Foot biomechanics can have effects on the body in more areas than simply the feet. Over-pronation, or ´falling arches´ can lead to significant knee pain due to the effect this has on the alignment of the leg. The ´rolling in´ of the feet will cause the knees to turn inwards, and sometimes the legs will ´bow´ inwards. The end result is mal-tracking of the kneecap, which can lead to excessive wear and tear on the knee joint, and earlier onset of such pathologies as osteoarthritis. This malignment can extend to the hip joints, the lower back and even higher in the spine. The provision of custom fitted orthotics will correct the biomechanics of the feet, and hence eliminate the associated problems further up the kinetic chain. For orthotics to provide the best possible support, it is important the feet are assessed correctly and the most appropriate, individual orthotic prescribed according to those assessment findings. Too many times the feet are assessed in the standing position alone, which does not allow for what happens when the foot moves through the walking or running process. At different points during the various stages of walking/running there are many different forces acting on the feet. If these forces are not measured and accounted for in the prescription of the orthotic, the feet will not have that ´dynamic stability´ that is needed during walking and running. Simple observation of the walking pattern will provide some information, however this is very basic and subjective. Move Well Physiotherapy now has the revolutionary new GaitScan technology which uses a pressure plate with an industry high 4096 sensors operating at 125 HZ scans per second. With this advanced technology, the foot pressures are able to be accurately and objectively assessed and graphed. A link to a computer program enables a 3 dimensional scan to be produced which accurately maps all areas of pressure throughout the weight bearing phase of gait. These scans and reports can be produced at no cost for you, and provide the vitally important information needed to correctly prescribe the most appropriate orthotic. Our orthotics are then produced by technicians who specialise in the fabrication of only the highest quality orthotics. The product is guaranteed for a lifetime against breakage.
There are a variety of specialised orthotics available, including:

• Dress orthotics for formal shoes with heels or dance shoes
• Casual orthotics for a variety of shoes
• Sport orthotics for high impact sports or work situations
• Specific diabetic care orthotics, designed to relieve high pressure areas
• Specific child orthotics

This technology is available at:

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THE IMPORTANCE OF STABILISING MUSCLE FUNCTION FOR RECOVERY FROM NECK AND BACK INJURY (INCL. WHIPLASH)

• The Stabilising Muscles
• The Lumbar Spine
• Ultrasound Imaging
• The Neck

The Stabilising Muscles

Throughout the body there are strength muscles and stabilising muscles. The strength muscles produce the movement of the body while the stabilising muscles support and protect the body. The stabilising muscles are essential for the protection of the joints and other tissues by providing "shock-absorption" so that movement does not jerk or jolt the body. The stabilising muscles also maintain a static contraction to provide continuous support during prolonged postures (eg. sitting at a desk or standing for a long time) and to absorb minor jarring (eg driving in a car).

Generally, the strength muscles are large powerful muscles that can produce tremendous power. The strength muscles are usually developed by performing strong exercises (eg sit-ups or gym exercises). Some of the most commonly known strength muscles are the biceps muscle of the arm and the quadriceps muscle of the thigh. The stabilising muscles however are much smaller deeper muscles that do not generate great force. The stabilising muscles can only be developed by very specific and often quite gentle exercises.

Without good stabilising muscle function, the physical stress from even gentle daily activities can cause damage. Ironically, the stronger the strength muscles, the more stress that the body must absorb and the more damage that can be caused. The stabilising muscles must therefore be developed in proportion with the strength muscles.

Research shows that the stabilising muscles almost always weaken following an injury and will not necessarily automatically or spontaneously re-strengthen. Your physiotherapist can assess the stabilising muscles and teach the specific exercises to re-develop them to ensure complete recovery from injury and reduce the chance of recurrence.

The Lumbar Spine

Correct function of the stabilising muscles of the lumbar spine is essential to maintain good spinal health. Following an injury to the lumbar spine or an episode of low back pain, the stabilising muscles often weaken and become unable to support and protect the spine. This lack of support and protection causes ongoing pain, slower recovery and increases the chance of re-injury.

Recent physiotherapy research has shown that the stabilising muscles for the lower back ("Multifidus" and "Transversus Abdominis") do not spontaneously re-develop following an injury and require very specific exercises to be re-strengthened. Sit-ups, back arches and similar exercises do not strengthen the stabilising muscles and in fact often cause more harm by developing the "wrong" muscles or stressing the injured tissues.

Stabilising muscle function should re-developed soon after the injury to prevent ongoing pain. Your physiotherapist will assess the stabilising muscles and will implement specific exercises as part of the treatment usually required for a full recovery from low back pain.

Ultrasound Imaging

The stabilising muscles of the lumbar spine are very deep and are difficult to assess accurately. It is also difficult to learn how to exercise the muscles correctly. Real-time ultrasound imaging produces an image of the stabilising muscles on a screen and allows the physiotherapist and the patient to watch the muscles work while they are being exercised. This allows accurate and measurable assessment of the muscles and helps the patients learn how to exercise the stabilising muscles correctly.

This Clinic offers real-time ultrasound imaging of the deep stabilising muscles of the lower back to assist with the assessment and rehabilitation of these muscles following an episode of low back pain. The Clinic sends a report outlining the real-time ultrasound imaging assessment findings to the doctor and the treating physiotherapist so the exercises can be progressed appropriately and precisely to suit the condition.

The Neck

The stabilising muscles of the neck "hold" the neck in the correct position and are therefore essential for good posture and correct movement. The stabilising muscles of the neck are also protect the spine from "micro-trauma" as a result of jarring or jerky movement.

Ongoing physiotherapy research has demonstrated that the deep stabilising muscles of the neck may weaken over several months or even years due to poor posture (eg sitting incorrectly at a desk for long periods) or the muscles may weaken over a few days as a result of an injury (eg. a car accident or carrying a heavy school bag). Whether neck pain occurs gradually or as a result of an injury, re-developing the stabilising muscles of the neck is usually essential for a full recovery.

If you have neck pain or neck-related headaches, the stabilising muscles will be assessed by your physiotherapist in combination with a full examination of your neck and posture. Like the exercises for the stabilising muscles of the lower back, the exercises for the stabilising muscles of the neck are very gentle. Your physiotherapist can teach you how to do these exercises properly.

If you have a history of neck problems you should also consult your physiotherapist before commencing a new exercise programme to be certain that the stabilising muscles of your neck are strong enough to support your head before you start lifting weights, swimming or jogging. The postural muscles of your back may also need to be strengthened to maintain good posture while you sit, stand and walk.

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REAL-TIME ULTRASOUND IMAGING FOR LOW BACK PAIN

• Physiotherapy Real-time Ultrasound Imaging for the Lumbar Spine
• The Stabilising Muscles of the Lumbar Spine
• Exercises for the Stabilising Muscles
• Real-time Ultrasound Imaging of the Stabilising Muscles
• Move Well's Service
• Ultrasound Imaging and Exercise Programme Research

Physiotherapy Real-time Ultrasound Imaging for the Lumbar Spine

Move Well Physiotherapy provides real-time ultrasound imaging of the stabilising muscles of the lumbar spine conducted by a physiotherapist. Real-time ultrasound imaging (RTUI) has been used widely in medicine for many years and has recently been used in research into low back pain. RTUI has provided vital improvements in the accuracy and effectiveness of the treatment of low back pain.

The Stabilising Muscles of the Lumbar Spine

Recent research published in medical and physiotherapy journals (see enclosed) has investigated the role of the deep stabilising muscles of the lumbar spine in low back pain. The research demonstrates that following lumbar spine injury, the stabilising muscles are significantly and inevitably inhibited. The subsequent weakening and loss of control of the stabilising muscles often leads to poor or incomplete recovery from the injury and the development of chronic or recurrent low back pain.

Exercises for the Stabilising Muscles

Since the stabilising muscles of the lumbar spine do not usually recover spontaneously following an episode of low back pain, specific exercises are required to stimulate their redevelopment. Research shows that stabilising muscle function is not correctly facilitated through global exercises such as Pilates, fit ball and strength exercises. The most effective exercises for the stabilising muscles need to be very specific and will depend on the patient's specific condition and stage of recovery. Accurate assessment of the stabilising muscles with normal palpation is very difficult because the stabilizing muscles are very deep and the timing and strength of their contraction is very subtle. In addition, patients with low back pain are often unable to contract the stabilising muscles correctly and have difficulty learning appropriate exercises for these muscles.

Real-time Ultrasound Imaging of the Stabilising Muscles

Real-time ultrasound imaging allows the physiotherapist to view the stabilising muscle contraction as it occurs and can provide an accurate assessment of the quality, timing and endurance of the stabilising muscle contraction. This allows the physiotherapist to quantify the degree of stabilising muscle dysfunction and may provide an insight into the severity of the condition through the degree of inhibition of the muscles. Since the patient may also view the video image of the muscle contraction as it occurs, ultrasound imaging can be an effective method of teaching the correct exercise techniques. Actually seeing the muscle as it contracts and feeling the sensation of a correct contraction technique is a powerful form of biofeedback and can speed up the rehabilitation of these critical muscles.

Move Well´s Service

Move Well Physiotherapy provides a comprehensive RTUI service for the stabilising muscles of the lumbar spine for the assessment and treatment of low back pain. A written report of the assessment findings is forwarded to the patient and the referring practitioner. The RTUI service can provide;

• Accurate assessment of the patient's stabilizing muscle function;
• Independent assessment and verification of stabilising muscle function;
• Effective treatment to improve stabilising muscle function; and
• Valuable information to other practitioners involved in the patient's care.

Most patients with ongoing low back pain will require several RTUI sessions to ensure correct stabilising muscle contraction and to progress their exercises appropriately.

For patients participating in a prescribed exercise programme, can be included as part of the programme, used as an adjunct to the programme or provide an independent assessment at key intervals during the programme.

Ultrasound Imaging and Exercise Programme Research

Physiotherapists are currently conducting research into the stabilising muscles of patients undergoing supervised exercise progammes. The research will compare the effectiveness of various exercise approaches including gym programmes, hydrotherapy and Pilates, in developing stabilising muscle function following ongoing low back pain. Interestingly, preliminary results for patients who have completed a supervised exercise programme have demonstrated a significantly lower level of stabilising muscle function and performance than that claimed by the exercise providers utilising manual assessment. This may suggest that some supervised exercise programmes may not be effectively retraining the lumbar spine stabilising muscles, leading to ongoing or recurrent lumbar spine pain following completion of the programme.

Some interesting statistics that have been published concerning low back pain:

• 80% of people aged between 20 and 50 will experience an episode of low back pain,
• 80% of these will recover after approximately 6 weeks while 20% will go on to develop chronic low back pain,
• 80% of those who recover within 6 weeks will experience another episode of low back pain within 12 months,
• after the second episode of pain, that person is more likely to experience more frequent and more severe exacerbations of pain with time,
• recent research has demonstrated that correct and effective retraining of the deep stabilising muscles (multifidus and transversus abdominis) following an episode of low back pain, compared to patients rehabilitated with standard exercise programmes, decreases the chance of recurrence of low back pain within a 2 year period by more than 13 times.

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PELVIC FLOOR

Assessment and retraining of the pelvic floor muscles with real-time ultrasound imaging.

The pelvic floor muscles are found between your tail bone and your pubic bone, and are like a sling holding up your abdominal contents. They need to be working properly to control your bowel and bladder function.

These muscles can become very weak after having a baby (even if you have had a caesarian), after prostate surgery, after abdominal surgery, after starting a new exercise regime, or they can just get weaker with age. Pelvic floor weakness can even be associated with low back pain. If these muscles are weak, the most common problem is called "stress incontinence". This is when a few drops of urine leak out when you cough, sneeze, run or laugh.

The pelvic floor can be viewed with RTUI trans-abdominally ­ that is, we can look at how the pelvic floor muscles are working by placing the probe of the ultrasound on your lower tummy. This gives us a picture of your bladder so you need to have a fairly full bladder when you come in for your appointment for us to get a good picture.

We can then assess if you are using your pelvic floor muscles properly, and if you are not, teach you how to lift the pelvic floor correctly. Many people with weakness may be pushing their pelvic floor muscles down rather than lifting them. This makes the pelvic floor weaker and weaker. We can also see how easily the muscles get tired when you are exercising them.

With the help of RTUI in most cases we can retrain your pelvic floor muscles easily and effectively. We can also see if there is a problem in retraining the muscles, and then refer you on for further medical assessment if indicated.

For the assessment and retraining of the pelvic floor muscles with real-time ultrasound imaging.

Contact

Move Well Physiotherapy - Applecross
Ph: 9316 1186

Gavin Kerruish, Julian Bowen and Lauren May
Move Well Physiotherapy - Arena Joondalup
Ph: 9301 1600

Blake Sutcliffe
Move Well Physiotherapy - Beaumauris
Ph: 9300 4844

Aaron Thomas and Sean Cowan
Move Well Physiotherapy - Belridge
Ph: 9307 2133

Ben Gabrovec
Move Well Physiotherapy - Quinns
Ph: 9305 0000

Mark Gibson
Move Well Physiotherapy - Rockingham
Ph: 9527 3844

Belinda Connelly and Emily Whiting
Move Well Physiotherapy - Warwick
Ph: 9243 3099

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WHOLE BODY VIBRATION

Whole body vibration (WBV) machines use vibrating platforms to enhance exercise and rehabilitation. It was originally developed by Russian Scientists in the 1970´s to help overcome the effect of low gravity on cosmonauts. Recently, this technology has been further developed to enable the general public to also benefit from it´s effects. Some trials have shown training with WBV can increase muscle strength by 20 to 30% in 85% less time. By concentrating the muscular contractions, the muscles receive a workout in a greatly reduced time frame. Sessions lasting 10 to 20 minutes are recommended for most conditions, 3 to 4 times per week.

WBV may be used for a number of conditions such as:

• Muscle strengthening
  • In general and for rehabilitation both post-op and post injury
  • The high level vibration ensures that muscles are being constantly activated by the extremely small movements. Therefore, any time spent on the vibrating platform magnifies the effect on muscles. By activating the ´stretch-reflex´, the brain is subconsciously adjusting the muscles and joints. The stretch reflex refers to the contraction the muscles automatically do when they are suddenly stretched, as seen when the Physio taps below the kneecap and the knee straightens. This automatic muscle contraction and feedback aids in retraining correct movement patterns, and rehabilitate the injured body part in a functional way.
• Balance re-training
  • Once again, due to the muscular reactions to the vibration, muscles are stimulated more effectively to improve correction to movement and balance. This aids in falls prevention, and sport specific retraining following injury, in particular to the knees and ankles.
• Bone strengthening
  • WBV can help directly by increasing the gravitational load on the bones and promoting bone growth. This is ideal for such conditions as stress fractures, osteoporosis, and osteopenia.
  • o It can also indirectly improve bone strength by strengthening muscles and hence, provide a greater pull on the bones, thereby stimulating bone growth.

Over 20 years of research into the use of WBV, has shown that it has benefits for not only the conditions listed above, but can also help with:

• Improving flexibility and range of motion
• Enhancing blood flow throughout the body
• Accelerating weight loss and reducing cellulite
• Enhancing certain hormone production, including growth hormone, testosterone, serotonin and neurothrophine
• Decreasing blood pressure
• Improving tendon strength
• Improving pelvic floor muscle contraction, therefore decreasing stress incontinence
• Retraining of lumbar stabilising muscles, improving their proprioception and performance

Move Well Belridge Physiotherapy uses the Sivermink V988 WBV Unit for all of the above conditions and their friendly, experienced Physiotherapists would be happy to take you through the benefits of Whole Body Vibration, either as part of your treatment and rehabilitation session, or as a stand-alone.

Whole Body Vibration is available at:

Move Well Physiotherapy - Belridge
Ph: 9307 2133

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