All posts by Suzanne Wootton

Shoulder injury not getting better? Could it be the Rotator Cuff?

Have you injured your shoulder?

Whether it is the result of a crash, accident or repetitive use strain, shoulder pain is a common complaint for many of our patients at Doveston Health.

Traumatic shoulder injuries often result from a direct fall onto the shoulder, onto an outstretched hand or from a fall whereby the arm is hyper-extended backwards or sideways.

Of these types of falls, many studies have concluded that the most common resulting injuries are clavicle fractures followed closely by acromioclavicular joint dislocations and rotator cuff tears (1).

Jessica Bates | Physiotherapist at Doveston Health

Acute rotator cuff injuries are frequently left undiagnosed and mistreated and can sometimes end up causing months of pain and shoulder dysfunction later down the track. It is important to seek medical treatment for shoulder injuries from physiotherapists (initially) and exercise physiologists (afterwards) earlier rather than later to increase successful treatment outcomes and be able to return to pre-injury level as fast as possible.






What is the rotator cuff?

The rotator cuff is a term used to describe four key muscles and their tendons that work together as a synergy to move and control the ball and socket joint that is your shoulder.

The muscles help to secure the ball (arm bone) into the socket (shoulder) to stabilise the joint and allow for correct movement patterns when moving the arm.

When just one of these four muscles is damaged, it can lead to altered movement patterns, which can cause further issues and pain within the joint.

If you are experiencing pain or difficulty with lifting your arm out to the side, rotating it outwards or lowering it from out in front, a rotator cuff issue could be present.


How do you treat it?

Treatment of this injury depends on the severity of tear, level of pain and restriction it is causing.

Treatment approaches can be surgical or non-surgical in nature. Interestingly, a recent study has shown that at a five year follow up of patients with full thickness chronic rotator cuff tears, there was no difference seen in the outcomes between the two different approaches. Simply put, this means that no treatment approach was proven to be better than the other.

Allied health interventions such as Physiotherapy and Exercise Physiology can provide you with this successful non-surgical treatment approach.

Physiotherapy involves in depth assessment of your injury, hands on treatment progressing to Exercise Physiology which provides specific exercise therapy to strengthen weakness and return full function to your shoulder.

Stay tuned for a four-part break down of each rotator cuff muscle and it’s important role on our website blog soon. If you have any questions regarding this article or regarding treatment please visit our website at www.dovestonhealth.com.au.


1. Goldstein Y, Dolkart O, Kaufman E, Amar E, Sharfman Z.T, Rath E, Mozes G and Maman E., (2016) Bicycle-related shoulder injuries: etiology and the need for Protective gear. IMAJ, Vol 18.

(2) Sørensen AK, Bak K, Krarup AL, Thune CH, Nygaard M, Jørgensen U, Sloth C, Torp-Pedersen S., (2007). Acute rotator cuff tear: do we miss the early diagnosis? A prospective study showing a high incidence of rotator cuff tears after shoulder trauma. J Shoulder Elbow Surg; Volume 16(2):174-80

(3) Boorman RS, More KD, Hollinshead RM, Wiley JP, Mohtadi NG, Lo IKY, Brett KR. (2018).

What happens to patients when we do not repair their cuff tears? Five-year rotator cuff quality-of-life index outcomes following non-operative treatment of patients with full-thickness rotator cuff tears. J Shoulder Elbow Surg; Volume 27(3): 444–448.

7 Tips For Women on Staying Strong and Healthy at Any Age

It is essential these days to maintain strength and health. We are all living longer and what is the point of a long life if we are plagued by health issues.

We as physiotherapists here at Pain Slayers, also known as Graceville Physiotherapy, believe that it does not need to be difficult to maintain and improve your health.

We have decided that there are 7 ways that you can help to remain strong and healthy at any age or stage of your Life.

Angela Melit | Principal Physiotherapist at Graceville Physiotherapy


No. 1 - Get Moving

Any movement is better than no movement.

Even if you are unwell it is beneficial to have a walk around your house or yard than to sit and do nothing. If you are so unwell that you are in bed or a recliner move whatever you can while you are in that position.  

Moving your feet backwards and forwards helps to promote blood flow through the legs and prevents blood clots. Lifting your arms up overhead helps to prevent shoulder and upper back stiffness. Squeezing your butt cheeks helps you to remain strong when standing.

Try not to get into the habit of letting your family do everything for you. Do as much as you can yourself. 


No. 2 - Do not sit for more than 30 minutes at a time

Sitting is the new smoking!

Sitting may be required for certain tasks but it is essential that you get up every 30 mins if you need to do a lot of sitting.

2 minutes of walking around after 30 minutes of sitting can negate all of the issues that can arise from sitting too much. Sitting causes us to become weak in our bottom or gluteal muscles which are essential for standing and prevent lower back pain. When you are watching TV don’t skip through the ads if you are watching something recorded. When the ads are on get up and move around a bit, your body will love you for it.

Sitting also puts more pressure on lower back structures. Ever wondered why it is hard to straighten up when you have been sitting? Your muscles and tissues have a memory and if you sit a lot it is more difficult to straighten up your back and hips after sitting. This should be reason in itself to avoid the sitting posture for too long.

Number 3 - Maintain a strong pelvic floor

Pelvic Floor muscles are one of the most important group of muscles in the body.

Maintaining a strong Pelvic Floor may not be as difficult as you might think but you first need to understand why it is necessary. 

Everybody knows that if our Pelvic Floor is weak we may experience some bowel or bladder incontinence. Our Pelvic Floor is like a hammock of muscles that hold all of our internal organs inside our abdominal cavity. When we contract or lift up through the pelvic floor we lift the abdominal organs up and this can help to prevent prolapse of some of these organs. Our pelvic floor muscles also support our lower back. Activation of the pelvic floor tilts the coccyx/tail bone and therefore sets up the lower spine in an optimal position for stability.


How to correctly engage your pelvic floor muscles

Strengthening your Pelvic Floor can be done during the day during your normal activities. Every time you lift, reach for something, push something or pull something think about breathing out and lifting up through the pelvic floor as if you are trying to stop yourself from urinating. This will get your pelvic floor working the way it should during your everyday activities. The heavier the item you need to lift the more you need to lift up through the pelvic floor. If you know that you have a weak pelvic floor it is essential that you do not lift anything more than 5 kgs as it can result in lower back pain.



Tips to protect your pelvic floor muscles

  • 1
    Sometimes we can mistakenly think that bracing our abdominals helps with our core strength but it is often this that causes our pelvic floor to become weak. Bracing the abdominals can result in holding the breath, increasing the intra-abdominal pressure and this then causes a big downward pressure onto the pelvic floor group of muscles stretching it and resulting in weakness.
  • 2
    Excessive coughing and sneezing cause pressure on the pelvic floor and can often lead to weakness and incontinence. A handy tip is to move your ribs to your hips while coughing and sneezing. This will lessen the downward pressure on the pelvic floor.
  • 3
    Straining on the toilet is one of the main reasons why women can do damage to their pelvic floor. Try to lean forward and have your knees a little higher than your hips when using the toilet.  A small foot stool is all that is needed to ensure correct positioning. You can also use a pack of unopened toilet paper to put your feet up on. Drinking plenty of water and fibre rich foods also will help. Avoiding medications with codeine in them is also a good idea as these medications cause constipation and often result in poor pelvic floor function.





No. 4 - Maintain strong bones with load-bearing exercise

It is necessary to load the bones and joints for them to keep strong. Any weight bearing exercise will keep those bones strong and help prevent osteoporosis. It is not always necessary to hold hand weights to do this.

Modified push ups on a bench is great for loading up the upper back, shoulders and arm bones,

Walking is great for loading up the hip joints, lower back and leg bones. Actually walking is one of the best forms of exercise around. It is particularly good for people with lower back pain as long as the pain does not worsen during the walk.

Load bearing exercise also helps to keep the pelvic floor strong as long as there is no straining involved. It is well known in the physiotherapy field that people doing a lot of weights, high impact exercise and dancers can all have poor pelvic floor function.


No. 5 - Maintain good balance and posture

Balance exercises are essential to prevent falls and keep you mobile. In fact they also help to keep your pelvic floor strong. If your balance is off your pelvic floor is usually weak also.

Good balance requires good activation of your core muscles and the ability to hold a good posture. Good balance also ensures that you look good. You hold your posture upright and tall and keep your tummy in when your balance and posture is good.

This can also help to make you look younger and who wouldn't like this!

Balance exercises are easy to do while you are in the kitchen cooking dinner, making a cup of tea, when you get up out of bed etc.

Number 6 - Exercise with a friend

Exercising with a friend usually means that you become more accountable and are less likely to stop exercising.

We are usually more likely to let ourselves down than let a friend or group of friends down.

Setting aside certain times during the week when you meet up with a friend to go for a walk or having a group class that you attend every week is a great way of ensuring that you keep up the exercise.

It is also very important socially and mentally that you maintain contact with other women.

How else are you going to unload some of the pressures that you might be feeling without being judged?! Everyone needs to complain about their partner or family occasionally and women friends are the best to vent to. They usually have a similar story so we learn that everyone has similar issues. This combined with physical exercise is essential for overall health and well being.

No. 7 - Do these simple exercise 3 times everyday

  • 1
    Sit to stand out of your chair 10 times trying not to use your arms. As you stand up squeeze your butt cheeks together and stand very tall.
  • 2
    Stand with your legs pressed together and while keeping your heels together raise up and down on your toes. Do this 10 times keeping your heels together and thinking about lifting through the pelvic floor muscles as you come up onto your toes also. You can do this holding on if you need to.
  • 3
    Stand with your legs pressed together and while keeping your heels together raise up and down on your toes. Do this 10 times keeping your heels together and thinking about lifting through the pelvic floor muscles as you come up onto your toes also. You can do this holding on if you need to.
  • 4
    Stand holding onto the kitchen bench or your desk. Lower your body down towards the bench/desk while pulling up through your pelvic floor. Ensure that you tuck your elbows in and keep your shoulders back and down. Lower your body down and up 10 times.
  • 5
    Practice standing on one leg ensuring that you squeeze your bottom of the leg you are standing on. Try to stand for at least one minute at a time. Do this 3 times on each side.
  • 6
    If possible walk around the block, your yard or even your house. Remember that walking is one of the best forms of exercise that you can do. When you walk keep your step length even and not too long. Stand up as tall as you can when walking. This will ensure that you are working the correct postural muscles and will help to keep your pelvic floor strong. Do not walk so far that you feel fatigue into your pelvic floor or lower back.
  • 7
    Hold onto the back of a chair and lower yourself down into a squat. Do this at least 10 times keeping the weight in your heels as you lower. Try to squeeze your butt as you lift up.
  • 8
    Hold onto the back of a chair. Lift up one arm and if you can look up towards it. Then follow your arm with your eyes around like a windmill and back to the start. Then do the same with the other arm. Do 10 on each side. Breathe in to raise your arm up and breathe out to follow the arm around and back to the beginning. Lift through your pelvic floor as you breathe out.

Staying healthy and feeling your best is important at any age. Follow these simple steps to help you stay as healthy and active as possible so you can get the most out of life!


Thanks Angela.

Stay tuned for more articles from Angela and the Graceville Physiotherapy team. 

In the meantime, if you wish to get in touch with Graceville Physiotherapy, visit their website or click the button below. 



Graceville Physiotherapy have developed a dedicated team that specialise in sports injuries, back and neck pain, workplace injuries, ante-natal and post-natal care, respiratory conditions and arthritis. 

They are also proud to offer Telehealth Consultations via their Physitrack App. Call them to find out more

5 Reasons Why Cyclists Get Neck Pain and What You Can Do About It

Are you a cyclist who sometimes or often gets neck pain during or after your ride?  Do you suffer from neck pain after only a short ride?

Is your neck pain then difficult to get rid of forcing you to take medications that you would not rather take or spending your hard earned cash on expensive massages, Physiotherapy or Chiropractic sessions?

Who would have thought that cycling could be so expensive!

First you outlay thousands for just the right bike not to mention the gear you need to make the ride more comfortable and then of course the bike racks etc ...  Why then should you be outlaying all of this extra money to eliminate the pain caused as a result of your bike ride.


Angela Melit | Principal Physiotherapist at Graceville Physiotherapy

Here are my 5 reasons cyclists get Neck Pain

1. Incorrect Bike Set Up

Everyone’s body is different.

 If you have had any neck issues in the past it is important that your handle bars be higher that your seat. This puts less strain on your neck and shoulder position.

As you become stronger in your riding position it may be possible to lower the height of the handle bars but this must be done gradually.

2. Looking too far forward and up while riding

Obviously it is essential that you look where you are going but many cyclists develop neck pain because they fail to activate the neck stabilisers while riding. 

It is important to have your chin gently tucked while looking forward in order to activate these important muscles.

The strength in your eye muscles has an effect on your neck also. This may be hard to believe but strengthening this "Occular Motor response" can help in stability of the neck and make it easier to look ahead while keeping the neck in a good position.

Often when there is weakness in the stability of the neck there is also weakness in the stability of the shoulder blade area also. Weakness in this area causes more strain on the neck as the muscles that attach into the back of the head overwork to compensate for this weakness.

3. Poor Core Activation while Riding

 Note that I have said Activation and not Strength.

There is too much emphasis on developing “Core Strength” in my opinion.  Everybody wants to strengthen their core. We see many injuries coming through our clinic due to poor Core activation and not poor Core strength.

You may go to Pilates, Yoga, Reformer classes etc to develop more core strength but unless your core is activated when it needs to be activated during your ride there can be a domino effect and the result can be Neck Pain.

Correct activation of the core during your ride will help with the shoulder blade area and neck stability also. Poor core activation causes you to lean on your handle bars and this causes tension in the neck resulting in tension headaches.

4. Inadequate Warm Up

If you are over 40, have had previous problems with your neck/previous whiplash type injuries or even if you work at a computer you are likely to already have some sort of neck tension and or stiffness.

It is then important before you get on your bike to do some gentle neck stretches. I say gentle because if you stretch the neck muscles too much this can lead to a bit of instability on the bike.

It may be also helpful to do some gentle mobility exercises for the shoulders, thoracic spine, lumbar spine and hips.

Doing this before you get on the bike will ensure that the muscles that need to be activated have already been prompted to activate and any tension is released (gently) before hopping onto the bike.

5. ​Turning your Head to talk to a rider next to you

Now obviously you will need to turn your head while riding to check for traffic etc but continuously turning your head to talk to someone alongside of you leads to neck problems.

We have seen it in our clinic on a number of occasions. If you are riding 2 abreast it may be necessary to speak to the rider alongside of you but it is not necessary to turn your head.

 I would suggest that the safer option is to not talk to the rider alongside you unless absolutely necessary. This action causes shortening of some of the muscles on one side of the neck and also leads to asymmetry which can then alter the way you ride and be the cause of problems lower down in the spine also.

It is easy to see then how a cyclist can develop neck pain leading to an uncomfortable ride.



What can we then do about it?

1. Bike Set Up

Ensure that your bike it set up by an expert. Your bike set up expert needs to be aware of any past history you have of neck pain and or injury. Tell them of your concerns and if you experience pain while riding make sure that you go back and report to the bike fitter what you are experiencing. Do not put up with the pain. If re jigging the set up does not work make an appointment to see a physiotherapist who can give you some exercises that will help you while you are on the bike.

2. Strengthening Neck, Eye and Shoulder Blades

Pilates style Dart exercises are great for neck and shoulder blade stability. These are done lying on your tummy. Firstly you activate your core by pulling in your belly button but not activating your lower back muscles. You then pull your shoulder blades back together and reach your fingers down towards your feet. Then you lift your chest and head off the ground just a little keeping your head in line with your body and your chin gently tucked in. Hold for 10 seconds and do 10. To strengthen your eye muscle response you can use a “Neck Tek” to strengthen the Occular motor response or practice moving your eyes to follow a square shape in both directions without moving your head and then try moving your head from side to side without moving your eyes.

3. Core Activation

Increasing the ability to activate your core can be done in a similar position to riding. If we do this on our hands and knees we can teach the core to activate in this position. While on hands and knees gently pull your belly button in towards your spine so that you feel some tension between your hip bones. Just practicing this activation while keeping the weight spread through your hands can help you to know when your core is activated or not. If you then gently lift up one arm or one leg you will notice that your core needs to activate to maintain a flat back. Getting used to this activation can help the core to activate while on the bike.

4. Stretching

Gentle stretches of the neck by taking your ear to the shoulder and then depressing the opposite shoulder can help to stretch some of those tight neck muscles. You can also turn your head to look in the same side armpit and then turn your head to look up to the opposite side to stretch other neck muscles. Rolling your shoulders up around and back can help to loosen up stiff shoulders and some gentle lunges to loosen up the hips may be of benefit.

In summary don’t let neck pain ruin your ride ... Bike riding is a fantastic form of exercise and should be pain free!  With a little care and attention to your set up and your bike riding form you will be able to enjoy riding well into the future.


Thanks Angela.

Stay tuned for more articles from Angela and the Graceville Physiotherapy Team. 

In the meantime, if your wish to book an appointment for your sore neck, or any other issue, please visit the Graceville Physiotherapy website or click the button below. 




Graceville Physiotherapy have developed a dedicated team that specialise in sports injuries, back and neck pain, workplace injuries, ante-natal and post-natal care, respiratory conditions and arthritis. 

They are also proud to offer Telehealth Consultations via their Physitrack App. Call them to find out more.

Eat your way to recovery – Part 1: Inflammation

When you suffer an injury, your first thought might be to seek treatment from a doctor or physiotherapist. And while that's the correct action to take, people often forget to think about how their diet can impact their recovery process. 

We sat down with nutritionist, Kate Jeffries from Katalyst Nutrition to talk through how you can eat your way to recovery.

Based in Brisbane, Kate holds a Bachelor of Behavioural Science (Psychology) and an Advanced Diploma of Nutritional Medicine and she uses her background in both of these areas to work to achieve optimal health and nutrition for her clients.

Read on to see her insights and find out what food you need to be eating and when.

What is inflammation?

Inflammation is a normal anatomical and physiological response to injury that helps with tissue repair and wound healing.

The acute inflammatory response is self-limiting and usually takes 8 – 10 days from onset to healing.  This is the most commonly encountered inflammatory response and one that most people would be familiar with.  

 

How does inflammation work?

The process of inflammation involves different cellular components and biochemical mediators that move to the site of injury and promote the classic symptoms associated with inflammation: redness, swelling, heat and pain.  Inflammatory responses as a result of injury can be rapid, occurring within seconds to minutes – depending on the location of the injury.  The diameter of the blood vessels surrounding the injured area increases, slowing blood flow and increasing the volume of blood flow to the injured site.  This allows an increased number of inflammatory cells and chemicals to reach the injured area.  

During the initial response the blood vessels also become more permeable which means that gaps appear between the cells that make up the blood vessels.  This allows plasma to leak out of the vessels, which in turn causes swelling at the site of injury.  Consequently, the circulating blood becomes thicker and flows more slowly.  The increased blood volume and increasing concentration of red blood cells at the site of inflammation cause the warmth and redness observed in inflamed regions.




On the Road to Recovery...

Inflammation is important during the first stage of recovery as it initiates healing through the removal of bacterial products and dead cells as well as activating mechanisms of repair.  However, if the acute inflammatory response proves inadequate, chronic inflammation may develop and persist for weeks or months.   When this occurs, it can cause cellular and tissue damage and can then actually delay recovery and impact mobility.

 

What can I do to ease the symptoms?

One of the ways to help modulate the inflammatory response is through diet.  Anti-inflammatory wholefoods such as extra virgin olive oil, nuts, seeds, fish or fish oil, avocado, and flaxseeds/flax meal/flax oil are all high in Omega-3 which is an essential fatty acid that helps to fight inflammation and should be consumed daily during the recovery process.  These foods are all sources of unsaturated fat (the healthy fat!) which is necessary for the optimal functioning of our bodies and which many people are severely lacking in their diets.  Other anti-inflammatory foods include turmeric, garlic and fruits and vegetables for their antioxidant properties, particularly berries as well as pineapple for its bromelain content.  

Some of these foods are available in supplement form which can further aid the recovery process as they are formulated so that their healing properties can be consumed at higher dosages than what you can practically eat in a day.  However, nutritional supplements (like medication) should be taken under the direction of a professional in the industry to avoid any potential interactions or side effects.  Foods to be avoided during the inflammation stage of recovery include vegetable oils, processed foods and large amounts of animal meat, alcohol, salt and sugar.  All of these foods contribute to inflammation in the body and can hinder and prolong the injury recovery process.



Thanks Kate

Stay tuned for Kate's next article in January. 

In the meantime, if you wish to get in touch with Kate phone 0423 493 330 or click the button below. 

Cycle Injury….. Falling On an Outstretched Arm

FOOSH is short for Falling On an Outstretched Arm and is common in sports like cycling, snowboarding or skateboarding.  This type of upper limb injury occurs when breaking a fall with your outstretched hand.  This can lead to an injury anywhere from the wrist forearm, elbow and shoulder.  With the busy traffic on the roads, it can be easy to lose balance.

Severe injuries can range from a fractured carpal bone in the hand, dislocation of the elbow or rotator cuff tear. 

Moderate to minor injuries can include wrist or shoulder strain, whiplash of the neck or elbow pain.

One thing to keep in mind is that a minor fall may not show up signs or symptoms until later on.  A FOOSH injury can impact the neck and spine due to the nature of the fall.  There is usually a twisting and a compensation occurring to avoid major injury. 

Instead of expecting the pain to disappear, it is important to have your posture, spine and muscles checked to see if it is out of alignment.  After all, your body is worth more than your bike. 

At Kurilpa Chiropractic & Sports Massage, we take a thorough history of the mechanism of your injury and any contributing factors that may be causing the pain and discomfort. Orthopedic testing and muscle strength is performed to find out the nature of the injury.  It may be necessary to send out for scans or x-rays prior to treatment, including any reports from other health professionals. 

Adele Lorigan, (Chiropractor) is part of Kurilpa Chiropractic & Sports Massage, based inside Cam’s Cycle Coaching.

If you have any questions call Adele on 0451-442-968 OR email
[email protected]

3 Simple Techniques to Get to Sleep with a Whiplash Injury

For this month's contribution from Maximize Health Group, we decided to get some advice on how to get to sleep with a whiplash injury.

We have again enlisted the help of Physiotherapist, Sean McCoola. Sean brings experience to his clients from 20 years as a physiotherapist and has a particular interest in sporting teams and rehabilitation programmes.

Read on to see his insights.


How does whiplash affect your sleep?

Whiplash from a motor vehicle accident can result in many and varied symptoms. Losing sleep and a loss in sleep quality, are manifestations of sleep deprivation that is a common affliction from a Whiplash injury. Sleep deprivation can result in irritability, lack of concentration, memory loss, decision making challenges and increase emotional instability. If sleep deprivation continues long enough, physical signs appear including weight gain, frequent illness, visual disturbances, skin changes, poor motor skills and some even feel they fall asleep at the wheel (a sign of the phenomenon called micro-sleep). 


Advice from your GP regarding appropriate medication, information from a psychologist regarding mental and emotional techniques and having a sleep or bed time routine are all useful and relevant options to limit sleep deprivation and may all be required to form a structured plan to cease your lack of sleep. You can also use the 3 simple techniques below to stop sleep deprivation today

​​​​Use a breathing technique

Controlling your breath and focusing on this, switches the “flight or fight” response that is commonly turned on after a whiplash injury to the more appropriate and normal “rest and digest” response required for body repair and rejuvenation while you sleep. A breathing technique will relax you physically and mentally and set you up for a continuous sleep. Try the simple technique-it’s all you need. Don’t be fooled by the simplicity, this method is fast and effective

  • Breathe in for 3 seconds
  • Breathe out for 3 seconds
  • Continue for 5-10 minutes before sleep while you are lying on your back in bed
  • Breathe in and out through your nose

Tip #1

Once you have practised this before bed in a lying position you will be able to expand your practise to different postural positions and times throughout the day.

This simple breathing technique will reduce stress, improve your concentration and enable you to be more effective throughout the day

Use heat

Heating your neck and shoulder areas while in bed will send you off to sleep. The heat reduces muscle spasm and pain, calms the nervous system and improves healing by increasing blood flow to the area and stimulating the metabolic rate. You can have a warm bath or shower before bed or use a heat pack (microwaveable wheat bags are very effective) while in bed.


Tip #2

As with all functions of the human body not everyone will get relief from heat. 

Try cold packs as an alternative.

Cold will also reduce muscle spasm and pain, calm the nervous system and can limit any inflammatory processes from Whiplash injury which will speed up repair and healing.

Use massage

Self -massage or massage from someone else is highly affective before bed and will reduce your sleep deprivation. Massage decreases muscle spasm and pain, returns muscle to normal length, sedates the nerve endings causing pain and other sleep depriving symptoms and improves blood flow to the area for improved natural healing.

Tip #3

For self -massage, lie on your back and reach across chest to massage the opposite shoulder and neck.

Also try lying on your back and placing one or two hands behind your head and neck-with this technique you can actively massage with finger/hand movement or allow gravity to place pressure on your neck and base of head through resting them on your fingers and hands to resolve those painful “trigger points”

If lying on your back is uncomfortable or not the position you sleep in, try lying on your side and reach hands across your body or up to the same side.

To stop sleep deprivation from whiplash, use all 3 of these simple techniques simultaneously. While lying in bed on your heat pack massage yourself while practising the breathing technique. Repeat if you wake during the night.


Thanks Sean.

Stay tuned next month for another article from Maximize Health Group.

In the meantime, if you have any questions regarding these tips, whiplash injury recovery or other health issues please do not hesitate to contact Sean on +61 7 3343 5494 or [email protected].

Part 2: What to do at each stage of your recovery: The next 2 weeks

Whether you have rolled your ankle, broken a rib or torn a ligament, your body goes through the same painful and uncomfortable process to repair itself. 

We sat down with Nick Marshall from Surf Life Physio in Miami, QLD earlier this month to get a better understanding of the recovery journey. Nick has over 17 years' experience as a physiotherapist, having practised both privately for his own practice Surf Life Physio and as a senior outpatient physio for Tweed Heads Hospital.




This article continues our injury recovery series. If you missed the first article on the inflammation stage, read it here.

Nick gives his insights on the next two weeks of an injury and provides tips on how best to manage this stage.

Keep an eye out for the next article on what happens after the first 2-3 weeks and for Nick's advice on how to speed up the recovery process, next month as well. 

What is the Proliferation phase?

The proliferation phase occurs following the inflammatory phase.

Just to remind you, in our analogy of a house fire, the inflammatory phase is like our emergency services  who, put out the fire, cordon off areas and stop an area being touched or moved.

The proliferation phase commences after about 3-4 days post injury.

This phase is the beginning of the rebuild. In our analogy, it is the phase where you contact the insurance company and builders to start the process of the rebuild.

Insurance Company

Much like the insurance company will (hopefully) provide resources to help rebuild the damaged house, your body will maintain increased blood flow to bring cells called fibroblasts and other nutrients required fro repair. These cells are essential to starting the process of rebuilding the damages muscular, skin or bone tissue. Fibroblasts provide the structural framework of collagen for new cells to develop.

Builders

Collagen cells are like our body's builders. They are deposited into the injured area to re-build all ligaments, tendons and muscle tissue. This new tissue is commonly called 'scar tissue'. 

At this stage your body doesn’t lay the collagen down is a neatly fashion. Instead, the collagen strands runs in all kinds of directions. This leaves the tissue weak and more susceptible to further injuries.





How long did this stage last for?

The proliferation phase commences around 3-4 days post-injury and then lasts until 21 days after the injury or about 2 weeks.


How would an injury feel in this stage?

The biggest difference between this phase and the inflammatory phase is that the injury is no longer sore at rest. It will be sore and restricted with movement and activity. But inflammation is characterised by constant pain without movement.

At this stage the pain should be much less, swelling should have reduced and bruises become darker.





What is the best treatment plan for this stage of someone's recovery?

This phase is about stimulating the blood flow to the area so the collagen and elastin forms and matures into its normal shape.

The body’s cells arrange themselves in a way so that they are best designed to resist future load and prevent damage. It’s in this phase that those early building blocks of the ligaments, tendons and muscles can be designed to reduce the risk of re-injury.

You should be aiming for controlled movement.


Should you see a physio during this middle phase?

This would be the most important area to see a physio.

As the injury is no longer sore all the time there is a tendency to get moving too soon. If your movement is not guided properly then a large amount of injuries develop scar tissue which leads to inelastic tissue and a very real cause of future re-injury.

It is also this phase where far too many people grit their teeth and get back to do normal activity. But unfortunately doing that in an inappropriate way during this phase can cause the injury to relapse into the inflammatory phase and stall healing.


Thanks Nick.

If you missed Nick's last article on the Stage 1 of injury recovery, click the link below. It's well worth the read.

Part 3: What to do at each stage of your recovery: The final phase
Whether you have rolled your ankle, broken a rib or torn a ligament, your body goes through the same painful[...]
Part 1: What to do at each stage of your recovery: The first 3 days
Whether you have rolled your ankle, broken a rib or torn a ligament, your body goes through the same painful[...]

Stay tuned next month for Nick's interview on the final stage of the recovery process in February. 

In the meantime, if you have any questions regarding these tips, injury recovery or other health issues please do not hesitate to contact Nick and his team at Surf Life Physio on (07) 5527 7830 or click the button below. 

The bridge that threatens to wipe out all cyclists.

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“The government has knowingly left a substantial hazard for cyclists. Every time it rains a new cyclist is injured. In our opinion,   something needs to be done”


Emily Billau - Principal Cyclelaw

The Goodwill Bridge – it’s probably one of the busiest cycle routes in Brisbane and now it’s become unsafe.


We represent far too many clients who have placed their trust into normally safe public infrastructure only to find out the hard way that the surface is unreliable. And unfortunately these hazards can have devastating and lifelong effects on the cyclists and their families.


The current state of the Goodwill Bridge surface needs urgent and prompt attention before there are too many more serious injuries.  

What's the situation?

Late last year, work had taken place on the Goodwill Bridge to fix the slippery surface after complaints of accidents.

Despite appearances, the upgraded blue surface is still a hazard causing cyclists to lose traction and sustain significant injury, even at really low speeds.

In response to fresh complaints, this month, the government has installed caution signs on the entrance to bridge instructing cyclists to “dismount when wet”.

The bridge remains a dangerous hazard to cyclists.


Asking cyclists to 'dismount when wet' is really just shifting the responsibility.


The authorities, not the cyclists, are responsible for rectifying the dangerous surface.

Emily Billiau

Principal, Cyclelaw

Does the State owe cyclists a duty of care?

Emily Billiau

Principal, Cyclelaw

Yes.


 The State does owe cyclists who use the Goodwill Bridge path a duty of care.


If they breach that duty of care they may be liable to compensate the cyclist.

Evidence (including likely expert evidence) would ultimately need to be obtained to support a case in negligence against the Sate and/or their contractors, servants or agents.

But for now, our preliminary thoughts are this...

We would argue that the surface:

  • check
    appears to not have a sufficient and/or appropriate slip resistance;
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    is such that it was sufficient to cause a number of cyclists to lose traction when wet;
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    is frequently used by cyclists and it was known to the State Government that this was the case;
  • check
    until recently, was not marked, barricaded or covered in any way to identify the hazard;
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    in the circumstances, presented a perpetual trap, such that it could not be detected by cyclists in time to avoid an accident.

We would say that the existence of the surface created a specific hazard which posed a foreseeable risk of injury to cyclists.

The State Government were and still are aware of growing issues with the slipperiness of the bridge.
There have been at least nine report of accidents since its resurfacing and countless more prior to that.  

Ultimately, in our opinion, the State have failed in their duty of care to cyclists by:-

  • failing to provide a safe surface for bicycle traffic;
  • failing to remove the hazardous surface from the path when it knew of the hazard;
  • failing to implement an appropriate remedial solution;
  • failing to construct the path is a reasonably competent manner;
  • causing, allowing or permitting the use of the path, in circumstances when they knew, or ought to have known, that it was a hazard to cyclists;
  • failing to give any, or any adequate, warning of the surface or the hazard.

What this could cost the authorities

If someone (a cyclist) is owed a duty of care by the State 

  • and the State breaches that duty of care to them (bad path surface)
  • and these people have suffered loss (damages)
  • these angry cyclists may very well form a  long line at the court house seeking hundreds of thousands (if not millions) in compensation.

Surely it is just much easier, and cheaper, to put down a non-slip surface over a 400 m bridge?

1 Simple Legislative Change That Would See More Motorists Prosecuted

In June 1817, Karl Drai’s a prolific German inventor, took his two-wheeled Laufmaschine (“running machine”) for a 13 kilometre ride along the banks of the Rhine. The voyage may have only lasted an hour, but it sparked a craze which has lasted centuries.

The number of people riding today is phenomenal, something Karl Drais surely never could have imagined. And the numbers continue to rise!

A report released recently by the Royal Automobile Association of South Australia found that 195 out of 277 collisions between motorists and bicycles were caused by the motorist (that is over 70% of collisions).

Unfortunately, the potential for injury to a cyclist in a road accident is ever present.

It is statistics like these that revive the age old debate about shifting the burden of proof in collisions involving cyclists.

Motorists are still the biggest contributors to road accidents. Do you think they should be presumed at-fault? Take the poll below.  

What is the current law in Queensland?

Currently, Queensland operates a common law or 'fault' based system.  To recover compensation (whether that is for damaged property, injuries or otherwise) the cyclist is required to overcome what is known as the “burden of proof” and prove that the collision was caused by the negligence of the driver of the vehicle.

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Overcoming the burden of proof and establishing liability or fault can sometimes prove difficult.


Some say that the current law places an unfair burden on the cyclist (the more vulnerable of the two parties on the road).  These people advocate for a system of strict liability.


EMILY BILLIAU - Principal, Cyclelaw

Presumption of fault

What many cyclists are calling for is a rule where a motorist will be liable for a crash with a cyclist unless the motorist can show the cyclist was at fault.  What is being suggested is that there be a presumption of fault. 

A presumption of fault would effectively mean a shift in the burden of proof (from the cyclist to the motorist).  

The case for and against strict liability/a shift in the burden of proof

Despite a significant reduction in road deaths in Australia over the past few decades, statistics show a concerning increase in the number of serious injuries amongst our most vulnerable road users (cyclists and pedestrians).


And I don’t think anyone can disagree that action must be taken to reverse this trend.

Emily Billiau

Principal, Cyclelaw

Those for

Proponents for a shift in the burden of proof say the change would encourage safer driving by motorists which would in turn lead to safer cycling for cyclists.

It is also said by some that it would simplify the insurance claims process because of the presumption of fault and ultimately result in a reduction in litigation and insurance costs.

Queensland’s largest cycling advocacy group, Bicycle Queensland, have come out this week supporting presumed liability laws and calling for their introduction in Queensland. Bicycle Queensland expect that with awareness of presumed liability laws, drivers would exercise greater care on our roads, reducing accidents and making our roads safer.

Those against

Those who oppose a shift in the burden of proof note that its application in other countries has not entirely avoided the issues about fault because most (including the Netherlands) still afford the insurer (or the motorist) the right to argue the cyclist is at fault.  

The cyclist just enjoys the very slight benefit of initially having a presumption of innocence until fault is established.

Would the change (if imposed) apply to both Civil and Criminal cases?

The debate is generally more focused on the civil arena rather than criminal offences of motorists.

It would be difficult to see the law being altered to assume a criminal offence was committed if a motorist was involved in an incident with a cyclist (irrespective of whether the driver had done anything wrong or not).

There are some more minor regulatory offences or even statutory workplace offences where such a position is adopted but there is much to be said, most would argue, for one of the cornerstones of our criminal system being maintained: the presumption of innocence until proven guilty.

8 Reasons the 1m Rule Could Cost Motorists $000’s in 2018

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"Every motorist that overtakes a rider within the legally-required 1 metre could be liable for the mental harm they cause that cyclist…"


Emily Billiau - Principal, CycleLaw

Finances are one things but the trauma of a near death experience is another. 


Fortunately for Queensland cyclists, their peak body, Bicycle Queensland (BQ), has stepped up to the plate to provide a free trauma counselling service for affected riders. 


The ”Incident Debrief Service" is an Australian first.


Leading Brisbane-based CycleLaw Principal, Emily Billiau praised BQ on their new initiative, which sees their members given 24/7 phone-based support from a qualified counsellor.


“This program gives unprecedented support to Queensland riders.  Any service that gives cyclists access to immediate and useful support is a win in our mind.”

The Elephant in the Room. 

We often hear reports of accidents involving cyclists and cars.

The physical injuries are often well-known.

Trauma is the elephant in the room.

The anxiety and mental problems riders face after they are involved in repeated ‘near misses' can be life changing.

Depression among cyclists triggered by road safety incidents could become costly to society.  Should the drivers pay?  Take this poll.

In January 2018, over 50 percent of the riders CycleLaw spoke to suffered psychological trauma as a result of an incident involving a motorist.

Emily Billiau said, "The cyclists who I spoke to listed the same anxiety triggers when getting back on the bike. These included the:

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    Feeling of fast movement
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    Sound of brake pads on the rim
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    Sound of the wind or traffic
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    Sight of the ground moving below the tyre
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    Feeling of wind on their face
  • 6
    Smells such as dry air, dust, gravel, moisture, oil, exhaust fumes
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    Feeling of their arms on handlebars
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    Proximity of other cyclists or motor vehicles."

These anxiety triggers, if left untreated, can sometimes develop in to more serious mental illness.

The downward spiral often has a devastating impact on the cyclists ability to carry out their job.

and this is where a successful lawsuit against the careless driver begins.

Emily Billiau

Principal, Cyclelaw

Never Hit a Cyclist? 

You don't have to physically touch a rider to be liable for the mental harm you cause them.

“It is a fact of law that driver's need to give riders at least 1 metre of space when overtaking. 


Failure to do so can leave drivers liable for the psychological harm they cause. 


Times are changing, and motorists can no longer ignore the mental consequences of their blatant disregard for rider's rights."

​​​​Emily Billiau - Principal, CycleLaw

In the meantime, initiatives such as Bicycle Queensland’s incident debrief service is a valuable support resource for cyclists.

If you would like more information on this service, please visit the BQ website here.