Perioperative Management of Antirheumatic Medications in Patients with RA and SLE Undergoing Elective Foot and Ankle Surgery

Historically, patients have been advised to withhold their Disease-modifying antirheumatic drugs (DMARDs) preoperatively, but the other joints suffer, and the patients struggle. Updates both in arthroplasty and foot and ankle surgery recommend continuing methotrexate.

DMARDs have made a massive improvement to medical management of rheumatoid arthritis, and other inflammatory joint disorders, reducing the previous reliance on steroids. The first generation of these are the “non-biologicals”. A number of RCT’s have been published, and the risk of infection was DECREASED with continuing non-biological DMARDs, with a relative risk of 0.39 (CI 0.17-0.91). Biological drugs act like proteins targeting specific areas of the immune system, examples include TNF inhibitors, Rituximab, and Belimumab. Currently most the data on the biologicals is not regarding perioperative periods. Although the infection rates may be lower, the scientific proof is not there yet. Generally, then, it is advised to do surgery in the week after missing a dose and recommencing once wound healing progressed.

For patients with severe SLE, it has been recommended to continue Mycophenolate mofetil, azathioprine, cyclosporine, and tacrolimus, but to withhold them for non-severe SLE. A discussion with the patient’s rheumatologist is clearly needed in SLE.

SUMMARY

DMARDs – continue

methotrexate
leflunomide
hydroxychloroquine
sulfasalazine

Biologics – do surgery in the week after a missed dose, recommence once wound healing is progressing well.

Patients with severe SLE – don’t withhold medication, get rheumatologist advice

Mild SLE – withhold:

Mycophenolate mofetil
azathioprine
cyclosporine
tacrolimus

Prednisolone
preferably operate with daily dose 20mg or less

References: Saunders, Noah E.; Holmes, James R. MD; Walton, David M. MD; Talusan, Paul G. MD. Perioperative Management of Antirheumatic Medications in Patients with RA and SLE Undergoing Elective Foot and Ankle Surgery, JBJS Reviews: June 2021 – Volume 9 – Issue 6 – e20.00201 doi:10.2106/JBJS.RVW.20.00201

Sports Medicine physicians can administer cortisone injections

Ballarat Sports Medicine physician can administer a range of injections to assist with pain, injury, and recovery. One of these is cortisone injections. The following provides an insight into cortisone. Patients should always be guided by a medical professional on the advantages and disadvantages of cortisone use.

Dr Greg Harris and Dr Bryn Savill are qualified to be able to assess your pain, injury and determine the best course of action for recovery, including if required the use of cortisone.

What is cortisone?

Cortisone is the name used to describe a group of drugs commonly known as corticosteroids. The types of cortisone used at BallaratOSM include Celestone (Betamethasone) and Depo-Medrol (Methylprednisolone). Cortisone is used to treat pain in various parts of the body where inflammation is felt to be the cause of this pain. The reason why cortisone is effective in treating such pain is because it is a powerful anti-inflammatory. It is not purely a painkiller. Cortisone is NOT an illegal steroid medication, such as those steroids used by some disqualified body builders and athletes.

Why inject cortisone?

In regard to musculoskeletal problems, cortisone injections are performed in order to reduce or even eliminate pain associated with a variety of disorders, such as:

  • Bursitis (most commonly subacromial and trochanteric bursitis)
  • Arthritis (any joint may be injected, including joints of the spine)
  • Nerve pain (most commonly for sciatica and carpal tunnel syndrome)
  • Some tendon conditions, such as plantar fasciitis, trigger finger, DeQuervain’s tenosynovitis). In pure tendon injuries cortisone is best avoided, as it can worsen a tendon tear.
  • Other miscellaneous conditions where inflammation is a contributor to the pain, for example frozen shoulder/adhesive capsulitis, Morton’s neuroma, ganglion cyst injections and Dupuytren’s contracture.

How is cortisone administered?

  • The skin is prepared using an antiseptic agent.
  • Many of the injections performed at Ballarat Sports Medicine will be done using ultrasound, with the needle being guided into the relevant body part. Some injections do not need guidance and can be done without the ultrasound.
  • The degree of discomfort during the procedure is generally mild, as the needle used is fine and local anaesthetic is mixed in with cortisone. If only one pass is planned (meaning that the needle will only penetrate the skin once) then local anaesthetic is usually NOT injected into the skin. It is our experience that injecting local anaesthetic into the skin in a single pass procedure is actually more painful, as local anaesthetic stings a little prior to taking effect. Also, the needle used to inject the local anaesthetic results in similar discomfort as the needle delivering the cortisone. Local anaesthetic is only injected into the skin if more than one pass is made through the skin. Of course, if you wish for local anaesthetic to be injected despite our recommendation, we are happy to do this.
  • A greater degree of discomfort may occur if:
    • the underlying inflammation is severe
    • the area to be injected is severely painful
    • the needle tip requires to be repositioned several times in order to distribute the cortisone effectively
    • a previous bad experience has resulted in a fear of needles, or there is a general anxiety/phobia of needles and other medical procedures.
  • In cases where a cyst, ganglion, bursa or joint is distended with fluid, the cortisone will be injected after an attempt to aspirate (remove) the fluid in order to improve comfort.

Benefits, Risks, Complications and Side-Effects of Cortisone

  • As for all medical procedures, there are risk associated with the administration of any medication, including cortisone. The chances of cortisone providing you with the benefit of pain relief in most patients outweighs the risk of experiencing a side effect(s) (discussed below). The decision to inject cortisone is not taken lightly and is carefully made by your referring doctor and based on your signs, symptoms and past medical history, as well as the suspected diagnosis. Frequently, a trial injection is made where the diagnosis is not clear, however the body region that is to be injected is suspected of causing your pain.

    The side effects and risks of a cortisone injection include:

    • Allergy to any of the substances utilised during the procedure, such as the cortisone, dressing, local anaesthetic or antiseptic. This is usually minor and self-limiting.
    • The cortisone may result in palpitations, hot flushes, insomnia, and mild mood disturbance. This usually resolves within 24 hours and no treatment is necessary.
    • Infection is a rare but serious complication (<0.1%), especially if injected into a joint. Most infections take at least a day or two to manifest, so pain at the injection site after 48 hours is considered to be due to an infection until proven otherwise. Even if not definitively proven, you may be commenced on empirical antibiotic treatment.
    • Local bruising.
    • Localised skin and subcutaneous fat atrophy (thinning resulting in dimpling).
    • Hypopigmentation (whitening of the skin) at the injection site. This most commonly happens in injections of the palm of the hand or sole of the foot.
    • Mild increase in blood sugar levels in diabetic patients for several days and may last up to a week.
    • Transient increase in pain at the injection site before the cortisone takes effect. Occasionally this may be severe, however usually lasts only 24–48 hours and is treated with a cold pack, paracetamol and anti-inflammatory medication. If this occurs and you are concerned, especially if the pain is not settling despite the above treatment, then please call contact your referring doctor so that they are able to examine, assess and manage you appropriately.
    • Cortisone injection administered directly into a tendon has been reported to weaken and damage the collagen fibres, thus carrying a risk of delayed rupture. For this reason, cortisone is only injected around the tissue surrounding a tendon and the tendon is rested for one week.
    • An extremely rare complication is avascular necrosis (bone death) which some doctors suspect may rarely occur when cortisone is injected into a joint, though this has not been proven.
    Remember that the side effects of cortisone that are commonly reported in the media, such as osteoporosis, weight gain, acne and diabetes only occur when taking cortisone tablets for at least several weeks (typically many months to years). These side effects do not occur with the careful use of cortisone injections.

Are there any alternatives to a cortisone injection?

Of course, there are. Since a cortisone injection is used for treating pain, it is an optional procedure. Other options should be discussed with you referring doctor and may include anti-inflammatory medications, exercise, physiotherapy and surgery to name a few.

How many cortisone injections are permitted?

There is no scientifically proven limit for cortisone injections, however as a general rule, three injections into the same body part are permitted over a twelve-month period. Injections more frequent than this are felt to place the injected tissue at risk of softening/ weakening, which may be an issue in a joint for example, as this may accelerate arthritis. Also, if you have failed to respond to a series of three injections, then it is probably time your condition was reassessed to find out if the diagnosis is correct. Has your condition worsened and are other forms of treatment, such as surgery, more appropriate?

If you do require more than three injections in a year, then the risk of the injection must be carefully balanced against the benefits of pain relief.

Management of concussion for AFL players

Management of concussion for AFL players

Sport related concussion is a topical injury particularly at AFL and NRL elite level, but an injury that can happen at any level of these sports. The Ballarat Football and Netball league utilise “THE MANAGEMENT OF SPORT-RELATED CONCUSSION IN AUSTRALIAN FOOTBALL – With Specific Provisions for Children and Adolescents (Aged 5-17 Years): for trainers, first-aid providers, coaches, club officials, players, and parents” as their concussion management tool, released by the AFL in April 2021.

Many sports at the elite level are moving to the use of specialist doctors in Sports Medicine rather than general practitioners as team doctors. Ballarat Sports Medicine physicians, Dr Greg Harris, Specialist in Sport & Exercise Medicine and Dr Bryn Savill, Registrar in Sport & Exercise Medicine, are both team doctors at elite level sport and conduct training at local AFL level for team trainers.

If you or your children have suffered a concussion injury or suspected concussion injury, both Greg and Bryn can assess your injury and provide specialist guidance for recovery and return to exercise, training and competitive sport.

BOOK AN APPOINTMENT

AFL Concussion

Head impacts can be associated with serious and potentially fatal brain injuries. In the early stages of injury, it is often not clear whether you are dealing with a concussion or if there is a more severe underlying structural head injury. For this reason, the most important steps in initial management include:

  • Recognising a suspected concussion;
  • Removing the player from the match or training; and
  • Referring the player to a medical doctor for assessment.

Any player who has suffered a concussion or is suspected of having a concussion (i.e. in cases where there is no medical doctor present to assess the player or the diagnosis of concussion cannot be ruled out at the time of injury) must be medically assessed as soon as possible after the injury and must NOT be allowed to return to play in the same match/training session. There should be an appropriately accredited first aid provider at every match and the basic rules of first aid should be used when dealing with any player who is unconscious or injured.

Important steps for return to play following concussion include:

  • A brief period of complete physical and cognitive rest (24-48 hours);
  • A period of symptom-limited activity to allow full recovery; and
  • A graded loading program (with monitoring).
  • Clearance by a medical doctor

Players should not enter the graded loading program until they have recovered from their concussion. Recovery means that all concussion-related symptoms and signs have fully resolved (for at least 24 hours) at rest and with activities of daily living, and they have successfully returned to work or school, without restrictions.

Any concussed player must not return to competitive contact sport (including full contact training sessions) before having moved through the graded recovery process and have obtained medical clearance.

The earliest that a player may return to play (once they have successfully completed a graded loading program and they have obtained medical clearance) is on the 12th day after the day on which the concussion was suffered.

VIEW COMPLETE AFL DOCUMENT

Return to exercise post-COVID-19 infection

Return to exercise post-COVID-19 infection: A pragmatic approach in mid-2022

Reference: D.C. Hughes, J.W. Orchard, E.M. Partridge, et al., Return to exercise post-COVID-19 infection: A pragmatic approach in mid-2022, Journal of Science and Medicine in Sport, https://doi.org/10.1016/j.jsams.2022.06.001

We posted in February (Returning to exercise after Covid-19) about returning to sport after COVID. With increasing experience in managing patients back to activity, we recommend the following approach

The following flow chart provides a safe pathway guide for individuals to return to exercise following Covid-19 infection.  The article identifies that the initial concerns of myocarditis in young healthy individuals has revealed very low rates and most individuals can return to exercise in 7-14 days post infection.

Our head of Physiotherapy at Ballarat Sports Medicine, Luke Blunden, recommends individuals consider the following flowchart along with medical advice for a return to exercise post Covid-19.

How a mother’s love and a miracle gave Xavier new life

When a car hit Xavier Mahabelo so hard it ripped the skin and muscle clean off his leg, his only shot at survival was on the other side of the world in a Melbourne hospital.

This wonderful article describes how our own BallaratOSM orthopaedic surgeon, Mr Shaun English, assessed Xavier’s injury on the ground in Madagascar in 2019, when he volunteered with Australian Doctors in Africa.  Shaun subsequently liaised with his colleague Professor Leo Donnan back in Australia, who offered to undertake the life changing surgery.  Read more about Xavier and the incredible gift dedicated orthopaedic surgeons provided HERE.

World Athletics Championships Oregon 22

Ballarat Sports Medicine’s Dr Greg Harris, Sport & Exercise Medicine Physician is soon to travel to Oregon, USA to be part of the World Athletics Championships. Greg will be the team doctor for the Australian contingent.

Initially the team will be based in Seattle for a pre-event training camp for 10 days before transferring to Eugene, Oregon for the main event, July 15th-24th 2022.  Greg will be reporting back to Ballarat Sports Medicine on his experiences upon when we aim to update our followers on social media about Greg’s experiences.  Outside the Olympics, the World Championships is the premier world event for track and field athletics.  It is not only a great honour and privilege being appointed to team doctor but a testament to the skills and experience that Greg brings.     

Greg will be unavailable for appointments from July 1st – July 29th but our Sport & Exercise Medicine registrar, Dr Bryn Savill will still be seeing patients. 

Perioperative Carbohydrate Loading

In our quest to improve Rapid Recovery Surgery, we’ve been carbohydrate loading our patients. Now there’s a Randomized Controlled Trial on the subject.

“Don’t upset the applecart” has been a key component to rapid recovery surgery. Simplifying peri-operative care has been a consequence. An old anaesthetic idea of “fasting for 6 hours” has been replaced with “no solid food for six hours, but free fluids until 2 hours prior to surgery”. By reducing the risk of vomiting, endotracheal tubes have been mainly replaced with laryngeal masks, which is more comfortable for the patients. By adding carbohydrate to the clear fluid (eg Powerade) the patients don’t feel as “starved” and have better energy mobilising after surgery. At BallaratOSM, we’ve done this since 2015, giving the patients a bottle of Powerade to have an hour before they’re due at the hospital.

In the Journal of America Academy of Orthopaedic Surgeons, there’s been a published randomised controlled trial, between 800ml “Nutricia Preop”, 400ml lemon flavoured water, and no water. No differences were found on the long list of things they tested…. Except readmission rate. The Odds Ratio of readmission was 0.08 between their carbohydrate loaded patients, and the entirely fasted group. p-0.024 Postoperative boluses of narcotics are more likely in the fasted group as well. Length of stay for their knee replacements, like ours, averaged a bit over a day.

We’ll stick to our plan of not upsetting the applecart.

Reference:

Kadado, Allen MD; Shaw, Jonathan H. MD; Ayoola, Ayooluwa S. MD; Akioyamen, Noel O. MD; North, W. Trevor MD; Charters, Michael A. MD. Effects of Preoperative Carbohydrate-rich Drinks on Immediate Postoperative Outcomes in Total Knee Arthroplasty: A Randomized Controlled Trial.

Journal of the American Academy of Orthopaedic Surgeons: June 1, 2022 – Volume 30 – Issue 11 – p e833-e841 doi: 10.5435/JAAOS-D-21-00960

Masters Swimming Ballarat

Do you know the most common injuries in swimming?

The Masters Swimming Australia National Championships were held April 20-24th at the Sydney Olympic Park Aquatic Centre this year. There are many Masters Swimming clubs around Australia, including a club in Ballarat. The Ballarat Masters Swimming club includes several members from the medical fraternity who swim regularly on Tuesday, Thursday, and Saturday each week. The President of the club is Dr Greg Hughes, Anaesthetist, and part of the Anaesthetic Group of Ballarat, with which BallaratOSM has a close working relationship. In addition, Dr Andrew Lowe, General Surgeon, specializing in upper gastrointestinal surgery and biliary and pancreatic surgery, Alicia Concannon, Medical Radiation Scientist, and our own Practice Manager, and Medical Scientist, Adrian Warmington. Programs in Ballarat are designed by a club member from Daylesford and former Canadian Olympic swimmer Tim Bach.
But as the name suggests, Masters swimmers are prone to injury. Swimming involves both explosive short distance sprinting and longer distance repetitive motion swimming. Different strokes involve a range of dynamic movements and use of a range of muscle groups.


Common injuries include

  • Labrum tear (SLAP-lesion)
  • Rotator cuff injury
  • Patellofemoral pain syndrome
The Ballarat Sports Medicine and BallaratOSM teams are always available to assess, diagnose and treat your injuries. Contact us to see our Physiotherapist, Sport & Exercise Medicine physicians, Rehabilitation Physician and Orthopaedic Surgeons.

Labrum tear (SLAP-lesion)

The glenoid labrum is a cartilaginous rim that stabilizes and protects the shoulder joint. Labrum injuries often occur in throwing sports and sports where the arm is frequently raised above shoulder height such as swimming and in particular butterfly.

The labrum is located where the upper arm attaches to the shoulder blade. It surrounds the head of the upper arm and thereby increases the stability of this joint during shoulder movements. The most common labrum injury is called a SLAP lesion. It occurs in the upper part of the cartilaginous rim, where the biceps tendon attaches.
The labrum can be damaged as a result of an acute injury and also as a result of an overuse injury from repeatedly performing a throwing movement with high forces. As such, SLAP lesions are common in throwing sports like water polo, where the arm is frequently used above shoulder height.

A common symptom of a SLAP lesion is pain in the upper or back part of the shoulder. The shoulder can also feel unstable, and there might be a sensation of “catching” or “clicking” in the joint.

Treatment

The first step in treatment will always be a rehabilitation period of at least 3 to 6 months with guidance from a physiotherapist or Sport & Exercise Medicine physician. If there is no improvement during this time, surgery may be considered. The surgeon will often determine how much the injured person should be allowed to move their shoulder once the surgery is completed. It is important to follow these restrictions as it allows healing to take place.
Between 80 to 100% of athletes return to sport following surgery, but only 50 to 60% of these can perform at the same level as before.

Rehabilitation

In the first phase following surgery and until the injured area has fully healed, it should be kept immobile. This usually takes up to 6 weeks.


During rehabilitation, it is important to train:

  • Mobility
  • Interaction between the muscles
  • Movement control
  • Strength


It takes on average 11 to 13 months before an athlete can return to sport. All measures to restore normal strength and control should be taken before the athlete’s return to sport.

Impingement of the rotator cuff

The rotator cuff is a term for the muscles around the shoulder blade. Shoulder impingement is a very common cause of shoulder pain in athletes it is considered an overuse injury.

Shoulder overuse injuries in athletes often occur when they perform many repeated movements. The tendons of the muscles can also be injured if they become impinged between bones in the shoulder joint during certain movements, such as throwing.

Injury to rotator cuff tendons usually happens gradually. In the early stages, pain can actually be felt without the occurrence of any structural damage. In later stages the tendon tissue can become weaker. This is known as tendinosis, and it can ultimately result in the partial or complete rupture (tearing) of the tendon.
Tendinosis of the rotator cuff is very common among athletes in sports that involve a lot of movement with the arms raised above shoulder height such as swimming. This activity places extreme demands on the shoulder.

Impingement

Impingement is one of the most common causes of shoulder pain in the rotator cuff. It results from a tendon becoming pinched between the upper arm and the shoulder blade (scapula) in certain positions when the arm is raised.

There are two main types of impingement: subacromial impingement. This is when the arm is raised straight up above the head, and posterior impingement, which occurs when the arm is held all the way back in a throwing position.

Subacromial impingement

Subacromial impingement occurs in the so-called subacromial space between the head of the upper arm and the top of the shoulder blade where they make up the shoulder joint. The supraspinatus tendon (one of the rotator cuff muscles) is most often affected. In addition, other structures such as a fat pad (subacromial bursa) can also be affected. Given that several structures can be involved, we often refer to this as impingement syndrome.
Subacromial impingement syndrome can be caused by variations in shoulder anatomy, muscle tightness, a stretched joint capsule or due to a lack of stability from the muscles around the shoulder blade. A common and effective way to treat this is to use an individualized training program. If conservative treatment fails, surgery can be performed to increase the subacromial space. Subacromial impingement is most common among people aged above 45, but it can also occur in younger athletes.


Posterior impingement

Posterior impingement is common amongst athletes in sports where the main activity is above shoulder height. The condition concerns the tendons of the infraspinatus and supraspinatus
muscles and occurs when the shoulder is held all the way back in a throwing position. Typically, athletes with posterior impingement experience pain in the back of the shoulder when in this position.

Posterior impingement can be caused by a lack of control and stability of the shoulder blade. Poor swimming technique during strokes such as butterfly and backstroke increase the risk of posterior impringement.

Treatment and rehabilitation

The first step in treatment for almost all injuries of the rotator cuff is an individualized rehabilitation program. During rehabilitation, the athlete should be removed from the activity or sport that caused the injury. A physiotherapist or Sport & Exercise Medicine physician should supervise the program and focus should be on specific factors such as:

  • Mobility of the shoulder
  • Strength and coordination of the rotator cuff
  • Control of the shoulder blade
  • Sport specific training (for example, in throwing sports strength and mobility of the hip, upper back, and shoulder are very crucial)


It is imperative that the load and demands on the shoulder are increased gradually so that the athlete can fully participate in the sport without experiencing pain. This approach is successful in the majority of cases, even when there is considerable structural damage to the tendon, such as with a full thickness tear. It often takes up to 6 months of rehabilitation before any significant improvements are noticeable.

Sometimes a cortisone injection can be of help in relieving the pain and allowing rehabilitation to proceed. A cortisone injection usually will not fix impingement by itself, and is best done with ultrasound or some other form of imaging guidance.

If conservative treatment is unsuccessful, surgery should be considered. However, surgery should not be viewed as a quick-fix solution. Recent research shows that around 25% of athletes in throwing sports don’t return to sport following surgery to the rotator cuff, and only a small percentage of those who do return manage to do so at their pre-injury level of performance. Also, rehabilitation following surgery takes a long time. The average duration for a return to sport is 12 months.

Patellofemoral pain syndrome

This condition is characterized by diffuse pain in and around the kneecap without a specific cause.

Studies have shown that around 50% of non-specific knee pain (pain of unknown cause) may be due to patellofemoral pain syndrome (PFPS). PFPS is not uncommon particularly in breaststroke swimmers. The amount of pain directly correlates with the number of years of training, amount of training, skill level and age.
PFPS may be caused by several factors, and with athletes it can be related to excessive overload.

Symptoms

The most common symptom is a diffuse pain in and around the kneecap without having an injury. The pain is aggravated by using stairs (especially going down), squatting, cycling, and with prolonged sitting. It is uncommon for the knee to lock-up or give-way, as is common with other knee injuries and conditions. The knee may feel stiff, even though it still has normal flexibility. Noises from your knee are common and not a sign of damage.

Diagnosis

A doctor, Sport & Exercise Medicine physician or a physiotherapist will take your medical history and conduct a physical examination to confirm the diagnosis. X-ray and MRI images are often normal and are therefore of limited use.

Risk factors

We do not know exactly what causes PFPS. Some anatomical and biomechanical factors have been suggested as risk factors for developing the condition. Examples include overpronation (when the foot lands on outside of the heel and rolls inward), reduced strength and hip control. It is also likely that the training volume and intensity may play an important role. When anatomical factors are combined with overuse, there may be a risk of developing PFPS.

Gender is also considered a risk factor; female athletes have 1.5 – 3 times higher occurrence of PFPS than their male counterparts.

Treatment and rehabilitation

The treatment of PFPS requires a holistic approach that considers all the potential factors that might have caused the condition. For some it might be appropriate to focus on strength, mobility or muscle control. This is usually done with a structured training program. It is advised to consult a physiotherapist or Sport & Exercise physician who has expertise in dealing with this condition.

Load management

Load management is one of the most important aspects of effective treatment and the athlete’s total training load should be summarized and evaluated. It is often necessary to reduce the amount of pain provoking activities for a short period. Using orthotics (knee braces) and tape may reduce symptoms, but often temporarily. They can, therefore, be used as part of the overall treatment strategy. The return to sport should be gradual and well structured. Good communication and collaboration with the coach are recommended throughout the rehabilitation.

For more information about water polo injuries visit https://fittoplay.org/sports/swimming/the-most-common-injuries-in-swimming/

Practice Nurses here to assist

BallaratOSM employs three highly skilled nurses. Not only do our nurses frequently assist our surgeons in theatre, but they are always present in our rooms during normal business hours to provide care for patients. Our practice has two dedicated treatment rooms, specifically designed and set-up to provide clinical care. Patients have both pre and post operative appointments with nurses, but if things are not going entirely to plan, the nurses are always available to take a call from a patient to discuss wound management and pain management; or any other question to ensure excellence in the patient health care experience.

The nurses have a dedicated mobile phone that is a particularly valuable tool particularly for remote patients. Rather than travel into the rooms, the nurses can frequently assist patients using video calls or MMS images of wounds. These can also be shown to the surgeon for review for specialist advice if required.

Our post graduate trained nurse practitioner adds the ability to refer patients to allied health and specialist clinicians such as physiotherapy, Sport & Exercise Medicine physicians and Rehabilitation physicians for specific health care options. Our nurse practitioner will also assist patient pain management by providing scripts for pharmaceutical needs. And post-surgery, when the patient is due for orthopaedic review, our nurse practitioner can refer the patient for radiological examination.

Our nurses are a key healthcare professional in the expansive team that is Ballarat Orthopaedics and Sports Medicine.

National Junior Basketball Champions!

‘It was a fun week learning from, teaching and working with amazing sports people in Ballarat’

The National Junior Basketball championships were held in Ballarat from 10th to 17th April at Selkirk stadium. You may have noticed that Luke Blunden was not in the clinic at Ballarat Sports Medicine as he had been asked to provide his Sports Physiotherapy expertise to the under 18 Victorian Metropolitan women’s basketball team. Luke supported the elite team coached by Michael Brookens assisting with team and player preparation, monitoring, recovery, rehabilitation and performance needs. The team benefited from the diversity of Lukes Sports Physiotherapy experience describing the input as a critical factor to their success.

The Vic Metro team was able to blast an undefeated path through the competition into the finals where it then overcame strong competition from the Victorian Country, North and South Queensland teams to claim the gold medal and national junior title!

For Luke it was a fun week stepping out of the clinic to support sporting teams for the first time in a few years. It was a great opportunity to support young talented athletes, providing them with an elite Physiotherapy experience to assist in their campaign and development as athletes. It was also a great learning opportunity meeting other sports physiotherapists, coaching and support staff from over Australia.

You can find out more about this event on the Basketball Australia website or Basketball Victoria Facebook page and games can be watched on Kayo sports or via you tube.