Is your ‘new work office’ a pain in the neck?

Is your ‘new work office’  a pain in the neck?- Quick Tips to Avoid Back & Neck Pain Whilst Working From Home during Covid-19.

With the unprecedented times we currently face, many of us find we are working in a different environment at the moment- One not designed for sitting eight hours a day….

Quick Tips from your friendly Physio:

  1. Comfort is key! Set up your workspace well- invest in a wireless/plug in keyboard & mouse. And even treat yourself to a laptop stand (or a stack of books works just as well).
  2. Take regular breaks- AWAY from your workspace; grab a glass of water, check on the kids or you could even do one of those stretches your physio prescribed you!
  3. Sit less!- be creative with cardboard boxes to make a standing desk, stand during online meetings or webinars, walk during phone calls.
  4. Use your Lunch Break to get MOVING! Even if you can’t spare half an hour to hit your daily activity quota, get creative- Walk Up & Down the Stairs, March on the Spot, or grab a ball and head outside with the kids.
  5. Whenever you feel uncomfortable- get up and stretch! Some examples below to try.

Levator Scapulae Stretch:

Gently take your nose towards your right armpit. Place your right hand on top of your head and apply slight over pressure into the stretch.
Hold here maintaining a gentle stretch for 10-20 seconds.
Repeat to the other side

image00001

Mid-Back Rotation:
Cross your left leg over your right leg, placing your right hand on the top knee.
Rotate the body to the left, looking over your left shoulder.
Hold here for 10-20 seconds
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If you’re doing these things and still struggling with pain, KEEP CALM AND CALL YOUR PHYSIO! We are open for Online Video Consultations.

Call 075761860 OR email: kim@buretaphysio.co.nz to book your appointment TODAY.

Written by Kimberley Pilbrow

Sleep Hygiene

SLEEP

 

If there is one thing I could say to our community right now in order to stay or get healthy is to prioritise SLEEP. The World Health Organisation deems sleep the foundational of the three pillars of health, with diet and exercise being the other two. Studies show that between a third and two thirds of the Western World do not get enough hours of sleep per night.

Sleep has a significant impact on the reduction of both illness and injury and is one of the few interventions that can help prevent both contact and non-contact injuries. Performance research shows us that adequate sleep improves our accuracy, sprint and reaction times as well as the perception of strength and effort. It also has a huge impact on mental health. The brain recalibrates during sleep. It is no surprise then to find out that mood swings, paranoia, depression, anxiety and dementia are all linked to poor sleep.

 

Now back to current times and COVID 19 where prioritizing sleep is important in strengthening our immune system in order to fight off illness particularly when our body is under stress – which currently is more likely to be mental than physical but the body doesn’t have the ability to alter its responses to this.

 

In order to ensure you have a good night’s sleep both sleep rhythm and sleep drive is needed. Sleep drive is the need for sleep ie how tired you are. This can be challenging in the current situation if you aren’t getting as much physical exertion into your day as normal but for many this drive is increased simply from the mental stress of the lockdown and the uncertainties surrounding this. Sleep rhythm is ensuring you have regular sleep and wake times. This is why when you have a night out or stay up late to watch that extra movie even though you feel exhausted you don’t sleep as well.

In an ideal world the majority of adults get around 7.5 hours sleep as a minimum as each sleep cycle is approximately 90 minutes and we need 5 of them for a full night’s sleep. This does vary with age. Our children should be getting more as their requirements are greater, given they are growing and the elderly may need less.

Genetics play a part. Early birds or lions make up only 15% of the population. Usually those that are list makers, many CEO’s and those in management make up the large proportion of this group. They are asleep early and up early.

Wolves or night owls on the other hand are categorised as generally being creative personalities, high risk takers, often introverted even if they are extroverted in public life i.e. actors’ musicians authors. Ideally sleep to your rhythm, this gives you the best chance to achieve a good night’s sleep.

 

 

But its not all about quantity.

Sleep is about quantity and quality. Poor sleep is linked with a large number of physical conditions and diseases including increased blood pressure, heart disease, reduced immune function, diabetes, ncreased intensity of pain when pain is felt, weight gain, poor decision making, lower testosterone and lower libido in females.

Most likely it is the relationship between sleep and decision making and reaction times that are likely where the link to injury prevention comes in – more sleep better reaction time and decision making.

 

Food, Vitamins and sleep

Metabolism is affected negatively by sleep deprivation as metabolism slows down. Increased stress results in increased cortisol release which results in increased appetite BUT slower metabolism and therefore fat deposition. We are also more likely to overeat when we are sleep deprived as leptin decreases and this is hormone that tells us we are full.

 

People who are sleep deprived lack vitamin C and Selenium which affects immune function. Things you can try and do to help with this are to put citrus in your water and eat mushrooms or Brazil nuts to boost these vitamins.  B vitamins are essential for good sleep and serotonin levels so eat food rich in B vitamins such as broccoli.

Magnesium helps boost the quality of sleep as it helps regulate your circadian rhythm.. Ensure meals and snacks contain greens, nuts, brown rice and other grains. Bananas are loaded with magnesium so are awesome for sleep.

A lack of vitamin D can cause poor sleep quality. Getting out and about in the sunshine particularly at this time of the year when the sun isn’t too hot(whilst staying within your bubble!) is the most useful way of ensuring adequate Vitamin D.

Salmon is one of the best foods for sleep as it helps melatonin production.

For those that suffer with restless legs – ensure iron intake is sufficient as this is often a cause or part of the picture– eat plenty of spinach, red meat and other iron sources at the same time as consuming vitamin C (ie orange juice) as this increases your iron absorption. Ensure you don’t consume tea or coffee near these meals as these both affect your body’s ability to absorb iron.

 

Supplements and sleep

Melatonin is not good for insomnia; it is for jet lag. It affects the rhythm. It’s a sleep regulator not initiator so really useful for shifting sleep rhythm where appropriate. A lack of melatonin causes shallow sleep, insomnia or regular awakenings so is the other time where it is useful. 1-1.5mg is ideal amount – many are taking far too much/too higher dose. It takes 90 minutes to work so needs to be taken 90 minutes before sleep or blood plasma levels aren’t sufficient to work. Take for right reason, at right time in right amount!

 

On return to normal life

If post lockdown you continue to struggle with sleep go see your GP for an assessment of this. You may require some blood tests to check your levels of Vitamin D, melatonin, iron and magnesium. If this doesn’t give you any answers we can help. Learning strategies to deal with poor sleep can be really useful and one of the most effective with this is correct breathing patterns and breathing exercises to ensure your parasympathetic nervous system is engaged and your body and mind is therefore able to wind down and sleep.

 

 

For those who struggle with sleep if you are going to stress about sleep and your lack of it you aren’t likely to get a good night’s sleep so it’s somewhat of a “catch 22”. So where do you start?

Number 1 – PRIORITISE SLEEP – do you really need to watch that movie? Watch one more episode on tv? Play around on your phone when it’s just before bed time?

Know that one nights poor sleep won’t cause you significant issues in the long term. Changing your sleep patterns is a process like any other aspect of improving health and wellness. It takes a plan and the implementation of it.

Sleep hygiene is where to start! If you have any questions on this please send us an email on reception@buretaphysio.co.nz or give us a call on 5761860.

 

IN THE MEANTIME SORT OUT TONIGHTS PLAN!!

Post Season Recovery and Pre Season Training

For many winter sports, the season is coming to a close. Summer is around the corner, and we all can become a bit more lazy with our off-season training. It can be prevalent that throughout the season, we pick up a couple of injuries and niggles. This offseason training, therefore, can have more importance than we realise to reduce the risk of injury when we start up training again.
Off-season training can be seen as a waste of time due to having no sport-specific goals. However off-season training can reduce injury rates, feeling burned out, can improve quality of training throughout the year, save money from not needing treatment from health professionals, and can improve an athlete’s overall health and wellbeing. Continued training can also open windows of opportunity to focus on recovery and develop weaker aspects of your game. It can also enable us to set new routines, new workouts, and even further research that apply to their sport.
The off-season can be used as an excellent opportunity to work on your game. This time enables athletes and coaches to reflect on the season and create plans for the year ahead. Training can become mixed up, incorporating more cross-training such as gym work. Improvements can range from technique, strength, equipment adjustments, mental training, recovery, or nutritional adaptations, which gives the perfect opportunity to develop these high-level skills.
When discussing training loads, we can talk about acute and chronic workload. This can be of great value as it helps us reduce the risk of developing load-related injury when starting up training again. During the season, it can be hard to fully recover from an injury, instead of working to manage it to be able to play and train. Working on patterns of injury – (i.e. a recurrent calf injury, etc.) the offseason gives the perfect time to work on your weaknesses, so in the in-season, you can refine your strengths. A lot of the time, it is seen that before an event or the beginning of the season that training is crammed together. Therefore having a peak in acute training load can impact the efficiency of our training. In turn, preseason training goals may not be accomplished, and an increase in the risk of injury earlier in the season can be seen.
A reduction in chronic load for four weeks (i.e. rest or minimal training load) can take an additional 2.5 weeks of further training to restore the body to full capacity. The key message is it takes time to get fit; this, unfortunately, can’t be done in a week or 2.
It is highly recommended that following a season, it is essential not just to stop training. Altering and adapting from what happened during the season and working with coaches or health professionals to set new and appropriate goals to hit the ground running come next season is a valuable exercise.

Written by Braedon Catchpole.

Concussion is a Mild Traumatic Brain Injury.

Concussions – Written by Kimberley Pilbrow (BHSc Physiotherapy)

With the start of another Winter Sports season now upon us, now is a good time for athletes, parents, coaches, officials & supporters to increase their knowledge about concussion.

Concussion is a Mild Traumatic Brain Injury which occurs when someone receives impact to the head or body causing a force to be transmitted to the brain, ie ‘shaking’ inside the skull. In a concussion injury there is no change to the macro-structure of the brain. Ie there is no permanent damage to the brain. However, there are changes at a micro level, meaning it may take some time to re-access the areas of the brain that were affected.

Historically people believed that to sustain a concussion you must be “knocked out” (loss of consciousness), this is not true- 90% of concussion occur without any loss of consciousness AND Loss of consciousness does not relate to their long-term outcomes. Ie someone who is knocked out may return safely to sport in 3-4 weeks, where as someone who is not may take 3months to recover- there is no relationship between “severity” of concussion and length of recovery.

As Concussion is a brain Injury- there is a wide range of symptoms such as:

Visible Signs:
-loss of consciousness
-slow to get up
-unsteady on feet/poor balance
-poor coordination or inappropriate playing behaviour (eg. standing out of position)
-clutching or grabbing at head
-dazed or confused
-vomiting (>once is of greater concern-take to Emergency Department)
-irritability/changes in emotions

Symptoms:
-dizziness
-headache
-nausea
-drowsiness
-“don’t feel right”
-blurred vision
-difficulty concentrating/remembering

If you (or your child) have an incident like this and have one or more of the following symptoms you should:
1) Be removed from sport immediately
2) Monitored by an adult
3) Seek Medical Attention from your GP or Concussion Trained Physiotherapist (Click here for our team)

A full list of symptoms can be found HERE– the Concussion Recognition Tool is a great resource for parents & coaches

Assessment and Treatment of Concussion:
A concussion must be diagnosed by a health professional. Examination from your Physiotherapist will include a group of tests as required including; SCAT5 or SCAT5 Child Assessment (Symptoms, Neurocognitive processing, Balance), Assessment of neck pain and movements, Neurological Exam, and Eye & Head Movements.
Treatment of each concussion is individual- REST IS NOT BEST!!
Your Physiotherapist will work with you on starting appropriate activities EARLY to aide a gradual return to daily activities (highly supported by research), followed by return to work/school and then return to sport. Your treatment plan may include; education about pacing activities, treatment of the neck joints and muscles, relearning eye tracking movements and gradual exercise progressing back to full function including work and sport specific tasks.

Key Points:
-90% of concussions occur without being knocked out
-If you suspect a concussion, remove the athlete from play IMMEDIATELY
-Seek Medical Assessment from someone trained in Concussion
-Rehabilitation is INDIVIDUALISED
-REST IS NOT BEST!
If you have had a concussion, Bureta Physiotherapy will work with you, your family and your doctor to take you through the required steps for full return to function-including sport, school or work.
Early Diagnosis is important for monitoring symptoms and guiding appropriate rehabilitation, contact us TODAY to book an appointment or discuss if our acute concussion service is right for you.

 

Written by Kimberley Pilbrow

 

 

Abnormalities found on scans in asymptomatic people.

There have been many studies that have explored the abnormalities within our bodies through using different imaging techniques. The key take home message that research has brought to us is we are not all perfect, even if we are walking around pain free performing all our daily activities without issues.
However when injury does occur we may get x-rays, an ultrasound or refer you to a specialist who can get an MRI which can come back with findings such as a disc bulge. As demonstrated in the infographic above, it shows us that at least 37-96% of individuals can have this problem in their lower back, and up to 87% in their neck.
It is also reported that for men aged between 40 and 70 years old, up to 96% of individuals have shoulder abnormalities . Although these individuals can carry out their daily routine symptom free.
There are many findings on imaging from head to toe that are part of the normal ageing process and yet do not affect any part of our social or work life or our physical activity. What we don’t know is that we may have already been living with them for many years in our lives. This goes to show that even if we have an ‘abnormality’ within our body on imaging, it doesn’t necessarily mean that we are ‘injured’ or that our injuries are as bad as they present.

Image: Leedarrenh

Lateral ankle sprains – How should they be managed?

Diagnosis, Treatment and prevention of ankle sprains: Update of an evidence-based clinical guideline – vuurberg et al., 2018.
Lateral ankle sprains, how should they be managed

Lateral (outside) ankle sprains are the most common ankle injury. Approximately 40% of all traumatic ankle injuries occur during sport, and only 50% of individuals seek medical attention.
Due to the poor attention to injury, a large population develop chronic ankle instability. 1-4 years following initial injury, 5-46% of individuals with chronic ankle instability still experience pain, 3-34% has recurrent sprains, and 33-55% report instability.
Risk Factors
Predisposing factors that increase the risk of sustaining a lateral ankle sprain compose of Intrinsic factors (patient-related), and Extrinsic factors (sport, environment).
Intrinsic risk factors
Modifiable risk factors include:
• Reduced strength around the ankle and calf
• Limited ankle mobility and range
• Poor proprioception (“the sense of the relative position of one’s own parts of the body and strength of effort being employed in movement”)
• Low cardiorespiratory endurance
• Increased BMI (Body mass index)
• Preseason deficiencies in postural control/balance e.g single leg stand
Non-modifiable risk factors include:
• Anatomical abnormalities in the ankle, knee alignment, and multiple clinical defects
Extrinsic risk factors
• Sport dependent – Highest incidence of lateral ankle sprains were found in: Basketball, indoor volleyball (landing following jumping), field sports, climbing.
• Playing surface – Natural grass vs artificial turf vs court
• Position played in sport – e.g within soccer, defenders obtain 42.3% of lateral ankle sprains in the sport.
Treatment
Below is some of the latest evidence for the best treatment options, and how we can get you back running around with the kids, or back onto the sports field.

 R.I.C.E (Rest, Ice, Compression, Elevation)
Purpose: to reduce pain and swelling, improve patient function
RICE alone as a treatment is not enough, the best evidence is to apply the RICE principles alongside with exercise therapy.

 Non-steroidal anti-inflammatory drugs (NSAID’S) – E.g Ibuprofen, naproxen, diclofenac
Purpose: to reduce pain and swelling for acute injuries
If you have any concerns in regards to medication please discuss with your doctor.
Adverse effects may include: stomach discomfort, allergic reactions, heart burn, nausea, vomiting, diarrhea and/or constipation and more.

Immobilisation
A minimum of 4 weeks in a low leg cast following an acute lateral ankle sprain results in less optimal outcomes when compared with functional support (brace, tape, tubigrip/bandage) and exercise strategies with duration of 4-6 weeks.
However recent evidence showed a short period (less than 10 days) of immobilisation with plaster cast or rigid support (brace) can be of added value in the treatment of acute lateral ligament injuries as it helps reduce pain and oedema (swelling), and improves functional outcomes

Functional support i.e ankle brace/ tape/ tubigrip
Tubigrip/compression stocking following the acute phase of treatment begins to become unhelpful as it doesn’t provide sufficient support. Therefore using a lace up brace or semi-rigid brace will provide enough ankle support
Ankle braces results in better outcome compared to rigid or K-tape
K-tape is unlikely to provide sufficient mechanical support to unstable ankles

 Exercise
Consist of neuromuscular and proprioceptive exercises
Reduce the risk of recurrent injuries by reducing ankle instability, and associated with quicker time to recovery and enhanced outcomes

 Manual mobilisations
Manual mobilisations provide short term increase in ankle range of movement and can reduce pain in lateral ankle sprains
However manual therapy in combination with exercise therapy results in better outcomes than exercises alone

 Surgical therapy
60-70% of individuals who sustain lateral ankle sprains respond well to non-surgical treatment programmes
Surgery is mainly reserved for patients who have chronic ankle instability and who have not responded to comprehensive exercise-based physio programme.

Other therapies
Other treatment options are can also be used during treatment, although please discussed with your physio if these are beneficial for you.
These including: Acupuncture, Vibration therapy, laser therapy, electrotherapy, shockwave therapy, ultrasound.

Here at Bureta Physio we can properly assess your injury and give you the appropriate recommendations to get you back into what you love doing. Call 07 576 1860 to arrange an appointment time or click here to book online

 

Strain and sprain is not OK!

“The perfect movers, without strain and pain are under 5 year olds”

Stiffness and strain for many is part of life, indeed a modus operandi for many. But imagine if stiffness and strain equates to dysfunction, pain and harm, this forms much of our function and day. I recently attended a Integrated Movement Patterns Course to upskill on the Milicich Method where the emphasis was on non – specific neck and back pain. These methods were derived from analysing the perfect movers of this world; the few uninjured high performing individuals, who work within gravity, pain free. A small percentage are in the adult population and a high percentage are the 5 years old’s and under, the perfect movers of this world; the young who display natural movement synergies. The ability to move their centre of mass with perfect balance is part of our natural physical development, which sets the foundation for future movement.

The Milicich Method aims to facilitate these fundamental movement patterns that are still within our central nervous system and awaken them to treat strain and sprain. Diaphragm function underpins strength and function within these movement synergies undoing habits, utilising language to facilitate existing pathways. These are key to the learning process. Many people have unlearned the pro-gravity system and reprogrammed the anti-gravity system in their brain, working against gravity instead of with gravity.

One aspect of our daily lives that contributes to neck and back strain is lifting and the Milicich Method addresses this concern looking at the way 5 year old’s squat and how power lifters perform. This was instrumental in re-establishing the pro-gravity movement pattern. The natural flat foot squat (FFS) position is a movement that much of the western society has lost. The FFS that every child performs, moves the centre of mass through a vertical range of motion, and this is a very specific sequence of movement incorporating diaphragmatic breathing to engage the power chain, which gains a successful lift without strain within gravity.
If this concept of eliminating strain and sprain, re-establishing fundamental principles of movement and working within gravity is something that you would like to explore then I look forward to facilitating this learning process.

Marcel Gyde
Senior Physiotherapist