Headache + Migraine: a pain in the neck?

Physiotherapy is often overlooked in the treatment of headache and migraine. It is the most common non-pharmacological treatment for headache and migraine. Physiotherapists can treat headache and migraine by treating the upper cervical segments to desensitise the lower brain stem which often contributes to these conditions. You don’t have to have neck pain or stiffness associated with your headache or migraine to benefit from this treatment. Physiotherapy has been shown to be effective in headache + migraine sufferers even without neck pain or stiffness as these patients will still be experiencing an over-sensitised lower brain stem which is enclosed by the upper cervical vertebrae.

Research has shown the following conditions can have successful outcomes with Physiotherapy treatment:

-        Cervicogenic Headache

-        Cluster Headaches

-        Tension-Type Headaches

-        Migraines

-        Abdominal Migraines

-        Menstrual Migraines

-        Migraines with Auras

-        Post Concussion Syndrome

-        Cyclic Vomiting Syndrome

-        Hemiplegic Migraines

-        Trigeminal Neuralgia

-        Vestibular Migraines

I am trained in the Watson Headache® Approach which is a manual, non-manipulative series of specific techniques used to assess the relevance of, and managing segmental behaviour/dysfunction of the C0-C3 segments. To learn more visit https://watsonheadache.com/

Written by Caitlyn Smith, Physiotherapist

What is an AHA and what do they do?

Allied Health Assistants (AHAs) work with allied health practitioners (such as Physiotherapists, Occupational Therapists and Exercise Physiologists), in a supportive and collaborative role. AHAs assist in implementing therapies following an initial assessment completed by an allied health practitioner. We work together to ensure that continuity and quality of care is achieved between patients and their treating allied health professional.  

AHAs play an integral role in supporting patients to participate in their individualised treatment plans, whilst ensuring that plans are manageable and enjoyable. We endeavor to maintain effective communication between patients and their treating allied health practitioner, as well as assist with administration tasks and reporting.  

We work with all ages and abilities, ranging from children to more experienced adults. You will find us in the clinic, the pool, a local gym, playgrounds, parks, kindergartens, schools, homes and more. Some therapies that we assist with are:  

• Pilates (Reformer & Mat-based) 

• Strength building 

• Balance 

• Neurological Rehabilition 

• Hydrotherapy 

• Early Intervention & play based therapy 

• Passive stretching 

Using an AHA can assist in stretching your therapy budget and allows for regular flexible interactions with a trained assistant to aid you in reaching your therapy goals. Maintaining a fun, comfortable and supportive environment is what we aim for to ensure that the best outcomes are achieved, and we are motivated to provide a positive experience and build strong relationships with our clients. 

Written by Lauren & Kylie, Allied Health Assistants 

RICER no more?

The acronym RICER was considered the ‘go to’ management strategy for people who have suffered an injury. The acronym breaks down some of the key acute injury management techniques to help individuals get a head start on swelling and pain management. This acronym is broken up into:

R- Rest, I- Ice, C- Compression, E- Elevation, R- Referral

However, with limited evidence supporting the once loved acronym RICER, there has been a shift to a new set of principles and acronym, PEACE & LOVE. Although still containing some of the same principles used within RICER and other acronyms such as POLICE, PEACE & LOVE contains the new principles to provide people with the most appropriate strategies post injury to optimise healing. The acronym is as follows:

P- Protection

·       Protect the injury by unloading and avoiding aggravating movements for the first 1-3 days

E- Elevation

·       Elevate the injured limb (higher than the heart) to help with swelling management

A- Avoid Anti-inflammatories

·       Avoid anti-inflams as they may reduce the benefits of the inflammatory process which is important in tissue healing

C- Compression

·       Compression through bandages, compression garments or Tubigrip to help with swelling management

E- Education

·       Seek medical/professional advice to help with the management of the injury

&

L- Load

·       Listen to your body as you increase load and integrate back into normal activities

O- Optimism

·       Stay positive and confident in yourself to optimise recovery

V- Vascularisation

·       Complete pain free cardiovascular exercises to help increase blood flow

E- Exercise

·       Complete exercises to improve strength, range of motion and proprioception

Although RICER is still used heavily today, PEACE & LOVE is slowly becoming more and more prevalent as many health professionals are integrating these principles into the early management of injuries.

So next time you sustain an injury whether that be at sport, work or day to day life, remember to follow the new and improved principles of PEACE & LOVE!

Written by Matthew Long, Physiotherapist

Have you ever wondered what Pillow a Physio uses themselves?

We regularly get asked what pillows we recommend and use by our clients, after all we spend a third of our lives on one!

Having a poor (or too old) pillow can cause neck pain, stiffness and headaches in some people.

The most important thing is to make sure you change your pillow about every 2 years. Just imagine if you spent the same amount of time walking in one pair of shoes that you do on a pillow and how quickly they would wear out! It’s also good for hygiene reasons. I usually find my neck tells me it’s time to get a new one before I’ve realised how quickly the two years has gone.

Other than that, a pillow is a super individual thing, if you have one that you like, you sleep well with and it doesn’t affect your neck, then I say just buy that same one every two years. No need to change brands unless it’s giving you grief!

We do have some brands that we recommend:

-       Therapillow

-       Denton’s

-       Dunlopillow

-       Tontine (but choose their more supportive options, some are just for decoration!)

I’ve always used Denton’s, since starting my first job 14 years ago and have recommended them to my patients and stock them in the clinic.

However, when I was pregnant with my little boy, I went searching for a pillow that was super low toxicity in the manufacturing process. Most products containing foam give off VOC’s (volatile organic compounds, think ‘new car smell’), and I figured it wasn’t great to be breathing them in every night from a new pillow.

So I did some research, finding that natural latex (as long as you’re not allergic) is an excellent choice.  I then found the brand “Therapillow” and purchased some in to try.  Luckily, not only is it a healthy natural latex, but I LOVE the pillow. It’s soft but supportive, which is quite difficult to find in a pillow. Often they’re too hard or they’re not supportive enough.  And I like a gentle contour personally.

This post was prompted by the fact I realised it was time to change over my therapillow, after getting some treatment on my neck from a colleague and I thought others might be interested in why I use the pillow I do!

We stock several sizes of therapillow and a few other brands too, because as I said, everyone is different!

Content provided by Shannyn McGrice, Physiotherapist

Lipoedema - What is it?

First described in the 1940s, it is a chronic and progressive disease that effects predominantly women and is the abnormal build-up of adipose (fatty) tissue around the hips, buttocks, legs and sometimes arms, leading to enlargement, swelling and pain.

It is a hereditary disorder effecting 11% of Australian women and is highly variable and unpredictable.

It is not the same as obesity or being overweight.

Signs and Symptoms of Lipoedema

• The legs are enlarged bilaterally - arms too can be affected

• The waist is small in proportion to thighs, buttocks and legs

• Feet and hands are exempt and a 'bracelet' effect can, in most cases, appear just above the ankles and wrists

• Legs/arms can be extremely painful, even to touch

• Affected limbs bruise easily

• The fat is soft to touch and wobbly, while skin can be cold to touch

• Lipoedema can become worse in hot weather

• Diet and exercise, while important, can have minimal effect

• Increase in Lipoedema is often noticed when significant hormonal changes happen

• Skin can have a cellulite or ‘mattress’ like appearance

• Skin on the legs and buttocks can be cold to touch.

• Associated with chronic venous and lymphatic insufficiency and early degenerative articular disease.

The onset of lipoedema usually begins at puberty and can develop further with hormonal changes such as pregnancy and menopause. For majority of women that develop symptoms during puberty most aren’t diagnosed until in their 30s-40s, when symptoms have become more severe.

A diagnosis will be made on clinical grounds through clinical assessment and discussing medical history with your doctor. However, many medical professionals are unaware of Lipoedema, and can get confused with Lymphoedema or simply diagnosing as obesity, but this is changing through organizations such as Lipoedema Australia.

There are many conservative treatment approaches that we can do to help, part of which can include Decongestive Lymphatic Therapy, a program that combines multiple treatment approaches to reduce the swelling and oedema-related symptoms of lipoedema. It involves regular sessions of MLD or intermittent pneumatic compression with a pump, compression garments, exercise, skin care and modified factors of daily living. Unfortunately, at this stage there is no cure for lipoedema, however with more awareness and proper management it can be well maintained.

More information can be found on the Lipoedema Australia website www.lipoedemaaustralia.com.au or speaking to a medical professional, qualified oedema therapist, myotherapist or physiotherapist.

Creating Healthy Habits

I’m sure you’ve all heard of SMART goals, a quick google will find 672,000,000 results discussing SMART goals. If smart goals were the (not so) hidden secret to success we’d all be retired and living on a yacht.

SMART goals are great but they often need a little more intention than this “set and forget” format. Which is where if/then planning come in.

After SMART goals are developed, it is time to implement the steps required to achieve those goals. These ‘implementation intentions’ specify when, where, and how the goal will be achieved. They take the form of an ‘If-then’ plan:

IF identifies the cue to act. This might be a time/place. Think about it as a ‘golden opportunity’ to act.

THEN identifies an effective goal-directed response.

If-then planning can also help us identify situations that you can link to the new behaviour. That is, it can help to seize opportunities to act.

For example:

·      If the kettle is boiling, then I’ll do my calf raises

·      If I’ve climbed into bed, then I’ll do my bridges + clams

·      If I’ve brushed my teeth, then I’ll take my medication

Essentially, when you make these plans you become much more aware of the cue in the environment that you are using as a trigger to act (ie the IF). This leads you to see these cues and leads to faster action of the plan. BUT – these plans need to be specific to your goals.

So when reflecting on your “new year, new me” goals for 2023, think to yourself what activity or time can I pair my goal with, to stop relying on motivation alone?

Written by Caitlyn Smith

Derived from Melbourne University

The mistreated ‘jarred’ finger…

The middle joint of the finger (known as the PIP joint) is the most frequently injured joint of the hand. Unfortunately finger injuries are frequently dismissed as just a ‘jarred’ finger or inappropriately treated. There can be long term complications associated with delayed treatment or mismanagement of PIP injuries such as recurring dislocations, chronic and flexed deformities. Unfortunately, these chronic issues can have significant impacts on your hand function and daily activities.

The PIP joint is a very complex structure requiring early assessment and diagnosis to provide patients with their best outcomes. Studies indicate that outcomes are significantly improved when they are treated early post injury, within 4 weeks.

PIP injuries include;

Ligament injuries:

Range from grade 1 tears (the true jarred finger) through to grade 3 full ligament ruptures and joint instability. Depending on the severity will depend on your best treatment. Grade 2 & 3 tears often require 2-6 weeks of splinting which must include exercises to prevent stiffness. Some severe ligament injuries may require surgical repair

Avulsions fractures:

Frequently a piece of bone where the thick ligament on the palm side of the PIP joints attaches can break off. These fractures are often very small but poorly treated. They are usually best treated by hand therapy unless the fracture is too large or unstable, they would require surgery

Dislocations +/- fractures:

Most stable finger fractures can be treated with custom splinting and hand therapy. Rarely will you have a finger fracture without complex soft tissue injuries. It is important to remember these soft tissue injuries won’t be seen on x-ray, so if you get the ‘all clear’ all might not be as it seems!

So next time you suffer a ‘jarred’ finger on the court or field, consider if there might be more to it? Early assessment and treatment for fingers is essential for good outcomes.

Content provided by Kate Cameron, Practitioner of Hand Therapy

Lymphatic Therapy with Nicole

I have studied with the Casley-Smith Method of Decongestive Lymphatic Therapy, which involves the treatment for lymphoedema, lipoedema, swelling, fibrosis and scarring. Treatment includes manual lymphatic drainage, gentle exercise prescription and recommendations for skin care, precautions and activity modification.

Manual Lympatic Drainage encourages the natural process of the lymphatic vessels to eliminate waste products. It stimulates the lymph system to absorb and transport lymph more effectively which promotes tissue health, detoxification and the immue system. It can be a beneficial treatment for; lymphoedema (preventaion and management), lipoedema, oedema reduction, pregnancy related swelling, post liposuction, pain relief, fibromyalgia, pre/post surgery, arthritis and headaches.

Lymphoedema is the accumulation of excessive amounts of protein-rich fluid resulting in swelling of one or more regions of the body. Lymphoedema may arise because the lymphatic vessels or nodes have been damages or were not formed correctly.

Sexual Pain... Physio can help

Did you know….Sexual pain and discomfort is a common issue amongst all genders. It may be associated with endometriosis or childbirth, however, many people suffer with sexual dysfunction for other reasons. Many genito-pelvic pain disorders appear in the form of pelvic floor muscle tension, which makes any type of penetration (sexual, tampons, gynaecological examination tools) very difficult or impossible.

One of the roles of pelvic floor physiotherapy is to assist in the treatment of sexual pain, by increasing muscle awareness and proprioception, improving muscle relaxation, strengthening muscles and increasing the elasticity of the tissues in order to eliminate or reduce pain. Different exercise techniques, biofeedback, manual therapy and insertion techniques are used to achieve positive results. These techniques, when performed by an appropriately qualified therapist, have been shown to have positive results in many women with sexual and pelvic pain difficulties. We are very fortunate to have two Physiotherapists who are trained in pelvic floor physiotherapy and are passionate about helping people with pelvic pain disorders. 

Content provided By Shannyn McGrice, Womens Health Physiotherapist.

Choose physio for dizziness and vertigo

Dizziness is a common issue in the general population. It is estimated that at least five percent of the Australian population (over one million people) will experience dizziness issues at some point in their lifetime. There are a number of causes for dizziness, and treatment options include medical management (eg, medications), physiotherapy and psychology intervention. Your GP can help determine the appropriate clinician for your specific needs.

Vestibular physiotherapy can be a very good option for treating symptoms of dizziness and vertigo, especially if these symptoms are triggered or aggravated by movement. In many cases dizziness that is worse with movement is caused by a disorder involving the inner ear (vestibular) system. Research has shown that vestibular physiotherapy is highly effective in treating vestibular disorders, such as benign paroxysmal positional vertigo (BPPV), viral infection of the inner ear (vestibular neuritis) and vestibular migraine (a form of migraine that causes vertigo and dizziness with or without symptoms of headache).

Your physiotherapist with specific skills in vestibular rehabilitation would conduct a comprehensive assessment of your dizziness and vertigo, and, in many cases, would be able to establish the cause for your symptoms. If unable to establish a cause for your symptoms, your physiotherapist would refer you to a medical specialist who would be able to order more extensive testing.

Vestibular physiotherapy involves:

• Habituation exercises: These exercises involve specific movements that are designed to gently stimulate the symptoms of dizziness in order to desensitize the vestibular system to those movements. These are designed to reduce symptoms of dizziness.

• Eye-head coordination exercises: These exercises are designed to improve focus and reduce symptoms of dizziness.

• Balance and gait exercises: These exercises involve challenging the vestibular balance system in order to strengthen it. They are designed to improve balance and confidence when walking.

• Re-positioning techniques: These techniques are used for a specific inner ear (vestibular) condition known as benign paroxysmal positional vertigo (BPPV). This condition results in significant symptoms of vertigo when changing position, such as when lying down or rolling over in bed. Techniques such as the Epley manoeuvre can successfully treat BPPV but should be performed by your physiotherapist with specific skills in vestibular rehabilitation.