ARTHRITIS MANAGEMENT – GLA:D PROGRAM

Researchers find simple way to avoid knee surgery

A skyrocketing number of people are undergoing surgery for knee pain, but now researchers have found there's a simple way to avoid an operation.www.7news.com.au#7News

Posted by 7 News Melbourne on Sunday, 6 May 2018

GLA:D® is an education and exercise program developed by researchers in Denmark for people with hip or knee osteoarthritis symptoms.

Research has proven the GLA:D® program to be the best management for osteoarthritis.

The GLA:D® program is for anyone who suffers from hip or knee pain due to osteoarthiritis, regardless of severity.

These classes help to reduce pain, increase strength and improve quality of life with osteoarthritis.

The GLA:D program is available at our sister practice Pursue Health. There is more information on their website pursuehealth.com.au/glad/.

Call them on 9131 4977 to find out more or speak to your physiotherapist and ask them if it’s right for you.

WHAT ZOOLANDER CAN REMIND CLINICIANS ABOUT PILATES.

By John Contreras

One of the challenges of teaching Pilates to patients is keeping all of your clinical skills front of mind. These skills include concepts of pathophysiology, pain science, biomechanics, load management and the biopsychosocial model to name but a few. When guiding a patient through a Pilates session, remembering the multitude of exercises, variations and cues, it can be easy to forget why the patient was doing Pilates in the first place.

Thinking about this ongoing challenge made be remember the 2001 classic film Zoolander. Stay with me here …

During the Slashie Award scene below,  male model Fabio receives his award and thanks the audience for confirming that he is now seen as an actor/model and not the other way around.

So, how is this relevant you may ask?

Providing patients with best practice Pilates requires the clinician to start each session reminding themselves that they are a Clinician/Pilates teachers and not the other way around.

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As a clinician, we should use our knowledge of Pilates repertoire to select the most evidence-based exercises based on our initial assessment, patient goals and current rehabilitation guidelines. For example, in leading a patient with patellofemoral pain through a Pilates session, a Physio/Pilates teacher would first consider what does the evidence suggest regarding the management of this condition. Once established they would then go on to think about which exercise series, pieces of equipment and/or principles are best indicated.

This may be in contrast to the Pilates teacher/Clinician who may skip the clinical reasoning step and use less efficacious exercises such as reformer leg press on a high foot bar (loading the knee in higher degrees of knee flexion), reformer feet in loops (nice exercises but may take time away from other more valuable ones) and fail to provide the appropriate education regarding load management during the weeks ahead.

To continually remind yourself of your Clinician/Pilates Teacher status, here are a few key points.

Before each session review the following:

  • the patient’s working diagnosis
  • which outcome measures (subjective and objective) need to be assessed
  • what your plan was following the last session

During each session, ensure you:

  • Remind your patient (and yourself) of the session’s goals
  • Reflect on your patient’s progress as if it is going to plan
  • Provide the relevant education

At the end of each session:

  • Highlight the positive aspect(s) your patient’s session (sometimes it may be that they turned up despite not feeling great)
  • Discuss the main parts that need to be address i.e. single leg balance
  • Establish a plan/goal for the next session i.e. introduce jump board exercises

I discuss this concept in more detail on the Pilates Essentials for Physiotherapists course.

For more information on the Pilates Essentials for Physiotherapists course click here or email info@physiosports.com.au.

PHYSIOSPORTS ‘PHYSIO BIKEFIT’ CASE STUDY

Comfort, Injury Management and Performance

Lower Back Pain in the Recreational Cyclist – a common presentation

 

54 year old recreational cyclist rides 100km/wk for 5 years

1 year history of right lower back and front of hip pain

 

HISTORY

Worse after 1 hour of riding especially when riding hard, power, faster rides. Lower back becomes sore then loss of power right side/tight hip

Stopping riding, stretch, roll, hands-on treatment helps short term

Treatment and personal training including squats for 1 year

Bike is 3 years old. Specialised Bikefit 3 yrs ago – client has “fiddled a little” with set-up

 

BODY

Slightly decreased R hip range of movement

Lower back, pelvis and hip combined function very poor on 1 leg R > L

Evidence of overload/overusing of the front of hip muscles/quadriceps

 

BODY on BIKE

See excessive lower back flexion (forward bend) in photo

 

BIKE

Seat too far back 10.5cm behind bottom bracket

Seat height slightly low (video knee angle measure + static calculation)

 

PRE: lower back flexed, increased hip angle at top of pedal stroke due to aggressive position.

POST: testing of seat up/forward with bars raised (using pads/towels) gives open hip position, less stress to lower back = less pain and better performance for longer. As body improves the bars can be lowered

Summary – Seat too far back and low with bars too aggressive for this body at this point in time. Lower back flexed is a risk factor for back pain and flexed posture overall challenges the back and hip region which leads to the wrong muscles working to produce power. Optimise bike and fix body