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Health News 6/5/22

6/5/2022

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  • Using BMI to measure your health is nonsense. Here’s why - 
  • Regaining fitness after COVID infection can be hard. Here are 5 things to keep in mind before you start exercising again - 
  • Restricting calories leads to weight loss, not necessarily the window of time you eat them in - 
  • You may be recovering from your workouts all wrong - 
  • Players who retired from concussion excluded from landmark AFL study - 
  • People attending GPs aren’t getting all the preventive health care they need. Here’s what could help - 
  • Lydia Ko’s ‘time of the month’ comment showed how far sportswomen have come – and how much still has to change - 
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Health News 27/4/22

27/4/2022

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  • The Latest Science on Compression Gear - 
  • How do I improve my motivation to exercise when I really hate it? 10 science-backed tips - 
  • A HOT BATH AFTER EXERCISE BOOSTS HEAT ACCLIMATION - 
  • There’s New Data on How Your Arm Swing Affects Running - 
  • Blackouts, migraines and amnesia: why a rugby player gave up the game he loved - 
  • Why Cyclists Can Handle Heat Better than Runners - 
  • Cadence — could it be the key to improving your running performance? - 
  • Post-concussion break from footy should be longer than 12 days - 
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Health News 14/4/22

14/4/2022

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  • Two physios who ran away with the circus. - 
  • What is aphasia, the condition Bruce Willis lives with? - 
  • Our cities are making us fat and unhealthy - 
  • Fatigue after COVID is way more than just feeling tired. 5 tips on what to do about it - 
  • The impact of menstruation on participation in adventurous activities - 
  • Has the monitoring of professional athletes’ intimate information gone too far? - 
  • Experts call for oversight on ‘wild west’ of athlete data collection - 
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Health News 28/3/22

28/3/2022

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  • 3 orthopaedic surgeries that might be doing patients (and their pockets) more harm than good - 
  • Former Eagle seeks AFL concussion payout - 
  • Will Pucovski cleared to play after panel concludes some of his 11 concussions were something else - 
  • NRL defends decision to position independent doctors in bunker instead of on sideline for concussion rulings - 
  • Elite athletes help remove the stigma around periods and sport - 
  • Dementia is ex-NRL star James McManus’ legacy of hard knocks - 
  • The AFL, the concussion doctor and the groundbreaking brain study that never appeared - 
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Health News 21/3/22

14/3/2022

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  • Research 'gaps' about periods, the pill and female physiology affecting women in sport - 
  • How often do young women die of heart attacks and what can you do to improve your heart health? - 
  • TRAINING ON SAND: EFFECTS ON SPRINT & JUMP PERFORMANCE - 
  • The arms race of the feet - 
  • CTE robbed footy player of his brain and then his life - 
  • Why AFLW players are up to six times more likely to injure their ACLs than men - 
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Health News 11/3/22

11/3/2022

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  • Yes, You Can Train Your Tendons - 
  • Hamstring Strain Injury in Athletes - 
  • Concerned about your risk of a heart attack? Here are 5 ways to improve your heart health - 
  • DESIGNING TIME-EFFICIENT TRAINING PROGRAMS FOR STRENGTH AND HYPERTROPHY - 
  • 8 ways to keep your daughter from ever saying “I suck at sports” - 
  • Robot helping Chris Cairns learn to walk again - 
  • Concussion in Para athletes: One size doesn’t fit all - 
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Health News 4/3/22

1/3/2022

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  • Neurodegeneration linked to repetitive head injury found in brains of former Australian sports players - 
  • How Australian football is tackling the ACL injury problem for women athletes - 
  • Two more studies point to danger of head injuries in sport - 
  • AFL's leadership on concussion issues - 
  • Why Performance Under Pressure Isn’t All in Your Head - 
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Health News 28/2/22

28/2/2022

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  • Do low-carb diets help you lose weight? - 
  • Why can COVID impact your ability to exercise? - 
  • How to care for your sore hands and wrists when your life is online - 
  • Best evidence suggests most children’s flat feet will be fine - 
  • NRL’s radical concussion change: Power taken away from club doctors - 
  • The postpartum gym classes easing new mums back into exercise - 
  • Athletes under 35 among ‘scary’ number of CTE cases - 
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Health News 18/2/22

18/2/2022

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  • AFL Women’s players grapple with injuries and flow-on effects that reach far beyond footy field - 
  • Is post-exercise muscle soreness a valid indicator of muscular adaptations? - ​
  • The importance of getting our kids back into community sports - 
  • At home with COVID? 5 easy tips to help you breathe more easily - 
  • Complaint says 30 players retired due to concussion, Worksafe urged to prosecute AFL - 
  • Opioids ease osteoarthritis pain only slightly. Their deadly risks need to be weighed against any benefit - 
  • Drooling is a common symptom of Parkinson’s. Could a workout for the swallowing muscles help? - 
  • Preventing arthritis after ACL injuries - 
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Health News 3/2/22

3/2/2022

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  • Three tips to help you stay motivated to keep exercising all year long - 
  • A healthier heart can protect your brain too. 5 lifestyle changes to prevent dementia - 
  • Cracking joints isn’t bad for you and could even serve a useful purpose - 
  • Go low, go slow: how to rapid antigen test your kid for COVID as school returns - 
  • How to get back to regular exercise post having COVID - 
  • Concussion management is changing as more research suggests exercise is best approach - 
  • Aussie kids heading back to school is great, but will they be as active as they need to be? - ​
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HEALTH NEWS 21/1/22

21/1/2022

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  • AFLW's round-one spate of ACL injuries highlights plight of semi-professional athletes - 
  • How to move: with chronic back pain - 
  • What’s a pulse oximeter? Should I buy one to monitor COVID at home? - 
  • 3 in 4 people want to ride a bike but are put off by lack of safe lanes - 
  • How to safely resume your exercise routine after recovering from COVID-19 - 
  • What are the symptoms of COVID-19 and when should you seek medical attention? - 
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Health News 11/1/21

11/1/2022

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  • When should you go to hospital for a headache? - 
  • Can vitamin D improve athletic performance? - 
  • 4 plant-based foods to eat every week (and why science suggests they’re good for you) - 
  • When should you seek medical attention for an eye injury? - 
  • Wearable resistance: how to get stronger by simply moving, with a little help from small weights - 
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Health News 15/12/21

15/12/2021

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  • Is foam rolling effective for muscle pain and flexibility? The science isn’t so sure - 
  • How to make sure your pandemic home gym equipment doesn't go to waste - 
  • COVID saw us sitting longer – and diabetes rose globally by 16% in 2 years. Time to get moving - 
  • Why wearable fitness trackers aren’t as useless as some make them out to be - 
  • COVID kilos: why now is the best time to shed them - 
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Health News 2/12/21

2/12/2021

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  • Getting an athlete's nutritional demands right for optimum performance - 
  • How young athletes can eat like a champion - 
  • World Rugby tells players head knocks one of just 12 factors causing dementia - 
  • Stress is a health hazard. But a supportive circle of friends can help undo the damaging effects on your DNA - 
  • World Rugby Tackling Brain Health - 
  • Base of the iceberg: the tragic cost of concussion in amateur sport - 
  • ‘Life is hardly worth living’: brain injury study reveals rugby’s mental health crisis - 
  • Considerations for the Pregnant Endurance Athlete - 
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VERTIGO

26/11/2021

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Benign paroxysmal positional vertigo (BPPV) is one of the most common forms of vertigo, affecting 2% of the population at some point in our lives. 

BPPV is caused by a problem with the inner ear, where a small calcium deposit forms and moves with gravity around the different angled canals of the inner ear. BPPV is “positional” as it is triggered by specific head movements, for example, turning your head to the left with rolling over in bed. Symptoms of vertigo are room spinning, disturbed balance, and nausea.

BPPV typically resolves within a few weeks, but can be recurring.

Your GP can give you anti-nausea medication, and Physiotherapists treat BPPV with a sequence of movements and positions, called the Epley Manoeuvre, that uses gravity to re-position the calcium crystals.

A video of the Dix Hallpike test for BPPV is HERE.

Information on the Epley Manoeuvre is HERE.

A video of the Epley Manoeuvre is HERE.

Do you have vertigo? Book a physiotherapy appointment in Mosman to perform the Epley Manoeuvre HERE.
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Health News 17/11/21

17/11/2021

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  • Physical activity benefits outweigh risks for people with long-term health conditions -
  • Helmets may be doing more harm than good for cricket concussions​ -  
  • The Connections Between Overtraining and Underfueling - 
  • 4 Ways to Use the Training Data from Wearable Tech - 
  • Recommendations and Nutritional Considerations for Female Athletes: Health and Performance - 
  • Youth Athlete Development and Nutrition - 
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Health News 4/11/21

4/11/2021

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  • Modern-day rugby league players at equal risk of brain injuries, says lawyer - 
  • Here’s How Weather Conditions Affect Your Running Speed - 
  • ‘You can expect the actual concussions to be 10 times this data’: Medicos call for rugby codes to do more - 
  • Here’s How Much Extra Energy a Gnarly Trail Burns - 
  • Hiding behind the concussion industry: The NRL’s ticking time bomb - 
  • 5 big reasons people don't exercise (and how you can overcome them) - 
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Health News 29/10/21

29/10/2021

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  • What is a ruptured ACL and how do you fix it? - 
  • NFL points the way for dealing with concussion - 
  • Caffeine Increases Exercise Performance, Maximal Oxygen Uptake, and Oxygen Deficit in Elite Male Endurance Athletes - 
  • Concussion history in rugby union players is associated with depressed cerebrovascular reactivity and cognition - 
  • World-first study of league players finds no link between concussions and depression risk - 
  • Former rugby league internationals launch concussion class action in Great Britain - 
  • 6 WAYS THE BODY TELLS ATHLETES IF THEY’RE EATING ENOUGH - 
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Health News 18/11/21

18/10/2021

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  • Nobel prize: how chilli peppers helped researchers uncover how humans feel pain - 
  • The Not-So-Terrifying Death Stats for 5K Races - 
  • Former England captain calls for heading ban to address dementia crisis - 
  • Concussion in Para athletes: One size doesn’t fit all - 
  • Does prevention pay off? Economic aspects of sports injury prevention: a systematic review - 
  • Why Women Might Need Different Hydration Advice - 
  • WHEN TRAINING IS ABOUT TO CHANGE, YOUR DIET SHOULD TOO - 
  • Law change allows rugby men to wear tights - 
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Recovery Protocol

13/10/2021

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Summary of: 
FOOTBALL RECOVERY STRATEGIES 
(Grégory Dupont, Mathieu Nédélec, Alan McCall, Serge Berthoin and Nicola A. Maffiuletti, 2015)
Cold water immersion for recovery

Does Fatigue Cause injury?

  • High intensity exercise leads to fatigue.  
  • Fatigue causes a decline in performance.  
  • A high percentage of injuries occur late in each half of a game, suggesting that fatigue is a risk factor for injury.

Fatigue Mechanisms

  • Combination of central and peripheral factors.
  • Central fatigue = decreased maximal voluntary muscle contraction and sprinting ability.
  • Peripheral fatigue = muscle soreness, damage, and inflammation.
  • Depletion of glycogen stores.
  • Dehydration.
  • Muscle damage / stiffness / swelling.
  • Mental fatigue / motivation.
  • Jet lag / disrupted body clock / stress / poor sleep.

How long does it take to recover from exercise?

  • Immediately after a match, 20M sprint time, quadriceps strength, and vertical jump height are decreased by about 10%.  
  • Full recovery can take between two and four days.  
  • Injury rates are increased when there are less than 6 days between matches.

"When playing two matches per week, the 3-day recovery time between two successive matches may consequently be insufficient to fully recover."



What can we do to reduce fatigue after exercise and recover faster?

Recovery Protocol

Nutrition & Hydration

Immediately after a match, players should drink a large volume of fluid (about 150% of the sweat loss) with a high concentration of sodium (about 500 to 700 mg/L of water), flavoured milk, and tart cherry or berry juice. Then, they should eat a meal containing high-glycaemic index carbohydrate and protein within the hour following play.

Rehydration and consumption of carbohydrates and protein are effective techniques for optimising repair of muscle damage.  The addition of sodium at 500-700mg/L promotes fluid retention, stimulates thirst, delays urine production, and increases glucose absorption.  It is recommended to drink a large volume of fluid after the match instead of small quantities gradually.

It is recommended to take 1.2g of carbohydrate per kilogram of bodyweight per hour for up to 5 hours after a match to enable maximum re-synthesis of muscle glycogen stores.

20g of milk protein during the first 2 hours of post-exercise recovery stimulates muscle protein synthesis.  Flavoured milk is an effective beverage for post-exercise recovery. It contains carbohydrate and proteins in similar amounts to those used in studies demonstrating improved post-exercise recovery.

Juices such as tart cherry juice, tomato juice, or berry juice are also recommended to enhancing the recovery process. These juices are loaded with a high antioxidant capacity, which reduce oxidative stress and inflammation.

Alcohol delays recovery as it is a diuretic, increases urine output, impairs sleep, delays the muscular recovery process, and decreases maximal strength.


Sleep

  • Sleep is an essential part of recovery management.
  • Lost sleep reduces endurance performance, maximal strength, cognitive performance, and the immune system.  
  • Less than 7 hours sleep per night triples the risk of infections and double the risk of musculoskeletal injuries.

Cold water immersion

  • Several meta-analyses confirm the benefits of cold-water immersion for recovery.
  • The recommended regime of cold-water immersion is: whole-body immersion lasting 10 to 20 minutes at a temperature of 12 to 15°C immediately after the match.

Active recovery

  • Active recovery performed after a match does not present any benefit for physical performance.

Massage

  • Most studies fail to find a significant beneficial effect of massage for recovery.
  • Psychological benefits: decreased subjective symptoms of soreness / improved perceptions of recovery.

Stretching

  • There is no substantial scientific evidence to support the use of stretching to enhance post-exercise recovery.
  • Stretching is not clinically worthwhile in reducing muscle soreness in the days following exercise. 
  • Recovery of physical performance is not improved after stretching.

Compression garments

  • Meta-analysis on the effects of compression garments on recovery following damaging exercise indicated that the use of compression garments had a moderate effect on recovery of muscle strength, muscle power, creatine kinase and in reducing the severity of delayed onset muscle soreness.  
  • A placebo effect due to wearing the garments could not be excluded.


CONCLUSION

  1. The first step is hydration; the mass of the players should be measured and compared to the pre-match body mass in order to propose the appropriate quantity of fluid to drink (150% of body mass lost). The fluid should contain a combination of water and a large amount of sodium (500 to 700 mg/L of water).
  2. The second step consists in drinking a tart cherry juice and chocolate milk in order to restore glycogen, to reduce oxidative stress and inflammation, to stimulate muscle repair and to promote quality and quantity of sleep.
  3. The third step is the cold bath. The players should immerse themselves up to the neck at a temperature between 12 and 15°C for 10 to 20 minutes to accelerate the recovery process.
  4. The fourth step is to wear a compression garment until bedtime.
  5. The fifth step is to eat a meal high in carbohydrate with a high-glycaemic index and protein within 1 hour after the match (for example soup, well-cooked white pasta or mashed potatoes, chicken or fish, yogurts or cake).
  6. The final step is to have a good night’s sleep.


WATCH DR DUPONT'S PRESENTATION AT ASPETAR'S POST-EXERCISE RECOVERY CONFERENCE:
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How Important is Stretching?

7/10/2021

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Often when I’m talking to my patient about their injury and why it has happened, they guiltily report that they don’t stretch enough.  

​We’ve all grown up being told how important is it to stretch:
  • to warm up
  • to cool down
  • to prevent injury
  • to help muscle soreness
  • to improve flexibility
  • to improve performance

​I’d guess that most people feel guilty about not stretching enough.

Interestingly, health professionals have changed our tune about the importance of stretching.  Research over the last 15 years has suggested static stretching is not as beneficial as was once thought.  I’ve been having conversations about the reasons to stretch (or not) for at least the last 15 years, but the current science on stretching just isn’t catching on.  

So, what do we know?…
​

​DOES STRETCHING PREVENT INJURIES?

No.  There is a lot of evidence that stretching does not reduce the risk of injury.  This systematic review and meta-analysis of randomised controlled trials found stretching does not prevent injuries, whether done before or after training.  This randomised controlled trial, and this systematic review concluded stretching before exercising only reduces the risk of injury by less than 1%.  

​Therefore, in practical terms the average athlete would need to stretch for 23 years to prevent one injury.  Definitely not worth it.
​

​DOES STRETCHING HELP MUSCLE SORENESS?

No.  A systematic review concluded that stretching before or after exercising does not confer protection from muscle soreness (ref).  Stretching was found to reduce muscle soreness by a trivially small amount - less than 2%.

“Most athletes will consider effects of this magnitude too small to make stretching to prevent later muscle soreness worthwhile.”

​DOES STRETCHING INCREASE RANGE OF MOVEMENT?

​No.  Stretching for the amount of time that most people would hold their stretches, does not make any actual difference to flexibility.  The mechanisms of stretching have been extensively studied.  There is moderate evidence from a systematic review that stretching can increase flexibility (ref). However, to achieve an actual improvement in muscle compliance we know the total duration of stretching needs to be at least five minutes per muscle group (ref).  Therefore to stretch hamstrings, quads, and calves, both left and right, as part of a warm up before sport, it should take at least 30 minutes - which is practically impossible as part of a warm up.  We know the one or two, thirty second stretches the majority of athletes would perform during their warm up are just not enough to actually improve their flexibility (ref).
​

​DOES STRETCHING HELP PERFORMANCE?

What people find most surprising about static stretching is it impairs subsequent performance (ref).

A substantial body of research has shown that sustained static stretching acutely decreases muscle strength and power (ref).  Stretching before an endurance event lowers endurance performance and increases the energy cost of running (ref).  Cycling efficiency and time to exhaustion are reduced after static stretching (ref).

Pretty much any measure of performance is made worse by stretching.  Static stretching impairs: 
  • strength
  • maximal  voluntary contraction
  • isometric force
  • isokinetic torque
  • one repetition maximum lifts
  • power
  • vertical jump
  • sprint times
  • running economy
  • agility
  • balance

A comprehensive review (ref) from 2011 concludes:

“Based on the majority of the literature, it would seem logical to recommend that prolonged static stretching not be performed prior to a high level or competitive athletic or training performance.”

​WHAT ABOUT DYNAMIC STRETCHING?

​Obviously, I’ve been talking about sustained, static stretching.  It has been shown that there is no stretch-induced strength loss with dynamic stretching (ref).  However, the efficacy of dynamic stretching for increasing flexibility is yet to be determined (ref).
​

​SO WHY STRETCH?

I do get people to stretch if there’s a specific pathology that needs treating.  And you do need to stretch if you need flexibility to achieve certain positions in your sporting performance (hurdlers / gymnasts / divers, etc).
​

​SO SHOULD WE STOP STRETCHING?

If you’re happy with your stretching routine, keep doing it.  If you think it feels good to stretch after exercise then there’s no harm.  But I definitely wouldn’t recommend stretching at the expense of other techniques that are proven to aid recovery.



Do you love a good stretch?  
​Or feel guilty you're not stretching enough?...

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HEALTH NEWS 30/9/21

30/9/2021

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  • Full-contact training should not exceed 15 minutes per week, World Rugby guidelines say - 
  • How to prevent and manage muscle injuries - 
  • How does sleep help recovery from exercise-induced muscle injuries? - 
  • Do very active people have a higher risk of heart attack? - 
  • HEALTHY SWAPS TO INCREASE FIBRE INTAKE - 
  • What parents need to know about sensitive periods in physical development - 
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Health News 22/9/21

22/9/2021

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  • Resistance band workouts are everywhere – but do they work? - 
  • Recommendations and Nutritional Considerations for Female Athletes: Health and Performance - 
  • Padded Headgear does not Reduce the Incidence of Match Concussions in Professional Men’s Rugby Union - 
  • Concussion is rising in community footy, with kids bearing the brunt - 
  • Management of plantar heel pain: a best practice guide informed by a systematic review, expert clinical reasoning and patient values - 
  • Major Sports Injuries Can Possibly Be Predicted and Avoided Through DNA Testing - 
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Health News 16/9/21

16/9/2021

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  • New solutions to deal with breast pain women experience after exercise - 
  • Hot pack or cold pack: which one to reach for when you’re injured or in pain - 
  • The Concussion Conversation: addressing medical inequality - 
  • Risk factors for pelvic floor problems and what can help - 
  • Aiming for 10,000 steps? It turns out 7,000 could be enough to cut your risk of early death - 
  • Kids’ fitness is at risk while they miss sport and hobbies — but mums are getting more physical - 
  • Exercise and fitness in the time of COVID — it's hard for some and easy for others - 
  • ‘Compelling’ new concussion figures spark call for AFL revamp - 
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"A BIT OF A TIDY UP"

10/9/2021

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I’ve been treating a chap with a sore knee who really wants to have an arthroscope (keyhole surgery). The knee’s been sore for a while. There’s some “degenerative changes” on a scan, including a torn meniscus. There’s a local knee surgeon who’s really good and is a friend of his. He thinks it’s a no-brainer. He needs an arthroscope. It a quick and easy solution to his problem that has worked well for him and his friends previously. It’s time to have “a bit of a tidy up”.
​
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This is a very common presentation, and having an arthroscopic debridement is a very popular decision. 75,000 knee arthroscopies are performed in Australia each year. Therefore, you would imagine there is good evidence to support having one. Unfortunately it depends on who you speak to…

A change has been in the air since a 2002 randomised controlled study allocated 180 patients with osteoarthritis to either an arthroscopic “tidy up”, or sham surgery (where the patient was given an anaesthetic, incisions were made, but no actual “tidying up” was done) and the study concluded there was no meaningful difference in pain or function between the groups at follow up.

Since then, a number of studies have compared arthroscopic debridements and partial meniscectomy for degenerative knee injuries with exercise or doing nothing (Herrlin 2007, Kirkley 2008, Katz 2013, Sihvonen 2013, Yim 2013, Kise 2016) and the results have been unanimous.

A recent systematic review summarises: “these findings do not support the practise of arthroscopic surgery for middle aged or older patients with knee pain, with or without signs of osteoarthritis.”  

And another: “A trial of nonoperative management should be the first-line treatment for such patients.” 



Editorials summarise that:
“This high quality evidence dictates that meniscectomy is an ineffective treatment for symptomatic degenerative meniscal tears.”

And that…

“Arthroscopy for degenerative meniscal tears is no longer supported.” (ref)

And

“There is now overwhelming evidence that arthroscopic knee surgery offers little benefit for most patients with knee pain.” (ref)
​​

​SO WHY DID THE ARTHROSCOPE WORK FOR ME?

We do a lot of arthroscopes and people get better. What’s happening?

When you come and see me with degenerative knee pain and I tell you, “you need to do six to twelve weeks of strengthening exercises”, it sounds like hard work. Pffft. Understandably we want an easier option.

“Have surgery” sounds like an easier option. Someone else is doing the work for you. After the surgery, you proceed to do six to twelve weeks of strengthening exercises, but this time you’re happier to do the work because we take surgical post-op instructions seriously.

Twelve weeks later both these two groups are a lot better. Bingo-bango, “surgery” fixed me.

Two million knee arthroscopies a year globally, costing billions of dollars.
​

​WHY DO PEOPLE HAVE SURGERY?

A pretty typical pathway goes something like:
  • Sore knee
  • GP says “you’re silly to have played football”, try some pain killers
  • Not much better
  • GP says “we better get a scan”
  • MRI shows “degenerative changes / meniscal tear” which seems like a structural injury
  • Who fixes structural injuries?… Surgeons
  • Refer to surgeon
  • Surgeon wants to help. What can he do? An arthroscope and a “bit of a tidy up”.

​I think we need to be careful at the MRI stage. MRIs are a lot cheaper and easier to get these days so it’s less of a big deal to get one. I was chatting to a mate with a sore knee and his MRI showed some degenerative changes. Rather than being told that it’s normal to see those sorts of things in knees as old as ours, and that it’s not necessarily the thing that’s giving him pain, he was told the knee is “bone on bone”. How can anyone ever expect to recover without surgery with that sort of imagery? Bone on bone seems definitive. Surely the only way to fix “bone on bone” is surgery?

But we know degenerative changes on MRI are poorly associated with symptoms, and degenerative changes are the norm in middle-aged knees (ref). 

Let’s try some strengthening. You will be surprised.
​

​SO WHO SHOULD HAVE SURGERY ON THEIR CARTILAGE?

The people I do refer to a surgeon for cartilage surgery have suffered an acute twisting injury with mechanical “locking” symptoms (i.e., an inability to fully extend the painful knee because of a meniscus tear lodged between the articular surfaces).
​



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