Tips for Rehab After Knee Surgery

iStock-928854906.jpg

 

How should I prepare?
Before the surgery, have a good chat with your surgeon about the amount of time you will need off work. Make sure you’re made aware of any rehabilitation requirements, for example any post op restrictions, how quickly you need to see the physio, or any exercises you should begin (or avoid!) straight away. Also discuss your own personal goals and get a rough idea about when you will be able be able to get started with your recreational activity of choice, whether that be the odd run around the block, or the half iron man 6 months from now!
It’s also worth noting that prehab is the best rehab: the stronger your knee can be leading up to the surgery, the better results you will get afterwards. If you can, get your physiotherapist at Rolleston Central Physio to make you up a program prior to going under the knife for best preparation!

 

What should I do immediately after surgery?
The knee will be swollen and painful following any type of surgery. Regular icing, elevation of the leg and use of a compression bandage will assist in settling down oedema as soon as possible.

The knee is somewhat predictable in its post op behaviour, whether you’ve had an ACL reconstruction, minor arthroscopy or knee replacement. Your stabilising quadriceps muscles have a tendency to switch off in the presence of any pain or swelling, which can lead to rapid wasting (atrophy) of your thigh muscles. This in turn can lead to feelings of instability, weakness and poor tracking of your patella. To address this quickly, you can start an exercise called ‘quads setting,’ which aims at getting your quads muscles activated so that they can do their job controlling your knee!

To do this, lie on your back and straighten your operated knee as much as possible. You can place a towel under your heel to help if you like. Then tighten the muscles at the front of your thighs, and press the back of your knee to the ground. Hold for 3-5 seconds, then relax. Repeat x 10 repetition, 3-4x per day.

Swelling and pain will also cause your knee to stiffen up and lose its range of movement. Starting some range of motion exercises (bending & straightening the knee, within your pain limits) early on will ensure that you regain your movement again quickly. Take note that some surgeons may request splints or movement restrictions for a portion of the post-op period, so be sure to follow your post op guidelines for this.

 

When should I see the physio, and what will physiotherapy involve?
We usually recommend seeing a physio within the first week to ten days following any joint surgery, as long as you are working on your swelling management, range of movement and quads setting exercises at home in this time – otherwise you may want to see them sooner. Your sessions will include some soft tissue massage and joint mobilisation, however the most emphasis will be placed on your home exercise or Pilates rehab program. This will address your specific weaknesses and often include strengthening of not only your thigh muscles but also those of your hip and core.

As you become stronger, your program will include sports specific drills, in order to progress you right on through to your recreational goals!


Lunges are commonly used for lower limb rehabilitation, particularly when returning to running or sport. 
 

 

 If you have any questions or would like some advice, feel free to give us a call at the clinic, or come in to see one of us today!

Benefits of exercising outdoors this winter

iStock-546183858.jpg

The weather's getting colder and sometimes it’s hard to fight the urge to rug up in front of the tv with a mug of hot chocolate. Sure, there’s nothing wrong with having a little downtime once in a while, but it’s important you don’t let the cold weather stop you from getting your dose of daily exercise.

If you're anything like me, the thought of stepping into a sweaty gym isn’t exactly at the top of your list of favourite things to do. I prefer to get my exercise the old fashioned (and non-expensive) way – walking.

So I’ve done a bit of research on ways to keep myself warm and safe while continuing my walking routine this winter – despite the colder weather. These same points apply if you're a runner or enjoy doing any sort of outdoor exercise:

 

  • Wear suitable clothing: Be aware of the weather conditions (including wind chill factor) and dress appropriately. Choose fabrics that will keep moisture away from your skin to stop you from getting wet and cold. Wearing lots of layers is also a good idea as you can discard them as you get warmer. And of course, brightly coloured clothing is a must for walkers and joggers for visibility. As one-third of your body heat escapes from your head, remember to grab a hat (as well as gloves) before you head out the door.
  • Safety first: Venture out in daylight as much as you can and be careful to avoid muddy, slippery surfaces. If you must head out at night, take a torch and wear reflective gear.
  • Drink lots of water: Even though it's not as muggy, keeping your fluids up is as important in winter as it is in summer.
  • Warming-up: If you are a jogger, set some extra time aside for your warm-up exercises. This is really important for warming up tight muscles in order to prevent injuries. And always remember that it's not a good idea to run when you have a flu or a cold, as it puts extra stress on your heart.

Just in case you need any more reasons for keeping your daily exercise routine outdoors this winter, check out these added benefits:

 

  • According to international studies, moderate exercise can boost your immune system and help fight off bacterial and viral infections. When your blood gets pumping, immune calls travel through your body at a faster pace which helps them to seek and destroy lurking infections.
  • You will burn more calories too, because your body is working harder to keep warm. As your metabolism gets cranking your body will burn more calories and fat to produce more energy.
  • It will boost your mood! If you’re someone who feels a bit blue when it’s all dark and chilly outside, exercise endorphins really help to pick you up and lift your mood. Also, you’ll get the benefit of increasing the production of mood-elevating Vitamin D.
  • And finally, it’s great for your will-power. After a couple of days of biting the bullet and heading outdoors, it will become easier to ignore the cosiness of the couch and instead burst outside with great gusto on a regular basis.

Don’t let the cold keep you inside this winter! Throw on a couple of extra layers, get outside and get moving – your body and your mood will thank you for it.

Posture, stress, headaches, back pain & so much more

iStock-863102258.jpg

Technology has advanced at an exponential rate and computers, tablets and mobile phones demand more of our time and energy and the amount of ‘screen time’ the average person spends per day is on the rise.

Even whilst writing this, I am adding to my own tally of time in front of a screen.

Prolonged screen time often relates to poor posture, especially for hand held devices such as smartphones or tablets.

A study of the biomechanics of the neck reveals that the weight of the head and subsequent work of the surrounding muscles increases exponentially with every inch forward of head position.

As the graphic below demonstrates, a head that normally weighs 5.4kg, can increase up to 19kg simply by being three inches further forward of the tip of the shoulder.

To put it in perspective, hold a 5-6kg weight close to your body and you will find it’s very easy to hold for a long time.  Then attempt to hold a 19-20kg dumbbell with an outstretched arm; with the resulting fatigue being similar to what your neck, shoulder and back muscles all have to endure with bad posture.

Poor posture and head-forward position leads to a myriad of neck, back, and shoulder injuries.

Cervicogenic headache’ (referred from the neck) is also a common problem amongst those with poor posture.

What can you do about it?

Make sure your office chair is at the right height, use a tablet or document holder at the computer and keep the tablet at eye level.

Exercises such as a ‘chin tuck’ (moving your chin and head backwards into a more neutral position) or incorporating a ‘seated row’ into your workout, to improve mid-back strength, can also help.

As Aristotle said, “We are what we repeatedly do, excellence then, is not an act, but a habit”.

If you are suffering from headaches, shoulder or neck pain then feel free to book an appointment with one of the team at Rolleston Central Health to help you turn good posture into a habit!

How Physio can help Arthritis

download (1).jpeg

 

How Physio can help Arthritis

Keeping moving is vital if you have arthritis. Physios are qualified and skilled in getting you moving around more freely despite your arthritis. They'll start by talking to you about your symptoms and your medical history so they can understand how your life is affected.

 

What is arthritis?

Arthritis means inflamed joint, when the joint is inflamed it can be sore and stiff. Sometimes it can be hot, red and swollen. People with arthritis can find it difficult to do everyday things such as getting dressed, walking to the shops, cooking and playing sport. More than half a million New Zealanders will be affected by arthritis at some time in their life. There is currently no cure for arthritis, but there are effective treatments, physiotherapy can help.

 

How can physiotherapy help?

A physio can help you manage your arthritis and continue (or return to) an active life doing the things you enjoy. Physio can also help with;

  • Managing your pain
  • Becoming stronger, fitter and more flexible
  • Staying active and independent
  • Avoiding or delaying the need for surgery

 

Exercise and arthritis

Your physio will work with you to develop an exercise plan that's right for you. This may involve some strengthening and stretching exercises. It'll also include general activities such as walking, swimming or whatever you enjoy that's beneficial to you. Your physio will help you get the right balance between activity and rest so you keep active without feeling undue pain.

 

Exercises you can try

If you are looking for exercises you can try then check out this ebook; exercises to keep you moving. Produced in partnership with Arthritis NZ it details simple exercises that you can do while sitting, standing or lying in bed. We hope this makes it easier for you to pick out a few exercises for the areas of your body that are causing you problems and fit them into your daily routine. Most exercises in this guide are stretches to help you get the basics right. There are also a few to help you improve strength. If you are unsure which type of exercise is best for you, we recommend you consult your health professional before beginning.

Does it really work?

Physiotherapy has helped people with arthritis reclaim their lives by increasing their movement, functioning and decreasing their level of pain. For some real stories watch our case studies on this page – they feature:

  • Jocelyn – who worked with a physio before and after her hip replacement, she is now enjoying being able to climb stairs again – without the pain or fear.
  • Whai – was told he’d soon be in a wheelchair, Whai’s now pursuing his career as a musician after his physio got him walking unaided in just a few months.

How does physio fit with my medical treatment?

Your physio assists with the physical side of your treatment and your doctor with the medical side. Your physio will work closely with you and your doctor to share information and review your treatment.

Plantar Fasciitis

iStock-928854866.jpg

What is Plantar Fasciitis?

Plantar Fasciitis is the most common source of heel pain in adults. Here the fibrous tissue under the foot becomes irritated and inflamed, and causes pain when running, jogging or walking.

 

Symptoms of Plantar Fasciitis

The following shows the common signs many people with plantar fasciitis complain of. Many experiences one or more of the following symptoms

  • Heel pain with the first steps in the morning or following long periods of sitting/lying
  • Pain in the inside of the heel
  • Limping during walking due to pain
  • Pain becomes worse when on barefoot or hard surfaces, such as; concrete and tiles
  • Pain in the heel when climbing stairs
  • Pain in heel during jogging, jumping, running or walking

How is Plantar Fasciitis Diagnosed?The physiotherapist is able to diagnose plantar fasciitis through your symptoms, history, and examination. Usually, those with plantar fasciitis have recently taken up a new activity such as long distance running and complain of a sudden onset of heel pain. Pain is usually worst in the morning and after long periods of sitting or lying. On examination, the physiotherapist may fell around the heel in order to see if there is any swelling or tenderness in the area. They may also look at movements of the ankle to see if it causes pain or if there is any restriction to normal movement.  The physiotherapist will generally look at your walking and/or running patterns, and foot posture to see if it could contribute to the symptoms present. On some occasions, you may be referred for an ultrasound or  x­‐ray to see if there is any damage to the bone or tissues in the area1.

 

What Causes Plantar Fasciitis?

The plantar fascia is a strong tissue structure located at the bottom of the foot connecting from the heel to the toes. Its role is to support the bones and arch of the foot in order to push off from the ground during walking, running or jumping. The plantar fascia also provides shock absorption when the foot is placed on the ground. Certain sports and activities, including those with repeated running or jumping place a lot of repeated stress on the plantar fascia bruising or overstretching it causing inflammation and heel pain. Also, those who have a high or low foot arch may also be at a greater risk of developing plantar fasciitis due to higher amounts of stretch and reduced shock absorption respectively.

How is Plantar Fasciitis treated?

At first gentle stretching of the plantar fascia is recommended to help with the healing process. Taping is another common technique a physiotherapist may use and suggest to help decrease the stress on the fascia especially during activity, where the pain is made worse. In the taping technique the tape is pulled under the heel and foot to help lift up and support the arch of the foot. The physiotherapist may recommend orthotics to place in the shoes to help distribute the pressure on the feet more evenly, which may help relieve the pain. Most often the physiotherapist will help provide a series of stretches and leg exercises to help stretch out the fascia and strengthen the muscles to help provide stability to the ankle.

Athlete Development, 6 Active Listening Techniques for a Coach or Parent

iStock-488653307.jpg

I’ve been lucky enough to interview many of New Zealand’s best athletes, both on the Athlete Development Show, and in the halls of AUT Millennium. One of the topics I love to ask the athletes about is the influence their parents had on their development and what they did to support their sporting journey.

Overwhelmingly, the stories are the same. Athletes speak of unconditional love and support, particularly through the tough times. They talk about parents who spent a lot of time providing taxi services, attending games, and who showed a keen interest in what they were doing without being overly pushy or offering too much advice. Ultimately, I’ve learnt from all my conversations with elite athletes that the best sporting parents spend more time listening than talking.

So, with that in mind, here are 7 active listening techniques to ensure you’re paying attention to what your child is saying and that you understand what is being said.

1) Affirmations

Nodding, saying yes, OK, or aha as your child speaks shows you’re interested and really care about what they’re saying. Most importantly, accompany your affirmations with eye contact.

2) Silence

Resist the urge to break the silence. It’s tempting to answer your own questions, or ask a second before giving your child time to think and respond to the first. If you ask a question about their game or competition, be patient enough to wait for the answer. Sometimes, particularly when there’s emotion attached to the answer, it might not come until later that evening, the following day, or even a week later.

3) Rephrasing

Get good at paraphrasing. That is, rewording what your child has said back to them. This is a great way to clarify that what you heard was right. The thoughts and feeling of new and challenging experiences in sport, such as losing a tight game, can be difficult to put into words, especially when you haven’t yet had the time to decipher it yourself.

4) Reflection

Adding emotive or behavioural reflection to a conversation, for example “that must have been difficult”, or “I could see that you’re upset”, shows you’re listening. What’s more, it also makes sure you get the right detail so that you can provide valid advice or help if it’s asked for.

5) Listening between the lines

Try to pick up on the little things that your child is alluding to or saying without directly addressing them. Often, it’s the little things that are hiding the struggles, and real pleasures for that matter, of your child’s sporting experience. And it’s not until you know what these are that you can ask more about them. For instance, listen for the genuine reasons why you child is loving the game, or becoming less motivated to play (e.g., a coach who doesn’t listen).

6) Summarise

Capture the key points from what you’ve heard in a conversation with your child so that you can decide what to do with it next. You may need to follow something up with a coach or teacher, look for ways to help your child through a challenging time, or file it under ‘unimportant’ and move on.

What have you learnt about communicating with your children to help them do better in sport? I’d love to hear about it in the comments below.

Be the best you can be,

Patellar Tendinopathy (Jumper’s Knee)

iStock-627817656.jpg

Patellar tendinopathy is common in jumping sports such as basketball, volleyball etc. in recognition of its association with jumping, patellar tendinopathy was first described and is commonly referred as to as “Jumper’s Knee” This term is misleading, however, as the condition is found in a wide variety of sports people, including those who do not participate in sports involving jumping eg. Tennis and aerobics athletes are also at risk.

Patellar tendinopathy (jumper’s knee) is a clinical diagnosis of pain and dysfunction in the patellar tendon. It most commonly affects jumping athletes from adolescence through to the fourth decade of life. This condition affects health and quality of life by limiting sports and activity participation for recreational athletes and can be career-ending for professional athletes. Once symptoms are aggravated, activities of daily living are affected, including stairs, squats, stand to sit, and prolonged sitting.

 

Clinical presentation

  • Patellar tendinopathy presents initially as well-localised anterior knee pain related to activity levels.
  • Pain is usually insidious and gradual in onset, and may be precipitated by an increase in the frequency or intensity of repetitive ballistic movements of the knee.
  • Initially pain may present as a dull ache at the beginning of or after strenuous activity. This initial symptom may be ignored as it warms up with further activity. With continued use; however, pain can progress to be present during activity and can ultimately interfere significantly with performance.
  • In some cases there is a constant ache at rest and night pain that disturbs sleep.
  • Other common complaints are pain when seated for long periods, and when ascending and descending stairs

 

Clinical Examination

Palpation

  • The most consistent finding is patellar tendon tenderness this is typically located at the inferior pole of the patella.
  • It is influenced by knee position .With the knee flexed to 90 the tendon is placed under tension, and tenderness significantly decreases and may disappear altogether. Thus, the patellar tendon should be palpated in relaxed full-knee extension.

Observation

  • Patients with chronic symptoms may exhibit wasting of the quadriceps, with the vastus medialis obliquus portion most commonly affected. Overall thigh circumference may be reduced and calf atrophy may also be present.

Functional Strength

  • Functional strength testing of the quadriceps may be performed by asking the patient to perform 15 one-legged step-downs in which the non-weight–bearing foot is not allowed to touch the ground between cycles
  • The work capacity of the calf can be assessed by performing single-legged heel raises. Both straight knees and bent knees, A jumping athlete should be able to perform a minimum of 40 raises
  • During both activities the onset of fatigue and the quality of movement should be monitored, and both activities should be performed bilaterally.

Key Functional Test

A key test is the single-leg decline squat. While standing on the affected leg on a 25 deg decline board, the patient is asked to maintain an upright trunk and squat up to 90 deg if possible.

The test is also done standing on the unaffected leg. For each leg, the maximum angle of knee flexion achieved is recorded, at which point pain is recorded on a visual analogue scale.

Diagnostically the pain should remain isolated to the tendon/ bone junction and not spread during this test.

Single Leg Decline Squat is an excellent self-assessment to isolate and monitor the tendon’s response to load on a daily basis.

Other Objective clinical test including single limb balance with eyes closed, depth of single limb squat, calf strength, repetitive single limb squats, modified gluteus maximus manual muscle test, gluteus medius manual muscle test, forward plank, side plank, knee to wall ankle dorsiflexion test, hamstrings flexibility test, Thomas test, hip internal rotation, and hip external rotation & Bio-mechanical assessment including Lower Extremity contact angle, knee joint angular stiffness etc. Are also essential to prevent and diagnose the conditions like Patellar Tendinopathy. 

Differential Diagnosis

The history and examination are crucial to distinguish patellar tendinopathy from other diagnoses including: patellofemoral pain; pathology of the plica or fat pad; patellar subluxation or a patellar tracking problem; and Osgood-Schlatter disease.

Imaging

It is commonly clinically diagnosed in conjunction with imaging (ultrasound or magnetic resonance, often to exclude differential diagnoses such as patellofemoral pain), where structural disruptions on the scans represent areas of tendon pathology. Importantly, there is a disconnection between pathology on imaging and pain;

It is common to have abnormal tendons on imaging in people with pain-free function

 

Risk and Associated Factors for Patellar Tendinopathy 

  • Gender :- Men > Women
  • Waist Circumference :- increased circumference higher the risk (It has been reported that men with a waist circumference greater than 83 cm are more likely to have abnormal changes on imaging
  • Hamstring Length :- Less extensible hamstrings – increase risk of patellar tendinopathy
  • Quadriceps length :- Stiffer quadriceps increase risk of patellar tendinopathy
  • Dorsiflexion (ankle mobility) :- Reduced dorsiflexion associated with increased pathology
  • Landing Strategies :- Less knee bend at landing (stiff knee landing), altered hip strategies associated with pathology
  • Fat Pad Size :- Increased fat pad size associated with patellar tendinopathy
  • Loading :- Excess loading associated with patellar tendinopathy

Treatment

Conservative v/s Surgical

No advantage has been demonstrated between surgical treatment and eccentric strength training. Therefore, eccentric training should be tried for 12 weeks before open tenotomy is considered for the Treatment of PT.

 

Balance: How to Jump Higher and Run Faster

iStock-648875254.jpg

In sport, athletic prowess matters. Subject to equal levels of skill, the fitter, faster, stronger athlete most often prevails. But it’s not only in competition that athletic primacy rules. So does avoiding injury. Stronger, more athletic athletes get injured less. Period. And every athlete I talk to agrees; the less time battling injury, the better! So, deliberately developing athleticism from a young age, on top of the inherent gains from just ‘playing’, is essential.

The road to athleticism begins by devoting time to its development. This is tough in today’s day and age, where a young athlete’s schedule is packed from an early age. But, like learning any new skill, accumulating hours and hours of practice is vital. The next step is to decide what a young athlete should focus their time on.

A few components of fitness come to mind. For starters, speed. Speed is a hugely prized skill at all levels of sporting performance due to its obvious links with success. A high level of aerobic fitness is also important, particularly in endurance and team-based sports. The fitter you are, the harder you can go for longer. Being fit also increases your ability to concentrate during a game, and recover more quickly once it has finished. And finally, muscular strength and power, which has been described by researchers as key ingredients in long term athletic development.

Speed, fitness, strength and power are often what are focused on in youth sport environments. However, to focus solely on them would be remiss. Consider a footballer’s ability to evade an opposing player with pace, before taking a centring pass on the half volley and scoring a goal. Speed, often expressed at distance travelled per unit of time, is the defining athletic factor. It’s the result of the total force generated each time the foot hits the ground, together with the amount of time spent on the ground.

But, principally, speed relies on good balance.

As it happens, a fundamental step in increasing a young athlete’s speed, is improving their balance. The ability of a young netballer to successfully perform an on-the-run rebound is no different. Any movement performed at high speed, and in an unstable position, requires incredible balance.

An association between balance, strength and power in youth athletes has been demonstrated by Hammami and colleagues in a paper they published in the Journal of Paediatric Exercise Science in 2016. In the study, 130 soccer players between the ages of 10 and 18 years old with a minimum of 4 years of soccer training, 3 times per week, were recruited. Using a scientifically validated method, participants were placed in three groups accordingly to their maturity status; prior to adolescent growth spurt, mid adolescent growth spurt, and post adolescent growth spurt. Each participant then completed tests to assess their static balance, dynamic balance, isometric back strength, and leg power. Three separate tests were used to measure leg power, including the standing long jump, a vertical jump, and a 3-hop jump. The findings showed a positive correlation (i.e., when two variables move in the same direction) between balance and the strength/power variables. Although associations were most clear for the post adolescent growth spurt group, medium to large correlations were shown across all participants.

For athletic development coaches working with young athletes, there are a few important points to take away from this study. First, effective programming for youth athletes requires knowledge of when to apply an appropriate training stimulus during development. The natural development of a young athlete interacts with athletic training, resulting in adaptations unique to adolescent populations. Therefore, what is important, or what works, for older athletes, doesn’t necessarily apply for a youth athlete. Second, based on the associations observed in this study, youth athletes with improved balance should performance better on tests of strength and power. And third, balance capabilities are an integral part of developing strength and power and, therefore, should be prioritised for the young athlete.

Finally, for parents interested in ways to enhance the athletic potential of their child, providing opportunities to challenge balance in both structured sport and playful environments (i.e., the backyard), is recommended.

In next week’s article, you’ll learn about 5 great exercise for developing balance.