We treat
Sports injuries
We provide sports specific rehabilitation programme from our gym that will progress you from the treatment table, to the gym and onto the pitch.

We specialise in
Orthopaedic & Musculoskeletal Injuries
PMC Physiotherapy are experts at understanding and correcting how your body moves.
Talk to us about
Women's Health
& Paediatrics
Our physiotherapists have many years experience treating affecting, womens health, children and babies.

Injury Prevention with return to Sport post Covid 19 lockdown

We have done the lockdown (not allowed call it lockdown), we’ve read the Government roadmap, we have all picked our favourite German soccer team and now we are ready to get back into sport. Or are we?

Different sports have been affected in different ways.

For the middle and long distance runners, unfortunately the Dublin City marathon has been cancelled but for many time at home has meant an increase in training mileage. As long as this has been increased gradually, all good. However up until recently, there has been no access to the track.

Cyclists ditto. Getting out on the road has been easier and miles registered on Zwift have increased.

Our Poor swimmers have had to completely change their training environment and training methods

For those involved in team or field sports, many have been pounding the pavements, doing 5km runs, 3km time trials, MAS runs, home weights and maybe some technical skills practice.

So no matter which way you look at it, everyone has had to make some modifications to how they train.

As facilities slowly reopen and in time as a competitive calendar starts to fill, the tendency is that we will all ramp up our training volume, increase our training intensity and change our training mode. This is where the problem lies.

Through international research, we know that the risk of injury increases with spikes in training load. For example during the first round of matches in the German Bundesliga following Covid 19 lockdown, there were 14 injuries over the weekend. Most of these were muscular injuries.

The Premier League are expecting a “25% increase in Injury Risk”

So what can we do?

Simple. The best way to avoid injury is to slowly increase your training load and training intensity over a 4-6 week period. Do not try and chase fitness that you may have let drop over the lockdown, Do not go from running 5km on the road to sprinting on the pitch without sufficient time to allow your body adapt. Reduced your running volume for a few weeks when transitioning from the road to the track, similarly when transitioning from the turbo trainer to the road.

This is called Load Management as is the cornerstone of Injury prevention and injury management throughout the world and across all sports. Professional teams will use GPS to monitor training load, but we can equally use our watch or phone to monitor miles run or even steps per day. Similarly miles can be easily counted on the bike or in the pool. If we build up or volume and intensity step by step, then the chances of an injury occurring reduce significantly.

In short, allow you body time to adapt back to the normal demands for your sport in this abnormal time.

References




Telehealth - May 2020

Luddite - A person opposed to new technology or ways of working

Technophile - A person who is enthusiastic about new technology

Which one are you? During the restrictions on travel and interaction around Covid 19, I feel a lot of Luddites have been converted, through necessity, into technophiles. This has allowed ongoing communication and connection to our community, which previously would not have been possible. In a healthcare setting, this has meant a shift towards Telehealth consultations and appointments.

What is Telehealth?

It comes under many pseudonyms (telemedicine, mHealth, E-Physio, E consultations) but in essence it is the use of phone call and/or video call apps to hold a Physio or Medical consultation.

Unlike the general public however, within healthcare we have to be mindful of patient confidentiality and data security. This makes the choice of whether to use Telehealth services a little trickier. We can be neither the Luddite or the Technophile. We need to embrace new ways of working but also be mindful of the checks and balances that need to be in place to make it a safe and effective form of treatment for patients.

Telehealth consultations have been carried out for years, particularly by health Insurance firms and in countries where there are areas of sparse population density (Australian Outback, Northern Canada, parts of Africa)

Given the current situation around Covid 19, there has been a surge in Telehealth consultations around the world, including Ireland. For example, in Scotland, there has been a 1000% increase in the use of Telehealth consultations since the beginning of Covid 19 restrictions.

Advantages and Disadvantages

A telehealth consultation has many advantages over a traditional face to face consultaions but also has many disadvantages.

The advantages include the fact there are no geographical boundaries. You can consult you Physiotherapist from the comfort and safety of your own home.

Studies from the NHS in the UK have found that during a telehealth consultation, patients do a lot more of the talking compared to a face to face consultation. This is never a bad thing and forces us clinicians to be quiet and listen. Telehealth consultations are on average a little shorter than a traditional consultation and as all treatment is based on advice and exercise prescription, it forces the patient to take control of the injury and responsibility for rehab.

The major limitation of a Telehealth consultation is that we cannot perform a full physical examination. Saying that, there are many tools available now such as wearable sensors, that are cheap and allow us to get a lot of physical information regarding a patient that we previously could only get in clinic.

We also need to err on the side of caution when making an assessment online. This is to make sure we don't miss any potentially serious issues going forward. If, during a Telehealth consultation, your Physio believes that your issue is something that needs to be seen face to face, then we make all arrangements to let that happen.

Overall Telehealth consultations offer a good solution at a time when face to face consultations are not possible. There are many potential uses for Telehealth and these all need to be explored. As long as we do so with due regard to its limitations then we can provide a safe and effective treatment tool.

References




I have been told I have vertigo... What does that mean?

The term vertigo is often associated with a spinning sensation. However, patients who attend physiotherapy for vestibular rehabilitation will often describe symptoms other than spinning. These can include:

  • Feeling imbalanced
  • A swaying sensation
  • Light-headedness
  • Fuzziness
  • Feeling woozy or faint
  • Unsteadiness
  • A swimming sensation
  • Hypersensitivity to crowds or busy environments
  • Spatial disorientation

These symptoms may be linked to certain movements such as turning in bed or bending over. They may be linked to certain situations such as being in a busy supermarket. Or you may not be able to pin point any patterns.

The first thing to remember is that vertigo is a symptom, not a diagnosis. My job is to figure out what is causing your vertigo... or light-headedness... or fuzziness... And the list of possible causes is as long as the list of different symptoms patients describe to me! These possible causes include:

  • Cardiovascular
  • Neurological
  • Metabolic
  • Vestibular
  • Visual impairment
  • Psychological
  • Diet and nutrition
  • Medication
  • Head injury
  • Drugs/alcohol

As the name would suggest, vestibular rehabilitation involves working with the vestibular system. This is the part of your inner ear that controls balance and spatial awareness. It is reported that about 1/3 of all dizziness reported to healthcare professionals, comes from the vestibular system. Once we have established that the cause is vestibular, a treatment plan can be formed.

Treatment strategies differ from patient to patient; depending on what way their vestibular system is affected. Some patients will require a repositioning manoeuvre, which involves moving the head around to remove calcium carbonate crystals, or otoconia from a specific part of the inner ear. Other patients will require an individualised exercise programme to address their vestibular dysfunction. Some may need both.

The good news is that when applied appropriately, vestibular rehabilitation has been shown to be a very effective treatment for vertigo, dizziness and the myriad of symptoms I described above (Hall et al, 2016). For some conditions, 90% of people will only need to be seen once (Prokopakis et al, 2005).

The plan for the next two blogs is to discuss the most common cause of vertigo- BPPV, or benign paroxysmal positional vertigo. This is the most common disorder of the inner ear, accounting for 42% of vertigo cases diagnosed in the primary care setting (Parnes et al, 2003). This is reflected in my practice and I would estimate that about half of my vestibular rehabilitation caseload is made up of BPPV cases. Thankfully it is one of the most satisfying to treat! It is quite a big subject, so the first blog will examine the causes and symptoms associated with BPPV. The second will discuss the diagnosis and treatment of BPPV.

If you are experiencing any of the symptoms listed above and think you may benefit from vestibular rehabilitation, give me a ring on 01-8253997 or email me at info@pmcphysiotherapy.ie or book in online by clicking here http://pmcphysiotherapy.ie/book-online.html

References

  • Hall CD, Herdman SJ, Whitney SL, Cass SP, Clendaniel RA, Fife TD, Furman JM, Getchius TSD, Goebel JA, Shepard NT, Woodhouse SN. Vestibular rehabilitation for peripheral vestibular hypofunction: an evidence based clinical practice guideline. J Neurol Phys Ther 2016. 40(2):124-55
  • Propakis EP, Chimona T, Tsagournisakis M, Christodoulou P, Hirsch BE, Lachanas VA, Helidonis ES, Plaitakis A, Velegrakis GA. Benign paroxysmal positional vertigo: 10 year experience in treating 592 patients with canalith repositioning procedure. Laryngoscope.2005. 115(9):1667-71
  • Parnes LS, Agrawal SK, Atlas J. Diagnosis and management of benign paroxysmal positional vertigo (BPPV). CMAJ 2003; 169(07):681-693
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