1 Comment
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.
Summary of:
FOOTBALL RECOVERY STRATEGIES (Grégory Dupont, Mathieu Nédélec, Alan McCall, Serge Berthoin and Nicola A. Maffiuletti, 2015) Does Fatigue Cause injury?
|
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:
|
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?
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?
DOES STRETCHING INCREASE RANGE OF MOVEMENT?
DOES STRETCHING HELP PERFORMANCE?
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:
WHAT ABOUT DYNAMIC STRETCHING?
SO WHY STRETCH?
SO SHOULD WE STOP STRETCHING?
Do you love a good stretch?
Or feel guilty you're not stretching enough?...
- 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 -
- 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 -
- 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 -
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.”
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?
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?
- 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?
Archives
May 2022
April 2022
March 2022
February 2022
January 2022
December 2021
November 2021
October 2021
September 2021
August 2021
July 2021
June 2021
May 2021
April 2021
March 2021
February 2021
January 2021
December 2020
November 2020
October 2020
September 2020
August 2020
July 2020
June 2020
May 2020
April 2020
March 2020
February 2020
December 2019
November 2019
October 2019
September 2019
August 2019
July 2019
June 2019
May 2019
April 2019
March 2019
January 2019
December 2018
November 2018
October 2018
September 2018
August 2018
July 2018
June 2018
May 2018
April 2018
March 2018
February 2018
January 2018
December 2017
November 2017
October 2017
September 2017
August 2017
July 2017
June 2017
May 2017
April 2017
March 2017
February 2017
January 2017
December 2016
November 2016
October 2016
May 2016
April 2016
November 2015
October 2015
September 2015
August 2015
July 2015
June 2015
May 2015
Categories
All
Achilles
ACL
Active Transport
Acupuncture
Ageing
AHPRA
Alcohol
Ankle
Ankylosing Spondylitis
Apps
Arthritis
Arthroscopy
#askyourphysio
Babies
Backpacks
Back Pain
Blood Pressure
BMI
Body Image
Bunions
Bursitis
Cancer
Chiro
Chiropractic
Cholesterol
Chronic Pain
Concussion
Copenhagen
Costochondritis
Cramp
Crossfit
Cycling
Dance
Dementia
Depression
De Quervains
Diet
Dieting
Elbow
Exercise
Falls
Fat
Feet
Fibromyalgia
Fibula
Finger
Fitness Test
Food
Foot
Fracture
Fractures
Glucosamine
Golfers Elbow
Groin
GTN
Hamstring
Health
Heart Disease
Heart Failure
Heat
HIIT Training
Hip Fracture
Hydration
Hyperalgesia
Ibuprofen
Injections
Injury
Injury Prevention
Isometric Exercise
Knee
Knee Arthroscopy
Knee Replacement
Knees
LARs Ligament Reconstruction
Lisfranc
Load
Low Back Pain
Massage
Meditation
Meniscus
Minimalist Shoes
MRI
MS
Multiple Sclerosis
Netball
Nutrition
OA
Obesity
Orthotics
Osgood-Schlatter
Osteoarthritis
Osteopath
Osteoperosis
Pain
Parkinsons
Patella
Peroneal Tendonitis
Physical Activity
Physio
Physio Mosman
Pigeon-toed
Pilates
Piriformis
Pokemon
Posture
Prehab
Prolotherapy
Pronation
PRP
Radiology
Recovery
Rehab
Rheumatoid
Rheumatoid-arthritis
Rotator Cuff
RTP
Rugby
Running
Running Shoes
Scan
Severs
Shin-pain
Shoes
Shoulder
Shoulder Dislocation
Sitting
Sleep
Soccer
Spinal Fusion
Spondyloarthritis
Spondylolisthesis
Sports Injury
Sports Physio
Standing
Standing-desk
Statins
Stem-cells
Stress Fracture
Stretching
Sugar
Supplements
Surgery
Sweat
Tendinopathy
Tendinosis
Tendonitis
Tmj
Treatment
Vertigo
Walking
Warm-Up
Weight Loss
Wheezing
Whiplash
Wrist
Yoga