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?...
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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?
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