I use some fascial release techniques that are a bit unusual which I learned from someone who practices Lana therapy. This is in addition to my normal physio stuff and I don't advocate Lana therapy anymore. Transcript: "I do use some facial release techniques that are a little bit unusual, which I learned from a lady who actually does something called linotherapy. And she's changed the way that she does linotherapy completely, but I still do quite a lot of the facial techniques that I learned from her originally. So it is a little bit unusual, not many people do it, but it seems to get really good results and I use it in conjunction with my normal physio stuff, so I certainly don't even remotely advocate that I practice linotherapy anymore, because I don't. But I do use some of the techniques which are quite cool."
It is important to not push into pain during knee strengthening exercises because it can lead to further inflammation, delayed healing, and delayed rehabilitation. This is especially important for people with arthritic knees, as they have a high pain tolerance and may need to be taught to recognize the difference between pain and soreness and fatigue. Transcript: "Can you explain the importance of not pushing into pain during knee strengthening exercises? Yes, with regards to total knees and arthritic patients, you have to really teach them and make them aware of what their trigger was to stop activities before and that was pain and they have an extremely high pain tolerance. So if you're not making your patients aware of this trigger, they will continue to manifest this automatically post-operatively and your body will not operate when it's in pain properly. So the whole idea is to try to teach them to recognize the difference between pain and soreness and fatigue. So it's vitally important that when you are working with somebody, you have to understand their triggers and their mentality and how they coped with everything before. Because a coping mechanism of just pushing through the pain is a normal reaction when you're arthritic and you're just waiting for a total knee. So in order for you to rehab correctly, you want to start day one trying to teach your patients that have knee pain from total knees to underestimate their ability and to move correctly and not use pain as their guide to stop their activities. Because their pain tolerance is so high that if they wait to do that, they're actually going to probably delay healing and create more inflammation and inability to move properly and delay the rehab."
Retro walking against a resistance cord is an exercise recommended for building leg strength after knee replacement. It helps with triple extension (heel, knee and hip) and restoring normal gait patterns. Transcript: "Are there any other exercises besides squats that you recommend for building leg strength after knee replacement? Yes, the one that I really like is retro walking against the resistance cord. And so you're working on triple extension, which means you're trying to get your heel, your knee straight, and your hip, your butt to work, or your gluteus maximus to work. And then controlling or eccentrically controlling the walk forwards against that assistance so it's pulling you forward. So sometimes in the mid to later stages, this is one that I really like because you do not just want isolated strength, but you want functional strength to restore normal gait patterns. And a lot of times I find with knee replacements is they're habitually walking slow and their gait is off. So what you want to do is try to facilitate some resistance so you're getting that knee straight when you want it straight, when your heel touches the ground. And then as the assistance pulls you forwards, you're working on more of the fluid movement of your gait pattern. So that's one that I think is very successful and has helped my clients a lot."
To help your tailbone pain, you may want to use a donut when sitting and visit a pelvic floor physical therapist for external mobilizations. Hip stretches can also help give you release. Transcript: "What would you do for tailbone pain? You fell skating last month and you're still sore and don't have a fracture. Oh, I'm so sorry because I know how painful this can be. So first, you may want to use some type of a donut when you are sitting on a chair. So sitting in particular can be really painful for people who have a tailbone or a coccyx bone injury. So kind of sitting on a donut so that way you're not putting pressure on that is probably an immediate help for you. The other thing is to go visit a pelvic floor physical therapist. There are some external mobilizations that they can do in order to kind of help mobilize that coccyx bone. Because depending on which way it's deviated from your fall, it could be kind of deviated forward and even be pressing against your rectum and causing constipation and issues that you may not even realize are related to this fall on your tailbone. So there are some really great external mobilizations so you don't have to worry about any type of internal work or internal exam. There's some external mobilizations that a pelvic floor physical therapist can do to mobilize that coccyx bone in order to improve your pain and it will significantly help. I know it significantly has helped me and my patients as well. So that would be my ultimate suggestion. But definitely start with positioning and a donut from a sitting perspective. You might be able to do some hip stretches that can help give you some release as well. But really my ultimate advice is to go see a pelvic floor PT."
I enjoy working with cricketers because of their complex biomechanical issues and I can alter throwing/bowling actions to improve performance. Additionally, cricketers are usually nice people and it's interesting to learn about the injuries and other fun aspects of the sport. Working at the National Cricket Academy as a new graduated physio was a great experience. Transcript: "I love working with cricketers because they get so many complex biomechanical issues. So, and there's a lot that you can alter as well with that. So you can change a throwing action, a bowling action, the way that they bat, the way that they stand. You can also really influence their performance, which I find really exciting. And not just because they feel better, because you can actually change things that make their game better. I also just really like cricket. I really like cricketers because they tend to be generally quite nice people. They spend a lot of time alone with their brains, so they have some interesting views on the world. And yeah, it's a really fun population to work with. And when I was a new grad physio, the practice where I worked looked after the National Cricket Academy. So we ended up seeing a lot of cricketers and I thought I really like seeing these. These are interesting injuries and really fun things. So yeah."
We see a lot of lumber spine stress fractures and shoulder pain from throwing, diving, bowling, and other activities. These can cause muscle injuries as well as joint pains, especially in the shoulder due to the amount of throwing it does. Transcript: "We see an awful lot of lumbar spine stress fractures unfortunately. Shoulder pain from throwing, diving, etc. Tendons, all tendons are sore, knees, Achilles. Fast burning is not good for you basically in a nutshell. So, that tends to affect the joints quite a lot. We do see the odd muscle injury, but it's more joint and the old shoulder takes the pounding from a lot of throwing. So, that's what we see a lot of."