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.
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:
- maximal voluntary contraction
- isometric force
- isokinetic torque
- one repetition maximum lifts
- vertical jump
- sprint times
- running economy
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.”
“Arthroscopy for degenerative meniscal tears is no longer supported.” (ref)
“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?
- How often should we exercise to get in shape? -
- Tokyo 2020: does the Paralympics empower disabled people? -
- Tokyo Paralympics: how Paralympians are affected by the heat -
- How online mindfulness training can help students thrive during the pandemic -
- Rugby players’ brains affected in single season, study suggests -
- How ‘Dr Cool’ will help Socceroos stay chilled in 40-degree Qatar furnace -
- Why has rugby taken so long to wake up to what boxing has long known? -
- Normal Concussion Recovery Could Take Up to a Month -
- COVID can worsen quickly at home. Here’s when to call an ambulance -
- 3 reasons why Paralympic powerlifters shift seemingly impossible weights -
- Why Fitter People Drink More Alcohol -
- Seeking a Grand Theory of Injury Prevention -
- PARALYMPIC CLASSIFICATION EXPLAINED -
- Why is Eliud Kipchoge So Much Better Than Everyone Else? -
- What is Bell’s palsy? -
- UNDERSTANDING YOUR PORTIONS – HOW TO MANAGE YOUR INTAKE -
- Innovation and inner-strength: the stories behind Australia’s Paralympians -
- Can 'lifestyle medicine' such as diet, exercise and mindfulness help treat chronic pain? -
- Return-to-running following childbirth -
- Muscles are important, but stiff tendons are the secret ingredient for high-speed performance -
- Soccer balls should have health warning: dementia expert -
- Shoe wars: World records spike on track as battle of brands intensifies -
- There’s New Evidence on Heart Health in Endurance Athletes -
- Heat, the track or super spikes: what is causing fast times at the Olympics? -
- Bed rest in hospital can be bad for you. Here’s what nurses say would help get patients moving -
- Why Older Athletes Lose Explosive Power -
- Use it or rapidly lose it: how to keep up strength training in lockdown -
- Exercise Vigorously for 4 Seconds. Repeat. Your Muscles May Thank You. -
- Kids’ grip strength is improving, but other measures of muscle fitness are getting worse -
- What Olympic gymnasts can teach us about improving our balance -
- How to feed an Olympian: the delicate mix of timing, carbs and protein -
- Strength training is as important as cardio - and you can do it from home during COVID-19 -
- For older people and those with chronic health conditions, staying active at home is extra important -
- How to stay fit and active at home during the coronavirus self-isolation -
- What Olympic athletes can teach us about regulating our emotions and staying dedicated -
- The Science of Track and Field’s New Super Spikes -
- Elite Athletes Don’t Sleep As Much As You Think -
- WHY ARE WARM-UPS SO IMPORTANT? -
- Damning DCMS report on head injuries in sport seen as ‘turning point’ -
- One in four elite rugby players could have brain damage, bombshell new study finds -
- ADVICE FOR ATHLETES EATING HEALTHY BUT NOT SEEING RESULTS -
- Thinking of choosing a health or PE subject in years 11 and 12? Here’s what you need to know -
- THIS MIGHT BE WHY YOU GET SO HUNGRY AT NIGHT -
- Keto diet may ramp up fat burning but comes at direct expense of elite performance -
- How Weight Training May Help With Weight Control -
- How Mental Training Can Make You Physically Stronger -
- Why strength training is important and how to get started -
- 30 minutes of daily exercise 'not enough' for those who spend days sitting down -
- How Walking Can Build Up the Brain -
- In search of walking equality: 70% of Indigenous people in Sydney live in neighbourhoods with low walkability -
- Sport science body to track female athletes’ hormonal changes linked to menstruation -
- Little changes can drive big gains at Olympic Games -
- How to Heat-Proof Your Training -
- Cardiac arrests in young people -
- ‘Modern day mouthguard’: female footy players embrace breast protection -
- Carbohydrates: why carbs are so important for exercise, recovery and brain function -
- Evaluating the effects of oral contraceptive use on biomarkers and body composition during a competitive season in collegiate female soccer players -
- Poor sleep is really bad for your health. But we found exercise can offset some of these harms -
- To Avoid Running Injuries, Don’t Shake Up Your Routine Too Much -
- Technological advances in elite marathon performance -
- 'Survival of the fittest': Tokyo set to be hottest ever Olympic Games -
- DIETARY TIPS TO HELP SUPPORT YOUR MENTAL HEALTH -
During this current lockdown, Fit As A Physio is staying open to continue offering quality care to my clients.
The Department of Health has specifically confirmed that physiotherapy is deemed an essential service. The Health Minister has encouraged private practices to remain open, as it will reduce demand on general practice and the hospitals if patients can still see their physiotherapist for their musculoskeletal and acute care management.
I have completed the Department of Health's "COVID-19 Infection Control Training". I have reviewed all clinic hygiene practices, to ensure optimal safety and care for every person who attends the clinic.
There are many things I am doing as a registered health professional to minimise risk of exposure, through rigorous hygiene practices, and patient screening, to keep you safe.
You are welcome to attend your appointment, subject to the following conditions:
- Please do not come to your appointment if you are unwell with any potential COVID symptoms.
- Please do not come to your appointment if you have been advised to quarantine or self-isolate.
- Please sign-in at the front door with the Service NSW QR code.
- Please wear a mask.
- Please use the hand sanitiser at the front desk on entering and leaving.
Thank you for your cooperation with these measures.
For our safety:
- I am leaving space in-between appointments to allow time for cleaning, and to minimise patient interaction in the waiting room.
- I will not be greeting you with hand shakes or other contact hand gestures.
- I am wiping down contact surfaces between appointments with Viraclean Hospital Grade disinfectant.
- I am continuing with my normal hand hygiene measures of thorough hand washing before and after all patient contact.
- I have the COVIDSafe app downloaded and open, and encourage you to do the same.
If you are in self-isolation or would prefer to minimise contact in any way, you may like to consult with me via video. "Telehealth" uses technology that’s readily available on your computer or phone to receive assessment, diagnosis, and rehab prescription. FaceTime, Skype, or PhysiApp are easy options. The standard consultation via telehealth is $39/15mins.
If you would like to talk to me about commencing or continuing your physio through Telehealth, please phone 9969 6925, email firstname.lastname@example.org, or book online here.
Stay safe and well.
Sports & Exercise Physiotherapist
Fit As A Physio | MOSMAN
- How to improve health and quality of life for long-term care residents: Sit less, move more -
- Leafy greens key to maintaining muscles -
- Ultramarathon running: how safe is the sport? -
- The Best Type of Exercise? -
- What It Takes to Run a Fast Mile -
- Lifelong Exercise Adds Up to Big Health Care Savings -
Recognising the clinical significance of MRI findings is often a challenge given the substantial discordance that exists between structural pathology and symptoms. Emerging evidence indicates a high prevalence of so-called abnormal findings on MRI in individuals without symptoms. A collation of systematic reviews (and cohort studies when no review available) highlights that typical features of deterioration, such as cartilage lesions, hip and shoulder labral tears and spinal changes (eg, disc degeneration/bulge) exist in many healthy asymptomatic adults (figure 1). Approximately 8 of 10 adults aged ≥40 years have asymptomatic disc degeneration, while almost half of all adults aged ≥40 years have knee cartilage lesions but no pain. Although the prognosis of these asymptomatic findings is not well established, even in cases of further structural deterioration (eg, longitudinal cartilage loss) the association with pain appears minimal.5 These findings are critical for clinicians and patients to understand the relevance of structural pathology and can be used to address recent calls for radiology reports to include age-matched asymptomatic prevalence rates. Such an approach, together with discussion with patients putting MRI findings into context, may help minimise patient anxiety, and beliefs they are damaged and vulnerable, as a result of a diagnostic label. Including such epidemiological information on spinal MRI reports reduced subsequent opioid prescription although had little effect on healthcare utilisation.
The high prevalence of asymptomatic changes on MRI emphasises that such features may not always be the source of pain in symptomatic patients and should not routinely be considered as pathological processes requiring intervention. Instead, in many people they likely represent part of the normal ageing process—like wrinkles on the skin.
Current evidence suggests that it is more common than not to have a cartilage lesion or disc bulge as we age. Perhaps it is time we redefine what a ‘normal’ MRI is and start being ‘CLEAR’ with patients when discussing imaging results—consistent language, including epidemiological information and assessment of relevance.
- PRACTICAL WAYS TO SUPPORT YOUR IMMUNE SYSTEM DURING SEASONAL CHANGE -
- Eating disorders and energy deficiency: athletes straddle fine line in pursuit of goals -
- How to Choose the Right Dose of Exercise for Your Brain -
- Science playing catch up in women's concussion research -
- New research reveals running boom during Covid-19 pandemic -
- How to Harness the Pain-Blocking Effects of Exercise -
- Rugby, concussions and duty of care: why the game is facing scrutiny -
- How Exercise Affects Pregnant Women -
- Revolutionary VR technology to detect concussions set to be trialled in Super Rugby Trans-Tasman -
- How long does it take to become unfit? -
- NRL can cut concussions within a season, says top rugby doctor-
- The advice every junior is given that could slash NRL head injuries -
- Christina was a rising star in soccer. Too many headers gave her a brain injury -
- What really happens inside Australia’s sports concussion labs -
- Are AFL players being as honest as they should be about head knocks? -
- Explainer: what we know about concussion in Australian sport -
- What's behind the runner's high? It's more likely endocannabinoids than endorphins
- Sports concussions affect men and women differently. Female athletes need more attention in brain research -
- Why Exercise Can Be So Draining for People With Rheumatoid Arthritis -
- The Science of Getting Stronger – Mid to Long Term Planning -
- The Elusive Art of Predicting Running Injuries -
- How Exercise May Help Us Flourish -
- Do Statins Really Cause Muscle Aches? -
- TRAINING THE GUT FOR MARATHON SUCCESS -
LARs Ligament Reconstruction
Low Back Pain