Chevron Island Physio

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Elbow pain – What could it be and what are your treatment options?

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There are many different types of elbow pain. Elbow pain may be due to muscles, ligaments tendons, bones or bursae (little pads of fat). Treatment of elbow pain depends on the cause of the pain.

1.MEDIAL EPICONDYLITIS (“golfer’s elbow” / “ little leaguer’s elbow”) affects the inner tendons in the elbow eg after repetitive throwing, during the downward swing of a golf club or after repetitive activity such as hammering. It usually causes pain along the inside of the elbow and is made worse by wrist movements.

2.LATERAL EPICONDYLITIS (“tennis elbow”) affects the tendons on the outside of the elbow eg after playing racquet sports, typing for long periods of time, painting or cooking. Mechanics, plumbers and carpenters also tend to get this type of problem. Symptoms such as pain or burning along the outside of the elbow and problems when gripping are common. Rest,  physiotherapy ( including massage, trigger point therapy, dry needling, electrotherapy, strength and range of motion exercises) and the use of a brace will usually help to improve the symptoms of medial and lateral epicondylitis.

RSI is an umbrella term referring to various conditions caused by repetitive tasks or sustained positions. Tennis elbow and golfer’s elbow are examples of conditions caused by overuse.

3.OLECRANON BURSITIS (“student’s elbow”, “miner’s elbow”, “draftsman’s elbow”) affects the bursae (small sacs of fluid that help protect the joints). Olecranon bursitis affects the bursae that protect the pointy bone of the elbow. It may be caused by leaning on the elbow for too long, a blow to the elbow, arthritis or infection. Symptoms include swelling, pain and difficulty moving the elbow. If there is warmth and redness, an infection may be present. In the absence of an infection, elbow pads, anti-inflammatories and physiotherapy may help this condition.

4.OSTEOARTHRITIS (OA) affects the cartilage and causes the tissue to wear down and become damaged. It may be caused by an elbow injury or wear and tear on the joints as we get older. Symptoms include pain, difficulty bending or straightening the elbow, a locking sensation in the elbow, a grating sound during movement and swelling. Medication and physiotherapy including joint mobilization, joint traction, massage, range of motion exercise, strengthening exercises and electrotherapy are often beneficial for this condition.

5.DISLOCATION OR FRACTURE OF THE ELBOW is usually caused by an injury to the elbow such as a fall on an outstretches arm or elbow. Dislocation occurs when a bone moves from its usual position. A fracture occurs when a bone cracks or breaks. Your doctor can move the dislocated bone back into place and put the dislocated or fractured elbow in a splint or cast. Physiotherapy is very helpful to restore range of motion and strength once the splint or cast has been removed.

6.LIGAMENT STRAINS AND SPRAINS may be the result of trauma or repeated stress. The ligament may be stretched, partially torn or completely torn. Symptoms include pain, joint instability, swelling and/or range of motion problems. Treatment may include rest, ice, anti-inflammatories, bracing of the elbow and physiotherapy including electrotherapy, dry needling, kinesiotaping and home exercises.

7.OSTEOCHONDRITIS DISSECANS (Panner’s disease”) occurs when small pieces of cartilage and bone become dislodged in the elbow joint eg as a result of a sporting injury. Symptoms may include pain and tenderness on the outside of the elbow, trouble extending the arm, or a feeling that the joint is locking. Immobilisation of the elbow combined with physiotherapy treatment often gets good results for this condition.

HOW CAN I PREVENT ELBOW PROBLEMS?

Most elbow problems are a result of overuse and injury. You can help to prevent them by correcting improper sporting techniques, using a proper-sized grip on sports equipment, using correct tension on racquets, warming up and stretching properly and using elbow padding or braces. It is also important to take breaks from repetitive tasks.

If you have long-lasting or severe elbow pain, talk to our reception staff about booking in for a physiotherapy appointment so that we can determine the main cause of your problem and develop a treatment plan. You do not need a referral from your GP to see a physiotherapist but if the physiotherapists think that you need any additional tests done, they will contact your GP to inform them.

Sleeping positions in pregnancy. What are your options?

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Sleeping in pregnancy can be tricky at the best of times, but what are the safest positions for you and Bub?

How can I sleep during pregnancy?

There is NO DIFFERENCE laying on your LEFT or RIGHT hand side in all stages of pregnancy! (Cronin et al 2019) ?

So if you have just been laying on your left side I hope you have a much better sleep tonight on your right. 

But what about laying on your back?

4 published studies from New Zealand, Australia and the United Kingdom now show that women who go to sleep lying on their backs after 28 weeks have an increased risk of stillbirth, that is independent of other stillbirth risk factors.

WHY??

When a healthy mother lies on her back (supine) in late pregnancy the uterus compresses the main abdominal vein [inferior vena cava] reducing blood flow by >80%.

The aorta is also partially compressed by the pregnant uterus with an approximate 30% reduction in flow.

BUT DON’T STRESS IF YOU WAKE UP ON YOUR BACK????

The mother ‘s circulatory system compensates for this reduction in blood flow when lying on her back by increasing blood flow back to the heart through collateral veins below the obstruction and increasing her heart rate. 

However, this does not fully maintain optimum blood flow so this is why we recommend not to do it.

The baby also responds by acutely reducing blood flow by conserving oxygen consumption.

Basically:

1. You can sleep on both sides 

2. Don’t sleep on your back 

3. If you wake up on your back don’t panic it’s okay just go back onto your side

4. The mother and the baby can compensate so there is no emergency but we want to prevent laying on our back

We also recommend that you see a women’s health physiotherapist so we can assess you as in individual and answer more specific questions. 

Do you suffer from vertigo or dizziness?

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Have you or your family/ friends suffered dizziness and been told “its just vertigo”? As a physio its very common for people to list vertigo in their medical history, despite never having it properly diagnosed (or treated!)

Contrary to popular belief the most common types of vertigo are quite treatable – its not something you just have to live with.

What is vertigo?
Vertigo is classified as a sudden spinning or dizzy sensation, on correlation with head movements. The culprit resides in our inner ear, and boils down to a mismatch of information between our inner ear and our other senses ie vision/ body awareness etc. As with most things, this becomes more common as we age (mean age is 55yo), and is more common in ladies.

How does vertigo differ from light headedness?
Vertigo symptoms (any sort of dizziness, spinning, visual disturbance) that occurs in response to head movements could be vertigo. However if you are standing/ sitting relatively still or walking with minimal head movements and you begin to have symptoms, it is unlikely that vertigo is the cause.

What else could it be?
As with any injury, there are often multiple possible causes, and they should always be thoroughly investigated – dizziness is common, but not normal.
Possible causes are blood pressure, dehydration, medications, anxiety, issues with flow through blood vessels, neural changes within the brain, or even brain tumours. 

Who do you see if you think you might have vertigo?
If you find you are dizzy with head movements (looking up into cupboards, rolling in bed, shoulder checking while driving, etc) then a physiotherapist is a great place to start.
Jess, one of our physios is able to comprehensively assess your vertigo symptoms, and either treat them or tell you what your next step might be – i.e. referral an audiologist or other appropriate specialists. 

If you think you fit any of the above descriptions please call the clinic and we can talk to you about whether physiotherapy would be appropriate for you!

We hope this helps!
Best Wishes

The Vaginal Exam – A patient’s perspective

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Why you need to see a Women’s Health Physio after having a baby…

Today I decided to experience first-hand an appointment with our wonderful Women’s Health Physio partner Alison from Chevron Physio. And although I was a little nervous, I was pleasantly surprised how comfortable and at ease she made me feel!

Fortunately for me, both my birth experiences went quite well and, with my exercise background, at the time I felt pretty in tune with my body so I didn’t see a WHP postnatally. But, although I didn’t have any pain related issues, I kind of wish I had gone anyway!!!

There are number of changes that happen to your body during and after pregnancy. Aside from the emotional rollercoaster, there’s postural changes, back pain, wrist swelling, abdominal separation, pelvic floor dysfunction and prolapse just to name a few.

The problem is that many of the major issues go undetected because they are either not pain driven or too embarrassing.

Pelvic floor dysfunction is one example. If it’s weak or not functioning properly it isn’t going to be painful. Things like a large baby, long pushing phase during delivery or the use of forceps can cause pelvic floor stretching, weakening or dysfunction. And sometimes those muscles can actually become hyper tonic (or really overactive and tight) like I discovered today. Mine weren’t painful but they are overly tight and if I had tried to have my babies vaginally instead of c-section, Alison advised me that I most likely would have had some major tearing!!! (Good to know!)

If your pelvic floor muscles aren’t working properly they can lead to things like:

Bladder or bowel incontinence
Urinary urgency
Lack of sensation or ability to orgasm
Painful sex
or even Prolapse

Prolapse is another condition that can go unnoticed in the early stages. It is a dropping of some or all of the pelvic organs into the pelvic cavity due to overstretched or weak pelvic floor. Sometimes it can caused by stretching of the internal ligaments. This condition again can go undetected if not assessed by a WHO and progress until the physical sensation finally triggers you to do something. But by then it can be too late to rehabilitate with exercise.

Even if your pelvic floor is fine and you ARE exercising it regularly, it’s important to note that over 50% of women who think they are doing pelvic floor lifts are actually pushing down. Bearing down only makes things worse. Another good reason to get the WHP to check your activation!

So what do we do? BE PROACTIVE!!! Get an assessment to check in on your body before it’s gone too far.

Here is what to expect at your first visit:

History:

Your WHP will briefly go through your pregnancy and birth history for all babies, whether you had vaginal or caesarean, a long pushing phase, tearing, stitches, the weight of your baby etc. just to understand what your body has endured.

Goals:

She will assess what your aim is – healing injury, improving pelvic floor, reducing prolapse, getting back to a certain sport etc.

Abdominal Exam:

She will check you for abdominal separation using 2 fingers on your belly above and below your navel while you lift your head. Checking for a separation of the rectus abdominals or thinning of the connective tissue. Again not pain triggered but can lead to back pain, hip pain or hernia if not treated.

Internal Exam:

This is similar but far less uncomfortable or evasive than a pap smear for sure! She will perform a gloved digital exam (one finger inserted) to feel the vaginal walls and detect pelvic floor strength and endurance. She looks for thinning of the muscles, bulges that could be prolapse, checks length that determine muscle tight or weakness. She will ask you to cough and bear down checking again for prolapse. It is definitely not as bad as it sounds. It’s all over pretty quick and you come out with information that could literally change your life!!

Musculoskeletal Checks:

She will also ask you about any other pain or weakness like hips, back, neck wrists and give you some gentle exercises that may assist with your daily mummy activities.

Plan:

With all of the information she will put together a rehabilitation plan or refer you onto a postnatal trainer like myself. Equipped with all of your info we can both work together to get you exercising safely and feeling wonderful in your new Mumma Life!

Christine – Mummylicious Fitness

Manage your constipation and protect your pelvic floor

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Managing constipation is such an important part of keeping your pelvic floor healthy. An impacted bowel or regular straining on the toilet puts immense pressure on our pelvic floor musculature and the ligaments and connective tissue that support our bladder, bowel and uterus.

Constipation is an uncomfortable and often embarrassing health concern that can be improved with diet and lifestyle changes. 

Symptoms – You are constipated if you pass fewer than three bowel movements per week, though passing a bowel movement at least once per day is optimal. Other symptoms are straining when you go to the toilet, feeling incomplete after you have passed a stool, lumpy or hard bowel movements, as well as associated signs such as bad breath, tiredness, headaches, loss of appetite, coated tongue, bloated tummy, body odour, flatulence and skin problems. 

How to Help – Dehydration and lack of fibre are the most common causes of constipation. Drink a mug of warm water with a squeeze of lemon juice every morning when you wake up. Aim to drink at least 500mls of water before lunch, and at least 500mls of water before dinner. Eat a variety of fresh foods containing fibre. Buy and cook a new vegetable this week. White flour products like biscuits and cakes can increase constipation. Eat at least 1 cup of cooked vegetables per meal and at least 2 serves of fruit per day. Add fruit, yoghurt and nuts to your afternoon snack. Stewed apples with cinnamon are a great source of soluble fibre and a yummy dessert. Include at least 1 heaped teaspoon of ground linseed or chia seed into your porridge or sprinkled on salad or soup.      
Consume a quality magnesium supplement daily with your dinner. Include bitter foods in your diet, such as rocket, collard greens and dandelion leaf. Drink herbal teas including ginger, fennel, liquorice or dandelion root. 

Other Contributing Factors – Constipation can be made worse by stress and muscle tension, lack of movement, shallow breathing, long term use of laxatives, medications for depression and blood pressure, iron supplements, history of abdominal operations or chronic health conditions  such as Diabetes. 

Need More help? – Already tried everything for constipation? Our physiotherapists can help you to improve your capacity for movement and can address pelvic floor or abdominal muscle issues that may contribute to your constipation. 

Our Naturopath can help you to make dietary changes and can prescribe herbal medicines and nutrients that can relieve constipation. Our Naturopath can also help you with other digestive issues including heartburn/reflux, bloating, IBS and diarrhoea.  

Please speak with your Health professional if you are experiencing abdominal pain, unexplained weight loss, or if you have noticed blood or mucous in your stool.

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