Clare qualified as a physiotherapist in 2000 from the University of the West of England. Since then Clare has worked in the UK, New Zealand and Australia in hospital and private settings. Clare has also completed a Certificate IV in fitness and clinical pilates and recently decided to return to studies and has just completed her Masters in Musculoskeletal Physiotherapy at La Trobe University.

Clare has managed a wide range of acute and chronic musculoskeletal, orthopaedic and sporting conditions over the years and particularly enjoys post-operative rehabilitation of clients.

Clare has experience in hydrotherapy, clinical pilates, and exercise prescription and utilises these skills in combination with hands-on techniques to provide an individualised management plan to promote optimal function and movement, required for returning to work and day-to-day activities. When not working Clare can be found walking the dog, in the gym,  scuba diving in the bay or completing DIY projects around the house.

Professional memberships:

Australian Physiotherapy Association (APA)

Musculoskeletal Physiotherapy Australia

ACL injuries are on the rise, and it is well known how devastating these injuries can be. Unfortunately I can personally attest to this after sustaining my own ACL injury in December last year.

What’s the big deal?
ACL – anterior cruciate ligament- is a major stabilising ligament of the knee- it controls the forward sliding motion of the lower leg and provides rotational stability with movement.

Commonly there will be accompanying bone bruising or fracture, possible cartilage or meniscus tears, or damage to other ligaments in the knee.

In the short term, the injury can result in time off work, inability to participate in sport, and prolonged rehabilitation. On average, professional elite athletes require 9 months out of sport and recreational athletes will take 12 months. Longer term, there is a high risk of osteoarthritis in people who have suffered an ACL injury, particularly if you sustained a concurrent meniscus injury. The cost of primary ACL reconstructive surgery in Australia between 2014-2015 has been estimated at $142 million, which includes surgical costs only and not the rehabilitation, burden of injury or time off work (Zbrojkiewicz, D., Vertullo, C. & Grayson, J., 2018).

How do they occur?

There is a small subgroup of ACL injuries that occur with contact- that is a direct blow to the knee- e.g. another skier collides with your leg resulting in injury.

The vast majority of these injuries however occur in a “non contact” manner. In other words, because of a landing error or twisting movement. It may be a movement that you have done countless times before, a small bump in the air prior to landing, or a timing error causing an awkward movement.

What can we do about them?

There is a growing body of evidence that many of these non-contact injuries can be prevented, and with the cost of ACL injury and the rate of injury on the rise it is crucial that we do everything that we can to avoid them.

“Neuromuscular” training programs have been shown to be effective in reducing the rates of ACL injuries. These programs are warmup routines that include balance, agility, plyometrics and landing control. Soccer, netball and AFL have all released sport specific programs that are readily available and should become part of your team’s warm up today (see links below).

A 2018 study (Webster & Hewett) showed neuromuscular training programs reduce the overall rates of ACL injuries by 50%, and in females by 67%. The research shows that the more you do these routines, the more effective the programs are at reducing the rate of injury. They are not only effective at reducing the rate of serious knee injury, but also all lower limb injuries. And if that’s not enough to get you started they have also been shown to be PERFORMANCE ENHANCING! Vertical jump and sprinting ability can improve with regular performance of a neuromuscular program (Garrison et al, 2011).

It is essential that we implement these widely from grass roots level up, and that if you’re not already doing them that you start today!

Footy First http://www.aflcommunityclub.com.au/index.php?id=906
Netball Knee https://knee.netball.com.au/
FIFA 11 Soccer http://www.footballfedvic.com.au/fifa-11plus/

Jane Higgs
Musculoskeletal Physiotherapist
Clifton Hill Physiotherapy

References
Dargo, L., Robinson, K. & Games, K. (2017). Prevention of Knee and Anterior Cruciate Ligament Injuries Through the Use of Neuromuscular and Proprioceptive Training: An Evidence-Based Review. Journal of Athletic Training, 52 (12), p 1171-1172.

Donnell-Fink, L. et al, (2015). Effectiveness of Knee Injury and Anterior Cruciate Ligament Tear Prevention Programs: A Meta-Analysis. PLoS ONE 10(12): e0144063.

Garrison, T., Smith, T., Tutalo, S., Barber-Westin, S., Campbell, D. & Noyes, F. (2011). Benefits of neuromuscular training program for knee injury prevention and performance enhancement in high school female basketball players. Journal of Strength and Conditioning Research, 25, pS12-S13.

Ramirez, R., Baldwin, K. & Franklin, C. (2014). Prevention of anterior cruciate ligament injuries in female athletes. Journal of Bone and Joint Surgery, 2 (9): e3.

Shaw, L. & Finch, C. (2017). Trends in Pediatric and Adolescent Anterior Cruciate Ligament Injuries in Victoria, Australia 2005–2015. International journal of environmental research and public health, 14, 599.

Webster, K. & Hewett, T. (2018). Meta-analysis of meta-analyses of anterior cruciate ligament injury reduction training programs. Journal of orthopaedic research. doi: 10.1002/jor.24043. [Epub ahead of print]

Zbrojkiewicz, D., Vertullo, C. & Grayson, J. (2018). Increasing rates of anterior cruciate ligament reconstruction in young Australians, 2000–2015. The Medical Journal of Australia, 208 (8): 354-358.

Our staff have been busy sharing their knowledge and expertise with Doctors and other Physios.

Issy has been busy presenting on two different topics this month!

Issy was asked to present to a support group of women who suffer with Endometriosis at the Epworth Hospital in East Melbourne. Issy presented on how physiotherapy can help women with pelvic pain and endometriosis. This common and debilitating illness is something our women’s health team sees frequently. They are able to help women with pain and bladder and bowel dysfunction.

The presentation went really well with many women asking questions on how they could be helped by physiotherapy. They were all amazed to hear of the self-help strategies that they could use at home with some simple steps. It was also pleasing to see so many of them came with a friend or partner to assist in managing their condition.

In that same week Issy presented her knowledge of gut focused treatment to a large group of GPs as part of their continuing education. She discussed some case studies of patients with constipation and incontinence and was able to inform the GPs of how they could manage their patients better.

There was lots of interest from the group not only on irritable bowel syndrome but also male pelvic pain and female sexual pain. The group was most interested by how physiotherapists can teach patients to regulate their bowel and be more in-control of their own health. It was exciting to see so many GPs (about 70) come out for this event, which was run by St Vincent’s Private Hospital.

Issy and Jen have also just tutored on a course on Female sexual pain for Physiotherapists and Brendon has just run 3 busy days in Bendigo teaching Health Professionals about Graded Motor Imagery and Explain Pain.

We are always striving to share our knowledge and continue our own learning.

If you have a endometriosis related pain, bladder, bowel or sexual dysfunction, consider coming in to see one of our experienced pelvic health physiotherapists who are able to sensitively navigate a management plan or chat with your GP, help is available.

CFA Bridge magazine  spoke to former Australian Netball Captain, Sharelle McMahon about incontinence amongst netballers and how she learned how to engage her pelvic floor.

An award-winning research reveals that 30 percent of women netballers experience urinary incontinence while playing Australian women’s most popular team sport. Nearly half of the women that had had babies leaked. They concluded that the prevalence of leakage while participating in netball was similar to other high impact sports and that screening for UI within netball clubs may assist symptomatic women to receive effective treatment.

Elite netballer, Sharelle McMahon remembers the day well. She was at a training session with the ANZ Championship team, the Melbourne Vixens when a physiotherapist used an external ultrasound to track how well the players were switching on their pelvic floor. “Only one of us in that group was actually activating our pelvic floor correctly, and that one wasn’t me,” said Sharelle. “The team’s physio was quite shocked. When we went through our training we were frequently asked to engage our core and our pelvic floor – that was part of the training program. So while that was a focus, we weren’t actually doing it very well.” The exercise was done about 10 years ago, and prompted Sharelle and her teammates to take action. She said the issues surrounding a weak pelvic floor do not necessarily start after having a child. The ultrasound exercise was used on her team about four years before she had her first child. Sharelle was referred to another physiotherapist, a pelvic floor specialist, who did an internal ultrasound to further identify how she was switching on her pelvic floor, and help her correctly engage the muscles.

Sharelle has participated in the pinnacle of the game, representing Australia in the Commonwealth Games between 1998 and 2010, winning gold in 1998 and 2002, and silver in 2006 and 2010. She played 118 games for Australia, won two World Championships, and was the Australian flag bearer for the opening ceremony of the 2010 Commonwealth Games in Delhi. In 2016, she was inducted into the Australian Sport Hall of Fame. She currently works as a specialist coach for the Melbourne Vixens and commentates on the sport for Channel 9.

Elite athletes such as netballers, basketballers, gymnasts, trampolinists, tennis players and runners are at increased risk of developing pelvic floor problems. This is because of the constant and excessive downward pressure that these sports place on their pelvic floor.

Sharelle believes the prevalence of continence-issues for netballers is likely due to the sport’s high impact activity involving jumping and running. “And the people playing are mostly female, so rather than it being an issue necessarily specific to netball, it’s likely something happening more broadly and it just happens to be that netball by its nature is one of those activities that has those high impact movements and a high number of female players,” she said. Sharelle returned to elite level netball about three months after she had her first child, Xavier. “So I went back into high level training pretty quickly,” she said. “Particularly with training, I had some pain associated with my pelvic floor which presented as pelvic pain and back pain. So in that year after having Xavier, I had a lot of treatment to help relieve the symptoms but also to work on strengthening my pelvic floor in particular. I was wearing a pelvic band to give myself a bit more stability as well.”

Sharelle said her session with a pelvic floor specialist helped her to properly engage her pelvic floor while she was exercising. This resulted in her being able to strengthen her pelvic floor muscles and reduce her symptoms. “You can see it on the screen and get a sense of that’s the feeling when you’re switching it on properly,” she said. Sharelle said she thought it was sad that research showed many affected by continence-related issues just resort to wearing pads or stop playing netball altogether. “For me personally, going to see someone to help in that space was incredibly beneficial. You don’t have to live with the symptoms of a weak pelvic floor. There are people who can really assist in that space,” she said. “It’s something that a lot of people are dealing with and just dealing with the symptoms is not the answer – it can lead to some much worse issues down the track.

Addressing the cause can really help.” She advises anyone going through any continence-related issues, or any issues related to pelvic or back pain to begin with seeing a physiotherapist. “Get advice to ensure you’re switching on the pelvic floor muscles correctly,” she said.

Gill, N.; Jeffrey, S.; Lin, K-Y; Frawley, H The prevalence of urinary incontinence in adult netball players in South Australia. Australian & New Zealand Continence Journal . Summer 2017, Vol. 23 Issue 4, p104-105. 2p. 1 Chart.

Jen Langford taken from article by Bridge magazine | Autumn 2018 | continence.org.au