Coping without Codeine

As you may have noticed, as of February 1st 2018, pharmaceutical products containing codeine have been pulled from Australian shelves by the Therapeutic Goods Administration (TGA). This has left a void in the market for patient's that rely on strong pain killers to manage their ailments from Migraines to Chronic Pain. Whilst many may see it as unnecessary to now see a doctor for a medication, which until two weeks ago was available over the counter, many fail to realise the potentially harmful side effects of medications containing codeine.

Codeine is an opiate based medication which is commonly used to reduce pain and reduce  coughing symptoms associated with colds and flus. For this reason it is used in combination with other drugs such as paracetamol or ibuprofen to treat pain, and cold and flu medications to reduce coughing. In controlled doses, with medical supervision codeine use can be managed and weaned effectively as part of a patient's medical management. The reason for its removal from over the counter transactions is due to the number of associated side effects such as:

  • Constipation
  • Nausea
  • Stomach Cramps
  • Mood Changes
  • Dizziness
  • Drowsiness
  • Feeling Faint
  • Poor Sleep and Unusual Dreams

In more serious circumstances following increased or chronic opiate use, patients may experience a number of the following symptoms which require immediate medical attention:

  • Itchy, raised or red skin rash
  • Swelling of the Face
  • Muscle Stiffness
  • Vomiting
  • Breathing Difficulties
  • Irregular Heartbeat
  • Blurred or Double Vision
  • Difficulty Urinating (Peeing)

What is important to note is that these symptoms relate to allergic reaction to the medication and/or withdrawal symptoms of physical dependence to the drug. Opiate based medication when used for an extended period of time our bodies can develop a tolerance to the dosage. This means greater dosages must be taken to create the same pain relieving effect over time, all the while tolerance to medication continues to increase. This leads to addiction and physical dependence to the drug once it has stopped being taken. This is one of the leading reasons the TGA have decided to remove codeine from Australian pharmacy shelves without a prescription. Furthermore prolonged usage of the medications mixed with codeine are not designed to be taken over a long period of time, which can have serious implications on the gastrointestinal lining and liver following continued use greater than the recommended dosage.

Now this may seem an overly conservative solution to a problem that only affects a minority of codeine users in Australia. But it also sheds a light on the potentially harmful side effects of a seemingly "safe" medication, which for years had been readily available to the public. This also opens the door for open discussion with your healthcare professionals whether they be your doctor or physiotherapist about managing your pain with or without codeine based medication. 

As Physiotherapists we understand that pain medication is an important factor in pain management for a variety of medical and musculoskeletal conditions. The use of which is particularly important in the initial stages of your condition in response to pathological and inflammatory changes to musculoskeletal tissue in response to changes in tissue load or damage. As time goes on the body's healing capacity restores tissue back to its original status in the months following injury, this can be complicated when pain continues in the months following initial injury. At this stage it is usually advised that pain medication be revised with medical guidance to see if any further management strategies can be used to better effectively control pain. If this sounds like a familiar story or you have any questions regarding managing your pain without codeine, please speak to your doctor or consult your Physiotherapist about management options when it comes to pain and medication. The team at Lifecare Kingsway are happy to discuss with you how pain affects the body and mind, to help you better understand and manage your condition.

For further information please head to the following websites:

Therapeutic Goods Administration Australia-

Australian Physiotherapy Association-

Christmas Hours

Wishing everyone a safe and happy Christmas and New Year! In case you need us over the holidays, here are our opening hours:

Monday 25th: Closed
Tuesday 26th: 8am - 12pm
Wednesday 27th: 7am - 7pm
Thursday 28th: 7am - 7pm
Friday 29th: 7am - 7pm
Saturday 30th: 8am - 12pm
Sunday 31st: Closed
Monday 1st: 8am - 12pm
Tuesday 2nd: 7am - 7pm

You are able to book online via Health Engine or give us a call on 9409 3993!


To Scan or not to Scan, that is the question?

Despite what you may think, Doctors and Allied Health Professionals are not superheroes. We do not possess X-ray vision, nor can we read minds and figure out what is going on underneath the skin without proper assessment. Assessment includes what you tell us about your injury or condition and the assessment of physical movements that stimulate your symptoms. From this we develop theories of potential causes influencing your injury or condition. In some cases we would send you for a scan to assess your internal structures to confirm or deny our theories.

Scans, otherwise known as medical imaging assists in looking beneath the surface and identifying affected structures within the body causing your injury. They are relatively cheap and accessible due to the number of practices offering imaging services and the improvement in medical technology. Most images range between bulk-billed ($0) to $350 depending on the type and nature of the image required. Physiotherapists as Allied Health Providers are qualified to send their patients for medical imaging to assist in the diagnosis process or to aid management of their patient's injury.

The question is, if we have such great access to medical imaging in the 21st century, why don't all patients' get sent for a scan? The simple answer is that most patients do not require getting imaging due to the nature of their injury/condition. Only a minority of patient require additional medical imaging to assist in the diagnosis/management process. This depends on a number of things that the patient has said about the history of the condition and what they have shown us with movement. The reason for referral for medical imaging could be for a suspected broken bone, a serious muscle/tendon/ligament injury or for potential nerve related conditions.

Before sending a patient for medical imaging we as physiotherapists must first determine if the patient fits the criteria for medical imaging. This is done by weighing up a number of important factors:

1) Imaging Algorithm

Does this injury tick the boxes indicated for this series of images to be performed? For example in the case for a sprained ankle. Before an X-Ray can be taken the patient must describe pain over the bony edges of the ankle or unable to stand on the affected ankle either immediately after the injury occurred or when they present for medical assessment. If the patient doesn't meet the recommended criteria it is unlikely the image requested will be of any benefit to the diagnosis process. The algorithm also directs the next course of treatment if the image comes back positive or negative for an ankle fracture. Your Physiotherapist would usually describe this process to you before sending you off for an image otherwise you can check out the pathway process on the WA health webpage.

2) Type of Image

Depending on the type of injury a different type of image may be necessary. The types of tissues we are interested in observing are bone, muscle, ligament, tendon, cartilage and nerve. Each type of image is specific to certain tissues compared to another type of medical imaging.

X-Ray: The image is formed by exposing the target area to electromagnetic radiation called X-Rays. The X-Rays pass through the body and leave a shadow of bony tissue as they cannot pass through the dense structure of bone. X-Ray is useful for diagnosing dislocation or fracture of bones, they are often used as a first step to rule out serious injury which may require surgical intervention.

Ultrasound: Ultrasound is produced by introducing a sound wave to the structures immediately beneath the skin. Much the same as whales and dolphins use echolocation, the soundwave produces an image of the structures beneath the skin. This image assists in identifying breaks in normal tissues and or swelling in the affected area. This works best for soft tissues such as ligaments and tendons, but is not as accurate as other forms of images. Ultrasound is often appropriate because it is a cheaper alternative to MRI.

CT (Computed Tomography): CT scans are a 3D representation of multiple X-Ray scans. The machine performs multiple X-Rays around the affected area in a circular fashion to produce a 3D image on a computer. The images are shown as cross sectional “slices” that show different tissues in different shades of grey. CT’s are useful at showing small fractures in bone tissue and changes in soft tissue consistency identifying damage to tissue. CT is often used as an alternative to MRI as there is no magnetic field produced by the machine and its operation.

MRI (Magnetic Resonance Imaging):  MRI imaging uses a magnetic field to identify structures within the body. Patients are required to lay still as they are introduced to a narrow tube containing the scanning equipment which highlights water and fat molecules within the body. These molecules in different proportions represent separate tissues within the body. Damage and injury can be observed as disruptions to the consistency of these tissues and inform clinicians of abnormality within the tissue. This results in a better image quality and more accurate diagnosis in internal structures than other forms of medical imaging. MRI may not be suitable for patients with certain metallic implants as the magnetic field produced by the machine can potentially cause harm if specific implants are brought within the magnet’s field.

3) Radiation

Certain types of medical imaging depend on the use of electromagnetic radiation to produce images. X-Rays and CT require the use of X-Rays which sit at the high frequency end of the electromagnetic spectrum. Radiation at this end of the spectrum has greater energy than visible light, infared or microwaves. With greater energy this form of radiation has the strength to affect normal atom behaviour within the body, this is known as ionising radiation. Changes in atom behaviour affect the electon cloud of the atom, changing the number of electrons attached to the atom. This can result in cell mutation which has the potential to increase the risk of cancerous cell development within the body.

As scary as ionising radiation sounds, the human body is exposed constantly to background ionising radiation in everyday life. Radiation is present in the air, in foods and in aeroplane travel, it is impossible to escape all forms of ionisating radiatrion in everyday life. Between cosmic radiation from space (UV light to Gamma Rays) and naturally occuring radiation in the environment (Radon Gas, Pottassium-40 and uranium) we are exposed to the equivalent of 75 chest X-Rays per year (1.5mSv). The safe dose of exposure is suggested to be up to 10 mSv per year in humans.


4) Clinical Relevance

It may sound silly but does the result of the medical image mean anything to my patient or my diagnosis? X does not always equal Y, and the same can be said regarding certain findings on medical images. The cornerstone of Physiotherapy is patient function, is thepatient displaying signs of dysfucntion or pain with their everyday lives? In many cases patients can have underlying changes to joints and tissues which are completely unrelated or a non issue in the management of their condition. The most common example can be found in MRI images of the lumbar spine. A study (Kjaer, etal 2005)was performed on symptomatic (69% of subjects had experienced pain in the previous year) and asymptomatic patients alike who were sent for a MRI of their lumbar spine. The results showed 25-50% of patients had some form of hypointense disc signal, annular tears, high intensity zones, disc protrusions, endplate changes, zygapophyseal joint degeneration, asymmetry, and foraminal stenosis. Importantly it also found that disc herniation and nerve root compromise were not consistently associated with lower back pain.

The take home message is that just because it shows up on MRI or X-ray doesn’t mean that this is the cause of your pain. Firstly your subjective and movement assessment must add up to the imaging result and most importantly it must be stopping you from performing normally!

5) Will it change my management?

The last and arguably the most important factor to consider with medical imaging is what do I do with the information I have found? A specific image may mean the difference between having surgery or not, or it may be the difference between returning to sport this week and waiting another week. In other cases it may not change a great deal at all with your treatment, this depends on the nature of your injury and your progress to date with management. For example if you broke your ankle 6 weeks ago and now you are out of the cast and prepared to walk again, an X-ray wouldn’t always be ordered to confirm that you can walk on the leg. Pain and dysfunction govern whether or not there has been any disruption to the healing process. The case would change in the following 3 weeks if the patient was still experiencing ongoing pain and dysfunction which do not align with treatment expectations.

If what the patient displays does not follow what is expected at the stage of management that is when a scan might be necessary to change the treatment approach. As diagnosis is not always clear cut, physiotherapists usually employ differential diagnosis to account for other possible conditions that may mimic or contribute to your current presentation. If a test or a line of treatment is unable to split the other associated diagnosis’ an image may be requested to clearly define the injury.


So as you can see its not as easy as saying “go get a scan” to see what is going on with your injury. These are the factors that determine whether imaging is a useful addition to your assessment or a waste of your time and money. It may be a useful tool, but it’s what you do with the image that affects patient management, not the scan itself.


Kjaer, P., Leboeuf-Yde, C., Korsholm, L.,Sorensen, J.S., Bendix, T. (2005) Magnetic Resonance Imaging and Low Back Pain in Adults: A Diagnostic Imaging Study of 40-Year-Old Men and Women. Spine.30(10):1173-1180

How long will this take? Time frames of tissue healing

Just like Rome, the human body wasn't built in a day and it certainly doesn't repair itself in that time frame. The body's response to damage is complex and variable, it depends on the extent of damage, the type of tissue, your age, your health and many more variables you cannot control. You cannot control how fast your body repairs itself following injury, you can only optimise it by avoiding factors that slow the normal healing process. This includes avoiding activity that re-injures the tissue such as running after a hamstring strain or even standing on a fractured foot. Activity that reproduces your pain and makes it more sensitive or intense is likely limit your ability to heal, so therefore "no pain no gain" is not a relevant mindset.

Just like the way your body deals with a cold or an infection the body has a set process to deal with tissue damage. Tissue describes a collection of similar cells which make up a type of body tissue, examples include muscle, epithelial (Skin and blood vessel lining), connective (Bone, ligament and tendon) and nerve. The process is similar for each tissue with small variations in the cells involved in the healing process. Not every tissue will heal in the exact same manner, this is due to blood supply to the area, the function of the tissue and the ability to protect the tissue in response to injury.

The majority of tissue injuries occur when a large amount of pressure is placed upon a structure. The pressure either quickly applied or accumulative over time, causes breakdown of tissue and damage occurs. An immediate reaction begins in response to damage in the tissue, this occurs in four distinct phases. Each phase takes time to complete and usually overlap before the next phase begins.

Phase 1) Bleeding (Vascular component of Inflammation): The immediate response to damaged tissue is usually bleeding and swelling around the injured tissue. This occurs at a cellular level when cells and blood vessels that make up the damaged tissue die and release a chemical called histamine that increase the rate of fluid flooding the area from the surrounding blood vessels. This causes dialation of blood vessels surrounding the damaged tissue, allowing migration of white blood cells, platelets and other blood products in and around the damaged tissue, starting the cellular inflammatory process. This occurs immediately following tissue damage and is managed in minutes to hours after injury.

Phase 2) Cellular Inflammation Phase: The arrival of blood products to the damage site allows for the tissue to prepare for the healing process. White blood cells, specifically leukocytes infiltrate the damaged tissue and consume debris and dead tissue in a process called phagocytosis. Once the damaged tissue is removed, the remaining tissue is prepared for rebuilding and the damaged cells no longer produce inflammatory chemicals, slowing down the inflammatory process. When damaged tissue is unable to be completely cleared or removed from the damage site, inflammation continues to cycle without stopping, this is called chronic inflammation. The normal process of inflammation spans between minutes following damage and the next 72 hours.

Phase 3) Proliferation: In the dying stages of inflammation, specialised cells called fibroblast begin to rapidly multiply in and around the damaged tissue in a process called proliferation. Fibroblasts reconstruct damaged blood vessels in the area and lay down bundles of collagen to rebuild the damaged tissue at the damage site. This may include surrounding muscle/connective/epithelial tissues that were also damaged by the abnormal load causing tissue breakdown. Once the immature tissue is laid down, the wound begins to contract to reduce the size of the damaged site. This begins in the first day of injury and extends up to a month post injury.

Phase 4) Remodelling: Remodelling describes the maturation of immature collagen cells within the wound that are roughly laid out in the proliferation phase. Type III collagen which is laid down in the proliferation phase is disorganised and randomly orientated. This collagen converts during the healing process to Type I, by applying gentle force such as stretch, contraction, weight bearing pressure to the healing tissue, aligning the fibres to run inline with the direction of tension and reduce the occurance of scar tissue. This process begins in the weeks following tissue damage and can extend over 12 months or more depending on the size and type of the wound.

This basic overview explains why tissue cannot simply heal overnight but takes weeks to months to fully restore. As Physiotherapists our job is to manage patient expectations regarding recovery from injuries and how to best manage your specific condition. In many cases medical and surgical assistance is required based on the best possible outcome or safest approach to rehabilitation. This will be assisted by your Physiotherapist who can perform manual therapy to assist with the condition of damaged tissue and instruct on appropriate activity and exercise to facillitate tissue healing.

If you would like to consult a Physiotherapist about your injury, call the team at Lifecare Kingsway to make an appointment on 9409 3993. Alternatively you can book online at or on the Health Engine App on your phone.

Osgood-Schlatter's Disease

Osgood-Schlatters Disease is a common cause of knee pain in children and adolescents.  Pain is felt at the front of the knee, and approximately 5cm below the knee cap on the bony prominence towards the top of the shin bone called the “tibial tuberosity”.  Although the use of the word “disease” can be frightening, with correct diagnosis and management it doesn’t have to be as scary as it sounds. Most importantly, unlike other diseases, Osgood-Schlatters isn’t contagious!

Technical definition alert…. Osgood Schlatter’s Disease is a tibial tuberosity apophysitis.  Alternatively, it can simply be referred to as a specific type of “growing pain”, whereby the growth plate becomes irritated by overuse (the tendon that runs from your kneecap attaches onto the growth plate). 

Both boys and girls can develop Osgood Scclatter’s disease, with adolescents who are active during growth spurts most vulnerable.  Generally speaking, boys between 11-15 years and girls between 8-13 years old.  Sports that lead to repetitive, strong quadriceps muscle contractions are at most risk; football, dance, gymnastics, basketball soccer etc.  The effect of such repetitive and strong quadriceps muscle contractions is high pulling forces being placed on maturing bone at the growth plate. 


What are the symptoms?

·         Localised pain at the tibial tuberosity (bony prominence at the top of the shin bone).  This area will tender to touch and possibly swollen

·         Intermittent pain, aggravated by exercises such as running and jumping

·         Pain on direct pressure to the area e.g kneeling

·         Often pain will linger after sport through to bedtime

·         Quadriceps muscle tightness and weakness may be observed


Primarily made following a clinical assessment.  X-ray imaging is occasionally used to exclude alternative causes of pain in some cases.  Further imaging such as MRI is rarely required.   


In the majority of cases, Osgood-Schlatters Disease can be successfully managed in physiotherapy.  Mild cases may settle in a matter of weeks, while most cases may take a few months to settle with conservative management.  In severe cases, symptoms may linger until the growth plate matures.


Correct diagnosis and treatment is vital to reduce pain, and prevent cases progressing to a stage where the growth plate can sustain and tolerate greater forces.  Physiotherapy treatment can include the following:

·         Education on the condition, pacing and activity modification

·         Exercise therapy to work on identified deficits e.g quadriceps strengthening or stretching

·         Taping may reduce symptom severity

·         Massage may also reduce symptom severity

·         Ice therapy


Physiotherapy has been proven to an effective method in managing Osgood-Schlatter’s.  If you think your child may be presenting with Osgood-Schlatter Disease then call LifeCare Kingsway Physiotherapy today for an assessment. 

Training For a Fun Run: A Load off your Mind

It's 2 weeks to the HBF Fun Run, the last 10 weeks have been torturous, up and down with aches and pains as you train for the event. Maybe your knee or your ankle is your Achilles heel? Maybe you're weaker in one limb than the other? Maybe your training has been the culprit the whole time! 

Training for a Fun Run is a delicate balance of under vs overload. Don't train hard enough and you won't improve your running time or endurance, train too hard and you risk overloading the body's soft tissue and aggravating underlying injuries. This delicate balance is hard to achieve especially if this is your first Fun Run or organised sporting event. Both under and overload are important parts to training, under-load can be useful to allow rest within a training program and reduce cumulative stress on the body and mind. In an ideal world the scales are slightly tilted towards overload, this allows you to appropriately stress your cardiorespiratory system and musculoskeletal system without significant  breakdown of system function. Appropriate stress on these systems allows for faster running times and more efficient function of your heart, lungs and muscles. So how do you plan for a Fun Run, a half marathon, marathon?

Training Load! Load is a figure made up of the volume of training you perform in a set amount of time whether it be a day, a week or a month. It also depends on the intensity of training you are performing. There's a difference between walking 3km per day and running 3km per day. As a run is more intense than walking, the stress on the heart, lungs and muscles is more and the training response as well should be more compared to walking. 

Volume x Intensity= Training Load

Volume can be broken up further into two seperate components; frequency of training and the amount of time spent training. Frequency relates to how often you train and influences the amount of time spent applying stress to your  cardiorespiratory and musculoskeletal systems. The common unit of measurement between the two factors would be the sum of training time in minutes or hours spent training.

Intensity relates to the rating of perceived exertion or maximal effort involved with training. This relates to the speed of your run as the faster you run the harder the effort for your cardiorespiratory and musculoskeletal systems.It is either calculated as a percentage of maximal effort or a rating of difficulty out of ten (ie. 10/10= hardest exercise ever experienced, 0/10 absolutely no effort, might as well be sleeping). In either case the end product is calculated as a numerical value between 0-10 and multiplied by volume to establish training load. Type of training also factors into intensity as some forms of exercise are more or less intense than running alone. For example swimming as a form of cross training is less intensive training for your musculoskeletal system compared to running. Whereas rowing is an example of  more intensive exercise for your cardiovascular system ran running alone. Lets assume for the sake of the Fun Run, your intensity stays a constant 6/10 intensity for the entirety of your training. This allows your to experience moderate physical stress without significant discomfort or intense physical effort.

Now some might think that it would be smart to start off with 1km runs and increase by 1km per week for the entire 12 weeks. Whilst this seems to be a logical systematic increase in load, particularly for those who have experience in running,  there is considerable risks of exposure to significantly increased training load in the first few weeks of training. Running 1km one week and 2km the next week represents a 100% increase in training load. This is the same as running 5km one week and then 10km the next week. Such large increases in training load is grounds for overload of previously healthy musculoskeletal tissue. A common rule amongst runners is the suggestion that training loads should be adjusted by no more than 10% per week. This minimises the chance of overload of soft tissues and promotes gradual increases in training load which is far more sustainable than 100% or even 50% of the previous training load.

A rough guide to planning your training program should start with your goal distance in mind. For example if your goal is the 12km Fun Run, your aim should be able to run at least twice that distance in a week if you were training 3 days a week running. This would equal two 6km runs and one 12 km run for a total of 24km per week. The week prior to this should be 10% less than this, repeat this until you meet your comfortable maximum running distance. If you can maximally run 3km in one go, it would take roughly 16 weeks of training to reach your goal distance of 12km as per the following table.

 Sample Running program for 3km runners: Compares Total load to 10% Load Increases per week, yellow scores indicate an increase in load greater than 10%

In theory this program should allow you to achieve your goal in 16 weeks, unfortunately as this is an ideal scenario, often the reality of a training program fails to account for changes to lifestyle or stress associated with everyday life. Therefore it is suggested that every 2-4 weeks the training load should be the same or slightly less to allow for under-load to assist recovery and reduce physical and mental stress. This also allows you to adapt your training load as you see fit over the course of your training, as your program should be individually focused after all.

The take home point associated with training for Fun Runs or recommencing running training is to plan ahead. It's much more difficult to plan when there is a set date of competition and you must plan your schedule to a time frame you cannot completely control. If you wish to improve your running ability, take your time and slowly progress your training load, keeping in mind the volume and the intensity of your training. Overall the process should be enjoyable, isn't that the point of a Fun Run? 

Run Away from Runners Knee

The weather is cooling down and you've found some motivation to start running. You might have even signed up to the City to Surf!  But then your knee has started to hurt and you're considering why you even contemplated this "running" lark. 

Pain on the outside of your knee is very common in runners. So common infact that it has been named several times over; "Ilio-Tibial Band Syndrome", "ITBS", "Runners Knee", "Friction Syndrome"...etc.. The list goes on like that hill you can't quite conquer. For the purpose of this blog, we will refer to subject as "ITBS". 

So what is ITBS? 
ITBS is an overuse injury which leads to pain on the outside of your knee. The ITB (ilio-tibial band) is a thick tendon that runs from the outside of your pelvis, down the side of your thigh and attaches onto the top part of your shin.  As the band crosses the outside of your knee, it runs over a bursa. This bursa is simply described as a fluid filled sac designed to reducefriction between the band and the underlying bone. In ITBS, this bursa becomes irritated and inflamed which leads to pain as the knee repeatedly moves from flexion to extension (as it does during every stride you take).  



Common causes? 
Training load/error
Muscle tightness
Muscle weakness
Often the cause is multifactorial

Diagnosis is generally fairly simple to make. A familiar tale of pain which comes on during running, and is exacerbated with every time your heel strikes the ground. Tenderness is readily bought on by direct pressure on the outside of your knee. Imaging such as X-rays or MRI scans are rarely required. 

How to get rid of this pesky ITBS? 
The key to successful treatment is identifying the underlying cause/s. A thorough assessment from a physiotherapist will be able to determine the cause in your individual case. Common treatments include:
-Training advice; we endeavour to keep runners running. COMPLETE REST is RARELY ADVISED. 
-Adressing muscle tightness; massage, dry needling, foam rolling
-Rectifing muscle weakness with progressive strengthening exercises

ITBS is a debilitating overuse injury for runners. With a thorough assessment and effective treatment it can swiftly be overcome. If you are struggling with ITBS, then book in with one of our physiotherapists today and we will strive to get you running away from your runners knee! 

Head in the Game: Concussions in Sport

In light of recent sporting events, now is as good a time as any to discuss the prevalence of concussion in professional and amateur sport. During the recent Danny Green vs Anthony Mundine fight earlier this month, in which Green won, there are questions surrounding whether the fight should have been called off in the first round? After a controversial punch was thrown by Mundine, which connected with Green's jaw, Green staggered around the ring and into the ropes before falling down. Green was assessed by two ringside doctors and the referee, where he was cleared to continue the fight, which he won by decision in 10 rounds.

After the fight it came to light that Green suffered a concussion following the blow and was cleared to fight on. One of the two ringside doctors, Dr Lou Lewis, quit the fight immediately following the decision to let the fight continue. He disagreed that Green was safe to continue fighting and was putting his immediate and long term health in jeopardy by continuing to trade blows. Many experts agree that allowing Green to continue fighting increases the risk of a serious or fatal injury to occur.

This is not the first case of athletes putting their health on the line with significant head trauma. In the 2014 NRL Grand Final, South Sydney's Sam Burgess ran head first into a tackle in the opening minute sustaining a depressed fracture of his cheekbone and a concussion. Sam played on the entire game, won the Clive Churchill Medal for best on ground and later admitted he has very limited recollection of the game due to that hit. Another instance of great sporting bravery comes from the 1989 AFL Grand Final, where Dermott Brereton was famously cleaned up in the first minute of the game deliberately by an opposing player. Dermott famously returned to the field of play after being assisted from the field by the team Medicos.

At what point does “Bravery” cross the line and become “Reckless” when it comes to Athletes short and long term health. As recent evidence suggests, repeated exposure to contact and high impact sports such as boxing, football and rugby increases the risk to long term changes to brain health. Repeated blows to the head increase the risk of exposure to chronic traumatic encephalopathy or CTE. CTE is a response that occurs in the connective neurons in the cerebrum to repeated concussions or traumatic brain injuries. This leads to atrophy or shrinking of brain matter in the frontal and temporal lobes Now the jury is still out on the direct link between an increase in mental health conditions and CTE, but there is undoubted change in the cerebral structure and function in athletes that are exposed to these forces. Whilst further study needs to be done to better understand the intricacies associated with concussion and brain function, more and more athletes are beginning to take ownership of their health despite their sporting affiliations.

In the AFL, 6 players in the last 18 months have called time on their careers in light of recent concussion related injuries. Herritier Lumamba (Melbourne), Justin Clarke (Brisbane), Sam Blease (Melbourne), Leigh Adams (North Melbourne), Matt Maguire (Brisbane) and Brent Reilly (Adelaide) have all retired with concussion related injuries. Overseas high profile athletes in the NFL have begun to prematurely end their careers with respect to their long term health. This includes most notably a rookie from San Francisco, Chris Borland, who after a sensational rookie season at the age of 24 called quits on his career after looking into the research associated with CTE and NFL players. It is certainly a difficult issue at the professional level of sport, where athletes collect annual salaries often in the realms above $100'000 at the bare minimum and in excess of millions of dollars otherwise. With so much money invested into their performance what is the cost of their long term health in the future?

In the Amateur sport environment, where athletes play for social benefit more than money, there is less at stake, as one would assume. Unfortunately this may not be the case as anecdotally seen in typical Australian sporting culture. The promotion of play hard whatever the cost has long been a common association with traditionally masculine sports such as Australian Rules Football, Rugby League and Rugby Union. Under reporting of concussions are far more likely in these sporting environments as there is less medical support made available to them compared to the professional sport. This has led to a review of many concussion protocols used by amateur sporting leagues and introducing removal from play rules to prevent re-injury or subsequent injury following concussion. For more information regarding concussion management and assessment tools on recognising concussion please make use of the following links below.

Giving Tennis Elbow the Backhand

Tennis elbow is a very common injury in both sporting and non sporting populations. Also known as lateral epicondylagia, the condition is specific to the outside edge of the elbow. Pain is produced with overuse of the muscles in the forearm causing strain on the central tendon at the elbow. This results in sharp, long lasting pain associated with gripping items such as a racquets, hammer, screwdriver or lifting a shopping bag.

Unlike regular muscular strains, tendon injuries do not respond well to generalised rest and inactivity. In fact leaving tendon injuries to rest and settle for a period of time only delays the healing process and extends the experience of discomfort. Like a rubber band, the fibres of collagen that make up tendons, stretch and spring like rubber. If you over stretch the fibres, the collagen breaks, tears and bleeds causing pain and discomfort. On the other hand if you keep the fibres still and don't stretch them enough, they become stiff and are easier to break apart once you stretch the tendon again. Therefore it is important to use the tendon just enough to keep it springy and elastic like healthy rubber band.

The trick with restoring tendon health lies in what you do with it. The amount of stress or load the tendon is exposed to is the biggest factor to how well it heals. It doesn't matter so much as to how big or how small the strain is, what's more important is how much load the tendon can tolerate before reproducing the pain symptoms. Muscle contractions pull on the tendon every time the finger or the wrist moves, exposing the tendon to minor amounts of stress. Repetitive movement of the fingers and wrist for a long period of time increases the amount of stress experienced by the tendon called load. Higher than normal loads over a short or extended period of time can lead the tendon to strain and aggravate the problem.

Normal load can be restored following injury with consultation from your Physiotherapist. They can identify a baseline level of load that your tendon can handle and slowly increase your tolerance to it with manual therapy and exercise. In some cases, braces or time off work may be necessary to control your initial symptoms before you can begin exercise. It is important you discuss with your Physio what your goals are so the treatment is directed towards what you want, not just what the Physio thinks is normal. This is particularly important for people who work with their hands such as trades people or sportsmen alike.

If you would like to consult a Physiotherapist about your elbow pain, call the team at LIfecare Kingsway to make an appointment on 9409 3993. Alternatively you can book online at or on the Health Engine App on your phone.

The Worst Christmas Stocking- Ankle Injuries and the Silly Season

The beginning of Summer brings with it the Silly Season and the perfect recipe for ankle injuries: Christmas Parties + Alcohol+ High Heels= Sprain.

The words spain, strain and tear are used interchangeably with ankle injuries. They all indicate damage to the soft tissues (ligaments) that surround your ankle joint. You can sprain either or both the inside (medial) or more commonly, the outside (lateral) ankle joint complex. This occurs when the foot rolls outward, putting the structures on the outside of your ankle under considerable stress. The potential for injury is clear, but the severity of injury can range greatly. A simple “rolled ankle” will result in pain for only a couple of days. On the other end of the scale, severe ankle sprains can result in significant ligament damage or even a broken bone. Pain, swelling and a considerable limp are commonplace post ankle sprain, regardless of the injury severity. For this reason, seeking early assessment with a health care professional is recommended.

Acute management of an ankle sprain is essential and effective. A good starting place is with the acronym “RICER”

Rest: Loading your ankle correctly is vital. Continue to walk on a fractured bone and you risk further damage, while immobilising a minor sprain risks delaying your rehabilitation. Diagnosis of your injury will help us guide you on optimal loading.

Ice: Applying ice to the painful and swollen area will help relieve your pain.

Compression: This will help reduce and limit swelling in the area.

Elevation: Positioning your injured ankle above your heart will reduce swelling by allowing gravity to assist venous drainage.

Referral: If “RICE” has not resolved any of your resting symptoms or if you are unable to walk and/or stand on your ankle, seek medical treatment to assess the injury. Referrals are not necessary to see a private practice Physiotherapist, it would be wise to refer your injury to a health professional to decide the best course of management.

 A Cam Boot is can be used to immobilise the ankle in severe cases.


Initially your physiotherapist will aim to assess, diagnose and manage the early symptoms of an ankle sprain. Following this, rehabilitation is often required to facilitate recovery back to pre-injury function. It is likely that exercises will also be prescribed to help prevent future ankle complex sprains.


If you have sprained your ankle, please call and speak to a Physiotherapist at LifeCare Kingsway to see if we can assist you. Call 9409 3993 to make an appointment or book online at

The Summer of Cricket: Hitting Stress Fractures for Six!

It's that time of year again... break out the whites, the zinc and the wide brimmed hat, its the Aussie Summer of Cricket.

While the Aussies are taking on South Africa and the local club is preparing for grade cricket, young Aussie bowlers are hitting their strides early on in the season. Fast bowlers in particular are much further at risk of injury compared to batsmen and their spin bowling counterparts due to the forces exposed to their spine during the delivery phase of their run up. To get an idea; stand up and lean back and to the side of your dominant arm, now stand on one leg and hop on the spot. Uncomfortable? Now try repeating 6 times an over (Plus wides and no balls); for 5,10,15+ overs; at the end of a 20 metre run up; in 30-40 degree Perth heat...Get the picture?

 The spine is rapidly extended and side-bent to increase the release velocity of the ball as the bowler approaches the crease.

The spine is rapidly extended and side-bent to increase the release velocity of the ball as the bowler approaches the crease.

This repetitive extension and side bending of the spine as the ball is released from the bowlers hand puts extensive pressure on the bony structures of your spine that limit excessive bending backwards and twisting. These are called facet joints and they line the outer edge of your vertebrae. Extreme pressure on these joint can cause conditions like sciatica (irritated nerve roots exiting the spinal cord) or even more worrying Stress Fractures of the Lumbar spine.

Stress Fractures (Pars Defect) is damage as a result of repetitive stress of the facet joint (Pars Interarticularis) from the joint above and below. Pressure accumulates over time until the bony material no longer can resist the force of the repetitive movement and fractures (Spondylolysis). Much the same as repetitively bending the wire of a coat hanger, at first it moves slowly and firmly, until it becomes increasingly flimsy and eventually snaps. In more severe cases the vertebrae can slip forward due to the fracture of the bony facet, compromising the stability of the spine (Spondylolisthesis).


Rehabilitation for Stress Fractures is a slow and tedious process. It is advised that players be removed from repetitively loading for 4-8 weeks depending on the severity of symptoms before they can return to spine loaded exercise. The key is catching the signs and symptoms of stress fractures before the fracture occurs. If you are experiencing pain in the lower back during and after repetitive bowling actions or if your pain is made worse by standing, leaning or arching your back it would be wise to review your bowling technique and speak to your local Physiotherapist.

If you'd like to speak to a Physiotherapist the staff at Lifecare Kingsway would be happy to assist in your condition. Call 9409 3993 to make an appointment or book online at


AFL Trade Period: Seperating Legends and Lemons, the Importance of Musculoskeletal Screens

It’s the end of the AFL season 2016 and teams are already frantically preparing to improve on last season’s efforts in the NAB AFL Trade Week. During this time head honchos and list managers will come together to argue, debate, negotiate and broker deals that brings talent and results to the club and the playing field in season 2017.

If you’re a West Coast or Fremantle Fan, you may be wondering how Sam Mitchell or Cam McCarthy are going to look in your favourite jumper next year. If you’re a coach you may be wondering how many disposals or goals they will have next year. Or if you’re a Physio or a Medical staff member, you may be wondering how their hamstrings or their knees are going to cope with another 12 months of intense AFL training. This usually requires a medical screening to assess the health and likelihood of injury of the players.

 Matt Priddis lays a tackle on new West Coast recruit Sam Mitchell

Just like buying a car, you want to know it’s reliable and unlikely to break down after only two laps. After all, no one wants to buy a lemon. Just like a mechanic, it’s up to the Physio and medical staff to take a look under the hood and check how the engine and parts are running.

Physiotherapists conduct a Musculoskeletal screen to assess any underlying injuries or potential injuries based on how your body moves, stretches and produces power. Common sites for assessment are the hips, groins, hamstrings and lower backs. Extra testing may be conducted for previous injuries the player may have suffered earlier in their career. 

-In 2015, recurrent hamstrings and hip/groin injuries represent 16% and 20% of all hamstring and hip/groin injuries suffered during the season. 

-Overall 11% of all injuries in 2015 were recurrences of previous injuries. This has been a consistent trend over the past 10 years where the rate of recurrence spans between 9-15% over that same timeframe.

AFL clubs perform these screens to protect their investment, but the screening is also a useful tool for injury management and providing the player with an effective program to manage their condition and minimise the risk of re-injury. The same can be said for Sam Mitchell and his hamstring history as well as the local footy club captain and his dodgy left hammy which he hurt just before finals this year. In both cases a Physiotherapist can screen and assess the damage or the risk of further injury with an assessment and plan for the future.

If you would like to book a musculoskeletal screen for your previous injury or would like to elevate your game to a higher level this preseason, call and make an appointment today. The Staff at Lifecare Kingsway would be happy to help you get back on the field and performing at your best . Call 94093993 to make an appointment or book online at


*2015 AFL Injury Survey-

Content Is Kingsway

Welcome To Lifecare Kingsway's Online Blog!

Content is Kingsway; thoughts, advice and grumbles

Each month, the team at LifeCare Kingsway will be releasing a blog on topical issues, with the aim of informing and advising you on what's new and helpful in Physiotherapy.
Blog content will vary from the most recent star footballer's knee injury concerns to separating fact from fads in the health industry. Hopefully we can bust a few myths, as well as improve your knowledge of what is relevant in your health over the forthcoming posts.

Content is Kingsway

Information will be posted by Matt and Michael with special inputs from Senior Physiotherapists Jos, Jermaine and Arno occasionally.

If any of our future blogs create more questions than answers for you, the please feel free to contact us on and we will do our best to clear things up.

For physiotherapy appointments at LifeCare Kingsway, please call 9409 3993 or book an appointment at the top of the menu.