Northside Physio News

As we continue into the colder months, we see an increase in injuries from runners, winter sporting injuries, and skiing. This month we highlight common knee conditions in the sporting population and how physiotherapy can assist. Common conditions that we see from running sports are (but not limited to):

• Patellofemoral pain syndrome/ runner’s knee
• Iliotibial band syndrome
• Patella tendinopathy
• Osgood Schlatters (seen in children and adolescents)

Patellofemoral pain syndrome/ Runner’s knee
A condition that commonly affects the front of the knee cap, but is affiliated with pain in the soft tissue and muscle, bone and joints, ligaments or a combination of these. The common signs are loaded bending of the knee, including running, climbing, lunging, squatting and travelling down an incline.

Iliotibial Band Syndrome (ITB syndrome)
The ITB is a thick band of tissue that runs from the side of the hip, all the way to the outside of the knee. It has several muscles connecting to it, so it can be involved with movement, however it does not control any movements itself. ITB syndrome can cause pain both at the hip and the knee, and is commonly seen in long distance runners and cyclists. It commonly elicits a pain response when going from a bent position to a straight position (i.e. when pushing off while running or pushing down while peddling). 

Patella Tendinopathy / Jumper’s knee
Patella Tendinopathy is a condition that is constantly being studied and researched It is a change at the cellular level of the tissue that goes from the base of the knee cap, to the top of the shin. It often occurs in people who are just starting/ returning to exercise, or those who have started increasing the amount of exercise over a short period of time. This pain will present when people have their knee bent post exercise, for example sitting or standing. It will often be ignored for a long time as it will improve when you warm up. 

Osgood Schlatters
A knee condition only seen in children and adolescents during growth periods. It can affect the growth plates in the knee, which have turned to bone in adults. It is common to have pain in the front of the knee, similar to that of Jumper’s knee, however pain can also be present at rest or throughout the night. It follows a similar pattern to that of Patella tendinopathy in adults.

Why come to the Physio?
After assessment of your lower limb, a treatment plan will be made not only to manage your pain symptoms, but a plan to help you return to sport. Treatment for all of the above conditions can be very similar. It would involve (but not be limited by):

• Pain management of symptoms including soft tissue work, massage and dry needling 
• Taping for knee stability, offloading and support 
• Sports modification/ specific exercise prescription, to allow for improved strength and stability to the knee and whole lower limb chain
• Detailed plan for a safe and successful return to activity and load 

If you have any questions regarding the above conditions, feel free to reach out to one of our physiotherapists for a consultation. 

Morgan joined Northside Physio in March 2023 as a physiotherapist. He has lived most of his life in the northern suburbs, with a brief adventure into the western suburbs. He completed his high schooling at Thornbury High, and university at La Trobe in Bundoora.

Morgan enjoys getting his hands dirty and using his manual skills to help relieve pain and stiffness in patients as well as using exercise to improve their understanding and strength. Morgan likes to get to know his patients and sometimes can get distracted when talking to them, but he is always aiming for people to feel welcome.

Morgan is passionate about upper limb injuries and is focused on trying to improve the habits that the pandemic has allowed us to make. When not at work, he is catching up with old friends and workmates, being involved with pop culture events and working with his partner to look after their guinea pigs, Toffee and Liquorice.

Morgan is in the clinic 5 days a week, including Saturdays.

Our receptionist Zoe is back from her euro adventure! Even though she went in the winter time, it was still an amazing experience to be had. Here is a brief description of her travels!

• Setting off in November 2022, her first stop was Dublin. Highlights were Galway, Edinburgh, the Scottish highlands and seeing Wicked on the West End in London!
• Train to Paris where she ate too many croissants and sat in a bar to watch France lose the world cup 🙁 
• Rome followed by Milan where she spent Christmas. She and five friends cooked up a big lunch and made a makeshift Christmas tree in their AirBnb where they spent Christmas day eating, drinking wine, and playing games.
• Switzerland where they took in the gorgeous scenery and kicked their feet up by the fireplace.
• Jam packed New Years Eve in Munich where she was converted into a (sometimes) beer drinker. 
• Austria next which, of course, meant doing the Sound of Music tour in Salzburg (a must).
• Budapest and Prague visiting the thermal mineral baths, lots of historical buildings, and eating lots of local food.
• Berlin with lots of shopping, museum visiting, and more beer drinking.
• Belgium, she went to Brussels and Bruges 
• Last Stop Amsterdam where her and friends enjoyed a cheese and wine canal cruise and fell in love with the streets of Amsterdam

Although she had a great time, she was keen to jet home for some warmer weather. Zoe is so excited to be back in the clinic and to share more stories with everyone!

Kellie joined Northside Physio in December 2022 as a receptionist on our admin team. She is born and bred northern suburbs girl and has inside knowledge of the area. Kellie is currently studying Sport and Exercise Science at La Trobe University and is loving it. She has a strong interest in strength and conditioning, as well as Physiotherapy as a long term career.

Kellie is currently undertaking a Sports Analytics and Sport Science placement at Melbourne City Football Club. Here she is gaining knowledge of how a high level sporting club operates, both clinically and non clinically. She gets to participate in training and attend matches regularly.

Kellie is very passionate sports fan, including being a lifelong Collingwood supporter. She has been playing netball her entire life and an avid gym goer. Her skills lie in playing Goal Attack “GA”, with giving it her all to take the win. In her spare time she enjoys time with her family, friends, watching sport and reading the occasional book.

If you’ve been in the clinic during January, you know that we’ve all had a break at some point. After a hectic 2022 all of the staff at Northside Physio took a deserved break for R&R and quality time with their families.

We look forward to being fully back on board by March 2023 after Josh returns from holidays.

With the festive season in full swing, the team recently took a Saturday off to celebrate Christmas by gallivanting around wineries in the Yarra Valley. We sang, drank beautiful wine, ate amazing food, laughed and enjoyed each other’s company. We couldn’t think of a better way to cap off another successful year at Northside Physio. 

On behalf of our team, we wish all of our Northside community a Merry Christmas, a safe and wonderful New Year. We can’t wait to see everyone’s smiling faces in 2023.

Article: Nutritional intake and bone health (https://doi.org/10.1016/S2213-8587(21)00119-4)

In this review published in Lancet Diabetes & Endocrinology, Rizzoli and colleagues provide  a great summary of the role that nutrients, foods, and dietary patterns play in maintaining bone health. As they admit, sometimes the role of nutrition in bone health is poorly understood – there are complex pathways involved and interactions between several factors. Most of what we know of this topic comes from observational studies (i.e. we can’t necessarily confirm causation from the studies, but we have found strong associations), since randomised trials of diets are particularly difficult to conduct.

The main takeaway from this review is that a “balanced diet with an optimal protein and calcium intake and vitamin D sufficiency, together with regular weight-bearing physical exercise” is best for bone health.

● Several studies indicate that fracture risk might be lower with a higher dietary protein intake and sufficient calcium intake. Of course, dairy products are a valuable source of both nutrients and calcium.

● Maintaining a healthy gut with good microbiota is also important so that there is good calcium absorption after intake. There is evidence from several studies that fermented dairy products, sufficient fruit and vegetable intake and Mediterranean style diets are associated with lower fracture risk. This is probably because these foods/diets have positive effects on gut microbiota.

● Other minerals such as magnesium and phosphorus, and Vitamins A, B, C, D and K may have some effects on bone health, but it is likely that these may only be a concern for bone health in the case of deficiencies, which shows the importance of having a balanced diet. Of these, it appears that Vitamin D might be most important because it regulates absorption of calcium.

● There is also a strong association between protein/energy malnourishment and being underweight in the risk of osteoporosis or fractures. When malnourished or underweight it increases the risk of falls that can lead to fractures.

● In those with poor bone health, dietary measures such as caloric restriction and intermittent fasting need to be implemented carefully since there is some evidence that these measures can negatively affect markers of bone health, particularly amongst those who are unable to do weight-bearing exercise.

Review by Dr Joosup Kim ( LEAN Nutrition Tech)

There is an enormous amount of interest in anti-inflammation diets out there and rightfully so.
Chronic inflammation is very common and is tied to a large list of serious illnesses such as diabetes,
cancers, auto-immune conditions, and heart disease to name a few but it is also a common cause of
musculoskeletal concerns like muscle, joint, tendon, spinal disc or nerve pain.
Acute inflammation is what we consider to be ‘good inflammation’ since this is simply the immune
system responding to some damage to the body, like a cut or infection. After the body recovers, the
inflammation goes away.
Chronic inflammation is where the immune system sticks around long after it has infection or injury
and can remain for months or years. This issue can lead to more serious illness over time or pain and
discomfort continuously. So what can we do about chronic inflammation?

There are medications called non-steroidal anti-inflammatories or NSAIDs such as ibuprofen, diclofenac and naproxen. These have been shown to be effective but come with them various side effects which become more noticeable when you have them longer term. Main ones being irritable bowel, reflux and stomach ulcers. In some cases there can be nausea and dizziness which would increase risk of injury particularly in older age groups.
What if instead of needing medication to alleviate symptoms of chronic inflammation, we actually eliminated the inflammation altogether? Wouldn’t that be a goal that everyone should strive for!?
Just like a lot of chronic health issues, diet, exercise and lifestyle can be the key!
There are many anti-inflammatory foods out there and the list is too long to go into. I’m sure if you
are interested in this topic you may have at least once done an internet search. The question remains
though – what is the most practical dietary pattern that can get a noticeable result? This is where it
gets more tricky.
Rather than focusing on all the possible anti-inflammatory foods let’s look at a dietary pattern that
will have enough of an impact to get a clinical difference. In other words – what gives you ‘best bang
for your buck’.

1. If you have excess weight – reduce it:
   Excess weight is associated with inflammation but why? One of the key features is that fat cells
   release these proteins called cytokines. These are used by cells to signal to each other. However the
   more fat cells we have, the more cytokines get produced and high amounts seem to lead to chronic
   inflammation.
2. Carbohydrate:
   The human body can use 3 primary fuels, glucose (from carbs), ketones (from fat) and alcohols.
   Provided you don’t drink alcohol or not drink too often, the body will always use carbs first and fat
   second. The ketones however when we are fat burning. The ketones we produce when fat burning
   have one of the most potent anti-inflammatory effects we know of. You can achieve this not be
   necessarily weight loss but, by being in ‘nutritional ketosis’ – fat burning not by cutting calories but by changing the composition of your diet to reducing carbs
3. Getting your unsaturated fat ratios right
   Unsaturated fats are considered to be ‘healthy fats’ but there are 2 different types; poly-unsaturated and mono-unsaturated. Both have great benefits however it has been studied that a poor ratio of too much poly and not enough mono is directly linked to inflammation. Examples of poly-unsaturated foods are sunflower oil, canola oil, salmon, walnut. Examples of mono-unsaturated fats are olive oil, almonds and avocado.
4. Gut health
   With approximately 70% of your immune cells present around your gut it is no wonder that gut
   health plays a major part in chronic inflammation. If you have gut dysfunction symptoms or
   diagnosed IBS it is important to get this treated. The next important element is the quality of your
   microbiome which is the types of bacteria in your gut and having the right foods and fermented
   foods can help here. Finally the strength of your gut mucosa is a key component to reducing chronic
   inflammation. The gut mucosa is a thin barrier that lines your small intestine. If this is weakened then
   bacteria or toxins can pass through and into the bloodstream. This of course results in a hyperactive
   immune system and leads to general bodily inflammation.

Notable mentions:
Some foods have great natural anti-inflammatory properties such as turmeric, garlic, ginger, pepper
and green tea.

With all this information on inflammation, is there an eating pattern or plan that is practical enough
to do and anti-inflammatory enough to achieve a difference?
Our dietitian Mike O’Sullivan has created a 6 week anti-inflammation program for this
You will get:
● 1 initial extended consultation
● 1 fully customised anti-inflammation meal plan ( 7 day meal plan, recipes, shopping list,
instructions)
● 2 follow up review consultations for further education and maintenance

Book here to register:
https://www.digitalweightloss.com.au/

This month we celebrated four birthdays in the clinic. Within the space of 10 days we celebrated Josh’s Birthday on the 10th, Nats on the 19th and Zoe’s on the 20th. Our lovely receptionist Kayla who is currently travelling around Europe, celebrated her 21st Birthday on the 19th in Malta! 

A busy couple of weeks in the clinic but having four birthdays means that we had four cakes. A special shoutout to Sutsa Cake Bar and Studio and Gusto Bakery for making the most delicious cakes – we were definitely all caked out by the end of the month. Thankfully, the next birthday is Connies in December so we have a few months to recover from our cake coma before we celebrate again!

This month Zoe started with Northside Physio in the role of receptionist. It is her first time working in a health clinic and she is absolutely loving it. Zoe is a health sciences student at Monash University with a special interest in women’s and Indigenous health and hopes to one day work in public health.

In her spare time she likes to go to pub trivia with her friends and footy games with her family. She supports the mighty Geelong Cats and is hoping for a flag this year. On sunny days you may find her walking her Maltese Shih-Tzu, Sandy, around the streets of Thornbury or picnicking at All Nations Park. 

She is very appreciative of a good podcast suggestion so be sure to let her know of your favourites when you see her in the clinic. 

Zoe hails from Northside herself, and is an alumni of Wales Street Primary. She still lives in the local area of Preston. Zoe is very excited to meet everyone in the Northside community!