Rehab

Lumbar Range of Motion 

Lumbar Range of Motion 
Lumbar Range of Motion  1200 600 Ace Health Centre

Lumbar Range of Motion

While some patients might be in a lot of pain and hesitant to move their back, having a patient move to assess the Lumbar Range of Motion is crucial to a physiotherapist. Normal amounts are –

  • Flexion (73-40 degrees) declines noted with age.
  • Lateral flexion (28-14 degrees, L&R) declined with age.
  • The extension (29-6 degrees) declined the greatest at 79% with age.
  • No decline in axial rotational (7%) way across the age spectrum.

The range of motion for the lumbar spine should be symmetrical on either side. When examining a patient’s lumbar range of motion we are not just checking if they have adequate motion, but also to make sure that range is symmetrical. A person’s range will also be dependent of the activities that they partake in. For example, somebody who just does general walking will need less range than a person who plays tennis. Therefore each patient should be assessed as an individual and not just what the textbook says is normal.

What does it Involve?

Firstly, a physiotherapist will take a good history. When diagnosing an injury, taking a complete history is one of the most important parts. Information is taken regarding their pain, pain patterns, mechanism of injury

if it has occurred in the past and if it has, what helped them, what helps to decrease the pain and what makes it worse.

The physio will then move on to the assessment. Your spine is made to move, therefore the therapist will ask the patient to bend and flex into certain key positions. They will be looking at how much movement is available in each spinal joint. They will look at what compensations you may have if one area is not moving as it should. Lastly and most importantly, how the patient feels throughout. This includes when they get pain, how much pain, and the type of pain.

Why a Lumbar Range of Motion needs to be done?

Knowing the type of pain and where the pain is throughout the assessment allows the physiotherapist to determine potential sources or causes of the patient’s pain. From just listening to what the patient says and observing how they move they can differentiate whether the injury is likely disc, bone, joint, neural or muscular in nature.

What next?

Once the history has been taken, and the range of motion assessment is complete, your physio will then develop a diagnosis and a treatment plan. This may include anything from massage, needling, shockwave, exercise, scans and more.

If you have a spine injury contact us today to book in with one of our physios.

Blog is written by our physio Lachlan.

ACE Custom made Insoles. 3d orthotics

Welcome to your new custom orthotics
Welcome to your new custom orthotics 1000 667 Ace Health Centre

Welcome to your new custom orthotics

Thank you for purchasing your new custom orthotics from Ace Health Centre. Here’s all of the information you will need about them. It details how your custom orthotics are prescribed, designed, manufactured, and what to expect.

Did you know it takes your podiatrist over an hour of extra work after your consult to finish your orthotics?

How your orthotics are prescribed

 

Your orthotics are prescribed from a mix of –

  • your injury
  • your flexibility
  • your posture
  • your alignment in your feet, knees hips and back
  • your weight
  • your shoes
  • your sport or activity
  • your medical history such as being diabetic
  • your blood flow to your feet
  • your nerves and feeling in your feet
  • your balance
  • history of other injuries
  • muscle strength
  • corns or callous
  • and more…

Orthotics prescription and design

When prescribing orthotics there are many different things that a podiatrist can do design-wise. The prescription itself will be determined from the assessment.

Your podiatrist will then have done a 3D scan of your feet. The 3D scan provides a base model of your feet giving them your base arch heights, foot length and widths.

The custom orthotics are then designed via computer software by your podiatrist after the consult. It takes a lot of time and practice to be able to use compete software to design up an orthotic to know how it will end up after being 3D printed. The software helps aid with consistency of the product being produced and is far more accurate than other methods of orthotic manufacture.

Every podiatrist will prescribe slightly different meaning you could go to 10 different podiatrists and get 10 different orthotics designs and prescriptions. The goal though will always be the same. The main difference is that many podiatrists get other companies to do computer design for them. At Ace, we do all of the computer design ourselves. Did you know Mike, our podiatrist does design work for other podiatry clinics around Australia as well in his spare time?

3D printing

Once your orthotics have been designed by computer the file is then sent to a 3D printer. The 3D printer is an industrial-size printer that prints around 30-50 sets of orthotics in one go. It cannot just print singles. It prints by laying down layers of very fine powder in microns and then heats the powder to fuse it in specific places. The printing process takes around 24-36 hours in total. The orthotics are then removed from the printer, sandblasted to remove any excess powder, and then washed. The orthotics are printed using an HP MJF 4200 using PA11 nylon material. This material is also eco-friendly and 3D printing minimises waste material.

Covering

Once the 3D-printed shell has arrived back at the clinic it’s time to cover the orthotics. This is all done via your podiatrist by hand. The covers that your orthotics will is decided by your podiatrist from your consultation. This is determined by factors such as – your activity, the shoes you will wear them in, your weight, your medical history, your injury and more. There are many different materials available. Covers on orthotics can be replaced if you ever want to give your orthotics a little TLC.

Fitting

Once the orthotics have been completed, our reception team will give you a call to arrange a fitting appointment. Your orthotics are always made slightly big for your shoes and require trimming up to ensure a good fit.

It’s important to remember that your orthotics are only as good as the shoes they are being put into. This means that although putting them into flat soft or flexible shoes will be much better than nothing at all, fitting them into a good supportive stable shoe will give much better results. Your podiatrist should have discussed footwear with you in the consult and possibly given you recommendations for shoes that your custom orthotics will work best in.

If you do require new shoes we recommended purchasing them before your fitting appointment. This way your podiatrist can check the fitting of the shoes, make sure the shoe is correct, and fit the orthotics into the shoes.

When fitting an enclosed lace-up shoe we usually recommended fitting them by – putting both shoes on, lacing the shoes up properly, standing up, and having a fingers width between the end of your longest toe and the end of the shoe. We also suggest being able to pick a small amount of fabric across the widest part of your forefoot. This ensures that the orthotics will fit the shoes, and will provide a more comfortable experience. It is always best to go shoe shopping at the end of the day when your feet are maximally swollen and expanded. This will give you a much better idea of fit and comfort.

For people that do spend a lot of time on their feet, it is sometimes beneficial to purchase 2 pairs of shoes and alternate them daily. The foam in the soles of shoes can take 24 – 48 hours to fully recover and expand back out. This means that having that rest day helps them last longer, maintaining more support and cushioning.

Shoes do have a lifespan. If you are in your shoes for 8 hours per day we recommended getting new shoes every 6-8 months. Just because the top looks ok doesn’t mean the foam is. We also recommended replacing shoes after having them for 1.5 years as the foam and glues in the shoes start to degrade. This means the shoes will not provide the same support and cushion as they once did when new.

Your orthotics may not fit every shoe but may be able to fit between shoes that are the same size. Just take out the original insole that is in your shoe and replace it with your custom orthotics

What to expect

Everybody is very different in the way their body reacts to orthotics. The orthotics as often designed to hold/guide your feet in a certain position. This means that different muscles will be used while wearing them. These muscles can take time to adjust. For that reason, we ask you to pay attention to your body. Aches or pains for up to the first 4 weeks are normal. If you experience this we suggest taking the orthotics out, putting the original insoles from the shoes back in, and then starting to use the orthotics again the next day.

Reviews

After the fitting appointment, we book you for a 3-4 week orthotics review. This review session is to see how you are getting on with them. Making sure you are happy, they are comfortable, and they are doing their job. If there are any issues at this stage the orthotics can be modified when needed. Things such as arch heights, cushioning, support, flexibility and more can be changed. Just like anything custom it can be changed and modified as needed. For the first 3 months reviews are done without any out-of-pocket cost.

If you are experiencing issues where you are not able to wear your custom orthotics due to pain we recommended calling up for a review appointment and coming in sooner.

We recommended having your orthotics reviewed every 12 months. This is due to changes within your body that may affect your orthotics prescription. This can be anything from strength, flexibility sensation, blood flow and more. You may also have a new injury or issues that the orthotic needs to be aimed at that may require a change in prescription again. Your orthotic shell may also become more flexible over time meaning it will provide less support. These changes may mean an update in your orthotics prescription.

If you need anything or have any questions please contact us here, or book here. 

 

online exercise prescription

Online exercise prescription
Online exercise prescription 1920 1009 Ace Health Centre

Online exercise prescription

One of the biggest factors to consider regarding patient rehabilitation and positive outcomes is exercise adherence. Patients no matter the condition are likely to get some form of home exercise program to continue progressing at home. It is reported as high as 50% of patients do not complete their exercise prescribed by the therapist thus limiting their rehabilitation. Often barriers to exercise adherence include lack to time, lack of understanding of exercises, forgetting how to complete the exercise or the prescription regarding sets and repetitions.

So what do we do to combat this?

We use an application called Physitrack for our online exercise prescription. Physitrack allows clinicians to prescribe individualised home exercise programs. Physitrack has multiple user-friendly features including demonstration videos with audible cues for the exercise, allowing the therapist to easily alter the repetitions, sets and resistance for each activity as well as a section for the clinician to add any specific notes for cues they want their patient to remember.

During the consult, we sit down with our clients and educate them on how to download pysitrack and view their program. We also print out the program for our patients which documents, the exercises, exercise explanations, the repetitions and more. We can also put individual notes from the physio to make sure you have everything written down and easy to understand. All these features make exercise adherence easier for the patient thus helping the patient stay on track for a speedy recovery.

Our podiatrist also uses this programme in order to give his exercise programmes. Each clinician can log in and view each person’s programme making it easier to work between practitioners and modalities. This communication between practitioners leads to much better client care.

Online consults

The use of this application also means that we can do online telehealth consultations. Over the phone, we can simply email your exercise programme to you, and know that you will have all the details you need to perform it correctly.

Book now to see our physio

What is Whiplash

What is Whiplash?
What is Whiplash? 840 438 Ace Health Centre

What is Whiplash

So, What is Whiplash? Whiplash is an acceleration-deceleration event that results in increased forces directed to the neck, usually from a motor vehicle collision. The impact from the accident may result in various injuries that could present in many different ways. Some symptoms you may experience if you are involved in a car accident include:
  • Neck Pain
  • Shoulder/Arm/Hand/Back pain
  • Pins, needles, or numbness down your arm
  • Sensitivity to touch
  • Decreased neck movement
  • Headaches
Although not as common, other symptoms could include:
  • Vision problems
  • Trouble with your hearing
  • Dizziness
  • Memory/Concentration problems
  • Jaw pain
  • Sleeping difficulty
  • Fatigue
  • Emotional changes

Whiplash Myths

Over the years, there have been mixed sayings on whether or not certain factors relate to recovery success. For example, awareness of the collision has been said to increase your whiplash symptoms. This is actually NOT true. Other myths that do NOT relate to how well you recover include:

  • Shoulder pain
  • Speed of collision
  • Age
  • Marital status
  • Seat belt use
  • Shoulder pain
  • Position in vehicle

How do I treat whiplash?

A motor vehicle accident can be a very scary and potentially traumatic event. It is important to seek both physical and psychological aid for coping and relief strategies. This will ensure you make a full and speedy recovery. Most do make a full recovery after their accident, however, the timeframe of recovery can greatly vary. Seeking treatment and support from your physiotherapist can help facilitate a quicker recovery. Treatment strategies can range from various neck movements to breathing exercises. Seeking assistance as soon as possible after your accident helps ensure your symptoms can be promptly addressed and taken care of.
Book in today for your assessment and realise that whiplash can be treated. Book Now. 
frozen shoulder

Frozen Shoulder
Frozen Shoulder 632 335 Ace Health Centre

The Frozen Shoulder

Adhesive capsulitis (aka frozen shoulder, painful stiff shoulder or periarthritis) is a self-limiting condition where the bones, tendons or ligaments cause pain on movement. Frozen shoulder later progresses too restricted active AND passive glenohumeral ROM. There is disagreement whether it stems from an inflammatory, fibrosing or algoneurodystrophic (a form of complex regional pain syndrome without demonstrable nerve lesions) conditions.
Frozen shoulder can affect the antero-superior joint capsule, axillary recess and the coracohumeral ligament. Common findings may include a small joint with loss of axillary fold, tight anterior capsule, and synovitis but no adhesions. The space surrounding the GHJ has been suspected to reduce from 15-35 cubic centimetres to 5-6cm.

Ethology of frozen shoulder

Frozen shoulder is classified as either primary (idiopathic onset) or secondary (a direct cause). Secondary onsets could include:
  • systemic (diabetes/metabolic conditions/hypothyroidism)
  • extrinsic (CVA, Parkinson’s, direct trauma)
  • intrinsic (rotator cuff/other shoulder muscle pathologies) factors of origin
It is also known as the 50 year old shoulder since it is much more prevalent in this age group. It is especially common in females over the age of 40 and those who are recovering from a mastectomy are at greater risk.
Frozen shoulder can be challenging to differentiate in the early stages from other shoulder pathologies. One of the main presenting factors is loss of external rotation. Restrictions in a capsular pattern present as ER limitations > Abd limitations > IR limitations. Patients may also complain of difficulties with dressing, overhead activities, grooming. Symptoms may also worsen at night.
The time frame for recovery varies greatly from 6 months to 11 years which could be spontaneous complete recovery or nearly-complete. Most tend to resolve around 3 years. Unfortunately, some patients’ symptoms may never fully resolve (estimated to be around 15%).

The three overlapping phases include:

1. Acute/freezing/painful phase: sharp pain with sleep interruptions – 2-9months
2. Adhesive/frozen/stiffening phase: pain decreases lingering at end ROM, ROM decreases in a capsular pattern – 4-12months
3. Resolution/thawing phase: spontaneous improvement in ROM – 5-24months Physical exam is usually sufficient to diagnose frozen shoulder, however X-rays, US or MRI can help rule out other issues.
A definitive treatment for frozen shoulder remains unclear, however, daily HEP along with an exercise therapy program and patient education are key to aid in the patient’s rehabilitation. It is key to manage your patient’s expectations to allow for a successful recovery. PNF has been found to be effective at decreasing pain and increasing ROM/function. MWMs may be helpful and superior than stretching alone during the second stiffening phase.
During the third phase of frozen shoulder rehab , strengthening should be increased with stretching being increased in frequency and duration but at the same intensity. The strongest evidence supports manual therapy and exercise in adjunct to corticosteroid injection.
For the ultimate frozen shoulder rehab contact us today.
unstable shoulder

Unstable shoulder
Unstable shoulder 774 619 Ace Health Centre

The Unstable Shoulder

There is new classification surrounding an unstable shoulder. Based on the Stanmore classification of shoulder instability there are 3 types:
Polar type I (structural instability), Polar type II (Atraumatic instability), and Polar type III (Neurological dysfunction/muscle patterning). This can be simplified to Born loose, Torn loose, Worn Loose.

Polar Type I:

The Unstable shoulder may present with general rotator cuff weakness, and positive apprehension test, while also showing deficits particularly in subscapularis with a lift-off test. As this type begins to progress a patients shoulder may exhibit increased scapular dysfunction, and abnormal muscle activation. Imaging should only be used when there is suspected structural instability, with arthroscopy being useful to pinpoint areas causing instability.

Polar Type II:

May present with increased capsular laxity, excessive ER, a sulcus sign, and potentially GIRD. Abnormal anterior translation may be present due to laxity, scapular dyskinesia, muscle imbalance, and congenital labral pathology.

Polar Type III:

Will present with large muscle activation occurring (Lat Dorsi, Pec Mj, Ant Delt, and Infraspinatus) while other rotator cuff muscles may be suppressed.

What can you do for an unstable shoulder?

Imaging can be used on the unstable shoulder using X-ray at first to gain an insight into the structural damage done and the position of joint. CT and MRI can be used when diagnoses is still unclear and soft tissue imaging could be of greater benefit.
Each polar type causes different mechanisms for instability and pain. It can be helpful to classify patients to better manage symptoms and create the appropriate exercise program. Physiotherapy can be beneficial to help manage symptoms and limit risk of dislocations.
Each program should be tailored to each patient, however early stages should start with regaining ROM, with AAROM or PROM to help normalise the movement. While Isometrics can be used to help with muscle activation, and proprioception (hands on table) to help with joint stability.
Once joint stability has been restored the patient can progress. Progression is to include increased strengthening within varying ranges, and stabilisation exercises (wall ball, wall push ups).
The Unstable shoulder final stage of rehab can include a progressed exercise program. This includes plyometric work and increased dynamic movements and stability work, along with return to sport/work activities.
Why do I have neck pain?

Why do I have neck pain?
Why do I have neck pain? 1280 500 Ace Health Centre

Why do I have neck pain?

Why do I have neck pain? Sometimes there can be no direct cause / incidence of why you have neck pain. Maybe you simply woke up in the morning and thought you slept in a funny position. Perhaps you twisted your neck too quickly to look at something. You might’ve bumped your head or jolted your shoulder during a scrimmage. Maybe you were in a car accident. Or simply, your neck pain just randomly began.

What symptoms Will I Get

Symptoms can vary greatly from person to person. Each person’s experience will be different. But could include one or several of the following:

  • Headaches
  • Dizziness
  • Lightheadedness
  • Nausea
  • Sharp shooting pain
  • Constant achy pain
  • Limited neck movement
  • Tight muscles around the neck/shoulder
  • Radiating pain down the arm
  • Tingly sensations or pins and needles
Factors contributing to the risk of getting neck pain include:
  • Poor posture
  • Anxiety
  • Sporting activities
  • Occupational activities
  • Depression
  • Previous neck injury
  • Age
Did you know that people that office workers have the highest risk and incidence of developing neck pain?
Specific factors for office workers that may increase your risk include:
  • High job strain
  • Long sitting hours
  • Less physical activity
  • Poor postures
  • Low social and work support
  • Job insecurity
  • Poor computer workstation layout

Why do I have neck pain? Physiotherapy Can tell you


Seeing a physiotherapist can help get rid of your neck pain by offering several pain-relieving modalities.

This could include:

  • Activity modifications
  • Advice and education regarding posture and sitting habits
  • Shoulder/head positional changes
  • Neck strengthening and endurance exercises
  • Taping techniques
  • Massage
  • Manual therapy
  • Functional training for neck/shoulder/trunk
  • Dry needling
  • Tailored therapeutic exercises
Your individualized physiotherapy treatment may encompass some or all of the above treatment options. It also depends on how long you have had the symptoms. The less time you’ve had your pain for, the quicker the recovery. Although this timeframe can vary, it is important to seek assistance sooner rather than later. That way, you can get back to doing what you need to do pain-free. Come speak to one of your physiotherapists today to address all your neck needs and concerns.
heel pain in runners

heel pain in runners
heel pain in runners 505 344 Ace Health Centre

The Top 5 Exercises for Heel Pain in Runners

The top 5 exercises for heel pain in runners will be discussed in this blog.
The exercises will help improve muscle strength and promote flexibility in the foot and leg muscles. Ultimately it will allow you to get back to running faster and free from pain.

Exercises for Heel Pain in Runners

1. Plantar fascia stretch – 

This stretch will relieve the tension in the plantar fascia. In sitting with the injured foot resting on the other leg, bend the ankle and toes up as shown in the picture. Hold for 10 seconds and repeat 10 times, do this 3 times per day.

2. Calf stretch – 

Tightness in the calf muscle can make the pain from plantar fasciitis worse.  Stretching the calf muscle can help ease the pain. Stand near a wall with one foot in front of the other, front knee slightly bent. Keep your back leg straight, heel on the ground, and lean toward the wall. Feel the stretch along the calf of your back leg. Hold the stretch for 30 seconds, repeat 10 times 1-2 times a day.

3. Rolling stretch – 

Place a round object like a golf ball or trigger point massage ball under the arch of the foot. Rollback and forth for 2 minutes. Repeat 2-3 times throughout the day.

4. Modified calf raises –

Of the top 5 exercises for heel pain in runners, this one is definitely the most challenging. Its best done barefoot.With a rolled-up towel under the toes. Push up into a calf raise, hold at the top, then slowly lower down. The speed should be 3 seconds up, 2-second hold at the top, 3 seconds lowering. Do 3 sets of 12 reps on each leg. If too painful or difficult, start on 2 legs and gradually progress under the guidance of a Podiatrist or Physiotherapist.

5. Short foot exercise –

The short foot exercise can be a little tricky but with the help of a Physiotherapist or Podiatrist, it can be mastered. The idea is to shorten the foot by contracting the small muscles in the foot to raise the arch.Sit in a chair barefoot and form a 90-degree angle at the knee and ankle. Try to shorten the foot by bringing the ball of the foot towards your heel, doming the arch of the foot. Do one foot at a time and try to avoid scrunching up the toes. Hold for 10 seconds then relax and repeat 10-12 times. Practice throughout the day, you can even do it sitting at your desk.

Conclusion

Combine the top 5 exercises for heel pain in runners with an appropriate level of activity that doesn’t aggravate symptoms. Choose suitable footwear and consider foot orthotics to help the pain settle. Contact us for more information and a consult with our podiatrist

Futsal injury prevention and treatment

Futsal injury prevention and treatment
Futsal injury prevention and treatment 1280 720 Ace Health Centre

Futsal injury prevention and treatment

In this blog we talk about Futsal injury prevention and treatment. Playing soccer / football can be a great activity for all ages, but like any other sport there is always an associated risk of injury. There are some injuries that are more evident in younger players such as Osgoode-schlatters or Severs, while in older players we might see more ACL, meniscus or concussion type injuries. Some common injuries are:

  • Stress fractures
  • Growing pain such as Osgoode-schlatters and Severs
  • Sprained ankles
  • Muscle strain or tears
  • Injured tendons for example Tendinopathy
  • Knee injuries such as ACL, MCL, PCL, LCL, Meniscus injury, Patellofemoral pain syndrome
  • Concussion
  • Shin splints
  • Foot injuries

Out of these there are 4 that stand out more than others.

Most common Injuries

  1. Shin splints – This is the overuse of the muscles along the inside of the leg. It can be related to flat feet and pronation, sudden increase in exercise, poor running posture and weakness.
  2. Ankle sprains – Its easy to sprain an ankle especially in futsal. Fast side to side movements. this can be related to foot posture, flexability and poor balance. This is the most common futsal injury.
  3. ACL injury – ACL stands for Anterior cruciate ligament. This ligament is in the knee joint. It gets put under high stress during turning and pivoting. This is why its such a highly injured area.
  4. Hamstring strain – Your hamstring is placed under high stress during most activities. Jumping, running, stopping. This must be rehabilitated properly post injury due to its high load job.

CLICK HERE to find out what signs and symptoms to look for and if you potentially have an injury. 

CLICK HERE to find out the most common futsal and football injuries a podiatrist treats

Futsal injury prevention and treatment is important for every part of the body. Every injury will cause some sort of disruption to the athletes level of performance. At Ace we want to keep you on the court/field performing at your very best. See one of our health professionals to prevent injury or return to your best post injury and at a high level of performance. We are able to provide proper advice and education to better understand your injury as well as provide proper rehab exercises and make shoe recommendations.

 

Contact us today for an appointment. Call us on 5572 6222 or click this link to go to our contact page.

Rotator Cuff Injury

Rotator Cuff Injury
Rotator Cuff Injury 1500 750 Ace Health Centre

Rotator Cuff Injury

What is the Rotator Cuff?

A Rotator Cuff Injury is very common. The rotator cuff is a key group of four muscles that support the shoulder joint. These four muscles allow you to perform all sorts of movements like reaching, twisting, and raising your arm. The rotator cuff muscles attach to bones of the shoulder. These bones include your collar bone on the front, your arm (humerus) bone on the side, and the shoulder blade (scapula) on the back.

Without these bones and attaching muscles, your shoulder would not be able to perform any movements. They make activities seem easy like brushing your hair, getting dressed, lifting, and carrying heavy objects.

What is a Rotator Cuff Injury?

An injury to any one of these four supporting shoulder muscles can occur. Usually, they are from a direct traumatic incident to the shoulder. They can also develop over time from general wear and tear. Injury to the rotator cuff muscles may result in some degree of tearing or inflammation of the muscle. One of the rotator cuff muscles called the supraspinatus is the most common muscle to be injured. This muscle helps lift your arm up to the side. The degree of injury and symptoms can vary greatly depending on several factors.

These include:

  • Age (risk increases with age, especially over the age of 60)
  • Occupation (repetitive arm movements increase the risk)
  • Family history
  • The location of the injury
  • History of trauma
  • The size of the potential tear to the muscle
It is interesting to note, some symptoms of your shoulder pain do not necessarily correspond with the injury severity. In other words, imaging may report a larger tear but you do not report having much pain. It’s important to be aware that this is very common. Your physiotherapist can help guide and treat your specific symptoms and concerns.

What is the treatment?

Physiotherapists can perform special and functional tests to diagnose and treat your injury. Manual therapy, specific exercises, and activity modifications can help regain the stability and strength of your shoulder and relieve your pain.
If you have any questions or concerns about your shoulder feel free to contact your physiotherapist at Ace Health Centre today.
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