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

Paediatric Physiotherapy – Physio for little humans

Paediatric physiotherapy primarily comprises of exercises and techniques that help aid in the physical development of an infant through to adolescence.

As a paediatric physiotherapist our main aim would be to ensure the achievement of the gross motor milestones and if not, then achieving the maximum out of a child to ensure independence and participation in their day to day lives through aids and equipment.

We know that nothing is more precious for a family then giving their little one the best chance at life despite their disabilities and as a paediatric physiotherapist we strive harder each day along with the family to give them that.

The conditions treated by a paediatric physiotherapist will often vary depending on the age of child attending treatment. Below is a list of common childhood conditions treated by a physiotherapist and the corresponding ages of treatment. It is important to remember that the cause of each of these conditions may vary and may therefore require different interventions.

Under 9 months of age

  • Positional Plagiocephaly (flattened spot on the back and side of the head)
  • Torticollis (Benign lump found in the neck)
  • Unusual foot posture
  • Delay in milestones e.g rolling, holding head up
  • Scoliosis
  • Developmental Hip Dysplasia (where the ball of the thigh bone doesn’t fit the socket of the pelvis)

9-17 months of age

  • Unable to crawl
  • Unable to walk
  • Walking on tiptoes
  • Turned in feet
  • Pigeon toes or knock knees
  • Juvenile Arthritis

17 months- 5 years of age

  • Delay in gross motor milestones (not keeping up with peers)
  • Musculoskeletal injuries
  • Toe walking
  • Juvenile Arthritis

5 years and older

  • Sporting injuries
  • Growth disorders (Severs Disease, Osgoodschlatters Syndrome)
  • Scoliosis
  • Poor gross motor abilities
  • Rehabilitation post orthopaedic surgery

Any treatment that a child receives from a physiotherapist will be unique to the age of the child and the condition being treated. Treatment for children less than 17 months of age will typically involve parental education regarding positioning and purposeful play, to encourage appropriate movement patterns. Older children may receive hands on treatment, taping and dry needling to encourage correct biomechanics and loading patterns. These treatments are provided in conjunction with a home exercise program to rectify muscle imbalances and restore joint range of motion.

The main purpose of paediatric physiotherapy is to assist children in overcoming physical difficulties interfering with their ability to function at home, school or on the sporting field. The best part of being a paediatric physiotherapist is the challenge that every child is different and unique. We know for sure that what works for one may be completely alien to the other especially the infants and the toddlers and hence, the treatment is more proactive and dynamic. It is a client tailored approach because every family walks in the clinic with similar yet such different goals. The fun part begins once the kid enters the teen years and can come up with such varied goals that challenge the physiotherapist on a day to day basis like being able to apply make up or being able to dance with a friend or being able to go to shop on their own to speak a few.

Our Physiotherapist Urvi Shelar is experienced in paediatric Physiotherapy. Click here to book an appointment or call us on 8555 4099.

We are hiring a full or part time Physio – Apply now!!

At InnerStrength of Bayside, we are a premier physiotherapy clinic with state of the art facilities and a large service offering. We specialise in Physio-led Exercise, drawing on the Clinical Pilates method, cancer rehabilitation (Pinc and Steel), joint mobilisation, massage, dry needling and exercise rehabilitation. Our friendly staff remains committed to providing clients and the wider community with industry-leading physiotherapy services.

About the Role 

We have an exciting opportunity for a junior or experienced Physiotherapist to join our team. Commencing January 2020 and working on a full-time or part-time basis, the role will involve supporting our busy schedule of over 40 Physio-led Exercise classes, including Group Physio (Clinical) and Mums & Bubs

Duties Include: 

  • Running Group Physio-led Exercise classes
  • Hands-on Physiotherapy manual techniques, writing and implementing rehabilitation programs
  • Clear and concise record keeping
  • Managing and building your own caseload
  • Build relationships to promote our services to the surrounding community, GP’s, schools and specialists

Skills & Experiences 

  • Fully Registered AHPRA Physiotherapist
  • Clinical Pilates experience/training highly regarded
  • Genuine interest in musculoskeletal clients
  • Dry needling training is desirable
  • A passion to deliver exceptional results that achieve optional physical health, not just clinical recovery

Benefits & Culture 

Great Working Environment – Enjoy working alongside a group of fun, like-minded individuals who share a passion for physiotherapy

Advance Your Career – Great opportunity to progress and develop within our industry-leading clinic

Fantastic Earning Potential – Great salary package + super + leave & bonus earnings

Flexible Arrangements – We accommodate our team’s lifestyles by arranging optimal working hours

To apply, please email your CV to lminogue@innerstrengthbayside.com.au or call Luci on 8555 4099 or 0415 582 980.

Do you get a sore lower back with a lot of end range back extension and rotation?

Do you play sport that involves a lot of end of range back extension with rotation? Such sports may include cricket fast bowling, tennis, gymnastics or ballet. These extreme positions can make you more susceptible to an increase in bone stress in your lower back, which if left unmanaged can lead to a stress fracture.

This bone stress is referred to as spondylolysis and it can be an active or inactive lesion. Active lesions, known as bone stress injuries, are a result of micro-trauma to an area of the vertebra over a period of time. The bone is loaded at a level higher than its tolerance level. This micro-trauma is caused by repetitive extension plus rotation positions. Chronic lesions are typically stress fractures which have not healed.

How common are lumbar spine bone stress injuries?

• 4-9% incidence in the general population

• 20% incidence in amateur athletes

• 44% incidence in professional athletes

• Higher incidence in adolescents involved in sports with repetitive spinal loading and extension/rotation movements.

What are the signs and symptoms of a lumbar spine bone stress injury?

• Gradual onset of low back pain which may radiate to the buttock and back of the thigh.

• Pain may start low level but will increase as you continue the aggravating activity and may lead to you not being able to play your sport.

• Pain on back extension and rotation movements.

• Tenderness and muscle tightness over the lower back. How do you diagnose a bone stress injury?

• Xray can be used, but does not detect early stages of bone stress injury

• MRI has no radiation and is better at localising the bone stress to a specific area of the spine.

Management

• Stop sporting activity which loads the area e.g. jumping, landing and other movements specific to your sport.

• Avoid repeated or end range low back positions such as extension, side bending and rotation.

• Bracing can be used to protect a stress fracture and reduce pain.

• An individually prescribed rehabilitation program to prevent muscle wasting and build core and global strength. It is important that these exercises be pain free to ensure you are not placing extra stress on the injured area.

• Progression of exercises once you are pain free and MRI shows signs of bone healing.

• It may be a 6-12 month rehabilitation program.

Please contact us on 8555 4099 if you would like any more information.

Written by Luci Minogue, Physiotherapist

Are you proud of the way you stand and sit?

Do you hang off your hips, with your shoulders behind your hips like Luci is in the photo on the left?
The correct way to stand is with your hips directly over your knees and ankles. Your chest should also be directly over your pelvis.
Years of standing incorrectly could wear down your hips, knees and also lead to low back pain.
Whilst there isn’t a 100% safe way to sit for everyone, there are a few things to avoid. In the photo on the left, Beth is slouched with weight on her thighs rather than the vase of her pelvis. Her chin is also poking forwards. Try to imagine a piece of string from the top of your head, pulling you up and straight. Your feet should be flat on the floor.

Written by Luci Minogue, Physiotherapist

Physio-led Exercise Improves Bone Density!

Osteoporosis or ‘porous bones’ is a disorder in which the density and quality of bone are reduced. It is often termed the ‘silent pathology’, as a person may not be aware they have it until a bone breaks. Breaks, or fractures, are most commonly seen in the thoracic spine (middle of your back), hip or wrist. Osteoporosis is more common in females post menopause, due to a decrease in oestrogen. In women from the age of 45 years, bone loss begins then accelerates at the onset of menopause. By 6-7 years post menopause, bone density has reduced by 20%. Post 70 years, females have lost 30-50% bone mass and men have lost 20-33%.

Drinking, smoking, lack of vitamin D, lack of exercise and a diet low in calcium may also predispose one to osteoporosis. Asians and Caucasians are more susceptible to osteoporosis than Hispanics and Africans.

What can you do to prevent or manage osteoporosis?

Regular physical activity and exercise plays an important role in maintaining healthy bones, especially if it is weight bearing as this promotes bone growth. Exercise is recognised as one of the most effective lifestyle strategies to help make bones as strong as possible, reducing the risk of fractures later in life. As well as improving or maintaining bone mineral density, exercise increases the size, strength and capacity of muscles.

Physio-led Exercise or Pilates, especially reformer based, is an ideal form of exercise for people with osteoporosis and for osteoporosis prevention alike. Weight bearing can be achieved on the equipment with spring resistance, and the exercises are controlled and balanced.

Osteoporosis Australia recommends that older adults and people at risk of osteoporosis participate in varied and supervised exercise programs, including weight-bearing activities, progressive resistance training and challenging balance and functional activities, at least 3 times per week. 

If you think you could benefit from reformer-based Physio-led Exercise, contact us today on 8555 4099 for a consultation or Book Online.

Written by Physiotherapist Kelly Gailis

Can I exercise while I’m pregnant?

Exercise is very beneficial during pregnancy and can actually help to prepare you for labour and prevent complications. It is perfectly safe to exercise during pregnancy, as long as activities are performed at an appropriate level for you and your body. Please note, if you have been given restrictions by a health care professional regarding exercise, it is important to adhere to said restrictions.

What are the benefits of regular exercise during pregnancy?

  • Increased energy
  • Improved fitness
  • Reduced back and pelvic pain
  • Stress relief

How much should you exercise?

  • 30 minutes, 3-4 days per week

What kinds of exercise are appropriate?

  • Pilates for pregnancy
  • Gentle yoga
  • Walking
  • Swimming
  • Pelvic floor exercises

What exercises should you avoid?

  • Heavy weights (excessive pressure on core and pelvic floor)
  • High impact exercise (e.g. netball or aerobics – this can put too much pressure on your joints or cause your core temperature to rise to an unsafe level for your baby)
  • Wide and/or deep squats and lunges (excessive pressure on pelvic floor)
  • Significant changes in pressure (eg. swimming in very deep in water)
  • Anything which brings on the following symptoms

What are warning signs you need to look out for?

  • Headaches
  • Dizziness or feeling faint
  • Chest pain
  • Calf pain or swelling
  • Cramping in the lower abdomen
  • Feeling too hot.

If any of these symptoms occur, ensure you contact your doctor, midwife or physiotherapist.

During this time, it is important to remember that your body is creating and carrying another being. Listen to your body so that you don’t push yourself too hard. Just keep yourself moving within your own capacity.

If you are pregnant and would like to start Pilates with us or would like some advice on what exercise would be appropriate for you based on your previous exercise levels, previous/current injuries or any pregnancy-related conditions, call us on 8555 4099 to make an appointment with one of our Physiotherapists, or click here to book online.

Post written by Lily Percoco (Work Experience Student) and Meg Doyle (Physiotherapist)

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