Ballarat Orthopaedics Sports Medicine, Author at BallaratOSM | Ballarat Orthopaedics & Sports Medicine

Rehabilitated Cyclist & the Peaks Challenge

Mr David Mitchell, Orthopaedic Surgeon and Dr Josh Collingwood, Rehabilitation Physician have completed the Peaks Challenge – one of the more gruelling bike rides in Australia.

235km. 4500m vertical climbing. From Falls Creek, one descends to Mt Beauty, across the Tawonga Gap to Harrietville, up Mt Hotham, down to Omeo, and up the back of Falls and across the high plains. Ironically, it was training for this ride that David had a spinal injury a year ago, but was allowed back on the exercise bike a week after surgery. Josh Collingwood, retired professional cyclist, now rehabilitation physician, saw this an opportunity for a special training program.

Individualised patient care!

Dr Bronwyn Sudholz is returning

Dr Bronwyn Sudholz is returning from Maternity leave after Easter and looking forward to once again receiving referrals and looking after patients. Bronwyn is a registered Clinical Health Psychologist who works with teenagers and adults presenting with anxiety, depression, trauma, and personality disorders, and has a particular interest and expertise in the areas of:

Bronwyn will be increasing her private practice hours to two full days (Tuesdays and Thursdays). She runs 50 minute sessions; clients can pay privately or gain rebates from Medicare, private health, or a third party (eg: Workcover, TAC).

Bronwyn has over 10 years’ experience in health psychology, gained from private and community settings, as well as at Deakin University in research and teaching. She has expertise in various evidence-based therapies: Cognitive Behavioural Therapy, Acceptance and Commitment Therapy (inc. Mindfulness), Dialectical Behaviour Therapy and Schema Therapy. For more information on her experience and approach see https://ballaratosm.com.au/psychology/.

Are you prepared to play?

‘There is strong evidence that injury prevention programs can reduce knee injuries by approximately 50%’

Many sports have started their pre-season training and are building towards their winter seasons. If athletes have been affected from the COVID-19 virus there are sports medicine considerations to be aware of and professional advice may be required. If athletes are recovering from injury and unsure if they are ready to return to sport, then a review with a sports physiotherapist would be a good idea.

As we emerge from the sport limited environment of the last two years, we need to be conscious of our personal fitness levels and gently re-engage in sport in order to limit and prevent injury.

Anterior Cruciate Ligament (ACL) injuries of the knee are common in Australian sport, and in the Women’s Australian Football League (AFLW) there are about 20,000 ACL injuries sustained nationally each year. This figure accounts for about 5% of the 500,000+ women who play.

Women are reported to experience ACL injuries at more than twice the rate of men and are two times more likely to sustain a concussion injury. If you are a woman and sustain an ACL injury it is reported that you may have;

Fortunately, there is strong evidence that injury prevention programs can reduce knee injury rates by about 50%. This sounds good but the difficulty comes in local clubs at the amateur level having knowledge of these programs, implementing them and sustaining implementation.

Some injury prevention programs across multiple codes are listed below;

A research study led by Professor Kay Crossley from La Trobe University and partnering with the Australian Football League (AFL), AFL Victoria, Medibank, the Australian Physiotherapy Association (APA), the Australasian Collage of Sport and Exercise Physicians (ACSEP) and Sports Medicine Australia (SMA) is rolling out Prep to Play across the state at the community level, and it will be delivered across Ballarat in the coming months with the aim of reducing injuries for female footballers.

I will be representing Ballarat Sports Medicine as a Sports Physiotherapist to assist our LaTrobe University colleagues to deliver this education, coaching and club support program across some Ballarat clubs.

The Prep to Play program is a supported program that implements;

The program focuses on reducing serious knee and head injuries by improving muscle function and quality of movement during change of direction and landing activities, improving the safe execution of ground balls, aerial contests, tackling and being tackled.

The components of this program contain some general fundamental exercises that are related to AFL. Sports Physiotherapists who are the experts in injury prevention, management and performance would typically implement a player and sport individualized program to achieve performance and injury prevention results.

If you are interested in learning more about the Prep to Play program or an individualized program for injury prevention, management or performance in your sport, then please email me at luke.blunden@ballaratosm.com.au.

By Luke Blunden

APA Sports and Exercise Physiotherapist
Ballarat Sports medicine

Victorian Country Water Polo Championships

Do you know the most common injuries in Water Polo?

The Victorian Country Water Polo Championships were held in Ballarat this year. Ballarat Water Polo one of the newest clubs in regional Victoria and is well represented by the local medical community with our BallaratOSM Practice Manager, Mr Adrian Warmington and Lake Imaging Radiologist, Dr Alex Meakin both executive members of the committee.

After a blow last year when Ballarat were unable to run the Championships due to a snap lockdown, this year forged ahead as planned. The tournament had 160 players, plus officials, and spectators supporting the event and local community.

Congratulations to Albury Sharks for winning the Women’s title, in a nail-biting penalty shoot-out with the Geelong Marlins. The Albury Tigers made it a double by taking the championship title for the Men’s competition.

Like any sport water polo can result in injury. Water polo players need to be able to move quickly, explosively and efficiently in order to avoid being pushed or hit, and to prepare for attack. You need to be in control of your shoulders, back, hips and knees – all at the same time.

Concussions and facial injuries are typical acute injuries among water polo players. These occur when the head is hit by an arm or the ball. The shoulder can also be injured when defense players try to block an attack. Muscular contusions from blows or pulled muscles also occur. Knee pain is also not uncommon. Because of the nature of the sport, many players are also susceptible to overuse injury that can cause prolonged problems in the knees, shoulders and low back.

Common injuries include:

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.

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:

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 water polo. 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 when throwing. Poor throwing technique can be a contributing factor.

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:

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. Knee pain is extremely common in adolescents who play sports.

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 common in running sports and cycling and most often seen in those between 16-25 years of age.

PFPS may be caused by several factors, and with athletes it can be related to excessive overload. PFPS can also be caused by direct trauma to the kneecap, for example by falling on it, even though this is much less common.

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/water-polo/the-most-common-injuries-in-waterpolo/

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.

Vestibular Webinar Series: Session 2

Concussion management

Western Victoria Primary Health Network are pleased to invite you to the second session in our Vestibular webinar series – Concussion Management in General Practice Learning Outcomes:

Describe how concussion is identified and assessed in various populations and have confidence to select one or more appropriate assessment tools for your patients.
Discuss the current guidelines for return to activities, particularly in school-age children and athletes.
Outline the role of the multi-disciplinary team in concussion management in order to select the appropriate professional/s for onward referrals to support full recovery for your patients.

Topics:

Identifying concussion: clinical assessment and the role of brain imaging
Sport-related concussion and concussion in the older person post fall
Common signs and symptoms, useful questionnaires/assessment tools
Current guidelines for return to school, training and sport
Early education and information for the diagnosing professional (eg. ED, GP)
When, who and how to refer, depending on your patient’s presentation

Speaker:

Rosie Marsiglio – Vestibular Physiotherapist (Neurological Physiotherapy Geelong)
Dr Sachin Khullar – Sport and Exercise Medicine Physician

Target Audience:

General Practitioners and Registrars
Practice Nurses
Nurse Practitioners
Allied Health Professionals

Webinar

Wednesday 23 March

7.00pm – 8.00pm

Disclaimer: Attendees registering for an event, workshop, conference, forum or activity hosted or promoted by the Western Victoria Primary Health Network (WVPHN) are advised that WVPHN does not necessarily endorse sponsors or external organisers affiliated with any such event.

Ballarat Sports Medicine have been busy over Summer

January in Ballarat meant cycling was back in town!

Each year the best of Australia’s cycling community come to Ballarat for the Federation University Australian Road Cycling Nationals. Over five days of competition, National titles are decided for time trials, criterium and road races, from Under 19, Under 23, elite and Masters levels.

Our Sports Medicine team has been the official medical provider for the “RoadNats” for the past 5 years, and spent the week by the side of the road and in the Race Doctor’s car.

Racing at this level is fast and furious, and has the potential to cause serious injuries from falls. The most common injuries are grazes, scrapes and bruises, but fractures of clavicles, wrists, arms, legs and hips do occur. Concussion and head injuries are also common. Add to that the ‘changeable’ weather in Ballarat, and both heat and cold can be a problem, plus the sheer exertion of riders pushing themselves to the limit.

Thankfully this year there were very few incidents, and the team enjoyed watching fantastic racing in perfect weather.

Elite basketball came to Ballarat too!

For the month of January, the Perth Lynx WNBL team was based in Ballarat. The WNBL is Australia’s premier women’s basketball competition, with Australian and international representative players in every team.

While the Lynx are here they are training and playing home games at the new Ballarat Sports and Exhibition Centre. As the local Sports Medicine specialists, we are proud to provide them with Sports Medicine support both on and off court.

Changes to our Sport & Exercise Medicine Team

Our much-loved Sport & Exercise Medicine Registrar Dr James Ooi has moved on after a two-year stint at Ballarat Sports Medicine to continue his training in Melbourne. We hope James will venture back to Ballarat once he attains his specialist qualifications and can once again serve the Ballarat community.

This has made way for our new Sport & Exercise Medicine Registrar, Dr Bryn Savill. Bryn graduated from his Medical Degree (Cardiff University, Wales, UK) in 2014 after completing a Sports Science degree (Loughborough University, England, UK). To further specialise, he then completed a Sports & Exercise Medicine Diploma degree whilst working in the hospital system in the UK before coming over to Melbourne.

He has many years of experience across a range of sports, especially rugby, both Union and League. He is currently the team doctor for the Melbourne Rebels and has been for the past 5 years, whilst he was also the team doctor for the Fiji Rugby Union for 3 years including the 2019 Rugby World Cup in Japan. He has worked in a number of other sports including AFL, soccer, Horse Racing and disability sport both in Australia and the UK. This experience has given him a passion for dealing with sports related injuries such as concussion, and other musculoskeletal injuries.

In addition to his clinical experience, Bryn has a strong interest in education and has led and been part of UK & European-wide Sports Medicine committees and is currently on the board of the Victorian Council of Sports Medicine Australia (SMA). Bryn was accredited as a World Rugby Medical Educator last year with the aim of improving medical management of trauma on the rugby field amongst sports trainers and medical personnel. In his spare time, Bryn enjoys running, cooking and playing in his local touch rugby competition.

Bryn will be available for consultations very soon with bookings available online. Referrals are preferred, but not absolutely essential. Patients will be no more than $50 out of pocket for initial consultations (excluding interventions/braces/other stock items).

In addition, we are delighted to welcome Dr Sachin Khullar, Sport & Exercise Medicine Physician to complement Dr Greg Harris. Sachin values respect, compassion, integrity, excellence and targets treating his patients with a holistic approach with a strong belief in the power of mind to help treat chronic musculoskeletal problems.

Sachin is a fellow of Australasian College of Sport and Exercise Medicine and has completed his Diploma in Sports Medicine with the International Olympic Committee. He has a background of being a Trained orthopaedic surgeon and has worked as Consultant Orthopaedic surgeon in his native India and in the Maldives. He has been active in ongoing research with many publications to his name.

Dr Khullar has many sporting pursuits. One of the highlights of his professional career has been him being a team leader and field of play doctor for Track cycling in Rio Olympics, 2016. He was a part of the medical team of the Richmond Football Club during their breakthrough premiership
year of 2017. He has travelled with Australian elite athletes and has provided expertise to various athletes in gymnastics, boxing, water polo, rugby, cycling and many other disciplines. He continues to work with AFL and the Vic Metro football team.

He will be consulting in Ballarat on Thursdays, with bookings available online or by calling the rooms.

Lastly, Dr Greg Harris, the head of Ballarat Sports Medicine not only practices in Ballarat, but also practices in Hoppers Crossing. Frequently you will be able to see Greg sooner by visiting Hoppers Crossing. If Hoppers Crossing is a more convenient option for you, appointments for Hoppers Crossing can be found online for Greg and can be arranged by phoning the rooms.

We’ve had a success with My Health Record at BallaratOSM !

We’ve had a success with My Health Record at BallaratOSM !!!

After some years of trying to get some specialist value from this federal government initiative, we can now link to it through our practice management software – Genie.

With a small degree of luck – we’re hoping to speed up our accessing patients radiology results. Sure if we know which radiology provider was used, we can see the pattient’s images – whether they were done at Lake Imaging, Ballarat Base Hospital, Sovereign Radiology, Healthcare (Eureka), Vision Radiology, or and of the country hospitals we deal with, where commonly Bendigo Radiology, or one of our above providers have radiology centres. The problem is, patients often don’t remember where!

GP Referral that come through with the radiology result does help us – we will look at the image, we just need to know where it was done, and the radiology reports invariably have this !

We look forward to learning other things from the patients My Health Record, the experiment with it is starting !!

Returning to Exercise after COVID-19

The ongoing COVID-19 pandemic has wrought havoc in all of our lives. Sporting teams and competitions have not been immune to this, as the sight of empty stands and endlessly changing fixtures will attest.

As we all get more used to ‘living with COVID-19’, most sporting competitions have been able to recommence in one form or another. At a community level this is vital for all the benefits that social sport brings: keeping people active and connected in an otherwise difficult time. But as things open up and more of us are exposed to the virus, care needs to be taken with returning to sport after COVID-19.

Anyone with a positive diagnosis of COVID-19 should follow the relevant local rules with regards to isolation, follow-up testing and notification of authorities. If they are unwell they should seek advice from their usual doctor or from emergency services as required. Once the person has recovered and completed the required period of isolation, there are some guidelines for a safe return to exercise.

If the person had very mild symptoms, such as less than 2 days of mild fever and common cold symptoms only, they should still rest from exercise for 7-10 days after testing positive. After that, they should recommence exercise gradually, and watch for any new or unusual symptoms with exercise. In this case, no special tests are recommended.
With more severe symptoms e.g. shortness of breath, chest pains, palpitations or more than 2 days of fevers or chills, more significant assessment is required. This also holds for people with pre-existing asthma or chronic fatigue. In this case, being seen by a doctor is strongly recommended. Depending on the symptoms, some tests may be suggested, such as blood tests for heart muscle inflammation, an ECG (heart rhythm trace) or echocardiograph (heart ultrasound). If these are normal and all symptoms have resolved, then a safe return to sport can be expected. People in this situation should still take it easy when restarting exercise. If any of these tests come back abnormal, further assessment and testing may be needed. A return to exercise should only be undertaken in consultation with appropriately qualified medical advice, such as a Sports Physician or a cardiologist (heart specialist).
Any new symptoms with exercise, especially chest pain, shortness of breath or palpitations, need to be assessed with blood tests and ECG or echo.
People with severe COVID-19 (i.e. needing hospitalisation) will also need a careful medical checkup before returning to activity. The return to exercise will need to be overseen by appropriate specialists

Coming back after a couple of weeks off can be enough to increase the risk of injury because of a loss of strength and fitness. Getting back into exercise will be great for the mental recovery from illness, but taking it easy will help the process go smoothly.

Walking the walk

In March this year Australia’s most decorated male track and field athlete and Ballarat legend Jared Tallent announced his retirement from competitive athletics.