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Why Seeing a Physiotherapist Early Matters for Acute Injuries

10/6/2025

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When you experience sudden pain or injury — whether it’s a pulled muscle, a rolled ankle, or sharp lower back pain — it can be tempting to “wait and see” if it gets better on its own. But early assessment and advice from a physiotherapist can make a world of difference to how quickly and fully you recover.

What Is an Acute Condition?
An acute condition is an injury or pain that comes on suddenly — often due to sport, exercise, or daily activity. Examples include:
  • Muscle strains or ligament sprains
  • Back or neck pain after lifting or twisting
  • Joint injuries from sport or falls
  • Post-surgical pain or stiffness
These problems often cause inflammation, swelling, or sharp pain, making it difficult to move normally.

The Benefits of Seeing a Physio Early
  1. Faster Recovery
    Early intervention helps calm inflammation, restore movement, and prevent stiffness. A physiotherapist can identify the underlying cause, apply hands-on treatment when appropriate, and prescribe targeted exercises to speed up healing.
  2. Personalised Advice and Education
    Physiotherapy isn’t always about treatment — sometimes it’s about knowing what you should and shouldn’t do. Your physiotherapist can provide tailored advice on safe activity levels, posture, work modifications, and when it’s okay to return to exercise or sport. This helps you avoid aggravating the injury while still staying active in a safe and effective way.
  3. Accurate Diagnosis and Screening for Serious Injury
    Physiotherapists are trained to identify not just soft tissue injuries but also red flags and more serious conditions that may need further investigation.
    Sometimes, what feels like a simple sprain or strain could actually involve:
    • A missed fracture or joint instability
    • Nerve irritation or compression
    • Infection or inflammatory joint conditions
    • Referred pain from the spine or internal organs
    Early professional assessment ensures these issues are recognised and managed appropriately — preventing complications and unnecessary suffering.
  4. Identifying Red Flags Early
    Physiotherapists are first-contact practitioners in Australia and are trained to identify red flags that may suggest something more serious than a typical musculoskeletal injury. These include:
    • Severe, unrelenting pain that doesn’t ease with rest or medication
    • Unexplained weight loss or night pain
    • Loss of bladder or bowel control
    • Numbness, weakness, or tingling in the arms or legs
    • Inability to bear weight after an injury
    • Swelling, redness, or fever accompanying joint pain
    If any of these are present, your physiotherapist will refer you promptly for further medical investigation.
  5. Prevent Chronic Pain and Recurring Injuries
    Without proper management, acute injuries can turn into long-term issues — such as recurring pain, weakness, or poor movement habits. Early guidance helps you heal correctly from the start.
  6. Avoid Over-Resting or Overdoing It
    Both doing too little and too much can slow recovery. A physiotherapist provides clear, personalised direction — helping you find the right balance between rest and movement.

The Risks of Delaying Treatment
Putting off physiotherapy can lead to:
  • Slower recovery and prolonged pain
  • Missed fractures or underlying conditions that go undetected
  • Muscle weakness and joint stiffness from inactivity
  • Poor movement patterns that cause compensations or new injuries
  • Reduced confidence returning to sport or work
  • Increased risk of chronic pain or re-injury
Many people find that when they finally seek help weeks later, it takes longer to recover — sometimes requiring more sessions or further medical tests.

Take Action Early
At Acland Street Physiotherapy, our experienced team can help you manage acute injuries effectively — whether it’s a sports strain, workplace incident, or flare-up of an old issue.
Early assessment doesn’t always mean treatment — sometimes, the best care is expert advice on what to do (and what not to do) while your body heals. And if we identify anything more serious, we’ll ensure you’re referred promptly for the right care.

Ready to get started?
Book an appointment today and take the first step towards recovery.
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Preventing Skiing and Snowboarding Injuries: Essential Tips from Acland Street Physiotherapy

8/24/2024

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During the Victorian winter season, many of us look forward to hitting the slopes for some alpine skiing or snowboarding at popular resorts such as Mt Buller, Mt Hotham and Falls Creek. These exhilarating sports not only offer a great way to stay active but also a chance to connect with nature and enjoy snowy landscapes. However, with the thrill of these activities comes the risk of injury, in particular ACL injuries. At Acland Street Physiotherapy, we're dedicated to helping you stay safe and injury-free while enjoying your time on the slopes.

The Risks Involved
Skiing and snowboarding are among the top contributors to sports-related injuries each year. The high velocities, varying terrains, and unpredictable conditions inherent to these sports increase the likelihood of injuries, particularly to the lower extremities. Common injuries include knee sprains, fractures, and muscle strains. However, with proper preparation, many of these injuries can be prevented.

The Importance of Physical Fitness
The role of physical fitness in preventing injuries cannot be overstated. A systematic review by Hébert-Losier and Holmberg (2013) found that while much of the focus on injury prevention has historically been on equipment and third-party involvement, there is a significant need for targeted physical fitness to meet the technical demands of skiing and snowboarding. Strength, endurance, agility, and balance are crucial components that help manage the intense physical demands these sports place on your body .

A more recent study by Wang et al. (2022) emphasises the importance of lower extremity fitness, specifically agility and balance, in reducing injury risk among recreational skiers. The study found that skiers with inferior agility or balance are at a higher risk of injury, highlighting the necessity of neuromuscular training that targets these areas .

Recommendations for Injury Prevention
Based on these findings, here are some evidence-based recommendations to help you prepare for a safe and enjoyable skiing or snowboarding season:

1. Focus on Lower Extremity Agility and Balance
  • Agility: Incorporate exercises that improve your ability to quickly change direction, such as lateral jumps, agility ladder drills, and cone drills. These exercises mimic the quick, multidirectional movements required in skiing and snowboarding. According to Wang et al. (2022), better agility was associated with a lower risk of injury .
  • Balance: Training on unstable surfaces, such as balance boards or Bosu balls, can enhance your ability to maintain control in challenging conditions. The same study by Wang et al. highlighted the importance of balance in preventing injuries, noting that lower composite YBT scores were associated with higher injury risk .
2. Build Endurance
  • Alpine skiing and snowboarding can be physically demanding, requiring sustained effort over extended periods. To prepare, engage in endurance exercises such as cycling, running, or circuit training that target the lower body. Incorporating squats or box jumps into your routine can build the muscular endurance necessary for the repetitive movements of skiing and snowboarding. Although endurance was not found to be a significant factor in injury occurrence in the multivariate analysis, its role in overall fitness and injury prevention remains important .
3. Strengthen Key Muscle Groups
  • Focus on strengthening the quadriceps, hamstrings, glutes, and core muscles. Strong muscles not only improve performance but also provide stability and support to your joints, reducing the risk of injury. Hébert-Losier and Holmberg (2013) emphasised the importance of physical fitness, including strength, in meeting the demands of alpine sports and preventing injuries .
4. Proper Warm-Up
  • Before hitting the slopes, make sure to warm up properly. Dynamic stretching and mobility exercises can increase blood flow to your muscles and prepare your body for the intense activity ahead. A well-prepared body is less likely to suffer from strains and sprains during skiing or snowboarding.
5. Invest in Quality Equipment
  • While physical fitness is crucial, don't forget the importance of well-fitted, quality equipment. Ensure that your bindings, boots, and skis or snowboard are properly adjusted to your specifications. According to Hébert-Losier and Holmberg (2013), equipment-related recommendations are among the most common in injury prevention, reflecting the importance of gear in reducing injury risk .

Conclusion
At Acland Street Physiotherapy, we believe that with the right preparation, you can significantly reduce your risk of injury and make the most of your skiing or snowboarding experience. By focusing on agility, balance, endurance, and strength, and using well-maintained equipment, you'll be well-equipped to enjoy the slopes safely. If you're preparing for the winter season and want personalised advice or training, don't hesitate to reach out to our team. We're here to help you stay fit, healthy, and ready for the challenges of the mountain.

Stay safe, stay active, and enjoy your winter adventures!
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References:
  1. Hébert-Losier, K., & Holmberg, H. C. (2013). Exercise-based injury prevention recommendations for recreational alpine skiing and snowboarding: A systematic review. Sports Med, 43(5), 355-66. doi: 10.1007/s40279-013-0032-2.
  2. Wang, Z., Cai, Y., Wu, J., Xie, S., & Jiao, W. (2022). Relationship between Lower Extremity Fitness Levels and Injury Risk among Recreational Alpine Skiers: A Prospective Cohort Study. Int J Environ Res Public Health, 19(16), 10430. doi: 10.3390/ijerph191610430.
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Our principal physiotherapist Barry and his son at Mt Buller
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Best Practices for Managing Acute Ankle Sprains: Insights from Recent Research

5/5/2024

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Ankle sprains are a common but painful injury that can temporarily limit your mobility. Recent studies have shed light on the most effective treatments for managing this condition. A systematic umbrella review by Gaddi et al. (2022) in Frontiers in Medicine examined multiple studies to establish a clear guide for treating acute ankle sprains. Here’s what you need to know to navigate the recovery from an ankle sprain effectively.
Understanding Ankle SprainsAnkle sprains occur when the ligaments that stabilise the ankle are overstretched or torn, usually due to twisting or rolling the foot. Symptoms typically include pain, swelling, and limited mobility. While these injuries are prevalent, especially in physically active individuals, understanding the latest research can significantly aid recovery.
Effective Non-Surgical TreatmentAccording to Gaddi et al. (2022), non-surgical interventions are highly effective in managing acute ankle sprains. These treatments focus on minimising pain and swelling while optimising the healing process without the need for surgery. Here are the key findings:
  • Functional Treatment Over Immobilisation: The review highlights a preference for functional treatment, such as physiotherapy and controlled exercises, over complete immobilisation. This approach encourages mild to moderate movement early in the recovery process, which has been shown to enhance the healing rate and improve long-term outcomes.
  • Pain Management: Traditionally, NSAIDs (non-steroidal anti-inflammatory drugs) have been used to manage pain and reduce inflammation. However, the review suggests that paracetamol (acetaminophen) or opioids can be effective alternatives, particularly for those who experience side effects from NSAIDs. Please see your GP or pharmacist for specific advice to understand what medications may help. 
  • Rehabilitation Therapies: Manipulative and supervised exercise therapies have been found effective in preventing re-injury and improving ankle dorsiflexion (the ability to move the foot upwards). These therapies help restore normal movement and strengthen the muscles around the ankle.
RICE Protocol: A Traditional ApproachThe RICE protocol—rest, ice, compression, and elevation—is a classic first-line treatment immediately following an ankle sprain. This method helps reduce swelling and pain in the critical initial hours and days post-injury:
  • Rest: Avoid putting weight on the injured ankle to prevent further damage.
  • Ice: Apply ice to reduce swelling and numb the pain. Ice should be applied over a cloth to protect the skin, for 20 minutes every two hours.
  • Compression: Use an elastic bandage to wrap the ankle. This helps prevent excessive swelling and provides support.
  • Elevation: Keep the ankle elevated above heart level to help reduce swelling.
When to Seek Professional AdviceWhile mild ankle sprains can often be treated at home, it’s crucial to consult a healthcare provider if you experience severe pain, cannot walk, or suspect a fracture. A medical professional can assess the injury and recommend appropriate treatment, which may include advanced therapies or imaging tests to rule out more severe damage.
ConclusionRecovering from an ankle sprain requires patience and adherence to proven treatment protocols. The insights from the umbrella review by Gaddi et al. (2022) emphasise the importance of functional recovery programs and appropriate pain management, tailored to individual needs and medical advice. By following these evidence-based recommendations, patients can expect a more efficient and effective recovery.
References
  • Gaddi, D., Mosca, A., Piatti, M., Munegato, D., Catalano, M., Di Lorenzo, G., Turati, M., Zanchi, N., Piscitelli, D., Chui, K., Zatti, G., & Bigoni, M. (2022). Acute Ankle Sprain Management: An Umbrella Review of Systematic Reviews. Frontiers in Medicine, 9:868474. doi: 10.3389/fmed.2022.868474. PMC9301067.
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Progressive Overload vs. Increasing Repetitions: Shaping Your Training for Optimal Gains

3/22/2024

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In the quest for muscle strength, hypertrophy, and endurance, the principle of progressive overload stands as a cornerstone of resistance training. Traditionally, increasing the weight (load) you lift has been the go-to method for achieving this. However, recent research sheds light on an equally effective strategy that might just change the way we approach our workouts: increasing repetitions while maintaining the same load. Let's dive into what this means for your training regimen.

Understanding Progressive Overload
Progressive overload involves gradually increasing the demands on your musculoskeletal system, thereby stimulating muscle growth, strength, and endurance. Traditionally, this has meant adding more weight to the bar. However, is this the only way to achieve muscular adaptations?

The Study: Load Increase vs. Repetition Increase
A groundbreaking study published in PeerJ (2022) by Plotkin et al. compared two groups over an 8-week period to see which method of progressive overload was more effective: increasing load or increasing repetitions[1]. Participants, all of whom had at least one year of lower body resistance training experience, were divided into two groups:
  • One group increased the load while keeping repetitions constant.
  • The other group increased repetitions while keeping the load constant.

Key Findings
The study found that both methods led to muscular adaptations, with some interesting nuances:
  • Rectus femoris (part of the quadriceps) growth modestly favoured the group that increased repetitions.
  • Dynamic strength increases slightly favoured the group that increased load.
  • No other notable differences were found across other outcomes, such as muscle thickness in different areas, muscular endurance, jump height, body fat, or leg segmental lean mass.

Implications for Training
These findings offer valuable insights for trainers and trainees alike, presenting another promising approach to programming resistance training. Here's what it means for your workouts:

Flexibility in Training
The study underscores the viability of both increasing loads and increasing repetitions for enhancing muscular adaptations. This flexibility allows for personalised training programs that can be adjusted based on individual goals, preferences, and the availability of equipment.

Tailored Goals
  • For Muscle Growth: Focusing on increasing repetitions might be particularly beneficial, especially for targeting specific muscle groups like the quadriceps.
  • For Increasing Strength: Adding more weight to your lifts remains a slightly more effective strategy, though the differences may not be significantly practical for most trainees.

Reducing Risk of Injury
For individuals recovering from injuries or those concerned about the risk of overloading with heavy weights, increasing repetitions offers a safer yet effective method of achieving progressive overload without the need to constantly increase the weight lifted.

Conclusion
The study by Plotkin et al. illuminates a path forward for those looking to optimise their resistance training strategy, offering evidence that both increasing loads and repetitions can lead to significant muscular adaptations. Whether your goal is muscle growth, strength, endurance, or rehabilitation, incorporating a mix of both strategies into your workout regimen can provide comprehensive benefits tailored to your unique fitness journey.
Embrace the flexibility in your training approach, and remember, the best workout is the one that is personalised, progressive, and most importantly, enjoyable!

Reference
  1. Plotkin, D., Coleman, M., Van Every, D., Maldonado, J., Oberlin, D., Israetel, M., Feather, J., Alto, A., Vigotsky, A.D., & Schoenfeld, B.J. (2022). Progressive overload without progressing load? The effects of load or repetition progression on muscular adaptations. PeerJ, 10, e14142.
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Multi-Joint vs. Single-Joint Resistance Exercises: What's Best for Your Fitness Journey?

3/22/2024

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When embarking on a resistance training journey, one of the most common dilemmas faced by beginners and seasoned gym-goers alike is choosing between multi-joint (MJ) and single-joint (SJ) exercises. Both types of exercises offer unique benefits and can be pivotal in shaping your fitness regimen. Recent studies shed light on their effects, helping you make an informed decision tailored to your goals.

Understanding the Basics
Multi-Joint Exercises involve two or more sets of joints and muscle groups. Classic examples include squats, bench presses, and deadlifts. These exercises are lauded for their efficiency in working multiple muscles simultaneously, potentially offering greater functional benefits.

Single-Joint Exercises focus on isolating one joint and primarily targeting a single muscle group, like bicep curls or leg extensions. They are often recommended for targeted muscle development and rehabilitation purposes.
The Research SpeaksTwo significant studies provide insight into the ongoing debate between MJ and SJ exercises. Gentil et al. (2015) found that both MJ and SJ exercises produced similar increases in muscle size and strength in untrained men, suggesting that neither type is superior for beginners aiming to increase muscle mass and strength[1]. On the other hand, Paoli et al. (2017) demonstrated that when the total work volume was equated, MJ exercises led to greater improvements in VO2max and muscle strength than SJ exercises[2]. This suggests that MJ exercises might offer added benefits for improving cardiovascular fitness and functional strength.

Making the Choice: What's Best for You?
The selection between MJ and SJ exercises should align with your fitness goals, practical considerations, and personal preferences:
  • For General Fitness and Functional Strength: MJ exercises may offer more bang for your buck by engaging multiple muscle groups, improving coordination, and enhancing cardiovascular health.
  • For Muscle Isolation and Rehabilitation: SJ exercises are invaluable. They allow for targeted muscle strengthening, which is particularly beneficial for rehabilitation and addressing muscle imbalances.
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Practical Advice
  • Beginners are advised to incorporate both MJ and SJ exercises to build a solid foundation of both muscle strength and isolation.
  • Advanced Athletes might focus on MJ exercises for overall strength and functional fitness but still use SJ exercises to target specific muscle groups as needed.
  • Rehabilitation Clients should consult with their physiotherapist to design a program that might include a higher proportion of SJ exercises initially, progressively incorporating MJ exercises as their condition improves.
Conclusion
Both MJ and SJ exercises have their place in a well-rounded fitness regimen. Understanding your personal goals, whether it's muscle gain, fat loss, strength, rehabilitation, or general fitness, is key to determining the right balance between the two. Consultation with fitness and health professionals can provide personalized advice and training programs, ensuring you get the most out of your workouts while minimizing the risk of injury.
Remember, the best exercise program is one that is sustainable, enjoyable, and tailored to your individual needs and goals. So, whether you're lifting heavy with the squats or focusing on that bicep peak with curls, you're on the right track to achieving your fitness aspirations.

References
  1. Gentil, P., Soares, S., & Bottaro, M. (2015). Single vs. Multi-Joint Resistance Exercises: Effects on Muscle Strength and Hypertrophy. Asian Journal of Sports Medicine, 6(2), e24057.
  2. Paoli, A., Gentil, P., Moro, T., Marcolin, G., & Bianco, A. (2017). Resistance Training with Single vs. Multi-joint Exercises at Equal Total Load Volume: Effects on Body Composition, Cardiorespiratory Fitness, and Muscle Strength. Frontiers in Physiology, 8, 1105.
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Stronger Backs, Healthier Lives: The Ageless Benefit of Deadlifts

3/22/2024

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The deadlift, often perceived as an exercise reserved for the most robust and athletic individuals, holds a treasure trove of benefits that extend well beyond the realms of elite sports. This fundamental movement not only enhances strength and performance but also plays a pivotal role in the rehabilitation and maintenance of back health for people of all ages. Through a careful examination of recent research, we unveil the multifaceted benefits of deadlifts and debunk the myth that they are unsafe for individuals with lower back pain.

Unveiling the Benefits
Deadlifts are more than just a strength-building exercise; they are a functional movement that mimics everyday activities such as lifting heavy objects off the ground. This exercise targets multiple muscle groups, including the glutes, hamstrings, lower back, and core, providing a comprehensive workout that can improve overall physical health and functionality.

Research indicates that incorporating deadlifts into a training program can result in significant improvements in lower body strength and power. A study comparing the effects of deadlifts and squats found that both exercises led to comparable enhancements in jump performance, a marker of lower body power (Nigro & Bartolomei, 2020)[1].

Moreover, deadlifts have been shown to have the highest muscle activation of paraspinal musculature compared to other exercises, making them a potent tool for strengthening the muscles supporting the spine (Fischer, Calley, & Hollman, 2020)[2].

Safety and Efficacy for Lower Back Pain
The prevalence of lower back pain in the general population has led to significant interest in finding effective exercises for both rehabilitation and prevention. Contrary to common misconceptions, deadlifts, when performed with proper technique, can be a safe and effective exercise for individuals with lower back pain.

A systematic review highlights that exercise programs including deadlifts can yield improvements in both pain and function for those living with low back pain, although not more beneficial than low load motor control exercises (Fischer et al., 2020)[2]. It is crucial, however, to note that individuals with lower pain levels and higher baseline lumbar extension strength may be most suitable for deadlift programs. This finding underscores the importance of personalised assessment and program design by healthcare professionals.

Implementing Deadlifts into Your Routine
For those considering adding deadlifts to their exercise regimen, especially individuals with a history of lower back pain, consulting with a physiotherapist is essential. These experts can assess your current physical condition, teach proper deadlift technique, and develop a tailored program that aligns with your health goals and capabilities.

It is also worth noting that starting with lighter weights and focusing on form over load can significantly reduce the risk of injury and ensure the long-term success of incorporating deadlifts into your routine.

Conclusion
The deadlift is a versatile exercise that offers extensive health and performance benefits for individuals across all age groups. Its efficacy in strengthening the lower back, improving functional performance, and aiding in the rehabilitation of back pain makes it a valuable addition to any exercise program. With proper guidance and technique, deadlifts can be safely performed by people with varying levels of fitness, including those with lower back pain, debunking the myth that they are inherently risky.
By embracing the deadlift, individuals can enjoy a healthier, more active lifestyle, underscored by the strength and stability this foundational movement provides.

References
  1. Nigro, F., & Bartolomei, S. (2020). A Comparison Between the Squat and the Deadlift for Lower Body Strength and Power Training. Journal of Human Kinetics, 73, 145–152. https://doi.org/10.2478/hukin-2019-0139
  2. Fischer, S.C., Calley, D.Q., & Hollman, J.H. (2020). Effect of an Exercise Program That Includes Deadlifts on Low Back Pain. Journal of Sport Rehabilitation. https://doi.org/10.1123/jsr.2020-0324
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The Potential of ACL Ruptures to Heal Without Surgery: A Closer Look at Recent Studies

3/17/2024

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Anterior Cruciate Ligament (ACL) injuries are a common concern among athletes and physically active individuals, often leading to a challenging decision: to opt for surgery or explore non-surgical treatment options. Recent research provides compelling evidence that ACL ruptures can potentially heal on their own, offering an alternative pathway to recovery without the need for surgical intervention. This blog post delves into the findings of two significant studies that shed light on the natural healing capabilities of the ACL and the implications for treatment strategies.

Healing of ACL Ruptures: Insights from the Cross Bracing Protocol Study
A groundbreaking study published in the British Journal of Sports Medicine by Filbay et al. (2023) investigated the outcomes of non-surgical management of acute ACL ruptures using the Cross Bracing Protocol (CBP). This protocol entails knee immobilisation at 90° flexion in a brace for four weeks, followed by progressive increases in range-of-motion until brace removal at 12 weeks, and physiotherapist-supervised, goal-oriented rehabilitation.

The study's findings are encouraging, showing that 90% of patients had evidence of ACL healing on a 3-month MRI. Participants with better healing outcomes reported higher scores on the Lysholm Scale and ACL Quality of Life (ACLQOL), experienced normal knee laxity, and were more likely to return to pre-injury levels of sport participation. These results highlight the potential of non-surgical management to support ACL healing, suggesting that such approaches could lead to favourable outcomes for certain patients.

The KANON Trial: A Secondary Analysis on ACL Healing and Patient-Reported Outcomes
Further supporting the potential for non-surgical recovery, a secondary analysis from the KANON trial, also published in the British Journal of Sports Medicine by Filbay et al. (2023), evaluated the natural course of ACL healing and its association with patient-reported outcomes. This analysis focused on participants who were managed with rehabilitation alone, comparing their outcomes to those who underwent early or optional delayed ACL reconstruction.

The results revealed that 53% of participants managed with rehabilitation alone exhibited MRI evidence of ACL healing at the 2-year follow-up. These individuals reported significantly better outcomes in terms of sports and recreational function, as well as quality of life, compared to those without evidence of healing or who underwent ACL reconstruction. The findings suggest that a considerable proportion of adults with ACL ruptures could achieve spontaneous healing, leading to favourable clinical outcomes.

Implications for Treatment Strategies
These studies challenge the conventional wisdom that surgery is the only solution for ACL ruptures, opening the door to non-surgical treatment options for selected patients. The evidence points towards the natural healing capabilities of the ACL, suggesting that with appropriate management, including bracing and physiotherapy-led rehabilitation, patients can achieve successful outcomes without the need for surgical intervention.

It is essential to recognise that the decision between surgical and non-surgical treatment should be personalised, taking into account the individual's specific circumstances, injury characteristics, and lifestyle needs. Patients should consult with healthcare professionals, including physiotherapists, to determine the most suitable treatment pathway for their situation.

Conclusion
The potential for ACL ruptures to heal without surgery offers a promising alternative for patients seeking non-surgical treatment options. The findings from recent research underscore the importance of exploring all available treatment pathways and highlight the role of physiotherapy in supporting recovery from ACL injuries. As we continue to learn more about the ACL's natural healing process, it is crucial to keep an open mind regarding the best practices for managing these challenging injuries.
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References
  1. Filbay, S. R., Dowsett, M., Jomaa, M. C., et al. (2023). Healing of acute anterior cruciate ligament rupture on MRI and outcomes following non-surgical management with the Cross Bracing Protocol. British Journal of Sports Medicine, 57(23), 1490. https://bjsm.bmj.com/content/57/23/1490
  2. Filbay, S. R., Roemer, F. W., Lohmander, L. S., et al. (2023). Evidence of ACL healing on MRI following ACL rupture treated with rehabilitation alone may be associated with better patient-reported outcomes: a secondary analysis from the KANON trial. British Journal of Sports Medicine, 57(2), 91. https://bjsm.bmj.com/content/57/2/91
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Rethinking Treatment for Partial Meniscal Tears: The Case Against Routine Arthroscopy

3/17/2024

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In the realm of orthopaedic injuries, meniscal tears stand out as both common and challenging, particularly in active individuals. Traditionally, arthroscopic partial meniscectomy (APM) has been a go-to treatment for these injuries, aiming to relieve pain and restore function. However, recent research suggests a pivotal shift in our approach—highlighting the effectiveness of conservative management, including physical therapy, over arthroscopy for certain cases. This blog post explores the evidence from recent studies, advocating for a more measured approach to treating partial meniscal tears.

The Debate: Arthroscopy vs. Physiotherapy
A landmark study published in the British Journal of Sports Medicine by van der Graaff et al. (2023) compared outcomes between arthroscopic partial meniscectomy and physical therapy in young patients with traumatic meniscal tears. This randomised controlled trial found no significant difference in International Knee Documentation Committee (IKDC) scores, which measure symptoms, knee function, and sports activity levels, at 24 months follow-up between the two groups​​. Interestingly, 41% of patients initially managed with physical therapy did not require subsequent arthroscopy, challenging the necessity of immediate surgical intervention.

Broadening the Perspective: Systematic Reviews

Further backing this shift, a systematic review by Brignardello-Petersen et al. (2017), published in BMJ Open, examined the effects and complications of knee arthroscopy compared with conservative management in patients with degenerative knee disease​​. The review found high-certainty evidence that knee arthroscopy offers very small to no long-term benefits in pain or function over conservative strategies. Similarly, Rotini et al. (2023) conducted a systematic review of systematic reviews, which concluded that exercise therapy often equals or surpasses arthroscopic surgery in improving pain and function for degenerative meniscal lesions​​.


Implications for Clinical Practice

These findings underscore a critical reassessment of the routine use of arthroscopy for partial meniscal tears, particularly in the context of degenerative knee conditions. Physiotherapy, focusing on strengthening and stabilising the knee joint, emerges as a potent first-line treatment option that can defer or even eliminate the need for surgery in many cases. However, it's essential to acknowledge that surgical intervention may still be necessary for specific patient populations. The challenge lies in accurately identifying those who may benefit from surgery after an unsuccessful trial of conservative treatment.

Conclusion

The shift towards conservative management for partial meniscal tears represents a more patient-centric approach, minimising the risks and costs associated with unnecessary surgery. These recent studies provide compelling evidence that physical therapy should be considered the first line of treatment for many patients with meniscal tears. As we move forward, personalised treatment plans, grounded in the latest research and tailored to each patient's unique situation, will likely yield the best outcomes.
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References
  1. van der Graaff, S. J. A., Eijgenraam, S. M., Meuffels, D. E., et al. (2023). Arthroscopic partial meniscectomy versus physical therapy for traumatic meniscal tears in a young study population: a randomised controlled trial. British Journal of Sports Medicine, 56(15), 870. https://bjsm.bmj.com/content/56/15/870
  2. Brignardello-Petersen, R., Guyatt, G. H., Buchbinder, R., et al. (2017). Knee arthroscopy versus conservative management in patients with degenerative knee disease: a systematic review. BMJ Open, 7(5), e016114. https://bmjopen.bmj.com/content/7/5/e016114
  3. Rotini, M., Papalia, G., Setaro, N., et al. (2023). Arthroscopic surgery or exercise therapy for degenerative meniscal lesions: a systematic review of systematic reviews. Musculoskeletal Surgery, 107, 127–141. https://link.springer.com/article/10.1007/s12306-022-00760-z
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Exploring Conservative Treatments for Subacromial Bursitis: Beyond Surgery

3/17/2024

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Subacromial bursitis, a common source of shoulder pain, often leads patients and healthcare providers to consider arthroscopic interventions. However, recent studies advocate for a more conservative approach, emphasising physiotherapy interventions that challenge the necessity of surgery. This blog post delves into the effectiveness of non-surgical treatments for subacromial bursitis, highlighting key findings from recent research that support exercise therapy and manual therapy as first-line treatments.

The Role of Exercise Therapy in Managing Subacromial Bursitis
A systematic review published in the Journal of Orthopaedic & Sports Physical Therapy (2020) by Louise Pieters and colleagues, underscores the significant benefit of exercise therapy for patients with subacromial shoulder pain (1). The review, which updated a previous 2013 examination, strongly recommends exercise therapy as the initial treatment strategy to improve pain, mobility, and function. It further suggests that manual therapy could be effectively integrated as an adjunct to exercise, providing a holistic approach to treatment. Interestingly, the review found moderate evidence indicating that other commonly prescribed interventions, such as laser therapy, extracorporeal shockwave therapy, and ultrasound, had no significant effect.

Proprioceptive-Based Strategies: A New Frontier
The exploration of proprioceptive-based strategies for treating subacromial impingement syndrome offers a refreshing perspective on managing shoulder pain. A systematic review by Harman Singh, Aaronvir Thind, and Nequesha S Mohamed, published in Cureus (2022), evaluated the effectiveness of kinesiology tape, myofascial trigger point release (MPTR), scapular stabilisation exercises (SSE), and resistance training compared to traditional modalities (2). Their findings reveal that all examined techniques demonstrated some degree of effectiveness in reducing pain and improving function, although the evidence suggests a need for further large-scale studies to solidify these outcomes.

Understanding the Clinical Course of Subacromial Shoulder Pain
A systematic review with meta-analysis conducted by Zohreh Jafarian Tangrood and colleagues, published in 2023, sought to understand the clinical course of pain and function in patients with subacromial pain (3). The study's insights are invaluable, revealing that without intervention, minimal improvement can be expected within the first three months. Conversely, 'usual care' - encompassing a broad range of conservative treatments - showed significant improvement in pain and function up to 12 months, with a substantial portion of this improvement occurring in the first six weeks.

The Effectiveness of Physiotherapy Exercises
The evidence supporting physiotherapy exercises for subacromial impingement syndrome continues to grow, as highlighted in a systematic review and meta-analysis by Hanratty CE and colleagues (4). This comprehensive analysis reinforces the notion that individually tailored physiotherapy exercises can lead to significant improvements in pain and function, further challenging the immediate recourse to surgical interventions.
ConclusionThe shift towards conservative management of subacromial bursitis, particularly through exercise therapy and manual therapy, is backed by a growing body of research. These studies collectively underscore the potential for significant improvements in pain, function, and mobility without the need for surgical intervention. As the healthcare community continues to advocate for evidence-based practices, the emphasis on physical therapy interventions as a first-line treatment offers a promising avenue for patients struggling with subacromial bursitis, advocating for a less invasive, more holistic approach to care.

References
  1. Pieters, L., Lewis, J., Kuppens, K., Jochems, J., Bruijstens, T., Joossens, L., & Struyf, F. (2020). An Update of Systematic Reviews Examining the Effectiveness of Conservative Physical Therapy Interventions for Subacromial Shoulder Pain. J Orthop Sports Phys Ther, 50(3), 131-141. https://pubmed.ncbi.nlm.nih.gov/31726927/
  2. Singh, H., Thind, A., & Mohamed, N. S. (2022). Subacromial Impingement Syndrome: A Systematic Review of Existing Treatment Modalities to Newer Proprioceptive-Based Strategies. Cureus, 14(8). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9509002/
  3. Jafarian Tangrood, Z., Gisselman, A. S., Sole, G., & Ribeiro, D. C. (2023). Clinical course of pain and function in subacromial shoulder pain: a systematic review with meta-analysis. https://www.tandfonline.com/doi/full/10.1080/10833196.2023.2192620
  4. Hanratty, C. E., McVeigh, J. G., Kerr, D. P., Basford, J. R., Finch, M. B., Pendleton, A., & Sim, J. (2012). The effectiveness of physiotherapy exercises in subacromial impingement syndrome: a systematic review and meta-analysis. Seminars in Arthritis and Rheumatism, 42(3), 297-316. https://www.ncbi.nlm.nih.gov/books/NBK116133/
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Sleep: The Unsung Hero of Injury Recovery and Athletic Performance

3/9/2024

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In the competitive world of sports and the meticulous field of physiotherapy, discussions frequently orbit training methodologies, nutritional strategies, and the forefront of recovery technologies. However, a crucial element in athletes' well-being and recuperation that is often overlooked is the role of sleep. Emerging research unequivocally emphasises the profound impact of sleep on injury recovery and athletic performance, spotlighting its indispensable role in an athlete's regimen.

The Foundation of Recovery
Sleep stands as a fundamental pillar in the body's recovery mechanism, providing not only rest but also facilitating cellular repair and hormonal equilibrium. A systematic review in the British Journal of Sports Medicine delineates the significant role of sleep in the convalescence of sports injuries, pointing out that inadequate sleep quality and duration are common among athletes and considerably amplify injury risks . This body of work stresses the importance of incorporating sleep management into training and competition schedules to curtail injury rates and expedite rehabilitation.


Enhancing Muscle Recovery
The intricate nexus between sleep and muscle recuperation is especially noteworthy. According to a narrative review in the Journal of Science and Medicine in Sport, extending sleep duration not only bolsters performance but also enhances pain sensitivity and anabolic responses, such as elevated levels of GH/IGF-I, pivotal for muscle repair and recuperation from exercise-induced injuries. This evidence suggests that sleep interventions could serve as a critical tool in hastening recovery processes, presenting a topic of keen interest for medical professionals and coaches alike.

Sleep’s Role in Injury Risk Management
Further research detailed in the Journal of Sports Rehabilitation elucidates the association between sleep and injury risk, demonstrating that chronic insufficient sleep is correlated with an increased risk of musculoskeletal pain and sports injuries. Specifically, consistently sleeping less than seven hours is linked with a higher injury risk, underscoring the necessity of adequate sleep for injury prevention .

The Impact on University Athletes
The challenge of managing sleep extends beyond professional athletes to include university athletes as well. A study published in Frontiers in Sports and Active Living reveals how academic and social stresses can exacerbate sleep disruption, leading to adverse effects such as performance decline, mood alterations, and an increased vulnerability to injuries and illnesses. This highlights the widespread applicability of sleep management strategies across different levels of athletic engagement.

Practical Implications for Your Recovery Journey
For athletes embarking on the recovery path, or anyone aspiring to elevate their physical performance, the directive is clear: sleep must be prioritizsed. Here are actionable steps to integrate into your routine:
  • Establish a Consistent Sleep Schedule: Strive for at least 8 hours of sleep each night, maintaining consistent bedtimes and wake-up times.
  • Create a Restful Sleeping Environment: Diminish noise and light exposure and ensure your sleep area is comfortable and conducive to rest.
  • Incorporate Relaxation Techniques: Engaging in activities like reading, meditation, or gentle yoga before bedtime can prime your body and mind for sleep.
  • Limit Screen Time: Minimise evening exposure to screens and electronic devices to reduce the impact of blue light on your sleep cycle.
Conclusion
The expanding corpus of research on sleep's effects on injury recovery and athletic performance furnishes invaluable insights for athletes, coaches, and healthcare practitioners. As we delve deeper into the myriad benefits of sleep, it becomes increasingly clear that sleep is not merely a passive rest period but a dynamic process integral to athletes' health, well-being, and achievement. By prioritising sleep, we can optimise our recovery processes, mitigate injury risks, and unlock our utmost potential in sports and beyond

References Used 
  1. Vermeir, P., De Leye, M., Grymonprez, R., Goethals, A., Vermeir, R., Vanden Bossche, L., & Mariman, A. (2021). The impact of sleep on the recovery of sport injuries. British Journal of Sports Medicine, 55(Suppl 1), A173.3. https://bjsm.bmj.com/content/55/Suppl_1/A173.3Chennaoui, M., Vanneau, T., Trignol, A., Arnal, P.,
  2. Gomez-Merino, D., Baudot, C., Perez, J., Pochettino, S., & Eirale, C. (2021). How does sleep help recovery from exercise-induced muscle injuries? Journal of Science and Medicine in Sport. https://pubmed.ncbi.nlm.nih.gov/34074604/
  3. Huang, K., & Ihm, J. (2021). Sleep and Injury Risk. Journal of Sports Rehabilitation. https://pubmed.ncbi.nlm.nih.gov/34099605/
  4. Hamlin, M.J., Deuchrass, R.W., Olsen, P.D., Choukri, M.A., Marshall, H.C., Lizamore, C.A., Leong, C., & Elliot, C.A. (2021). The Effect of Sleep Quality and Quantity on Athlete's Health and Perceived Training Quality. Frontiers in Sports and Active Living. https://www.frontiersin.org/articles/10.3389/fspor.2021.705650/full​
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    ​Barry Nguyen
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    Barry is an Australian qualified physiotherapist with over 19 years clinical experience in sports and musculoskeletal injuries.
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