Knee reconstructive surgery

A torn cruciate ligament may not mean immediate reconstruction

By Julia Newton, physiotherapist

We've all seen it on television and cringed. The footballer stepping to pass a defender, his body weight going one way and his knee the other. This is followed by the big man collapsing on a knee buckling inward. Ooooh! The commentators lament on a possible anterior cruciate ligament (ACL) tear with a passing mention of year off to rehabilitate. Australia has the highest reported rate of ACL reconstructions in the world, costing an estimated $142 million per year for hospital systems.

For those that aren't familiar with ACL, it is a ligament that runs from the femur (thigh) to the tibia (shin) and its purpose is to limit excessive forward translation or slipping of the knee joint. Without this important ligament, the knee can feel unstable and weak.

Despite it being such an important ligament, it is actually possible to function with a complete ACL tear and therefore may not actually always be mandatory to get an ACL reconstruction ASAP.

A recent and very interesting study compared 3 groups of participants with a complete ACL tear. The first group had an immediate ACL reconstruction combined with exercise therapy. The second group had a delayed ACL reconstruction (which allowed extra time for strengthening exercises in preparation of surgery). The third group received exercise therapy treatment alone, with no reconstruction surgery. Surprisingly, there were poorer outcomes from some participants in the first group that had immediate ACL reconstruction. In this group, they found that those with a higher impairment in the knee, with additional cartilage damage did poorer post operatively and would have benefited more from having a delayed reconstruction and some exercise therapy beforehand in preparation.

This study highlighted the fact that every person is different, and in order to make an informed decision about management options, there needs to be a discussion tailored to the individual's sporting, personal and injury-related characteristics.

The main take home point from this is to not rush into a decision on your management straight away, and get an opinion from more than one practitioner if you feel you need to.

Some steps to take for supple and strong feet

by Julia Newton, physiotherapist

We use our feet everyday. After-all, it is our mode of transport! So why shouldn’t we make foot health one of our main priorities? Keeping feet flexible and strong is not just important for preventing pain and injuries, but it can have a profound effect on the rest of your body. If you are loading well in your feet, this can really help set you up for optimum movement while you get about.

Here are 4 great tips  on how to become more aware and caring of your feet.

Self massage and mobilise your feet.  This is not just a great feeling after a long day on your feet, but also an important step in keeping range of motion in your feet! Just pick up one foot, grab your toes, extend them up towards your ankle and massage out the arch of your foot.

Walk in bare feet when possible. This is where you are getting the most feedback from your feet to your brain and vice versa. Pay attention to how you’re loading your feet while you’re walking. The added bonus here is that by walking slowly and mindfully, you’re also calming your nervous system and feeling that grounding effect of your feet on the floor! However if you’re a runner or regularly exercise in shoes, it might be worth also feeling how your feet are in shoes as well

Exercises for the intrinsic muscles in your foot. Intrinsic muscles in the foot are small muscles located in the sole of your foot that are responsible for providing arch support and fine motor movements. Toe curls is an example of a traditional exercise that challenges the intrinsic muscles in your feet. Simply place a towel under your foot and scrunch your toes so that the towel is pulled towards you.

Practice good balance. Try standing on one leg with evenness throughout your foot. Notice if you tend to weight bear on one side of the foot more than the other or if you’re scrunching your foot in order to keep your balance. You can even challenge this further by balancing on a cushion or bosu ball, or make it easier by holding onto a wall with one or two fingers. There should be some amount of effort in your foot, but not to the point that you’re feeling tighter as a result

Have a go at doing the above action points and let us know how you go! If you have noticed anything about your feet or if you simply would just like some more information, we would love to hear from you!

Yes please!

by Aline Filipe Nunes, women's health physiotherapist

Pregnancy is an event when many changes occur in a small period of time. The changes can affect your body, your mood, your fatigue levels as well as several psychological and social factors.  It is with no surprise that pregnancy can have an impact in your sex life and sexual routine.

Pregnancy is in its core a period of preparation: your body and your mind focus in building a baby but also prepare for the arrival of a new family member. The roles of parenthood start changing here. It is quite common that the future parents start feeling anxious or depressed during pregnancy in anticipation of the arrival of their baby. The anxiety in itself and the anticipation of the impact of the baby in the couple’s life, as well as the anticipation of the changes in the roles, can be enough to change how you feel as a “sexual being”.

I just don't feel like sex now that I am pregnant