According to Brendan Browner, a Physiotherapist with 20 years experience and specialising in the McKenzie Method of diagnosing and treating back pain, the most important thing you need a practitioner to do for you is to distinguish between treatable problems (mechanical back-pain) and non-treatable and  more serious causes (non-mechanical back pain). So here are 3 questions you should ask prior to choosing your practitioner:

1. How much 1:1 time will the practitioner spend with me on my first visit? – 1-hour is preferred. Anything less makes mistakes in diagnosis more likely.
2.  How many appointments per hour does the practitioner take for a first visit? – Only one. If the practitioner is taking 2 or more patients/hour for your first visit they will spend less time with you.
3. Will I leave the first session with a clear strategy of how to manage the problem myself? – This should include simple exercises and definite instructions on modifying behaviour. Without this advice any benefit from treatment will not last and you will have to visit the practitioner more often (Hmm I wonder who that is benefiting!!).

First thing, whatever you do, do not let Larry the trainer smear Dencorub all over the injury site and attempt to “rub it out” (no matter how many years Larry has been at the club, nor no matter whether he played first grade back in the days of Artie Beetson).  Also, do not crack open seven VBs to drown your sorrows over your long lost try.

When an injury occurs the body sets up a chain of events called the inflammatory process which lasts 2-3 days and is vital for recovery.  Part of the process is the bleeding and swelling that occurs. The swelling, although restrictive and uncomfortable, contains enzymes that cause the blood to clot and dissolve the damaged tissues.  While all of this bleeding and swelling is going on you can help things along.  The R.I.C.E. principle of injury management is the general rule-of-thumb for damage control.

REST:  Resting from vigorous or pain-producing activity will minimise the extent of damage, and prevent further damage to the already hurting tissues.  Be guided by pain and swelling in regards to activity levels.

ICE:  Ice reduces the bleeding by causing the blood vessels in the area to constrict or narrow.  Alcohol on the other hand, causes the peripheral blood vessels to dilate or widen and increases the blood flow to the area.  Although alcohol will numb the pain while you are out that night at Cargo Bar, it will only make your bleeding and bruising worse the next day.  Massage will also increase the blood circulation in the area and worsen bleeding and swelling.  It too should be avoided for the first couple of days.

COMPRESSION:  Compressive bandaging helps the blood to clot and stops the injured area from ‘blowing out’ with too much swelling. Firm bandaging should be worn during the day but should be removed when you go to bed at night (just in case it’s a little too tight and causes a couple of toes to drop off in your sleep).

ELEVATION:  Elevation aids in swelling reduction by using gravity to drain fluid back towards the heart.

So next time you injure yourself go straight for the ice-pack, grab a Gatorade, elevate and compress your injured body part and take it easy for a couple of days.  Any queries on this article please email me at info@protherapy.net.au.

The shoulder is a ball-and-socket joint, with the humerus, or the arm bone, sitting in the socket of the scapula, or the shoulder blade. The socket is terribly shallow and the ball is particularly big, making dislocation of the joint relatively easy. Dislocation occurs when the humerus and shoulder blade separate and the joint surfaces are no longer in contact with each other. Ouchy wah wah!

Most times the shoulder will “pop out” forwards, or anteriorly, and occasionally it will dislocate backwards, or posteriorly. The shoulder dislocates anteriorly when the arm is in an elevated and outwardly turned position, such as a tackle or a fall, or when the arm is pulled vigorously outwards and backwards by another player. One example of how the arm can dislocate posteriorly is by punching a vending machine when it takes your money and your can of coke doesn’t drop (that’s how one of my recent female patients dislocated her shoulder).

When the shoulder dislocates it really hurts, just ask Benji Marshall or Petria Thomas who dislocated her shoulder reaching to turn off her alarm clock. The arm hangs loosely beside the body and it looks awfully weird compared to the other side. The athlete will generally know that something is very wrong or out-of-place. An X-ray is indicated to check alignment and once a fracture is excluded some lucky person can attempt to relocate the joint, preferably not Larry the trainer, and preferably with the help of some nitrous oxide (for the patient, not Larry).

After the shoulder has dislocated once there is a massive probability that it will happen again, especially if the athlete is young. When dislocation becomes recurrent surgery is generally indicated. Lucky for the Sydney Swans, Leo Barry and Jason Ball had their shoulders reconstructed well before last year’s grand final. And luckily for the Galloping Greens and the NSW Waratahs, Timmy Wright, my physio colleague at Pro-Therapy and the skinniest man to ever play opposite a 110kg NZ maori, also chose a shoulder reco some years back.

If you have any queries about shoulder dislocations or their treatment please contact me at info@protherapy.net.au

The calf muscle, technically know as the gastrocnemius, is the big muscle at the back of your lower leg. It is a powerful muscle that plantarflexes, or points the foot downwards, and it gives you strength when you go to push-off to run or jump. Damage to this muscle is common in dynamic sports with rapid movements such as tennis, squash, basketball, football and or course netball.

When the calf is torn there is a sudden pain in the leg and the athlete often feels as though they have been hit by something. When I tore my left calf three years ago I literally turned around on the netball court to see where the tennis ball had come from. Unfortunately there was no tennis ball just a torn muscle.

Once the calf is torn there will be tenderness over the tear site, swelling and bruising and sometimes you can see and feel a gap in the muscle tissue. People come limping into the clinic, often on crutches, unable to put their heel to the ground due to pain.

Initial treatment follows the RICE principle then progresses to many weeks worth of some of the most painful massaging and stretching known to man. Massaging out a calf tear will reduce even the biggest men to tears. It is, however, essential as an untreated muscle rupture will lead to scarring, and will put the athlete at massive risk of repeated rupture (I wish I had written this article 6 months ago and could have taken my own advice!).

Before returning to sport/activity the calf needs to be re-strengthened. Physios will graduate your strength programme specific to the demands of the sport, and return to playing can only be considered when all repetitive testing activities are strong and painfree. A good rule of thumb is that when the leg feels good, give it another week…the injury is possibly one of the most recurrent and annoying injuries we treat.

For more information contact me on info@protherapy.net.au

There are two cruciate ligaments in the knee, the anterior and the posterior. The ACL is the weaker of the two and is more readily torn. It attaches to the tibia (the shin bone) at the front of the knee joint, passes backwards through the knee and attaches to the femur (the thigh bone) at the back of the joint. It prevents the thigh from moving backwards on the shin, and prevents knee joint hyperextension.

Landing from a jump, pivoting or decelerating suddenly are the most common ways of tearing the ACL. Often the incident is minor and no contact from other players is involved eg: Ricky Stewart who tore his ACL changing direction in back play. Most people report hearing a “crack” or a “pop” and initially feel extreme pain in the knee. The joint will usually swell very quickly and becomes very difficult to move.

The knee joint becomes very unstable when the ACL is torn. Living without an ACL can involve frequent falling down stairs, falling off ladders and embarrassing knee buckling episodes, usually when you are carrying a tray of drinks. Generally if athletes wish to return to twisting, turning and pivoting sports, and not resign themselves to a life of lawn-bowls, then surgical repair of the ACL and any other damaged structures such as other ligaments or cartilage is highly recommended.

The operation is done via keyhole surgery, or arthroscopically, and replaces the torn ACL with a graft that is most commonly taken from the hamstring tendons at the back of the knee, or the patella tendon at the front of the knee. Alternatively, you could be like Alisa Camplin and take your graft from the Achilles tendon of a dead man! I kid you not!

Surgery is followed by at least six months of intensive rehabilitation before the athlete can even consider returning to sport. It doesn’t matter how diligent people are with their rehab programmes, the graft has a mind of its own and will strengthen itself with time. People who do not follow the instructions of their surgeons/physios will often find themselves “under the knife” a second time when their first graft tears. Physiotherapy gets the joint moving again, builds up the muscles around the joint, and regains the balance, co-ordination and skills required to return the athlete to their chosen sport. If you have any queries about this article please contact me at info@protherapy.net.au.

The technical term for hay fever is ‘seasonal allergic rhinitis’ and common symptoms include sneezing, red, itchy eyes, a runny nose and a sore, tickly throat and husky voice (sweet if you are a drag queen but otherwise largely inappropriate).

Most sufferers, in between sneezes and “God-bless-yous,” reach for antihistamines and nasal sprays, which provide excellent immediate but short-term relief. Acupuncture, in the treatment of hay fever, provides not only immediate relief but longer-term relief by gradually desensitising the sufferer against irritating allergens.

Antihistamines and nasal sprays can still be taken while undergoing acupuncture treatment. Eastern and Western medicine form a nice team here and when used in conjunction, annoying symptoms can be controlled until the desensitising effects of acupuncture take over.

As the cliché suggests, prevention is better than cure. Even previously severe Snuffleupagus’s can use acupuncture to prevent hay fever, and breeze through spring and summer largely symptom-free. For those who leave it too late for prevention, acupuncture can still provide substantial, if not complete relief, though it may take a week or two longer.

Both Holographic Health at Double Bay and Pro-Therapy at Maroubra have acupuncturists who specialise in the prevention and treatment of hay fever. Christopher Booth works at Double Bay, 9328-1200, and Josie Grech works at Maroubra, 9349-4253. If you have any queries then please call or email them at chris@holographichealth.com.au or protherapy321@optusnet.com.au

Important points to note :

• Site in front of your workstation such that your monitor is directly front on.
• Your arms should be at right angles from your shoulders when you type
• Your wrists should be in line with your forearms, both horizontally and vertically
• Your keyboard should be flat
• the top of your monitor should be level with your eys
• Do not sit too close to your monitor – at least an arms length away
• Ensure your seat is properly adjusted
• If your feet don’t reach teh ground, use a foot rest.
• Do not reach too far for your mouse, keep it close to your keyboard and support your arm on the desk when using your mouse
• Use a document holder attached to the site of the monitor
• Take regular breaks every hour, stretch your legs and perform simple mobility exercises to limber

Optimal Chair Setup

Correct seating posture is an essential ingredient to preventing spinal injury and fatigue.

The basic features of a good chair are :

• height adjustable
• pelvic tilt on seat
• lumbar support
• Adjust the height of your chair such that your knees are level or just below hip height and that your feet are flat on the floor.
• If your seat has a pelvic tilt, this should be set to a slight forward incline to promote a natural inward lower back curve.
• Move the lumbar support so that it fits snuggly into the curve of your lower back. This will help to prevent lumbar strain and helps to maintain a straight spine and neck whilst seated.
• Never sit with your legs crossed! Crossing at the ankles is a preferable alternative.