goes away while you’re running but comes back with a vengeance when you stop, those are signs you could have an actual injury. Ferber says the best thing to do is stop running, and go see a professional to figure out what’s going on before you cause any permanent damage from your running injuries.

There are a lot of ways you can sprain, strain, tweak, and tear yourself when you run, but below, we’ve laid out the four most common overuse injuries that physical therapists see in beginner runners, and how they typically suggest treating them. These types of injuries occur when you train too hard too fast and your body doesn’t have time to adapt. Most of them start out minor, but will get worse if you keep pushing too hard.

1. Runners knee

What it is: “Patellofemoral pain syndrome, more commonly referred to as runner’s knee, is a dull, achy pain that originates underneath your kneecap and is typically felt during running, especially uphill, walking down stairs, or when moving from a sitting position to a standing position,” John Gallucci, Jr., M.S., D.P.T., president and CEO of JAG Physical Therapy, tells SELF.

This is the most common running injury, especially for new runners, Ferber says. He notes that for some people, the pain may start at the beginning of the run, subside throughout, and then pick up again as soon as you stop running.

What causes it: “It’s a grinding injury,” Ferber says. There’s cartilage under your kneecap and also along your thigh bone, and a layer of fluid in between the two works as cushioning, Ferber explains. He says to think of the knee cap as a train and the thigh bone (femur) as the train track. When the hips are weak, the thigh bone loses its stability and moves underneath the kneecap. “The railroad track starts moving. Those pieces of cartilage start to rub together, and that’s what causes the pain,” Ferber explains.

How to fix it: This is something most runners can deal with and will attempt to run through, Gallucci says. But (surprise!) that’s not a good idea. “If not properly managed, patellofemoral syndrome can progress into a more severe injury that would require surgical intervention, such as a fissuring or fracturing of the patella,” he says.

Initially, you should stop running and try to limit inflammation—taking anti-inflammatory medications such as ibuprofen can help. Then, work on strengthening your hips, says Ferber, who co-authored a study on the benefits of treating runner’s knee with hip and core exercises.

2. Shin splints

What it is: Medial tibial stress syndrome, more commonly known as dreaded shin splints, cause pain on the inside surface of the shin, “especially when walking, running, and pulling the foot upward or stretching it downward,” Licameli says. The pain can occur on the inner or outer side of the shins.

What causes it: “There’s a muscle that attaches to the back of the shin bone and that muscle wraps around the inside of the ankle bone and helps to control the foot when it pronates [rotates inward and downward], and also helps during push-off to propel you forward,” Ferber explains. Shin splints happen when there’s repetitive trauma to the connective tissue that attaches this muscle to the tibia bone, says Gallucci. The tissue breaks down, becomes inflamed, and sometimes, scar tissue forms during the healing process, “which produces pain and tightness.”

How to fix it: Getting running sneakers with more cushioning is a good start, but shoe choice is just a minor part of this, Ferber says. “The true fix is strengthening.” He tells patients to follow a heel raises program to strengthen the calves and ankles.

3. Plantarfasciitis

What it is: Plantar fasciitis causes a stabbing pain on the bottom of the foot near the heel. “It’s usually a little bit stiff at the beginning of a run and then the pain goes away. Then, it’s a little stiff when you finish,” says Ferber. “But it hurts first thing in the morning. That first step out of bed is excruciating at the heel. It can take 15 to 30 steps to get it warmed up and to go away, and then you kind of forget about it.”

What causes it: The plantar fascia is a thick band of connective tissue that runs along the sole of the foot from the toes to the heel. Its job is to support your arch, Ferber says. “It gets stretched every time the foot comes down, and rung back out as the foot pronates,” he explains. It’s designed to be thick enough to withstand these forces, but too much repeated tension on the fascia can cause irritation and inflammation.

Since the fascia is connected to so many parts of your foot and leg, there are many things that can contribute to plantar fasciitis. “Poor running mechanics, flat feet, weakness of the hips, weakness of the core, poor control of pelvic positioning, and nerve irritation in the lower back,” can all contribute to this inflammation and pain, Licameli says. Tight calf muscles or even inflexible toes can strain this connective tissue, too, adds Ferber.

How to fix it: “We say to stretch and do heel raises to make sure the muscles crossing underneath the foot are good and strong. That takes the load off the plantar fascia,” Ferber says. “Plus, a good arch support (just an over-the-counter orthotic) will take some stress off.” Licameli also suggests strengthening the hips and the core. “And always warm up properly,” he says.

4. Achilles tendinopathy

What it is: This type of tendon injury causes pain in the Achilles tendon, “especially when walking, running, raising up on toes, and stretching the calf muscles,” Licameli says. It’s an aching, dull pain, that can start where the muscle transitions to tendon. The pain can also be deeper in the thickest part of your tendon, which is more common as you age. Why? “As you age, you lose blood supply in the mid part of the Achilles tendon and it becomes brittle. It starts happening in about your 40s,” Ferber explains.

What causes it: Any weakness or tightness in the calves, glutes, or hamstrings can impact the Achilles tendon. We use our calf muscles and glutes to propel us forward, and if they’re not their doing jobs, smaller things like tendons have to kind of take over, which can end up causing a lot of strain. Licameli adds that having weak hips or core or flat feet can all impact how much strain is on the Achilles tendon.

How to fix it: Again, strengthening and stretching the muscles at play is key here. Often it’s the hips or calves that need to be strengthened, but issues with the feet are core are common, too. Ferber adds that since there can be so many different causes, you need to figure out the main one in order to properly treat it—that’s why it’s so important to see a professional to help you get to the bottom of it.

Source: Self.com

 

Health

Foam rollers are simply good

I’m not going to lie, we stole this one directly from GQ.com – surprisingly, it just happened to explain things in a very GQ way. Please consult your osteopath if you’re not sure if these exercises are for you!

Foam rollers (FR) can reduce pain, prevent injury. Here’s how to use one.

By now, you’ve probably seen all kinds of foam rollers scattered around your gym. Vibrating ones. Knobbed ones. Extra long, torso-sized ones. Foam rollers that actually roll up and fit in your carry-on. If you’ve never used one, the fitness tool looks a lot more like a Mega Man buster gun than an essential instrument for overall fitness and health. And now is the time to start.

“Using a roller will make you more efficient in every movement you do,” says fascia and alignment specialist Lauren Roxburgh, who has worked with her fair share of professional American Basketball and Baseball players. “It will help you roll away density, scar tissue, and knots that build up in your body, lubricate joints, and reduce inflammation in the body while increasing flexibility and range of motion.”

So essentially, foam rolling is to your workout plan like Bruno Mars is to the music industry: groundbreaking. But, like Mars, it can’t really be for everyone, right?

Turns out, like “Uptown Funk,” it can be. “[A roller can] help you reach your highest physical potential, whatever your age or stage. So whether you want to reduce persistent pain, boost your fitness or improve your pickup basketball game. The roller can really help.”

All of that for the very reasonable price of $35ish. For advice on how to use one, Roxburgh breaks it down for us by muscle group.

Lats

Lie on a mat with the roller placed under your upper back, leaning your mid-back over to the left on the roller. Interlace your fingers behind your head to support your head and neck. Using your feet to drive the movement, inhale as you roll up and lean to the left on the roller to massage the lats and underarm area, stopping at your armpit. Exhale as you roll and massage down the armpit and lats, stopping at the bottom of your ribcage, and then roll back up.

Repeat this movement 8 to 10 times on each side.

Quads

Come down to your forearms with your stomach facing the floor. Place the roller under your hips. Keep your abs engaged to prevent overarching your lower back. Exhale as you roll all the way down to the tops of your knees. Inhale as you slowly roll up to your hips.

Repeat this motion eight times on each side.

Adductors/Inner Thighs

Come down to your forearms with your torso facing the mat, and place the roller under your right upper inner thigh. (To do this you will need to bend your right knee up and out to the side and place the foam roller up and under your groin, parallel to your torso.) Taking care to keep your upper body square to the ground as you move, use your forearms and left leg to power the motion as you roll the roller out toward the knee—stopping just above it—and back up to your groin.

Repeat this motion eight times on each side.

Hamstrings

Sit on your mat and place the roller beneath your hamstrings. Place your hands behind you with fingertips pointing out to the side. Press your hands into the mat to lift your bottom off the floor. Continue pressing your hands into the mat and engage your core to rock yourself forward and backward, pushing the roller up and down the hamstrings, from just under the bones at the base of your pelvis that you sit on to just above the knee. Breath deeply, exhaling as you move forward and inhaling as you move backward.

Repeat this motion eight times on each side.

Calves

With the roller placed under your calves, right below the knee (but take care to stay off the back of the knee). Cross your left calf over your right calf on the roller. Place your hands on the ground a few inches out on either side of your hips, fingers pointing outward. Press down into your hands to lift your bottom off the mat, keeping your calves balanced on the roller. Roll out each calf 10 times.

Upper back (added)

This is the big one they left out, your upper back. Type 1: Firstly, position the top of the roller (vertically) where your collar would be, then have the FR right down the middle of your back. Keep both knees bent up and your feet should be the only part of your body touching the ground, with your pelvis either on the FR too, or suspending above the ground. Place both arms out like you are surrendering and let your arms fall to the ground, initiating a pec stretch. This is the perfect reversal of your computer or car posture!

Type 2 (harder): As seen above, with the FR horizontal. Ensure you don’t roll below the base of your rib cage. Use your hands to hold your neck up, and preferably keep your elbows pointing to the ceiling to pull your shoulder blades out of the way. Do a few ‘drive-by’ or rolls to assess the sore areas, often you will notice one or two spots that are more tender than the rest. They are the ones we want to pause on for 15-30 seconds. Try to breathe through them and allow your body to relax, but this can be a bit much unless you are used to it.

Did you notice what was missing? We left off the ITB…ask us why! While you’re at it, ask us how to add your glutes in here too.

Roughly, I would use the FR for my back 1-2/week, and as needed for the rest of my body! As you can see, some simple home exercises to add to your stretching regime that can help relieve tension but help your recovery.

Look after yourselves,

Evan

Exercise Health

DOMS

 

Delayed onset muscle soreness (DOMS) is a wonderful thing. It’s that rewarding, yet oh so painful feeling usually first thing the next morning after exercise. DOMS comes from tiny tears in the muscle that are necessary for growth. If it helps, try and think about the hulk breaking his clothes as he gets bigger (and greener). Your muscles are actually doing damage to themselves to build more bridges to assist next time they’re required.

 

What DOMS isn’t

  • It’s not a build up in lactic acid like they thought back in the day, that tends to feel like your muscle is losing power and just can’t do any more push ups
  • It’s not likely a muscle strain, these are usually sharp and instantaneous.

What should I do to make it go away?

  • I say this a lot, but moving will help.
  • You’ll notice you’re at your worst when you’ve been sitting or lying down for an extended period of time.
  • Wait – usually it will pass within 24 hours, but can last for up to 72 hours/3 days

 

If you’re ever not sure, it’s worth asking us. A simple call or email can often give you a much better understanding and save you from Dr Google. Sam and I are at Warrandyte and Templestowe and we love this stuff!

The next time you’re grimacing as you climb those stairs after your work out, think about the hard work it represents and turn that grimace into a smile!

Look after yourselves,

Evan