How Does Trigger Point Dry Needling Help With Musculoskeletal Pain?

What is dry needling?

Commonly also known as trigger point dry needling, it is a procedure where fine needles (finer than what is used for a blood test) are inserted directly into the skin and the muscle for therapeutic purposes. These may include relieving acute and chronic pain, improving muscle length, altering muscle activation patterns or assisting with sleep and relaxation. The therapist may choose a dry needling technique over other manual therapy options as it is often less painful to the person while still being effective in achieving the treatment objective. The needle can be inserted at varying depths depending on the location and the body type of the person being treated.

What is a trigger point?

A myofascial trigger point is a localised tender spot on a band of taut muscle and is often painful when pressure is applied directly to it. A trigger point can be divided into 2 categories: active and latent. An active trigger point is painful without additional pressure; alternatively, a latent trigger point is painful only when pressure is applied. Presence of trigger points may lead to physical symptoms such as muscle weakness, poor muscle activation, or restricted range of movement. Furthermore, trigger point can alter the pain response within your nerves and brain contributing to referral pain or an increase response (more pain) to the original pain. In the most aggravating stage, trigger point can trigger pain by a stimulus (such as light touch) that is normally not painful.

Why dry needling?

Pain is probably the one thing that everyone can relate to. Whether the pain is derived from hitting your knee on the table, spraining your ankle while doing a high jump, or sustaining an acid reflex in your stomach, pain has a physical and a central component. The physical component in these instances are the body parts that are injured whereas the central component is the pain signal your nerves and brain are receiving from these injured body parts.

Dry needling in physiotherapy aims at treating musculoskeletal problems by attempting to alter both the physical and central components of pain. Insertion of needles trigger a response at the injured site to re-organise the muscle activation pattern, restore the original pain response, and relaxes the muscle fascia in the surrounding area. In short, dry needling treatment can relax the muscle, restore strength and movement lost due to pain, improve muscle activation pattern, reduce referral pain, and rewire and normalise the pain response.

What are some symptoms/diagnoses dry needling can treat?

  1. Muscular pain e.g. lower back, upper back pain
  2. Overuse injuries such as tennis elbow, shin splints, gluteal tendinopathy
  3. Referred pain such piriformis syndrome or a headache from neck tension
  4. Athletic injuries such ankle sprains, tight hip flexors
  5. Acute injury such as a neck whiplash pain

What should I expect in a dry needling session?

Your physiotherapist will ask you a comprehensive subjective history of the presenting problem followed by a physical examination. The subjective and physical assessments provide the basis of clinical reasoning required to rationalise dry needling treatment. If dry needling is considered clinically and symptomatically beneficial, your therapist will proceed to explain the goal of dry needling follow by potential post dry needling symptoms you may experience. A signed consent form is required to demonstrate your understanding of the treatment being delivered. The area undergoing treatment will need to be exposed (ie. not covered by clothes) to facilitate accurate palpation and needle insertion. You may feel slight soreness or discomfort with needle insertion; in some instances, dry needling may cause a slight twitch in the muscle. The entire session may require 30 – 45 min depending on the therapist and the condition being treated. Dry needling may be an adjunct treatment to other manual therapy and exercise rehabilitation.

If you believe dry needling may be beneficial to you, please contact us on 8555 4099 or book online.

Written by Michelle Lin, Physiotherapist.

What do you need to know about our Online Video Consultations/Telehealth?

We are still open for appointments within the clinic, however if you are isolating or prefer to stay at home, we also offer online video consultations. If this sounds daunting, don’t worry – we will walk you through the process.

Our Online Consultation Fees: Once you book in, you will receive an email with information on how to join the online video consultation or group session.
As of April 6th 2020 some Private health insurers will now cover individual online video consultations. Please consult your health fund for more information.

Online Physiotherapy Assessment$95811
Online Physio-led Exercise Assessment$95811
Online Follow-up Physio Appointment$50812
Online Mums & Bubs Assessment$80811
Online Mums & Bubs Group Session$25
Online Mums & Bubs Group Session 5 classes pre paid$100
Online Physio-led Exercise 2:1$32 per person
Online Physio-led Exercise 1:1$60812

Are you currently working from home?

Is your desk set-up working for you?

Are you struggling with neck and back pain or stiffness when you are working?

An ideal desk set-up is imperative to ensure you reduce the impact of computer/ desk based work on your spine. Stepping back and having a look at your workstation can help you determine what is wrong and how you can make it better for your body. I recommend that you have a family member take a photo of you at your workstation as this enables you to look at it more objectively. You can even show the photo to your physio. 

Here are a few simple things that you can do today to improve your work station.

1. Clear away the clutter. 

2. Ensure you have a chair with good lower back support and that the chair is at a height that you are able to place your feet flat on the ground (or on a stool). Try to bring your chair close to the desk so that your elbows are bent to approx 90 degrees and you do not have to lean forward to reach the keyboard or mouse.

3. Ensure that your computer screen is at the right height. The top of your screen should be around eye height.

4. If you are working from a laptop; use a separate/ wireless keyboard & mouse and elevate your screen (using some books or a stand).

5. Keep moving. If you cannot remember to get up from your desk regularly, set yourself an alarm to avoid sessions of prolonged sitting. 

6. Remember to also give your eyes a rest. Periodically take your focus off the screen. 

Additionally, you can try to break up the day with some thoracic mobility exercises which you can access via the link below.  These can be done all in one go morning and night or can be done one at a time throughout the day during your breaks.

If you have any further questions, or are needing more advice regarding your home workstation or are needing physiotherapy treatment, call the clinic on 8555 4099 to make an appointment (in person or online) with one of our physios or click here to book online.

Written by Caitlin Collenette

Thoracic Mobility Exercises

Have you got a stiff upper back or neck at the moment? Try these stretches:

Child’s Pose Stretch (+/- foam roller)

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Start in kneeling position with knees apart and feet together. Sit on your heels and place the palms of your hands on the mat/ roller. Slowly slide/roll your hands forward, lowering your chest towards the floor.
Hold and breathe for 5-20 seconds. Repeat up to 3x.

Thread Needle (+/- foam roller)

Start on your hands and knees with the foam roller parallel to your body.
Feed one hand (palm upwards) underneath the opposite arm resting it on either the floor or the foam roller.
Slide/roll your hand further away from your body to enhance the stretch.
Repeat 3-5x each side.

Clam Shell Stretch

Start in side lying with knees/ hips bent, top knee on the floor in front of the bottom leg, and a pillow/ support under head and neck. Reach arms out in front with palms together.
Reach top arm up and rotate backwards with your torso and head. Try to keep looking at your hand. Set lower abdominal muscles to keep your hips still.
Ensure you can breathe, hold for a few seconds. Slowly return the top arm back to the starting position.
Repeat 5-10x each side.

Bow and Arrow (+/- theraband)

Start in side lying with knees/ hips bent and a pillow/ support under head and neck.
Reach arms out in front with palms together.
If using a theraband grip one end of it in each hand.
Set your abdominals to ensure your hips do not roll backwards.
Slowly draw the top arm back along the line of you lower arm (like a bow) until your top hand reaches your shoulder, pulling on the theraband as resistance. There should be some upper back twisting to reach this position.
Breathe and hold for a second or two and then return your hand to the starting position.
Repeat 8-12x each side.

Sunbather (+/- foam roller)

Lying on your back on a mat or on a foam roller with your knees bent and feet flat on the floor.
Place your hands behind your head allowing the elbows and shoulders to relax out to the side towards the floor.
Hold for 10-30seconds.

Foam Roller Thoracic Spine Extension

Lie gently back on the roller (across upper/mid back), knees bent, hands behind your head.
Ensure to switch on your lower abdominals to avoid excessive lower back extension.
Slowly extend your upper back over the roller, keep breathing, hold for a few seconds and return to starting position.
Repeat a few times with the roller over slightly different parts of your mid to upper spine.
NOTE: do not place foam roller directly under lower back or neck.

Foam Roller Chest Stretch

Lying along the foam roller (ensure head is fully supported), feet a few inches apart.
Place hands on the floor either side of you palms facing upwards.
Slowly raise your arms upwards (maintaining contact with the floor) until a stretch across the chest is felt.
Hold 30-60 secs.

Thoracic resisted rotation

Start sitting on a fit ball (or chair or kneeling) with theraband/ tubing attached to a door handle or post.
Hold each end of the band in your hands and rotating your torso to initiate the movement.
Twist to one side drawing the band back with your arm
Try to avoid over twisting with your neck or pulling too much with your arm.
Ensure to keep the resistance light to ensure the movement comes from your thoracic spine rather than your arms.
Repeat 8-12x each side.

Online Video Consultations

WE ARE NOW OFFERING ONLINE VIDEO CONSULTATIONS! Please contact us on 8555 4099 to learn more or book online!.

All you need is a computer, tablet or smart phone with a camera and microphone.

From April 12th, some private health funds will cover online video consultations (telehealth) Until this time, we are introducing temporary reduced pricing.

Australian Physiotherapy Association National President Phil Calvert said, “Physio telehealth has been used in a variety of settings for some time. It is safe, it is effective and it is the right thing to do to reduce infection rates in our communities.  We thank PHA and its members for getting on board so quickly to help us do our bit to keep Australians moving and pain free from the safety of their own homes.”

Several private health funds have agreed to provide benefits for individual (one on one) physiotherapy teleconsultations where:

  • The customer is undergoing an existing course of treatment and the customer has seen the physiotherapist over the past six months, or
  • For new patients, the tele-physiotherapy service has been recommended by their general practitioner or relevant medical specialist, and
  • The primary condition being treated is one of:
    • Post orthopaedic surgery rehabilitation (e.g. Total hip or knee replacement)
    • Chronic musculoskeletal condition (e.g. osteoarthritis)
    • Cardiac rehabilitation
    • Pulmonary rehabilitation, or
    • pelvic floor muscle training,
  • The service is delivered before 30 September 2020, and
  • The service is undertaken in accordance with Australian Physiotherapy Association guidelines.

Health funds will provide coverage for teleconsultations provided by physiotherapists from Tuesday 14 April 2020 subject to the conditions listed above.

Health fund members should check with their health fund to see if they will cover tele-physiotherapy consultations. Some funds may impose additional conditions.

Initially benefit payments will be on production of a receipt from the provider.  Patients will have to pay the provider for the consultation and then claim the benefit through their health fund.

We are here to help and will guide you through the technical part of video consultations!

COVID-19: We are still open

InnerStrength of Bayside takes your health and safety very seriously. At this time, we have had no cases of COVID-19 (Coronavirus) associated with the clinic and we are open as usual.

We always practice hand hygiene and maintain a clean environment for our patients by cleaning equipment between patients and regularly changing linen. In addition to these regular practices, we will be taking extra measures to ensure the cleanliness of our exercise studio, waiting area, bathrooms and treatment rooms. We will encourage everyone to regularly wash their hands and are providing hand sanitizer and alcohol wipes for our patients to use prior to and after physio led exercise or in rooms physiotherapy sessions.

We are also investigating telehealth options to be able to still provide physiotherapy and physio-led exercise services remotely via online video conferencing software.

Please listen to your body and the government’s recommendations. Do not attend InnerStrength of Bayside if you are experiencing a cough, fever or shortness of breath. Please also do not attend if you have travelled overseas in the last 14 days, or had contact with someone affected by or who is suspected of having Coronavirus.

Thank you 😊

Are you feeling shoulder pain and wondering what to do about it?

The shoulder is a complex joint.  There are many structures which are involved in stabilising the shoulder, and therefore, many different injuries can occur.

Did you experience trauma to the shoulder before experiencing the pain?

It is possible that you are aware of what caused your shoulder pain. For example, it may have been due to a fall or over-reaching.  Otherwise, it may be non-traumatic which means that the specific way in which you have injured your shoulder is unclear.  Either way, we’re here to help!

What is involved in treating the shoulder?

Initially, the physiotherapist will do a thorough assessment of the shoulder as well as the whole body to ascertain the main problems that need to be addressed. The physiotherapist may also try to see if they can improve your pain by altering the way you move your shoulder.  As the body is a chain that is all linked, other parts of the body such as the neck and back may need to be treated to achieve optimal results. You may also need to strengthen muscles such as around your hip to help the shoulder function optimally.

Information you provide regarding the history of the injury and your symptoms are very important in the management of the injury.  A physiotherapist will work with you to improve your symptoms and function, which is the top priority.  Specifically diagnosing a shoulder injury is not the main focus as it will most likely not change or enhance the treatment.  It is important however, to rule out conditions such as fractures, dislocations and sinister pathology. 

How can you prevent a shoulder injury?

  1. Listen to your body: If you feel pain, stop and evaluate your movement. 
  2. Avoid over-reaching and straining your muscles.  Place your body in an optimal position prior to reaching
  3. General body strength and control: Staying generally active is important in preventing injuries.  A physiotherapist can provide you with an exercise program that assists in optimising function through strength and motor control exercises.

If you have any more questions or would like to book in for an assessment, please contact InnerStrength of Bayside on 8555 4099 or book online.

Written by Maryan Tawfik, Physiotherapist

Tips for a school backpack

It is that time of the year post holidays where the children are returning school and it’s time to think about school supplies. We would like to shed some light on one of the most pertinent school supplies: backpack. Do you know what to look for in a backpack for your child? Do you know the maximum safe weight limit is for your child to carry?

What should I look for in a good backpack?

1. Weight of the backpack – lighter the better

Research has shown a backpack should not be more than 15% of your child’s body weight. If a child is carrying more than 15% of the body weight, the child would have to compensate for the weight by either arching their back or bending forward. In addition to fatigue and physical stress, the compensation pattern could lead to poor posture and consequently musculoskeletal issues.

2. Broad shoulder straps with decent support and padding

Decent shoulder straps with broad contact on the shoulders reduce the likelihood of straps digging into the skin. They also help to alleviate the weight of the backpack by distributing the weight more evenly across a broader surface area.

3. Waist and chest straps/belts are good options

Waist and chest belts help to alleviate the stress placed on the shoulders. Ensure waist belt is properly adjusted to just above pelvis to optimise support.

How a backpack should fit?

  1. No larger than your child’s back
  2. Top of the backpack sitting ~2cm below their shoulders
  3. Bottom of the backpack is at the pelvis level
  4. Equal length in straps
  5. Good surface contact between your child’s back and the backpack

While wearing the backpack with only one strap or riding it low on the buttock may be “cool,” this could lead to shoulder strain or lower back pain.

If your child is complaining of shoulder or back pain, or if you notice a poor posture, please contact us on 8555 4099 or book online for an appointment with one of our InnerStrength of Bayside physiotherapists.

Written by Michelle Lin, Physiotherapist

Are you pregnant and wondering what you need to do about your pelvic floor?

Pregnancy is overwhelming right from the beginning. Right from the first few seconds that you see two pink lines to the exhausting times in the labour room to having that tiny bub in your hands, every bit of it is like a trip to the moon and back. You will have people talking to you about prams, car seats, houses, cots and the list goes on. But sadly not many women will tell you about those tiny muscles that bear the entire load before, during and after pregnancy.

The pelvic floor is pretty much the floor on which the whole journey rides on and we have got to talk more about them.

Where are they?

Why are they important?

How do we train them?

As someone who is writing a blog, I know that we all are just one click away to finding the information we are looking for but the challenge here is who we trust. As a physiotherapist I am always aware of the fact that before a client steps into my office he/ she has probably visited more google sites than doctors. This blog is an attempt to make the concept of pelvic floor simple and easy to absorb. So easy that next time if a friend is pregnant, the first words from your mouth would be, ‘do your pelvic floor, and let me show you how.’

What is your pelvic floor and where is it?

The pelvic floor is a sheet of muscles that extend from your tail bone (Tip of the lower back, point where your butt crack starts) to your pubic bone at the front. (The hard bit you feel when you press through your crotch)

These muscles form a ‘floor’ between your legs that supports the contents of your pelvis – your bladder, uterus (womb) and back passage. It also controls the openings of the following organs, which pass through it:

• The urethra – the tube which you pass urine through

• The vagina – birth canal, important during intercourse

• The anus – back passage, through which you open your bowels.

Why are they so important?

Unlike any other muscles, the pelvic floor muscles actually hold onto the contents of the body.

If they are strong, the overall health and hygiene of a woman depends on them especially through the turmoil of pregnancy when the woman’s body is going through so many changes.

If they are weak, it can cause problems such as, incontinence (the involuntary loss of urine or faeces) and prolapse (lack of support) of the bladder, uterus and bowel. The pelvic floor muscles also help you to control bladder and bowel function, such as allowing you to ‘hold on’ until an appropriate time and place.

Some of the common causes of pelvic floor muscle weakness are:

• Pregnancy

• Childbirth – particularly following delivery of a large baby or prolonged pushing during delivery

• Being overweight

• Constipation (excessive straining to empty your bowel)

• Persistent heavy lifting

• Excessive coughing

• Changes in hormonal levels at menopause

• Growing older.

How do I train my pelvic floor muscles?

It is recommended that all women exercise their pelvic floor muscles everyday throughout life, to prevent weakness and improve strength. Exercising weak muscles regularly, over a period of time can strengthen them and make them work effectively again.

Although with practice, pelvic floor exercises can be done anywhere and anytime, it is best to learn the exercises in the following position:

• Sit on a chair, toilet seat or toilet lid.

• Make sure that your feet are flat on the floor and your legs are slightly apart.

• Lean forwards, resting your elbows on your knees.

There are two types of exercises – slow twitch and fast twitch. It is important that you do the slow twitch first and then the fast twitch each time you exercise your pelvic floor muscles.

To perform the slow twitch exercises:

1. On a breath out, close and draw up the muscles around back passage, as if you are trying to stop passing wind. Make sure that you do not contract your buttock muscles while you do this.

 2. Keep breathing and continue to close and draw up the muscles around your vagina and urethra, as though you are trying to stop the flow of urine (Trying to stop urine mid-stream is a great way to get the feedback. Get into the habit ladies, but only do this once a fortnight to avoid any bladder infections).

3. Hold for as long as you can, and then slowly relax and let go.

Rest for the same amount of time.  Rest is important as these are small muscles and they fatigue easily. Once these muscles fatigue and if you continue to squeeze then there is a high chance that you would be using the surrounding muscles.  For example, hold for a count of 8 and then relax for a count of 8.

4. Slowly increase the length of time that you hold each contraction for and do as many as you can until you feel your muscle getting tired.

To perform the fast twitch exercises:

1. Pull up the pelvic floor muscles as before.

2. Hold for one second and then relax.

3. Repeat 5-10 times or until your muscles feel tired.

The fast twitch exercises can be done when you are travelling in trains, watching television and even bored in a meeting. It might even look like you are trying to concentrate on what your boss is saying so it’s a win-win for all because pelvic floor muscles tire easily and you may notice that it takes a lot of concentration to begin with to do these exercises correctly.

If you find that the muscles ‘let go’ too quickly and that you cannot hold, just hold them for as long as you can. Use this as your baseline. For example, if you can only hold the contraction for a count of three, then every time you do your exercises, contract the muscles for a count of three. Gradually try to work up to four, then five.

It is important to try not to:

• squeeze your buttocks together

• bring your knees together

• hold your breath

• lift your shoulders / eyebrows or toes upwards. If you do any of these, you are not contracting (tightening) your muscles correctly.

How often should you do your exercises?

Aim to do your pelvic floor exercises on a daily basis and be sure to include both types of pelvic floor contractions (both fast and slow twitch).

Fewer good squeezes are better than lots of half-hearted ones; however, you should try to challenge yourself by attempting to increase both the number of repetitions and the holding time. If you do not see a change in your muscle strength after three months, ask for help from your physiotherapist.

If you are an adventurer, then you can feel your pelvic floor contracting by putting one or two fingers into your vagina whilst having a bath or shower. Tighten your pelvic floor so that the muscles squeeze your finger hard. Ladies, self-feedback is the best feedback.

Every two weeks, test the strength of your pelvic floor by stopping the flow of urine mid-stream. This will feel similar to the exercises above and uses the same muscles. You may not be able to completely stop the flow of urine to begin with, but you may notice that you are able to slow the flow down. This is your baseline assessment. Gradually over the weeks you should notice an improvement. It is important that you do not do this test more than once a fortnight as it may cause problems with your bladder. This is just a test to see how you are progressing.

Use ‘the knack’ – always try to brace your pelvic floor muscle (by squeezing up and holding your pelvic floor contraction) before you cough, laugh, sneeze, lift anything heavy, or prior to any activity you know is going to be strenuous.

***Do not expect instant results! It will take several weeks of regular exercise to regain the strength in your pelvic floor muscles. You need to do these exercises for the rest of your life. If you stop exercising, your problems might return.

Please contact us on 8555 4099 or Book Online if you would like to book an appointment with one of our experienced Physiotherapists.

Written by Urvi Shelar, Physiotherapist

Aerobic exercise may be the key to sticking with hormone therapy for 10 years

Women or men with hormone positive breast cancer, that is breast cancer which uses hormones to grow, are often recommended to go on hormone therapy for ten years. This has the goal to shut down the production of these hormones that are the lifeline for the cancer. Whilst it is amazing to have this treatment option, the side effects can often be  quite debilitating for people and have a negative impact on quality of life.  

Side effects of hormone therapy may include 

  • Joint pain
  • Bone pain
  • Muscle pain
  • Weight gain
  • Hot flushes
  • Loss of libido
  • Vaginal dryness

What can we do about these side effects? 

Recent research has shown that aerobic exercise has a positive impact on the side effects mentioned above. As you exercise, your muscles move and this creates an increase in endorphins released in the body. This has been shown to have an analgesic effect on the body and also reduce joint and muscle pain. You will notice that your body will become more conditioned and therefore more efficient with daily tasks such as carrying the groceries or climbing a flight of stairs.  

An increase in aerobic exercise will also help with weight loss or preventing weight gain, which can be a concern of people going on this medication. Interestingly, your  expectations can also affect the level of side effects experienced. 

Research found that women with negative expectations had worse side effects and a lower reported quality of life two years after commencing the medication. These patients also had a poorer adherence to their medication. 

How much aerobic exercise should you be doing? 

The World Health Organisation recommends 150 minutes of moderate exercise per week, or 75 minutes of high intensity (vigorous) exercise plus two muscle  strengthening sessions per week. The key is to pick something that you enjoy such as cycling, swimming, hiking, aerobics or jogging and aim to get to  60-70% of your maximal heart rate, based on your age. 

It is important to see a skilled cancer rehabilitation physiotherapist or exercise physiologist to help guide you with your exercise. Such therapists have knowledge of the  changes your body is experiencing during treatment such as chemotherapy and radiation and any surgery you may be having. 

Whilst the idea of being on hormone therapy for ten years may be frustrating for some people, there are options out there to reduce the side effects and research shows that  people who take the medication have a significant decreased chance of breast cancer recurrence. 

To book an appointment with InnerStrength’s Cancer Rehabilitation Physiotherapist Luci Minogue please click here or call us on 8555 4099. 

Written by Luci Minogue, Cancer Rehabilitation Physiotherapist

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