So, you’ve found a great Classic Car on Trademe. You know, one of those really nice old things, that is really elegant,  classy and run down. Cobwebs can be found everywhere. The hubcaps are barely holding in place. Ok. So you start with your project. Let's do this thing up…

Problems

Do you think there will be a few bumps in the road? Frustration from things not fixing easily, not working the way you expect. Maybe you might accidentally break something along the way.

Solution

You may have to turn over numerous stones along the way to get what you need, the right fit for your vehicle. Some times you may feel stress, emotion due to the roadblocks that appear.

But... if you persevere for long enough, then you get the reward. And you get to jump in your beautifully restored vehicle driving away into the sunshine with the wind in your hair, enjoying the leather upholstery (maybe a bench seat) and other primitive but elegant fashioning of the vehicle.

Body Maintenance is Like Classic Car Restoration

This is how I liken dealing with the Cause of people’s physical problems.

Unfortunately though, this approach whilst the correct way takes longer, more thought and more reflection. Unfortunately, most treatment avaialble for healthcare is directed to superficial quick fix jobs only.

How much better would you feel if your Body (“Classic Car”) was humming again?

Is it worth trying to fully restore your old body, your old classic car?

Get the Right Solution for Your Body from Vigeo Physio.

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The covid-19 lockdown has opened our eyes to a new, video connection & collaboration normal. Video physio can be extremely effective and make your life much easier! Getting the help you need for an injury or problem without having to leave your home or office means a huge amount of pressure off your day. Vigeo Physio offers comprehensive physiotherapy care via video. And, if you are in acute pain, it might save you a lot of pain & irritation from not having to drive to-from a clinic on the other side of town!

Book a Video Consultation now

So, how do video consultations work and how do you get the most out of them?

What information will my physio need to best help me?

Scans/investigations (make sure relevant ones are at your fingertips or shared with us) - we have live-access to your radiology scans if privately performed but it takes time/release of information in order to gain access to hospital based scans.

Any other relevant information would be handy to have nearby. Just in case.

Prepare your space

• Camera-height (shin-ankle, waist and shoulder-head heights) and the ability to quickly move from 1 height to the next during your consultation
• Space for you to sit,, stand and lay flat (and have your arms move in all directions)
• A wall that is free of obstructions - just in case we need it
• Useful Equipment (therapy, exercise) - simple things that you have around home are normally suitable. A chair, towels and pillows, small weights, fitness mat, swiss ball/soccer ball if you have one and anything else that may be relevant for you.
• Elevated Surface (ideally firm) - If you struggle getting on and off the floor, be sure to make an elevated surface available

Is Video (Telehealth) physiotherapy effective?

As physiotherapists, we are trained to observe how bodies work (and don’t work). The words you use to explain your problem(s) also provide a huge amount of valuable information. Most things we do don’t require hands on techniques any way.

For many conditions we have found great ways to impact the deeper tissues including fascia that can have a similar if not better effect than manual therapy. They are in tune with how your body operates normally. Even better, once you learn the technique(s), you won’t need to rely on someone performing techniques on you. You will be able to manage things yourself. Which provides you with the ultimate fix - self-therapy.

The better we understand your problem and what is happening in your body, the better our solutions are able to target what you need. The more effective your solution will be.

If you are looking for someone to perform manual therapy directly on your body, Video (Telehealth) physiotherapy alone is not for you. Many chronic problems come from treatment with hands on techniques not targetting the source of a person's problem. We know the ins and outs of manual therapy, if that could complement your therapy, we know who or where to look for the manual therapy you need.

Education, exercises and experience

A reasonable amount of the information you need has been delivered hundreds if not thousands of times before. We just need to make it specific for your situation. Our solutions provide instruction or video to help you.

Visibility

Visibility is vital. In order to best understand your body and what is impacting you, we look at your spine alignment, your shoulders and shoulder blades, your neck and your thigh-knee-leg/foot during your consultation. Both in posture/static positions as well as during movement.

Ensure your camera can provide a great view of you so we can see how your body is aligned. Using the wall and using the floor and whilst sitting in a chair.

Clothing

Shorts if necessary and a thin tank top for ladies means we can view the alignment of your body, shoulder(s), neck, and limbs.

Preparation if essential. Ask us if you need more information

Let us know when your book your appointment or pre-consultation if you have a specific situation and need ideas.

Chances are we have a simple solution that can make solving your problem and frustrations easy.

Book a Video Consultation now

Ian Harris, UNSW; Denise O'Connor, Monash University, and Rachelle Buchbinder

From time to time, we hear or read about medical procedures that can be ineffective and needlessly drive up the nation’s health-care costs. This occasional series explores such needless treatments or procedures individually and explains why they could cause more harm than good in particular circumstances.

More than 70,000 knee arthroscopies were performed in 2011 in Australia and, though rates of the surgical procedure are now falling, it still remains one of the most common surgical procedures.

The word arthroscopy means to look inside a joint, in this case the knee. But newer imaging techniques, such as magnetic resonance imaging (MRI) scans, mean performing a knee arthroscopy simply to look inside the knee joint is rare.

Knee arthroscopies are most commonly performed to treat osteoarthritis (wear and tear in the joint) or problems with the menisci (the two rubbery discs between the bone ends). An arthroscopy involves making a small incision in the skin and inserting a kind of camera on a stick. Another incision is made to insert other instruments to cut and remove tissue.

In the case of osteoarthitis or meniscal problems, arthroscopy can be used to clear debris from the joint or to trim loose cartilage or torn parts of the menisci. The procedure can also be used to perform ligament reconstructions, help with treating fractures or infections in the knee, or simply to take a sample of tissue from the joint.

The camera can see structures such as the cartilage that covers the end of the bones, the lining (synovium), the menisci  and ligaments. Knee arthroscopy requires admission to hospital and an anaesthetic. It carries some risk of harm such as infection or further damage in the joint.

         Read more: Needless treatments: spinal fusion surgery for lower back pain is costly and there's little evidence it'll work    

It’s rarely effective

Most knee arthroscopies are done in older people for degenerative conditions such as osteoarthritis. The prevalence of knee osteoarthritis, which can involve wear and tear of the menisci as well as the cartilage that lines the bone, increases with age. Most people aged 50 years and over have some osteoarthritis in the joint and roughly one-quarter will have some wear and tear in the menisci.

Many people with osteoarthritis or a torn meniscus also have knee pain. This has led to the belief that the osteoarthritis changes or the meniscus tear cause the pain. But these changes are also common in those who have no pain at all. And menisci mostly don’t have nerves, so they can’t be felt unless there is a large tear, often resulting from a major injury. In fact, most people with a torn meniscus don’t have knee pain.

Many studies have now shown the outcomes from arthroscopic surgery for osteoarthritis and degenerative meniscal tears are no better than the outcomes from placebo (fake) surgery or other treatments (such as exercise therapy).

A recent summary of these studies made “a strong recommendation against the use of arthroscopy in nearly all patients with degenerative knee disease” (osteoarthritis and degenerative tears of the menisci) and concluded “further research is unlikely to alter this recommendation”.

Many surgeons believe the presence of mechanical symptoms – a concept that is not clearly defined but involves pain and abnormal feelings (such as catching, clicking and locking) when moving the joint – can be treated with arthroscopy. However, studies have also shown having arthroscopy does not provide better results than fake surgery for the treatment of mechanical symptoms.

Sometimes, a meniscus can be so badly torn it folds over on itself, jamming the knee and restricting the ability to straighten the knee. This is a relatively uncommon type of meniscus tear and if the symptoms don’t improve on their own, the torn part of the meniscus can be removed arthroscopically.

Why do surgeons still recommend it?

Doctors tend to overestimate how good their treatments are and underestimate the harms that come from them. Surgeons are often faced with patients in pain and, other than surgery, have little else to offer except continued non-operative treatment, reassurance and time.

         Read more: Explainer: what is pain and what is happening when we feel it?    

Patients may want a quick fix or may have failed to improve with other treatments, but unfortunately the failure of other treatments doesn’t make knee arthroscopy any more successful.

Knee pain due to osteoarthritis often fluctuates in severity and patients tend to present for treatment when their pain is most severe. This means any treatment given at this time will appear more effective than it truly is. This is why comparative studies, particularly placebo studies, are important, as these show the true effects of treatments.

Though some surgeons may believe they can predict which patients will do well from surgery, this belief has not been validated. Despite the desire for this procedure to work, arthroscopy for degenerative knee conditions puts patients at risk of harm, including death, for no important benefits.

How can we stop it?

Changing practice in response to evidence is often slow. The first high-quality trial to demonstrate knee arthroscopy was no better than placebo surgery was published in 2002, yet overuse of knee arthroscopy has persisted.

Barring financial and regulatory controls, practice change in medicine is largely a social phenomenon. It requires leaders in the field and informed consumers to change practice.

The rates of knee arthroscopy in Australia are starting to fall, particularly in New South Wales, where the rate of knee arthroscopies in people aged 50 and over has nearly halved  since 2011. More action is needed. All surgeons, particularly in high-volume states such as Western Australia, South Australia and Victoria, need to take a good hard look at the evidence, question their practice, and take action to reduce this overuse.

         Read more: Needless procedures: when is a colonoscopy necessary?    

Ian Harris, Professor of Orthopaedic Surgery, UNSW; Denise O'Connor, Senior Research Fellow, Monash University, and Rachelle Buchbinder, Professor of Clinical Epidemiology and Rheumatologist

This article is republished from The Conversation under a Creative Commons license. Read the original article.

When you are in pain, having sleepless nights and feeling emotional, you need to find the best solution. So you can get back to doing everything you love. And, if you have had your pain for a long time, you start to think that there must be something really wrong that needs fixing. If you could just fix that problem, everything will go away...right?

It's not as simple as that. There are few situations that need surgery. If surgery is really needed, go ahead. But if you try to fix with surgery you could end up worse off and you it may not fix the problem you had intended!

Needless Treatments: Spinal Fusion Surgery for Low Back Pain

Needless Treatments: Knee Arthroscopy is one of the most common but least effective surgeries

Let us know if you are contemplating surgery and have uncertainty (or just want to be sure its right for you). It might just be that our fresh perspective can head you in the right direction.

Gustavo Machado, University of Sydney; Christine Lin, University of Sydney, and Ian Harris, UNSW

From time to time, we hear or read about medical procedures that can be ineffective and needlessly drive up the nation’s health-care costs. This occasional series explores such needless treatments or procedures individually and explains why they could cause more harm than good in particular circumstances.

Back pain affects one in four Australians. It’s so common, nearly all of us (about 85%) will have at least one episode at some stage of our lives. It’s one of the most common reasons to visit a GP and the main health condition forcing older Australians to retire prematurely from the workforce.

Treatment costs for back pain in Australia total almost A$5 billion every year. A  great proportion of this is spent on spinal surgical procedures. Recently, Choosing Wisely, the campaign to educate medical professionals and the public about tests, treatments and procedures that have little benefit, or lead to harm, added spinal fusion for lower back pain to its list.

Read more: Australians are undergoing unnecessary surgery – here's what we can do about it    

This is because, despite rates of the procedure being on the rise, current evidence doesn’t support spinal fusion for back pain. Randomised trials (regarded as studies providing the highest-quality evidence) suggest spinal fusion has little advantage over a well-structured rehabilitation program, or psychological interventions, for back pain.

What is spinal fusion?

Spinal surgery is most commonly performed to remove pressure on nerves that causes pain and other nerve symptoms in the legs. This surgery is called decompression. The next most common procedure is spinal fusion, where two or more vertebrae are joined together (using such methods as transplanted bone from the patient, a donor or artificial bone substitutes) to stop them moving on each other and make one solid bone.

Spinal fusion may be performed for fractures, dislocations and tumours, and is commonly performed in conjunction with decompression. For back pain, it’s performed when the origin of the pain is thought to be related to abnormal or painful movement between the vertebrae (from degenerative joints and discs, for example).

Rates of spinal fusions have been rising and continue to increase, outstripping other surgical procedures for back pain. In the United States, rates of spinal fusion more than doubled from 2000 to 2009. In Australia, rates increased by 167% in the private sector between 1997 and 2006, despite almost no increase in the public sector.

Spinal fusion rates differ significantly between regions of Australia, with the highest being in Tasmania and the lowest in South Australia: a seven-fold variation. Significant variations are also seen between countries. For instance, spinal fusion rates in the United States are eight times those in the United Kingdom.

The greatest increase in the use of spinal fusion has been in older Australians, often in conjunction with decompression surgery for spinal stenosis – a condition that causes narrowing of the spinal canal (the cavity that runs through the spinal cord).

Differences in clinical training, professional opinion, and local practices are likely to play a role in such variations.

Evidence for spinal surgery

There is little high-quality evidence to support the use of spinal fusion for most back-related conditions, including spinal stenosis. And there is disagreement between surgeons on when spinal fusion surgery should be performed, not only for back pain but also for more acute conditions such as tumours and spine fractures.

There have also been no studies comparing spinal fusion to a placebo procedure. Most research to date compares one fusion technique to another technique or to a form of non-surgical treatment, so we still don’t know whether spine fusion is effective against placebo.

We also know that spine fusion surgery is expensive and associated with more complications than decompression surgery. And the surgery often fails. Around one in five patients who undergo spine fusion will have revision surgery within ten years.

Research also shows most patients having spine fusion surgery under workers’ compensation won’t return to the usual job, will still be having physiotherapy and be on opioid medication two years after surgery.

Read more: Thinking of taking opioids for low back pain? Here's what you need to know    

So why are rates going up?

There are several factors, including an ageing population, that may contribute to the rapid increase in spinal fusion despite the lack of evidence supporting its use. Financial incentives might also explain the differences in rates between private and public sectors in Australia and between the United Kingdom and the United States.

We don’t have high-quality evidence on the benefits and harms of spinal fusion. This means there is uncertainty, which allows practitioners to continue doing the procedures they were trained to do unchallenged. This then leads to overtreatment, particularly where reimbursement rates are high, such as in the workers’ compensation setting.

Uncertainty about the appropriateness of spine fusion results in practice variation, wastes scarce health care resources and leads to worse patient outcomes.

We need better research in this area. This means research efforts should shift from studies looking at different ways of performing the surgery and focus on investigating whether or not it works better than non-operative treatments or a placebo, and, if so, whether the benefits outweigh the harms.

In the absence of such evidence, patients can consider other evidence-based and less costly treatments, such as exercise, cognitive behavioural therapy and physiotherapy.

Read more: Ouch! The drugs don't work for back pain, but here's what does    

Gustavo Machado, NHMRC Early Career Fellow, University of Sydney; Christine Lin, Principal Research Fellow and Associate Professor, University of Sydney, and Ian Harris, Professor of Orthopaedic Surgery, UNSW

This article is republished from The Conversation under a Creative Commons license. Read the original article.

If solving health problems was just about symptoms and their management, healthcare would be really easy. Getting to the cause of the problem, that is the real way to feel and be your best.

Do you ever feel like you are chasing your tail? Does the lack of progress frustrate you?

It can be extremely difficult for customers experiencing pain, can be quite distressing, but with the right focus...solutions can be found.

As a therapist we see the distress and really want to help ease customers symptoms in the fastest and easiest possible way.

Sometimes we are lucky and the source of the problem equates with the symptoms and the solution is fairly simple. But, many times this isn’t the case. And the problem continues. In fact the stats for chronic pain are high. Way too high. And, if the problem has been there long enough, it can then go on and start to affect more and more things in your life.

The real solution is to find the cause, and to solve that.

If chronic pain is the problem, that is the thing to focus on. There is no quick fix, but finding the most appropriate solution can be achieved with the right approach. The solution is worth fighting for, it is worth finding.

The solution you need

We’re experienced in providing a range of solutions, designed to identify the cause of your issue and to deal with chronic, even complex injuries or problems.

Contact us today

Wouldn’t you like to be back on top of your world?

You may have injured your spine (back, neck, upper back) recently, a few months ago or the problem may have occurred for no apparent reason. Either way you now have a problem and your body isn’t working right. You can’t do what you want to do and you are over it.

You can have it so you’re back on top of your world

To recover good physical function you need help from professionals. Sort it properly so that you recover well and get back to normal. Our experienced physiotherapist diagnoses the problem and takes action. We have many different solutions all helping you recover a strong, healthy spine (and body).

It’s closer than you can imagine

All it takes is one appointment to find out what the problem is and to start treatment. And, depending on what is best for your problem we will discuss the options from there. It may either be a quick fix one time consultation or a longer rehabilitation period to provide you with a more thorough solution.

All it takes is a few clicks to book in and get underway

Book now by calling Merivale Physiotherapy (03 355 9775)

Telehealth Video Consultations available also if you need to avoid contact or if you live far away.

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Spine problems are extremely common. Fortunately, most problems are able to be managed and improved if not solved. Unfortunately, like a frog in a saucepan that only perceives rapid temperature changes rather than gradual, many people live with problems or have become accustomed to their body not performing and put up with more than they need to. They only do something when it causes a significant problem (pain or loss of function).

Some of the problems people have are well known and well recognised and some aren’t.

Types of Spine Problems that people have:

Pain-related

Soft Tissue

• Muscle
• Fascia
• Scars

Nerve

Joint

Mind/Brain

Alignment Issues

Genetic (scoliosis, chest deformities)

Fractures of the Spine

Behaviour Related (posture, sleep, work, etc)

Spine-Extremity Problems

Nutrition-related problems

Surgery

Trauma

Even More - Given the nature and complexity of the spine, there are likely to be more that we have missed.

Spine Solutions, a Project

There is an almost endless range of spine problems that people have and solutions that are available.

When you realise that something needs to be done, particularly if the problem is longstanding or complex, it can be helpful to think of your spine problem as a project. As with any project it needs to cope with change and development over time. And resources may need to be allocated for an appropriate solution. Each person we see is unique and their solution tailored for this reason.

Light at the end of the tunnel

But we believe in positivity. Spine solutions should help you to feel strong, healthy and able to do everything that you love. We look forward to helping you.

Repetitive activity can lead to muscle imbalances (and more)

With simple, effective guidance, learn how to look after yourself so you can complete the challenge.

Contact us if you need tailored support.