There are many uncertainties over the exact pathophysiology of tendinopathies. With the emergence of new treatment modalities making decisions regarding management can be difficult. A systematic review conducted over the past 12 months highlights the benefits that surgery and physio have. Though the study shows very little difference between the two management techniques. The management techniques target the reduction of patient symptoms and improving function. The study has moderate level evidence and concludes that loading exercise treatment should be encouraged for at least 12 months before the idea of surgery is entertained.    

Yoga is an ancient practice, with records indicating that it has been practiced in India some form for close to 4,500 years. Since being introduction to Western culture in the 1960's, it has remained a popular form of physical activity. A physical Yoga practice usually consists of an opening sequence called a sun salutation. It is then followed by a sequence of standing and floor postures. The primary reason for commencing a yoga practice is to improve general health and well-being, and to improve muscle flexibility, strength, and endurance. Recent studies have found that a regular Yoga practice significantly improves isokinetic and isometic muscle strength. The same study also established that a regular practice can increase cardio-respiratory capacity by 6-7% in 8 weeks. This is the ability of the circulatory and respiratory systems to supply oxygen to muscles during physical activity. It has also been established that in peri-menopausal populations, a regular long-term practice has a positive effect on bone formation. Similar results have been seen in this patient population with respect to Tai Chi and bone formation.

This weekend Mitchell Physiotherapy once again ran a pop up information stand at Maitland Parkrun. One of the most common injuries runners wanted to talk about was achilles tendinopathy. This occurs when the achilles tendon is overloaded repeatedly (such as running far or often). Without allowing sufficient rest and recovery the tendon becomes swollen and painful. This may initially only occur after a run, but continually training means the pain will likely occur earlier into your run, eventually becoming continuous. In order to treat this condition we need to strengthen the achilles tendon and manage the loads it experiences during running. Calf muscles are our major propulsive force during running, contributing 25% more power to the running cycle than our quadriceps muscles. Resting and stretching are NOT the answer for this issue, as this will weaken the calf muscle and achilles tendon. (BUT you still may need to decrease your running for a period of time) Seeing a physiotherapist is vital for the rehabilitation of your tendon. They will provide you with a progressive strengthening program which incorporates the different types of load that a tendon needs (strength, power, endurance, etc). Tendon rehabilitation does take time usually 12 weeks to 6 months. This is due to tendons adapting to change slower than other soft tissues. However, if you stick to a structured and progressive loading protocol your tendon will get better. The good news by increasing the strength of your tendon and calves your Parkrun time should get better as well! If you are experiencing achilles tendon pain contact us for an appointment or come and have a chat the next time you see us at Parkrun.

Have a look at this muscle referral pattern. This muscle, Adductor Magnus can refer pain into the vagina, bowel, and lower abdomen.  On the right of the picture, is adductor magnus, the x marks where trigger points are usually located. This is one of the muscles that gets sore when you ride a horse for the first time. Adductor Magnus is a big powerful muscle, hence the name Magnus.   This picture shows where, in your body, you may experience pain if one of these trigger points becomes active. An active trigger point is a focal area of intense muscle activity that does not relax, this then becomes painful, and can refer pain to other locations in the body. Adductor Magnus can be implicated in women that experience pain during intercourse, lower abdominal pain and deep bladder pain. We generally get trigger points in muscles that are weak and then overloaded, however this is not the only cause. Accepted treatments to settle trigger points are either ischemic pressure or dry needling. Beware that there are big important muscles and blood vessels in the upper thigh, and you don’t want these interfered with, so make sure your therapist is well trained. I recommend using a physiotherapist with dry needling training. Remember pain in this area can be due to a number of medical conditions also, do not discount these make sure you are checked by a doctor. It may not be obvious that the muscle is causing the pain, and even when testing the muscle, it may not be obvious.

Sean graduated from the University of Newcastle with first class honours in 2015 and currently operates out of the Maitland and Dungog clinics. Sean prides himself on patient education and providing clarity with regards to the rehabilitation process. He has a passion for sport- with particular interest in football and currently plays for Beresfield USSC in the ZPL and has recently finished working with the Maitland Blacks Rugby Club as their club physiotherapist (2016 and 2017). His interests in physiotherapy lay in post-surgical rehabilitation, Parkinson’s disease and sporting injuries. Sean utilises techniques including advanced dry needling and also designs individualised exercise programs in order to suit patient needs. This also includes the Parkinson’s Disease Warrior exercise program- a specialised set of exercises tailored to stem to progression of the neurological disease. Sean also instructs weekly mat based pilates classes out of the Dungog location. Mitchell Physiotherapy has been a stalwart of healthcare in the Hunter region for over 40 years. With over 10,000 success stories, we pride ourselves on patient centred care and strong communication channels. Our dedication to being ‘simply the best’ has seen the clinic grow into more areas of speciality, inclusive of Women’ Health, Hand Therapy and until recently, a specialised neurological service. We have a passion for improving the quality of living for patients particularly with Parkinsons disease. All too often patients are given dated advice on generalised exercise programs. This passion has led to rolling out the PD Warrior program in the Hunter, and enables us to be at the forefront of neurological rehabilitation.

Vertigo is defined as the feeling that you or your surroundings are moving when they are actually still. It is a sensation often described as feeling like you are spinning, swaying, tilting or falling. Vertigo is often associated with nausea, vomiting and sweating. Your balance may also be affected and standing or walking may be challenging, which can lead to increased chance of falls. Vertigo affects your vestibular system. The vestibular system is the sensory system that controls information regarding motion, equilibrium and spatial orientation. Causes Vertigo is most commonly caused by a condition called BPPV or benign paroxysmal positional vertigo. This occurs when tiny calcium particles clump together in the inner ear and become loose, affecting the balance receptors and messages sent to the brain regarding balance. Symptoms are often triggered by lying down, rolling over in bed or tilting the head backwards. BPPV usually affects people older than 50 years. There may be no obvious cause, but in some cases it may develop after a minor head injury, ear surgery, or following a period of prolonged bed rest. Symptoms

• Loss of co-ordination/un-steadiness
• Nausea
• Sweating
• Blurred vision
• Ringing on the ears
• Headaches

 Treatment Treatment depends on the cause. In most cases vertigo goes away without treatment. For instance, vertigo may go away in a few weeks as the brain learns to compensate for an imbalance caused by the inner ear. However, if symptoms persist treatment options are available

• Vestibular rehabilitation or balance training – this is a type of physical therapy that strengthens the vestibular system and aims to restore a person's sense of balance using other senses​
• Canalith repositioning procedure – this is useful if the cause is BPPV. The treatment aims at moving these calcium deposits out of the inner ear canal so they can be absorbed by the body

A couple of techniques which Brian Mulligan developed are for regaining ankle dorsiflexion that is pulling your toes towards you, and plantarflexion or pushing them down or away. The first technique uses a movement of the tibia and fibula forwards while pushing the talus and navicular back. The patient is then asked to dorsiflex their ankle while overpressure is applied. It is interesting that the joint is moving in the opposite direction to which you would expect. This is because the joint actually glides as well as moving and getting the glide part right first, gives a much better result.

The second technique for plantarflexion is where the tibia and fibula are moved back and the talus and navicular are moved down while the patient is asked to point their toes and ankle down. Again this relies upon a pain free technique and a glide of the joints before the movement occurs.

These techniques can work very well in stiff ankles.

By Melissa McConaghy The problem with Parkinson’s is not that it slows you down, that it impairs your thinking and can make you depressed. The problem with Parkinson’s is that it takes away your control – your independence, dignity and ability to do the things you want to do. Sometimes it takes away your hope. The medical model that manages Parkinson’s makes this even worse – medications, while an important part, take you further into the sick role. Taking medication is a relatively passive activity where you have minimal control over the outcome. Time and time again I used to meet people like you. I would hear their frustration, their fears of the unknown. What were they going to be like in five years, 10 years? Before, I didn’t really have much to offer. I was only starting to work with people in the moderate stages of their disease when falls and daily life were becoming really bothersome. I was well trained to work on balance, walking and daily skill training – but not much really changed long-term. As a therapist it was not satisfying work and it would have done little to have improved your situation. Now, with PD Warrior – it is very different. Because I know that I can help, that PD Warrior can help. PD Warrior was originally designed just as an exercise program. The physical results were amazing, it was a novel treatment, we were working people harder and more specifically for their Parkinson’s and people were loving it – but there was something even more amazing. People’s levels of confidence and quality of life were improving. Their perspective on how they were going to live with their Parkinson’s was changing. They were making friends with other people who were also working hard to be their best. People were starting to drag their ‘bucket list’ out again. They then started ticking things off. Cycling up the hills of the Tour de France, travelling to Antarctica, returning to playing Tennis, golf, looking after the grandkids. Folding the laundry. Creating their own support network. None of this was insignificant. PD Warrior was giving people hope that there was life after diagnosis. That they could regain the control they thought had been taken away. They were developing a self-belief they didn’t even know they’d lost. And word was spreading fast. PD Warrior has now touched the lives of thousands of people around the world and has challenged both medical and health professionals to reflect on the current model of management. It has created a community of people who want to connect, engage and support each other – through the highs and the lows. PD Warrior remains in direct contrast to traditional management and we now know that taking medication is not enough. We want to see you early, work you hard and help you set up a strategy to keep exercising well, long into the future. So, if you thought PD Warrior was all about the exercise, you’ve missed the most important part. PD Warrior is about helping you have a better life, in spite of and because of your Parkinson’s. PD Warrior has changed lives, and we’d like to change yours too. Join the community and do something your future self will thank you for.   About the author Melissa McConaghy I am the owner and creator of PD Warrior. As a physiotherapist with a special interest in Parkinson's and neurological Rehab I am here to help!  

This group of drugs include, codene, endone and morphine. They have a direct slowing effect on the bowel. The drug binds with the opioid receptors located along the length of the gut. The end result is decreased peristalsis (muscle action in the gut to move contents along), decreased fluid secretion, vital to keep the stool soft and moist, increased sphincter tone, (the valves become smaller), increase fluid absorption, drying out the stool. This has become such an issue that we now have a label, Narcotic Bowel Syndrome. People with pelvic pain syndrome may well be making themselves worse by taking pain medication that is opioid based. It is important to keep your pain under control but there are other medications and methods that maybe need to be explored.  Many people ask me “should I use ice or heat?”. My answer is always the same, use what ever gives you relief. Ice is intended to help settle inflammatory pain, which it does pretty well in the acute setting. While heat tends to work better where there is muscle or joint pain of a more long term nature. What many people don’t try is placing the heat or ice pack, against the labia, in the Saddle region. Lots of relief can be gained doing this, get 2 pack one down there and one on the tummy. There also stick on heat patches, one use only. These last up to 12 hours and would be great as panty liners. We have these at our practice and they are cheap and effective. I placed one on as a trial. Put it on at 7.00pm wore it all night to bed and was very surprised when it was still emitting a gentle heat the next morning. Great if you have to travel, if at an event, or just going to work. I am not sure about use during plane flight. May not get through security as it relies on a chemical reaction, to make it work.  

A complete half a day was dedicated to IBS at the International Pelvic Pain Conference. The reason being is that this is a very common illness which can cause pain in the region of the pelvis. If you suffer from IBS you will know that IBS is a cluster of symptoms, including pain, constipation, diarrhoea. It appears that researchers are getting closer to a brain/neurology model of irritability. We are becoming more and more aware as health professionals that the mind and body are intimately linked. There is now work looking at transcutaneously (through the skin) stimulating the vagal nerve, which is leading to reduction in bowel irritability. Obviously there is more work required, but the research is well underway.