Syndesmosis sprains : The high ankle injury

You may have heard various athletes suffering a high ankle sprain or injuring their syndesmosis. But what exactly is a syndesmosis injury? And how does it differ to a normal lateral ankle sprain?

The ankle syndesmosis is the joint between the distal (lowest aspect) of your tibia and fibula. It is comprised by three main supporting ligamentous structures – The anterior inferior tibiofibular ligament, posterior inferior tibiofibular ligament, and interosseous membrane (see Figure 1).  The role of the syndesmosis is to provide stability to the tibia and fibula and resist separation of these two bones during weightbearing tasks. It also plays a role in assisting with mobility of the ankle.

Figure 1: Syndesmosis anatomy

How does it differ to a common ankle sprain?

Generally, a lateral ankle sprain is a result of and inversion injury and will result in an injury to the outside ligaments of your ankle (ATFL, CFL, PTFL). These ligaments are positioned slightly lower than the syndesmosis and provide stability to the true ankle joint.

Figure 2: Inversion sprain mechanism

Mechanisms of injury:

The most common mechanism for injuring your syndesmosis is a forced dorsiflexion combined with an Eversion movement. Essentially the foot/ankle moves in an upward direction and to the outside of the leg (See figure 3).

Figure 3: Syndesmosis Mechanism - Dorsiflexion + Eversion

The syndesmosis can also be injured with a typical inversion or lateral ankle sprain (Figure 2) mechanism. This usually occurs when the incident is of high force and will result with an injury to the lateral ligaments as well.

Signs and symptoms:

·       Mechanism of injury consistent with a syndesmosis injury (forced dorsiflexion + Eversion)

·       Pain location may extend above the ankle and into the lower shin

·       Swelling may sit slightly above the cease line of the ankle joint

·       Difficulty weightbearing, particularly when the foot is in dorsiflexion (knee over toe)

·       Low confidence/feeling of instability

Gradings:

• Grade 1: isolated injury to the AITFL

• Grade 2: Injury to the AITFL and interosseous membrane

• Grade 3: Injury to the AITFL, interosseous membrane and PITFL

• Grade 4: Injury to the AITFL, interosseous membrane, PITFL and deltoid ligament

Immediate management:

As always if you have recently suffered an injury, please seek medical attention from your physio or doctor for accurate diagnosis and management.

If a syndesmosis injury is suspected acute management will initially involve offloading and protecting the tissues. This may be in the form of one or a combination of crutches, a cam walker (moon) boot and strapping.

Your physio or Doctor may also refer you for imaging such as an x-ray or MRI to assist with diagnosis and understanding the severity of the injury.

Following the acute period of offloading and protection a period of rehabilitation will be required to restore normal function of the foot and ankle. In more severe cases surgery may be required to stabilise the syndesmosis and therefore rehab will commence following a period of protection post-surgery.

If you have experienced an ankle sprain yourself, please book in with one of our physiotherapists for an individualised rehabiltation program.

Relative Energy Deficiency in Sport (RED-S)

Are you unable to recover between training sessions? Experiencing severe wide-spread muscle ache/DOMS? As a female athlete, has your menstruation ever been affected by your training? These can all be signs of energy deficiencies and overtraining. Our blog explores what energy deficiency is, how to identify it and how to treat it.  

What is RED-S? 

Relative Energy Deficiency in Sport (or RED-S) is due to low energy availability in athletes. This means the fuel going into the body from food is less than the energy burnt during exercise. This energy balance should be at least equal and is additional to the normal calories consumed during the day. When energy input is at a deficit, RED-S can have significant impact on many body systems, affecting both injury risk and performance. 

RED-S used to be known as the ‘female athlete triad,’ terminology which is no longer used as it affects ALL athletes. The most well-known consequences of poor energy availability are bone stress injury and female athletes losing their period. These are both extreme consequences of RED-S, however there are much earlier signs and symptoms which are lesser known. 

Signs and Symptoms 

·      Poor sporting performance 

·      Inability to recovery between sessions

·      Poor wound healing 

·      Regular cold and flu sickness

·      Irregular/cessation of menstruation/periods (see below; ‘The female athlete’)

·      Poor bone health/osteopenia/bone stress response

·      Mood changes 

·      Iron deficiency 

·      Arrythmias (in severe cases)

Why does it matter? 

1.     Adverse effect on performance 

·      Quicker onset of fatigue from less energy available to skeletal muscles

·      Reduction in muscle strength/size due to impaired testosterone production and compromised neuromuscular control  

·      Impaired recovery increasing the risk of overtraining 

2.     Impact on health and wellbeing 

·      Increased the risk of chronic fatigue 

·      Low energy availability decreases the ability to heal from injury. Strains, sprains, cuts and bone injuries will take longer to heal

·      Impaired growth and development from inadequate cell turnover

The good news is most effects of RED-S are reversible if picked up early.

Athletes are often worried increasing food intake can result in weight gain. This is not the case for most athletes. Nutritionists and sports science professionals understand the energy demands of sport and ensure the balance between energy input and output is correct. 

The female athlete

1.     Menstruation 

If an athlete has low energy availability, their body is unable to produce normal levels of hormones. This can affect the menstrual cycle in female athletes. Periods may become irregular, or even cease altogether. Although the female menstrual cycle is variable between individuals, an individual’s cycle should be quite consistent. Irregularity or cessation of periods for longer than 6 months, or not getting a period by 16 years of age should be reviewed by a doctor. 

2.     Contraception 

Female athletes may be advised the oral contraceptive pill can treat symptoms and normalise their menstrual cycle. The combined pill produces a synthetic estrogen the body can not process and therefore does not assist with improving bone health. This can mask hormonal problems, without assisting in bone health. Athletes using contraception that contains estrogen may also be screened for risk factors of RED-S. Athletes using contraception that alters the normal production of a period (e.g. Mirena, Implanon) must also be monitored for RED-S symptoms.

How can physio help?

Physios can help review your training program and lifestyle to assess energy availability. If an athlete is at significant risk of RED-S, a Sports Physician should be involved to identify any hormonal/nutritional deficiencies and directly address them. This is commonly done through a blood test. 

After any nutritional deficits have been addressed, a physio can help modify training loads and aid with recovery techniques.

Who else can help? 

Sports doctor – Vital for initial diagnosis and hormonal/nutritional testing. Depending on severity, medical intervention may be needed (e.g. iron infusion)

Nutritionist – Eat the right food… and enough food, is vital for good energy availability   

Strength and conditioning coach – Clever programming results in efficient training and decreases the risk of overtraining. 

Dietary Supplementation

The dietary supplement and health food market is massive and is continuing to grow. To gain that extra edge it is not a surprise that athletes of all backgrounds find themselves drawn to additional dietary help to improve their physical output. Unfortunately, most of the supplements on shelves are not what they are made out to be and there is no substitute for good old-fashioned hard work. However, it is not all bad news, there are some foods and supplements that have been backed by science that can play a marginal performance enhancing role in sport and exercise.

Here we will briefly go over some of these health foods and supplements that may have a positive effect on performance directly. There are also many other dietary foods/supplements that claim to have an indirect on performance such as aiding recovery, assisting muscle development or improving immune function which we will not go into detail.

Caffeine:

One of the most commonly used supplements and widely used legal drug (in the form of coffee).  There is significant scientific for caffeine as a positive performance enhancement for some athletes in range of different types of activities.

Possible benefits are improved endurance capacity such as exercise time to fatigue and time-trial activities of varying duration (5-150min). This has been shown across activities such as cycling, running, rowing and various team-sports. Improvement in performance measures such as time-trial time have shown to range from 3-7%.

How does it work?

Caffeine is a stimulant which can enhance vigilance and alertness, perception of fatigue and exertion during exercise and improve neuromuscular function.  It can also stimulate an endorphin release which can assist in feelings of wellness.

A systematic review by Ganio et al (2009) has shown 3-6mg/kg of body mass consumed 60 min prior to exercise is sufficient to provide positive effects. However lower doses <3mg/kg of body mass has shown to also be effective. To put that in perspective the average cup of coffee has about 100mg of caffeine in it.

Possible side effects:

Larger doses of caffeine have shown not to further increase performance enhancement and in fact increase likelihood of negative side effects.

Possible side effects include; nausea, anxiety, insomnia and restlessness. Caffeine is also a diuretic which can increase urine flow but is small when consumed at the doses that have shown to improve performance.

Sodium Bicarbonate:

Sodium bicarbonate is a commonly occurring substance in most foods. In fact, most households will have this In their kitchen without even knowing as it is commonly known as baking soda.

How does it work?

It helps regulate PH in the blood which commonly increases in acidity during exercise. Sodium bicarbonate is naturally occurring in the body and helps buffer excess acid that accumulates during bouts of high intensity exercise. By keeping muscle PH level closer to its normal it can enhance exercise capacity.

Sodium bicarbonate has shown to enhance performance during short term, high-intensity exercise of approximately 60s in duration of approximately 2%. Improvements reduce as duration of effort exceeds 10 min.

Protocol of use:

According to the evidence various strategies of consumption have been suggested.

1.     Single dose of sodium bicarbonate of 0.2-0.4 g/kg of body mass, 60-150 mins prior to exercise

2.     Split dosage (i.e multiple smaller doses totalling 0.2-0.4 g/kg) over 60-180 min

3.     Serial loading with 3-4 smaller doses per day for 2-4 days consecutive prior to an event

Potential side effects:

It is well established that gastro-intestinal upset can be associated with sodium bicarbonate. Therefore, may not be appropriate for some athletes or ideal consumption strategies may be person dependant.

Creatine:

Creatine is naturally occurring substance in body where it is found in the substance creatine phosphate. Its use as a supplement has grown significantly over recent times. Creatine works by aiding resynthesis rate of the phosphocreatine energy system. In short aiding the use of the energy system in the body that is utilised in short, high-intensity bouts of exercise.

In term creatine has shown to have positive effects particularly in sports that involve repeated high-intensity exercise (eg. Most team sports). it has also shown to assist in increased gains of lean mass and muscle strength and power.

Potential side effects:

No negative health effects are noted with long-term use (up to 4 years) when appropriate consumption use is followed. However, a 1-2 kg of body mass increase has shown to be a possible side effect which is primarily the result of water retention. This is an important consideration as the possible detrimental effect of increase weight gain may outweigh the positive effect of creatine.

Nitrate or Beetroot Juice:

It may seem as an odd one to add in but nitrate which is readily found in beetroot has been shown to have positive performance enhancing benefits. High nitrate rich foods include leafy green and root vegetables, including spinach, rocket, celery and of course beetroot which accounts for one highest sources of nitrate.

How does it work?

Nitrate contributes to the production of nitric oxide in the body. Nitric oxide is a vasodilator which improves blood flow and oxygen delivery to muscles. It therefore can improve the muscle efficiency in utilising oxygen and can improve the performance and energy efficiency of type 2 or fast twitch muscle fibres.

Supplementation of nitrate has been associated with improvements of 4-25 % in time to exhaustion during exercise and 1-3 % in sport specific time trial events lasting less than 40 mins.

Protocol of use:

Nitrate consumption within 2-3 hours of activity as bee associated with improved performance. Prolonged use of nitrate also appears to be beneficial and has been suggested strategy for highly trained athletes where improvements from nitrate supplementation is smaller.  

Potential side effects:

There appears to be few side effects or limitations to nitrate supplementation. It is suggested that there is potential of gastro-intestinal upset and therefore suggested to be trialled in trainings before the use in competition. It also appears that performance gains and harder to obtain in highly trained athletes.

Beta-Alanine:

A naturally occurring amino acid, beta-alanine plays a role in the development of a carnosine.

How does it work?

Similar to sodium bicarbonate, carnosine acts as a acidity buffer in the muscle and therefore helps maintain an optimal PH level for muscular performance. It helps resist muscle fatigue and in term potentially assists performance.

Protocol of use:

Beta-alanine is commonly found in meat, poultry and fish and therefore most people can get enough beta-alanine through their regular diet.

Dietary supplementation however can further assist our daily intake. It is suggested a daily consumption of 65mg/kg of body mass taken in 3-4 smaller doses throughout the day.

Potential side effects:

Possible side effects include skin rashes and/or transient paraesthesia (tingling feeling in the skin) when taken with high single doses. This effect is temporary and harmless.

It should also be noted the effectiveness of supplementation appears to be harder to realise in well-trained athletes.

It should go without saying please seek professional medical advice whenever considering whether additional dietary supplementation is right for you.

If must also be noted that inadvertently consuming a known banned/prohibited substance should be risk considered when weighing up the decision to pursue dietary supplementation.  Please find some useful links below which can assist in determining whether a specific product is considered banned or has gone through the necessary batch testing to determine if it is safe for consumption under the anti-doping rules.

Useful resources:

https://www.informed-sport.com/

https://www.asada.gov.au/substances/check-your-substances

1.     Maughan R, Burke LM, Dvorak J et al 2018 IOC consensus statement: dietary supplements and the high-performance athlete. British Journal of Sports Medicine; 52 418-419. doi: 10.1136/bjsports-2018-099199

Busting Running Myths

Are you a seasoned runner or just starting out? Training for your first marathon or just enjoy your Sunday jog? Check out these commonly assumed running myths to know what is and isn’t important for improving performance and reducing injury!

Myth #1

‘The wrong shoe type can cause injury’

• There is some largely subjective and unreliable evidence claiming barefoot running reduced injury by 2.6x compared to running in shoes

• More recent research shows runners who change from a ‘bulkier’ shoe to a minimalistic shoe have a huge varied response in how their running style is affected from this change (with no correlation to injury)

• There is a common belief that shoes should be fitted for a person’s foot type (i.e. pronated feet require more arch support). There is actually no evidence that this type of shoe ‘prescription’ affects performance or injury risk 

Myth #2

‘Changing running style or becoming a forefoot runner is more efficient and reduces injury’

• Forefoot strikers place more force through their ankles and calves, while rearfoot (heel) strikers place more force through their knees and hips

• Despite the differing biomechanics, no running style has proved to enhance performance or reduce injury risk

• There are large variations in the running styles of national 10K runners, with zero correlation to injury or finishing position

• The biomechanical changes that occur when transitioning between running styles changes force distribution to certain muscles and joints, in fact INCREASING injury risk due to this shift in load

• Forcing a running style that feels unnatural uses more energy when you run 

Myth #3

‘Running will damage your knees’

• Evidence is continuing to prove recreational runners are less likely to develop knee osteoarthritis (OA) than non-runners. It appears elite athletes who compete at an international level have the same risk of developing knee OA as non-runners.

• Although further evidence is needed for a conclusive answer, a recent study has shown running does not speed the progression of existing OA and may even help to reduce symptoms. 

• There is strong evidence to suggest resistance training reduces the risk of OA, and slows progression of existing OA

Myth #4

‘You will get sore/injured if you don’t stretch’ 

• Static stretching post run has no positive or negative influence on delayed onset muscle soreness, injury risk or running performance. That being said, as there are no detrimental effects and it can psychologically help runners ‘relax’ after a big training, stretching is still warranted if it feels beneficial for you.

• It is well proven that sleep is one of the best forms of recovery. Athletes who sleep for less than 8 hours increase their injury risk by 1.7x compared to those getting 8 hours or more. 

• Re-fuelling your body with appropriate food will provide your cells with adequate nutrients to recover and grow muscle tissue. Low GI carbohydrates gives your body sustainable energy while you run, and High GI carbohydrates and protein are necessary for filling energy stores and muscle growth

• An active warm-up including dynamic stretching (eg walking lunges, leg swings) and easy jogging is commonly used prior to exercise, but has not been proven to have an effect on injury risk.

Myth #5

‘The only thing that will improve running, is more running!’

• The biggest injury predictor for runners is overload (doing too much too quickly). Total running load or volume should increase by no more than 10% per week to give your body time to recover and adapt.

• Twice weekly strength training has been shown to improve performance, improve fitness or running efficiency and reduce injury risk.

• There is no benefit to running performance by training low weight, high rep endurance exercises, nor circuit training.

• Have a look at our ‘Basic Guide to Resistance Training’ blog for an explanation between different types of gym training

What does this all mean? 

• The number one biggest predictor of injury is a significant load increase of more than 10% per week (Running too much too quickly)

• Choose a shoe you are comfortable in – there are more effective strategies to help your running than changing shoes 

• The body is adaptable and resilient, and there is no ‘perfect’ running style

• Well thought out recovery (diet, sleep) is one of the most effective ways of reducing injury 

• Twice weekly strength training will reduce your injury risk and improve your running performance. 

Our physiotherapists at East Vic Park Physiotherapy can answer all your running questions and can help review your running program to get you the best possible results

Sleep Hygiene: Simple tips to keep it clean

There is a reason we spend approximately one third of our lives sleeping. It is a very important aspect of life and affects just about every biological system of the human body in one way or another. With that in mind it is still amazing how many people still deprive themselves of it. According to the Geneva Convention, sleep deprivation can be interpreted as a form of torture. So, it begs the question, why do we knowingly do it to ourselves?

It has been reported that up to 45 % of Australians suffer from inadequate sleep. With 24/7 nature of life today, the time we would normally allocate to sleep is now taken up with other “more important” activities such as studying for an exam, working late to earn that promotion or just partying. As a consequence, both sleep quality and quantity are being affected which is having a bigger impact than we think on our health.

Loss of sleep affects our ability to function at optimal efficiency. It can affect physical performance such as reaction time, tissue recovery and aerobic endurance as well as cognitive performance such as alertness and ability to perform complex problem-solving tasks.

In addition to the obvious and more noticeable and immediate side effects of sleep deprivation. There are many invisible yet serious consequences that affect our immune, hormone and metabolic function. They can subsequently increase the risk of obesity, diabetes, hypertension, depression, chronic pain disorders, developing the cold/flu and even increase the risk of sustaining sporting injuries by nearly 2-fold.

So how much sleep do i need?

Age and genetics play a key role in this. However generally:

·  Infants need around 16-18 hours of sleep

·  Teenagers need around 9 hours

·  Adults need between 7-8 hours

Research has shown that both deprivation of sleep quantity and continuous sleep interruption (waking throughout the night) may have very similar effects. Therefore, not only getting an adequate amount of sleep is important but also sleep without regular waking is required for good sleep health.

Can I nap during the day?

Having an afternoon nap can help offset the negative effects of sleep deprivation. Research have also shown It can also have a positive effect on sporting performance although only for people who have had reduced night time sleep. Napping can be an effective way to improve sleep health. Just be mindful not to nap too late in the afternoon or for too long which may impact the quality of night time sleep.  Napping/sleeping more than 30 minutes can lead to “sleep inertia” which is a physiological state where you feel less alert and drowsier when waking.

How can I achieve good sleep hygiene?

Good sleep environment

Numerous studies have shown a relaxing environment has a significant impact on sleep. A dark and quiet bedroom will help optimise sleep. Additionally, the temperature of the room can also play a big role with research showing a bedroom temperature of 18-22 degrees appears to best for a good night’s sleep. If you are still struggling to reduce external stimuli, the use of earplugs and eye masks can be helpful.

Get off the grid and unplug before bed

Limit use of devices such as phones, tablets, laptops at least 1 hour before bed. The use of these devices will make it difficult to relax prior to bed due to an increase in brain activity. Blue light also has a suppressive effect on production of the hormone melatonin which assists the body in falling asleep. If you must use a device close to bed Night Shift setting on devices or applications that filter blue light are recommended.  

Avoid stimulants too close to bedtime

Avoid taking stimulants such as caffeine (within 5-8 hours before bed) and alcohol before bed. Although alcohol may seem to assist in getting to sleep faster it can actually affect the quality of sleep throughout the night

Food and drink

 Avoid large meals and large quantity of fluids immediately before going to sleep. This has shown to have a negative effect on sleep. Try to aim to eat approximately 2-4 hours prior to sleep.

Have a routine

Try to have a consistent night time routine before going to bed each day. Additionally, try going to bed and waking up at the same time each day.  This consistency will help regulate your body clock allowing for better quality sleep

Get out and exercise

Regular exercise is an extremely effective way to help manage stress and ensure you are tired enough to get to sleep at the end of the day.

 Additionally, exposure to natural light during the day can help normalise your body clock and hormone levels and in turn assist in good sleep health.

Wind down before sleep

Try to reduce any physical, emotional and cognitive stressors. Activities that increase physical or mental alertness will make it difficult for the body to switch off when it’s time to go bed. If you are the type to have an active mind before sleeping, techniques such as mindfulness/meditation and journaling has shown to help switch off a racing mind.

FIVE questions you should ALWAYS ask your orthopaedic surgeon before making a decision on managemen

Orthopedic surgeons are indispensable members of the health profession and have a level of anatomical and biomechanical knowledge and a degree of experience that is rarely surpassed.

However, if you’ve ever been for a consultation with an orthopedic surgeon, you’ll know how fast the appointment passes. Many of our patients have reported being in-and-out without feeling like they’ve said more than 10 words.

Most consults will last 10-15 minutes and within this short space the surgeon has a certain “volume” of assessment to conduct and information they MUST deliver. It’s easy to see why they can occupy most of consultation to you leaving little opportunity for questions or express your opinion. When the opportunity finally arises, many patients are so bombarded with information that they forget the questions that had been circling in their head for days!

The surgeon is not to blame here as they are exceptionally busy individuals and with a huge demand on their limited time and wealth of knowledge and experience.

However, it makes it imperative that you use the time well and ask direct and concise questions to ensure you leave the session fully informed and able to make the decision that is best for you in your unique situation.

We decided to put together a list of questions that you should leave the consultation with the answers to. We’d recommend you print the 5 questions (and add any others you think of) and review them quickly before leaving the consultation to ensure you don’t leave with unaddressed concerns.

1. Is there any way that I can AVOID surgery and how would outcomes compare if I took this option?

ALWAYS ASK THIS QUESTION.

There is ALWAYS an alternative when it comes to surgery.

For example, considering a shoulder dislocation in a young male AFL player, a stabilisation surgery is highly recommended. Without surgery, this patient would have at least a 70% risk of the injury recurring. In contrast, with a Latarjet stabilisation he could expect as low as a 2.7% risk of recurrence.

However, you always have choices. You could try and be one of the 30% who survive non-operatively. Likewise some patients might have no desire to return to AFL and consider moving to a less “risky” sport such as triathlons where an operation is completely unnecessary. So even though we would recommend the stabilisation surgery in general, for 3 different people, they may choose 3 different options based on their own preferences.

To sum up, there is never a single option and you need to ask this question to have accurate information to allow you to weigh up the positives and negatives of all your options and make the right choice for you.

2. How long CAN it take to recover - worst case scenario? What will I feel/how painful will it be?

Yes, the problem/pathology may be fixed with surgery, but the soft tissue that is disrupted in the process will be painful and take some time to recover from. This obviously depends on the nature of the surgery but it will almost always be very painful initially.

Everyone asks how long it will take to recover. The surgeon will often tell you how long it usually takes based on average outcomes.

However, humans are complex and varied creatures, and so surgery is not like changing a part on a car.

For example, if a surgeon advises that you CAN start walking crutch-free at 7 days-post does not mean that you WILL. Some may be ready at 4 days, while some may take 14.

Many patients get disheartened because they’re running behind the timeline, or because a friend had the same procedure and was much better at this point. However, the timeline is based on the average recovery, and your friend may be an unusually high performer due to a whole host of factors such as severity of condition, genetics and specific surgical differences.

To manage these complex situations, it’s always a good option to ask the surgeon how long it CAN take and ask for the worst case scenario. It’s important to not catastrophize about this as it is an unlikely outcome, but knowing it can help prevent frustration when your’re running behind the average timeline. This also gives us a clear definition to differentiate between things are going slowly and things are going wrong.

3. Are there other ways to do this surgery? Why have we chosen this variation?

This question will get a bit technical and some may prefer not to worry about it, but there are many ways of surgically achieving your goal.

Clinical trials help provide us with some answers as to which way is the most likely to be effective, but also provide an insight as to what can go wrong.

For example, to revisit shoulder dislocations, there are two surgical approaches most commonly used: the Latarjet procedure or an arthroscopic bankart repart.

There is now a solid amount of research indicating a higher rate of return to sport and a lower rate of recurrence of dislocation with a Latarjet. However, it is also associated with a slightly higher risk of adverse effects, so the decision is not always cut-and-dry.

Similarly, with and ACL reconstruction, choice of graft (hamstring, quad, patellar etc), tunnel location, single or double bundle, nerve block used can all effect outcome. Many factors influence the surgeons decision, and they will undoubtedly offer the best solution in their opinion. While you do no need to have personal knowledge on any of the above, we think it’s a good idea to obtain this information and understand WHY they have made the decisions they have.

It’s a good idea to write this down too as the technical terms are usually hard to recall.

4. How many of these procedures do you perform a year?

There is a body of research regarding total knee replacement operations and ACL repairs that consistently associates higher yearly volume (how many a year the surgeon performs) with fewer infections, shorter procedure time, shorter hospital stays, lower rate of transfusion, and better outcomes in the long-term. Research on other procedures is less available, but it’s safe to extrapolate that experience matters, just like any other profession.

If the surgeon has a relatively low yearly volume, it doesn’t mean that they will do a bad job as they will have undergone may procedures in their training and education.

Likewise, certain procedures as less commonly performed (e.g. repair of a complex bone break) so a high yearly volume is not feasible.

In any case, it’s worth asking how often they perform the procedure. If they perform a low number annually (<10 on a common procedure such as TKR), you could consider politely inquire if they have colleagues that specialize in this procedure and perform it more often.

With something as serious as a surgical procedure, you are always entitled to a second opinion. A good surgeon will have the self-awareness to know when they are and are not the right person for the job. If they can confidently assure you they have the necessary skill-set and experience, then you leave the consult knowing you are in safe hands.

5. Always ask YOURSELF, do I understand the diagnosis and/or the proposed solution? Test this by trying to summarize the information to you surgeon before you leave.

It’s a simple place to finish but make sure you fully understand what your surgeon has told you in the first place as errors in communication are so common in this situation.

The true test of this comes when you go home and try the “family/friend test”. If you can explain your problem well to family/friends, then you probably took the information in effectively. However, if it makes perfect sense in your head at the time, but you struggle to explain it later then you may not have understood it as well as you thought.

To ensure you pass the” family/friends test’, I recommend people try and perform a summary at the end of their consult, e.g.:

“So, if I understand correctly, my problem is that……and the proposed solution would fix this by…….all going well I should expect……but it may take as long as……..”.

This way, your surgeon will be able to highlight and correct anything that got lost in translation on the first occasion.  

Conclusion:

There you have it – five important questions you should always ask in a consultation with an orthopedic surgeon. Any situation that requires the consideration of surgery is bound to be complex so it’s imperative that you get all the information. These five questions will help keep you focused and ensure you get the information needed to make a fully-informed decision that is right for you and your set of circumstances

PREHAB: TAKING CONTROL OF YOUR RECOVERY

Optimising recovery from surgery:

Regardless of what it’s for, surgery can be scary and overwhelming. It is normal to feel a sense of helplessness or feeling as if you don’t have control over the end outcome. However, it is important to understand that you play the single most important role in the outcome of your recovery and it starts long before you meet with your surgeon. Preparing your body and mind for what you are about to encounter is an important aspect of recovery and creates good habits for your post-surgery rehabilitation.

How do you do this, you ask?

We call this Prehab

Prehab is a programme designed to prevent injuries before they actually occur. This can be applied to anyone or any injury however in the context of surgery it is you taking an active approach to prepare yourself physically and mentally for what you are about to go through. It plays a massive part in giving you the power to control the success of your upcoming surgery.

Why should you do Prehab?

Numerous studies have shown that patients who participate in Prehab have significantly better outcomes than those who do not. Those who undergo prehab generally have quicker recovery times, return to sport faster, have less complications and are generally more satisfied with their end outcome.

Does this apply to me?

Prehab is highly recommended for anyone planning to undertake or has been referred for surgery. Research has shown Prehab to be effective in enhancing recovery for patients undergoing total hip and knee replacements, ACL reconstructions, shoulder surgery such as rotator cuff repairs and lower back surgery.

What does it involve and how long for?

Ideally, undergoing 6-12 weeks of Prehab prior to surgery will optimise post-surgical outcomes. In most situations this is not possible due to availability with your surgeon. This does not mean that Prehab won’t help be helpful for you. As they say, something is better than nothing and there are still many meaningful benefits to be gained with only 2 weeks of preparation.

5 reasons to Prehab:

1.     Get control of your pain:

 A prehab program should give you the tools to minimise pain. Reducing pain early will enable normal muscle activity and put you in a good head space leading up to surgery.

2.     Get in optimal physical shape:

Through a specific exercise program, you can improve muscle strength, flexibility, balance and coordination which has shown to optimise and speed up the recovery process post-surgery. Additionally, improving general fitness and wellbeing has many added benefits such as weight loss and improving mental resilience which is extremely important to recovery.

3.     Create good habits and kick the bad habits

Firstly, creating good habits beforehand will make your life so much easier once you have been discharged from hospital. Good habits start with getting in a healthy exercise regime This extends to healthy sleep, nutrition and lifestyle habits which your physiotherapist and health practitioners can guide you on.

Conversely, bad habits will have the opposite effect, so you can imagine the importance in changing these prior to surgery.

4.     Manage anxiety/stress

It is completely normal to feel anxious or stressed prior to surgery. In addition to physically preparing yourself you must also get yourself in the right headspace. Prehab will help mentally prepare you by getting you in a good mindset for the upcoming rehabilitation process. It will also teach you appropriate coping strategies to deal with pain and stress associated with the injury.

5.     Speed up your recovery and reduce post-operative complications

Prehab sets you up for a successful recovery leading to quicker recovery and return to sport times. It also reduces the risk of common complications associated with surgery.

Please feel free to contact our team at East Vic Park Physio on 9361 3777 if you have any questions or would like to find out if Prehab is appropriate for you.

AC Joint pain - The "Other" Shoulder Pain

Anatomy

The Acromioclavicular (AC) joint is located at the lateral tip of the shoulder. The joint is formed by two bones, the clavicle (collarbone) and the acromion (a portion of the scapula/shoulder blade). In between the joint sits a fibrocartilage meniscal disc and the bones are connected by a number of ligaments, muscles and a joint capsule.

Role

The AC joint acts as a pivot point in the shoulder allowing the shoulder blade to rotate as the arm is lifted upwards. If it is dysfunctional it affects the control of your shoulder.

About

The AC joint is very commonly injured in contact sports that involve tackling like rugby or AFL. This is classified as a traumatic injury in which the ligaments can be torn and the capsule disrupted which results in the bone separating. However, you can also have AC joint pain from overloading the joint or degeneration of the fibrocartilage meniscus. It can also develop into a condition called osteolysis which is quite common in gym goers.

Differentiation from “bursitis” or impingement (common shoulder pain)

Shoulder bursitis/impingement is a very common condition in which the bursa and tendons in the shoulder get inflamed or overloaded. Often a cortisone injection is prescribed which can reduce the pain if the bursa is the main issue. However, if it is not the correct diagnosis then ongoing pain and disability can perpetuate. It is very important to get your shoulder assessed by a physiotherapist to differentiate between the two conditions so the right treatment plan can be selected. Please note that Impingement CAN occur as a result of AC joint pain or injury but is not the primary diagnosis.

Common presentation

·         Pain at the top or tip of the shoulder

·         Difficulty lying on the shoulder

·         Difficulty bringing the arm across the body

·         Pain with lifting an object above your head

·         Pain with gym activities like bench press

General advice

·         Try icing the area especially when it is painful

·         Rubbing voltaren gel on the area can help reduce pain, the joint is superficial enough for the gel to have some effect

·         Applying taping to pull the shoulder upwards can take the pressure off the joint and relieve discomfort

·         A structured rehab program is helpful in making the muscles around the joint stronger so there is less load on the area

·         A cortisone injection can be helpful if conservative treatment isn’t effective, as long as they inject the right spot

·         Most importantly, visit your highly trained physiotherapist for a thorough assessment and in-depth treatment plan

SPORTS INJURY MANAGEMENT SEMINAR

a FREE seminar on sports injury management presented by the Physiotherapists at East Vic Park Physiotherapy. Topics will include muscle contusion (corkie) management, post-game recovery and a practical session on strapping. 

Whether your sports season is heading into finals or you are about to start gearing up for the summer season ahead, the information presented will help you to perform at your best.

Appropriate for all athletes, parents, trainers and coaches.

Food will be provided - let us know if you have any dietary requests.

Spaces are limited so call us on 9361 3777 to secure your place now.