<![CDATA[RURAL HEALTH - News & Updates]]>Wed, 01 Dec 2021 12:00:20 +1100Weebly<![CDATA[“A pain in the neck” - Acute wry neck]]>Wed, 01 Dec 2021 01:00:00 GMThttp://rhpl.com.au/blog/a-pain-in-the-neck-acute-wry-neckPicture
​We all experience aches and pains in our necks from time to time. Maybe you slept wrong or spent hours in front of the computer studying or working and have a stiff neck. Our necks are an integral part of our skeleton that protect vitally important structures and provide stability & mobility for our heads to take in the world around us.

Neck pain that comes on quickly or suddenly could be from a few causes. Your Physiotherapist can accurately assess and diagnose where the problem is coming from and work with you to correct it. Acute wry neck is one of the more common causes of neck pain & is characterised as “a sudden onset of sharp neck pain with a protective deformity and limitation of movement” 
Typically occurs:
  • on waking
  • after a sudden quick movement
  • Possible abnormal or prolonged postures or unusual movements prior to onset

Two main causes:
Facet or Zygopophyseal - The joints in our neck overlap between the vertebrae that sits above and below it. Sometimes these joints get stiff or ‘lock’, restricting movement & causing pain. Nerves from our spinal cord exit between these joints so can become irritated, so even tiny movements of our head and neck can hurt, causing muscles to protectively spasm, further restricting movement. 
  • more common in kids or young adults
  • brought on by a sudden movement & sharp pain
  • usually has a fixed posture of the neck - I.e looking to one side and unable to turn the head as a result of pain or muscle spasm

​Discogenic Wry Neck - Arising from the discs between the vertebral bodies. 
  • more gradual onset - typically when waking from a long sleep in an abnormal posture
  • more affected if middle aged & older
  • pain can be felt in the lower neck or upper back, sometimes radiating towards the shoulder blades
  • A history of joint disease or arthritis in the lower neck may be present

How long will it be stuck?
Facet joint wry neck is quick onset, so recovery is usually swift in ‘unlocking’ the joint again, however the protective muscle spasm and swelling can last for a few days to over a week to settle. Discogenic wry neck can take some more time from weeks to months to settle. Physiotherapy can greatly assist with recovery & prevent reoccurrences.
Treatment will depend on the cause and may include:
  • Manual therapy (soft tissue massage & joint mobilisations and/or traction)
  • Ice, heat or other electrotherapeutic modalities may be used in addition to treatment 
  • Home exercises to help restore movement and flexibility, aiming to improve strength of deep supporting muscles of the neck

You don't have to put up with neck pain, get in touch today to see how our team can help you. Book online or call 02 5926 3806
Fun Fact! Did you know that humans and Giraffe have the same number of bones in our necks! They’re just a lot bigger and weight significantly more.
<![CDATA[“Not worth the headache” – Cervicogenic headache]]>Mon, 01 Nov 2021 06:00:00 GMThttp://rhpl.com.au/blog/not-worth-the-headache-cervicogenic-headachePicture
Headaches can strike for a multitude of reasons, Physiotherapists treat a lot of cervicogenic headaches. This type of chronic headache often originates with pain felt in the neck and may travel to the base of the skull, sometimes over the temples towards the forehead and behind the eyes.

​The source of the headache is referred from the cervical spine (neck). Physiotherapists can accurately diagnose whether the pain originates from a joint, an entrapped nerve, ligament, disc or muscle and work with you treat pain and prevent reoccurrence.

Often, cervicogenic headache originates from poor posture of our neck and spine where certain muscles become tight and/or weak.  
  • Women are more commonly affected
  • Pain is usually felt on one side of the head/scalp (but could be both)
  • Gradual onset, ranging from moderate to severe intensity
  • Usually worsens with neck movement
  • Stiffness or limited movement in the neck
  • Emotional stressors may also contribute
*Important screening tests are done by your physiotherapist to rule out serious pathology. 

What does treatment involve?
After a thorough assessment, your Physiotherapist may utilise manual therapy skills, including massage, joint mobilisations or manipulations. Based on assessment findings and response to initial  treatment, stretching and/or strengthening exercises may be prescribed to maintain joint mobility, muscle flexibility and the strength of your neck to reduce or prevent reoccurrence.

How long until it gets better?
Depending on the severity of the headache, it could resolve within a matter of days, weeks or months as it takes time for muscle imbalances and postures to be corrected. Self-management techniques for after your treatment session could involve:
  • Altering ergonomics – i.e modifying occupational and/or leisure activtity positions and postures
  • Managing emotional stress or triggers that may increase muscular tension
  • Home exercises for strengthening weak muscles or stretching tight ones
  • Self mobilization of joints to reduce stiffness (i.e using a foam roller, massage ball or towel as instructed by your physiotherapist)
  • Heat therapy

Should I get an X-ray?
Often, imaging alone won’t tell you the cause of the problem but it may help support the diagnosis given to you by your healthcare professional. 

SO if you don’t have time for headaches, get in touch today to see how our team can help you. Book online or call 02 5926 3806
Fun Fact! As long ago as the 17th century, “trepanation” was common practice for part of the skull to be surgically removed for the treatment of headaches. It was believed that demons and evil spirits trapped in the skull were the cause for headaches and they had to be released. 
<![CDATA[Pre-habilitation]]>Sun, 31 Oct 2021 13:00:00 GMThttp://rhpl.com.au/blog/pre-habilitationWe all know about rehabilitation, but what on earth is 'pre-habilitation'?
Pre-habilitation, or 'prehab', is a proactive approach to avoiding pain and injury. It's about improving your body's ability to withstand extra stress - like an upcoming surgery, that overnight hike you've planned for the next holiday, or the next season of footy. It's getting yourself in the best shape you can be - so you perform and recover better.

No matter the treatment - whether it's heart surgery, joint replacement or cancer treatment - you're more likely to have a better and quicker recovery if your strength, fitness, and mental health are as good as they can be pre-treatment.

Let's take John* for example...

John is 65 years old, he's been having pain in his left knee for over 10 years now and the surgeon has recently recommended a knee replacement. Now, because John has this knee pain he's stopped playing bowls, his wife is now going for the morning walk solo, he's barely doing any gardening anymore, and is struggling to push a half-full wheelbarrow up to the house. It's not doubt he's lost some strength and fitness, but the 'new knee' will fix all of that. Right?!?


But if John is starting his rehab journey with his strength and fitness where it is now, there's a big climb back up the hill ahead of him. If we can get John's knee moving as freely as possible, increase the strength of the rest of his leg muscles, find some ways for him to improve his fitness, and make a plan for his rehabilitation all before he goes in for his surgery - his recovery is going to be looking a whole lot easier.

The concept of pre-habilitation doesn't just apply to individuals having surgery. It goes for anyone who wants to reduce their risk of injury. We know there's some sports that are strongly linked to certain types of injury (think 'runner's knee' or 'golfer's elbow'), as well as those athletes who are at high risk of ACL injuries.

If we're relying heavily on a certain joint or body part to complete a task, but we're not giving it the extra love and support it deserves, chances are we'll end up with an injuries throughout our sporting careers.

Do you have an old injury holding you back or a surgery pending? Have a think about starting your pre-
habilitation journey today, for more information or bookings phone 02 5926 3806.
<![CDATA[Archies - Foot friendly thongs!]]>Thu, 07 Oct 2021 09:53:30 GMThttp://rhpl.com.au/blog/archiesThey look like regular thongs…but they are better for your feet!! Archies! With arch support built up an extra 2.2cm they are designed to position the foot in a more biomechanically efficient posture. This reduces the stress and strain placed on the musculoskeletal system from the ground up.
I am sure we have all experienced tired feet after a long day in thongs or even barefoot. The reason this happens is because when the foot has no support the arch and ankle can roll too far inward, a movement referred to as “pronation”. This can have effects further up the kinetic chain at the knees, hips and lower back as well.

Do you experience pain in these areas? If so it may be time to check the support from your footwear.

Additional to the increased arch support, Archies are constructed of a specialised, closed cell foam formulated to mould to your foot over time making them super comfortable. They have a firm strap design, ensuring you don’t subconsciously claw your toes to hold your thongs to your feet. Toe clawing is a terrible habit associated with flat thongs and can lead to toe deformities long term. Being very lightweight, you will barely notice they’re even on.

While thongs will never be recommended footwear from your podiatrist, the Archies are a great compromise for those times we just need a pair of quick slip-on shoes for convenience. They can also be a fantastic adjunct relief in cases where it is painful to go barefoot around the house, Archies are a great source of cushioning and support inside the home when slippers are not an option in the warmer months.
Want to treat your feet and grab a pair of the best summer footwear available? Drop into Rural Health Tumut to pick your favourite colour and get fitted up!
<![CDATA[What is an ACL Injury?]]>Sun, 03 Oct 2021 13:00:00 GMThttp://rhpl.com.au/blog/what-is-an-acl-injuryPicture
Your ACL or anterior cruciate ligament is one of four knee ligaments that are critical for the stability of your knee joint. Your ACL is made of tough fibrous material and functions to prevent excessive anterior (forward) movement of the tibia off of the femur, as well as hyperextension of the knee. One of the most common problems involving the knee joint is an anterior cruciate ligament injury or ACL tear.

What Causes an ACL Injury?
An ACL injury is usually a sports-related knee injury. About 80% of sports-related ACL tears are "non-contact" injuries. Most often ACL tears occur when pivoting or landing from a jump. Your knee gives out from under you once you tear your ACL.

Female athletes are known to have a higher risk of an ACL tear while participating in competitive sports. Unfortunately, understanding why women are more prone to ACL injury is unclear. There are some suggestions it is biomechanical, strength and hormonally related. In truth, it is probably a factor of all three. 

What Sports have a High Incidence of ACL Injuries?
Many sports require a functioning ACL to perform common manoeuvres such as cutting, pivoting, and sudden turns.

The high directional demands of sports include football, rugby, netball, touch, basketball, tennis, volleyball, hockey, dance and gymnastics

You may be able to function in your normal daily activities without a normal ACL, but high-demand multi-directional sports may prove difficult. 

What are the Symptoms of an ACL Injury?
The diagnosis of an ACL tear is made by several methods. Patients who have an ACL tear commonly sustain a sports-related knee injury.

They may have felt or heard a "pop" in their knee, and the knee usually gives out from under them. ACL tears cause significant knee swelling and pain.

How is an ACL Injury Diagnosed?
On clinical knee examination, your Podiatrist will look for signs of ACL ligament instability. These special ACL tests place stress on the anterior cruciate ligament and can detect an ACL tear or rupture.

An MRI may also be used to determine if you have an ACL tear. It will also look for signs of any associated injuries in the knee, such as bone bruising or meniscus damage, that regularly occur in combination with an ACL tear.

X-rays are of little clinical value in diagnosing an ACL tear.

How is an ACL Injury Treated?
Many patients with an ACL tear start to feel better within a few days or weeks of an ACL injury. These individuals may feel as though their knee is normal again because their swelling has started to settle. However, this is when your problems with knee instability and giving way may start or worsen.

ACL tears do not necessarily require ACL reconstruction surgery. There are several important factors to consider before deciding to undergo ACL reconstruction surgery.

Your age?
Do you regularly perform sports or activities that normally require a functional ACL?
Do you experience knee instability?
What are your plans for the future?
If you don't participate in a multi-directional sport that requires a patent ACL, and you don't have an unstable knee, then you may not need ACL surgery. 

Rehabilitation and ACL Exercises
Your best way to avoid ACL reconstructive surgery is to undertake a comprehensive ACL-Deficient Knee Rehabilitation Program that involves leg strengthening, proprioception and high-level balance retraining, plus sport-specific agility and functional enhancement. Your sports physiotherapist is an expert in the prescription of ACL tear exercises.

PhysioWorks has developed a specific ACL Deficient Knee Rehabilitation Program to address ACL injuries for the patient who wishes to avoid or delay ACL reconstructive surgery.

Management will aim to:
  • Reduce pain and inflammation.
  • Normalise your joint range of motion.
  • Strengthen muscles supporting your knee: Quadriceps (especially VMO) and Hamstrings.
  • Strengthen your lower limb: Calves, Hip and Pelvis muscles.
  • Improve patellofemoral (kneecap) alignment
  • Normalise your muscle lengths (muscles tighten post acute injury)
  • Improve your proprioception, agility and balance
  • Improve your technique and function eg walking, running, squatting, hopping and landing.
  • Minimise your chance of re-injury.
  • Refer as required for surgical review

At Rural Health our team are skilled in the assessment and management of recent and old knee injuries. Call us today to book an assessment on 02 5963 2707.
<![CDATA[Motion is lotion - osteoarthritis and exercise]]>Mon, 06 Sep 2021 04:30:00 GMThttp://rhpl.com.au/blog/motion-is-lotion-osteoarthritis-and-exerciseWhat is Osteoarthritis (OA)? Picture
Joints are places in your body where bones meet. Bones, muscles, ligaments and tendons all work together so that you can bend, twist, stretch and move about. Osteoarthritis (OA) can affect any joint, but is often seen in the knees, hips, finger joints and big toe. It can develop at any age, but tends to be more common in people aged over 40 years and those who have had joint injuries.

OA may include:
  • inflammation of the tissue around a joint
  • changes to joint cartilage - the protective cushion on the ends of your bones which allows a joint to move smoothly
  • bony spurs growing around the edge of a joint
  • some weakening of ligaments (the tough bands that hold your joint together) and tendons (cords that attach muscles to bones)

OA symptoms will usually develop slowly, and most commonly cause pain and stiffness in the joint.

An x-ray may show narrowing and changes in the shape of your joint. However an x-ray that shows these changes does not mean you will have pain or problems (and you may have a very painful joint despite x-rays showing no changes).

Why Exercise?

Let's think of cartilage like a sponge full of water...
When we apply loads to our cartilage (exercise), we push fluid out of our cartilage. Then when we rest, the nutrient rich joint fluid in the capsule surrounding is restored, like a sponge.

When we walk for example, loads press down on our cartilage. The cartilage absorbs the shock and fluids squeeze out into the surrounding joint space. Once loads are removed, or when we rest, the cartilage sucks the fluid back in from the surrounding area.

This lubricates the joint, reduces stiffness and improves mobility over time.

We like to say that 'motion is lotion'.

Firstly, because we really like catchy rhymes.

Secondly, because we love the fact that by exercising regularly we can help nourish and give some love back to those joints that have kept us moving through life so far.

Regular physical activity can keep the muscles around affected joints strong, decrease bone loss, promote weight loss and keep the rest of your body moving as efficiently as possible. You can have great improvements in your function and return to activities you previously enjoyed by following a regular, structured exercise program.

What Exercise?

If you're someone living with OA you've probably already heard that exercise can help, have tried some form of exercise to no avail, and are still feeling that same pain every time you sit down on a chair.

We know that exercise isn't 'wearing and tearing' your joints, but we want to find ways that you can exercise with minimal discomfort, and most importantly ways that you enjoy!

We're aiming to do at least 30 minutes of moderate exercise most days, as well as doing strength training twice a week. It's important to start small and slowly build upon weight bearing activities.

If you're not sure which sort of exercise is best, or you haven't yet found a way to exercise right for your body, come and have a chat with our Exercise Physiologist.

And remember, motion is lotion.

<![CDATA[Diabetes and Your Feet]]>Sun, 01 Aug 2021 14:00:00 GMThttp://rhpl.com.au/blog/diabetes-and-your-feetDiabetes, if present long term or if glucose levels are poorly controlled can have significant negative implications on the health of your feet. Two of the most common effects include nerve damage and reduced blood supply to the feet. 
Nerve damage can present in the feet and legs in several ways, including:
  • Numbness
  • Coldness 
  • Tingling
  • Pins and needles
  • Burning
  • Altered sensations

Nerve damage can result in loss of sensation which protects the feet from accidental damage occurring when you can’t feel pain. Without detection, a minor injury can develop into an ulcer, which could eventually penetrate to bone. This significantly increases the risk of bone infection and may require amputation to prevent blood poisoning.

Reduced blood supply to the feet and legs is another common risk of poorly controlled glucose levels with diabetes. Poor blood flow increases the risk of infection following any injury that breaks the skin. Signs of reduced bloody flow can be leg cramps after walking short distances, cold feet, reddish-blue coloured skin in the feet and legs, and cuts or skin abrasions that are slow to heal. Reduced blood flow also makes it difficult for the body to fight infection should it occur.

Your Podiatrist will perform assessments to check the health of your nerve supply and bloody flow and provide assistance in managing these risk factors if they are prevalent.

Diabetes Australia advises a yearly diabetic foot check to ensure early identification of any negative changes.

For further information or to book a Diabetic foot assessment with a Podiatrist, phone 02 5926 3806.
<![CDATA[Exercising: Warm ups - what, why & when!]]>Tue, 06 Jul 2021 02:00:00 GMThttp://rhpl.com.au/blog/exercising-warm-ups-what-why-whenPicture
Warm-ups: we all know we’re meant to do them, but who really wants to waste that valuable time when you could get stuck straight in to your training or game. Especially as the temperature drops, winter sets in and everyone wants to be back indoors as quickly as possible!

You might think of a warm-up as running a couple of low-intensity laps around the oval before a training session, or jumping on the bike or rower for 5 minutes before a gym session - basically anything to get the heart pumping a bit faster and the body feeling a bit warmer, but you should think about a warm-up as much more than that!

​Let’s look at what a warm-up can really offer you…

Why should I warm up?

Studies Racinais and Oksa (2010) found that a variation in muscle temperature of just one degree Celsius can modify performance by 2-5%.

To put that into perspective - an average vertical jump height for a male is around 45cm. Adding 5% increases the jump to 47.25cm, this may not seem like much, but 2.5cm in the basketball world could be the difference between a block or a basket.

Effective implementation of a warm-up strategies also reduces the likelihood of musculoskeletal injury by loosening up your joints and improving blood flow to your muscles you are significantly reducing risk of soft tissue rips and tears, or joints twisting in a harmful way.

So what actually happens?

For us to move, our muscles contract and relax to bend our joints. As we move, heat is produced by friction from sliding filaments during muscle contractions. More blood flows to our working muscles, our blood vessels expand to help the blood flow through easily, and the viscosity (thickness) of our tissues reduces - this makes our muscles and joints less stiff. 

Like when you’re chewing gum, or playing with play dough, or preparing to roll out your famous homemade pizza dough. It can be a tough job to start with, but as you apply pressure it starts to become easier and easier to move and shape, until suddenly you’re the master of the gum/dough and it can be moulded however you want. We want to be the master of our muscles.

Elevating tissue temperatures also results in nerve impulses travelling more rapidly, meaning our rate of muscle contractions and reaction time will be faster.

So what's wrong with the 2 minute jog?

Warm-ups that include specific drills like movement preparation, muscle activation, dynamic stretching and mobility work have shown to have the most benefits to both performance (Fradkin et al. 2010), and injury prevention. So if we want to be able to sprint faster, or lift heavier, then we need to make sure we’re focusing on the right movements in our warm-ups.

​But not only from a physical perspective - when our warm-ups involve skill-specific movements it gives us the chance to visualise our goals, mentally prepare for the game or session at hand, and connect with teammates, coaches and our surrounding environment.

Then how should I warm-up?

Depending on what your session involves, each warm-up will be different:
  • Any sports involving sprinting movements need some prepared glute, hamstring, and calf muscles. 
  • Need to be jumping higher during your game? Then don’t forget to actually jump before you get on the court.
  • Planning on hitting your squat PB? Chances are much lower if your ankles aren’t going to let you get down that low, if all the muscles that make up your glutes aren’t ready to go, or your back and the small muscles around your spine aren’t able to get into the positions they need to be.
  • ​Tackling a frosty 6am run? Let’s think about what we’re wearing, and how that temperature is going to affect us.
​Not sure whether you’re getting the most out of your warm-up? Accredited Exercise Physiologist Brodie can help you find that extra 5%, for more information or bookings phone 02 5926 3806.
<![CDATA[Cortisone injections]]>Sun, 06 Jun 2021 14:00:00 GMThttp://rhpl.com.au/blog/cortisone-injectionsPicture
Are you experiencing pain in your foot and/or ankle that isn't responding well to conservative treatment?

​A cortisone injection may be an adjunct treatment option for you consider...

What is a cortisone injection? A cortisone injection is a type of corticosteroid which mimics your bodies natural anti-inflammatory hormones reducing inflammation, pain and swelling at the site of administration. ​ Cortisone injection may provide you short-to-medium pain relief for a wide range of inflammatory foot and ankle complaints such as:
  • Plantar Fasciitis
  • Morton’s Neuroma
  • Bursitis
  • Sesamoiditis
  • Synovitis
  • Capsulitis
  • Plantar Plate Tears
  • Sinus Tarsi Syndrome
  • Achilles tendinopathy
  • Tarsal tunnel syndrome
  • Posterior tibial tendonitis

What does a cortisone injection do?
There are different types of cortisone which have varied durations of action. Your GP will make a prescription appropriate to your presenting condition which can then be then administered by your Podiatrist. Typically a long-duration cortisone will be prescribed which will take effect within several weeks and last between 1-9 months, depending on your condition and the severity of it. During the period of cortisone effect it is important to continue your rehabilitation program to prevent reoccurrence of pain as cortisone effect progressively fades.

What happens during a cortisone injection?
Your Podiatrist will review the painful areas, GP prescription and any correspondence, if you have any concerns these will be discussed. Local anesthetic will be administered prior or with the cortisone to provide immediate pain relief. You may feel some pressure during administration which typically fades quickly as local anesthetic takes effect. 

How many injections are required?
Your Podiatrist will discuss with you the most beneficial treatment plan based on your injury. Often it will be guided by your response to the first injection and your injury or condition. Sometimes one injection is enough while other times multiple injections spaced weeks or months apart can be appropriate. Typically you will see your Podiatrist 2 weeks after cortisone injection to review progress and plan further care.

Risk of a cortisone injection?
Every procedure has associated risks. Potential side effects of cortisone injection include infection, bruising or reaction to the substance (eg. anaesthetic, corticosteroid). To reduce risk of complications we take great care by using sterile equipment, aseptic technique and injecting well below your safe maximum dose of local anaesthetic.

Where and how can I get a foot or ankle cortisone injection?
For further information regarding cortisone injections, our Podiatrist (Evan) and your GP can discuss which option will best suit you, for further information phone 02 5926 3806
<![CDATA[Wart treatment - curettage]]>Sun, 09 May 2021 23:30:09 GMThttp://rhpl.com.au/blog/wart-treatment-curettagePicture
What is it? Curettage is a procedure performed under local anaesthesia​ in which your Podiatrist will surgically remove the affected wart tissue and cauterise the site to prevent reoccurrence.

Not sure if this treatment is appropriate for you? Read on to find out more... 

What is the advantage of this treatment? 
Curettage is a relatively quick in consult surgical procedure, once local anesthetic is administered procedural pain is significantly reduced. Warts are difficult to treat and curettage is typically considered if topical treatments have failed. Studies report a success rates of 65% to 85% making curettage a viable treatment option.

Is it painful?
To lessen pain during procedure local anaesthetic is administered prior too commencing. There may be some moderate pain during local anesthetic administration although this will typically pass quickly as local anesthetic takes affect. Depending on the location of the wart your foot will typically be anaesthetized at the level of the ankle, your foot and the surgical site will typically be numb for 1 hour after the procedure. 

Risks and complications of the procedure?  Possible complications of this treatment include infection, reoccurrence, ulcer formation and scarring. Scarring and/or wart recurrence are reported to  occur in up to 30% of patients. As this procedure involves local anesthetic administration you will need to arrange for transportation to and from our rooms on the day of surgery. During the procedure our  Podiatrists take care to not go deeper than the epidermal/dermal layer which reduces risk of scarring and you will be provided strict post procedure care instructions to reduce risk of complications.

You must not use this treatment if:
  • You have poor circulation
  • Are living with diabetes
  • Experience needle phobia
  • Take anti-coagulants

If it does not work, what are my options? Healing of the site typically takes 7-14 days, at 2 weeks post procedure you will return for review. Wart curettage has a high success rate eradicating warts. However, there is always a chance for resistant warts to return especially when you are on immunosuppressive drugs and have diminished immune system, in case of reoccurrence further treatment options can be discussed.

Our Podiatrists are experienced in the treatment of persistent warts and can discuss which option will best suit you, for further information phone 02 5926 3806