The Australian Bureau of Statistics stated in 2018, that 5% of Australians have type 2 Diabetes mellitus. That is equal to one million Australians. Diabetes in fact, is the fastest growing disease in Australia. Currently two hundred and eighty Australians are diagnosed every day. How does this relate to Podiatry, you may well ask?

Type two Diabetes mellitus is a progressive disease. As the pancreas fails to produce sufficient amounts of insulin, blood glucose rises. It also causes a lowering of the good cholesterol (HDL) and a rise in the bad cholesterol (LDL) and triglycerides. This leads to a hardening and narrowing of blood vessels in the legs, compromising blood supply to your feet. Both high blood glucose and high levels of bad cholesterol plus the toxic effects of their metabolic by-products they generate, damages nerves in your feet.

The combined effect can result in numbness, tingling and painful feet.
Also, an increased risk of bacterial infections, delayed healing and ulceration. In fact, Diabetes Australia quotes four thousand four hundred foot amputations occur every year due to diabetes. There are ten thousand Hospital admissions annually due to diabetes and foot ulcerations.

There is no denying the seriousness of this disease adversely affecting your feet. It is not just a touch of sugar.

Prevention is always better than cure.
So, if you are over fifty five years of age, have diabetes in your family, are of Chinese, Indian, Aboriginal or Pacific Island background or if you had gestational diabetes, you are at a high level of risk in developing type two Diabetes mellitus.

If you smoke cigarettes, have high blood pressure, if your waist circumference is greater than one hundred and two Cm if you are male or greater than eighty eight Cm for a female or if your Body Mass Index is greater than twenty five, you too are at a high risk of diagnosis.

If you are always tired, always hungry, put on weight easily especially around your waist, are slow to heal, have blurred vision and are thirsty, these are the symptoms of type two Diabetes mellitus.

So, see your GP for a test. Eat well, exercise and lose weight. See your Podiatrist, Erica Michaelson at

CHP + R, to assess your foot health or provide a comprehensive diabetic assessment.

Erica Michaelson

Podiatrist

Erica consults on all aspects of foot care and lower limb biomechanics, including advice on footwear, running shoes, the assessment of foot posture and orthotic prescription and treatment of foot and lower limb pain. Erica has a special interest in children’s feet, diabetic foot care, skin and nail conditions of the feet and sports and dance injuries.

Erica is very experienced with difficult foot problems and is one of the very few podiatrists endorsed by the Australian Health Practitioners Registration Agency to prescribe medications such as anti-inflammatories, anti-fungals and anti-biotics and to perform pain-relieving foot injections.

An exercise and education program for people with hip or knee osteoarthritis (OA) symptoms.

The GLA:D program is an exercise and education program developed by researchers in Denmark for people with hip or knee osteoarthritis symptoms.

Results from the GLA:D program in Denmark have shown:

• Symptom progression reduction of 32%
• Less pain
• Reduced use of joint related pain killers
• Less people on sick leave
• High levels of satisfaction with the program
• Increased levels of physical activity 12 months after starting the program

 On the success of the GLA:D program in Denmark, this program has been implemented in other countries, and most recently it has been launched in Australia.

The GLA:D Australia program consists of:

• Two education session which teach you about OA, how the GLA:D Australia exercises improve joint stability, and how to retain this improved joint stability outside of the program
• Collection data on your current functional ability
• Group neuromuscular training sessions twice a week for six weeks to improve muscle control of the joint which leads to a reduction in symptoms and improved quality of life

OA is the most common lifestyle disease in individuals 65 years of age and older, but can also affect individuals as young as 30 years of age. Current national and international clinical guidelines recommend patient education, exercise and weight loss as the first line of treatment for OA. In Australia, treatment usually focuses on surgery. The GLA:D Australia program offers a better and safer alternative. The GLA:D program is unique in that the education and exercises provided can be applied to everyday activities. By strengthening and correcting daily movement patterns, participants will train their bodies to move more effectively, prevent symptom progression and reduce pain.

At Clifton Hill Physiotherapy and Pilates and Rehab we were one of the first practices in the country to implement this program which reflects the latest evidence in OA research. We have now been offering the program for more than two years and have had more than 30 participants complete the program. Our graduates have consistently achieved good gains in their physical functioning, high levels of satisfaction with the program. Preliminary analysis of the outcome measures collected from our cohort doing the program at Clifton Hill Physiotherapy have shown the following improvements 3 months after starting the program:

• A reduction in pain levels
• Mean improvement of 7% in walking speed
• Mean improvement of 20% in sit to stand functional test performance
• Significant improvements in quality of life measures

We have also been very pleased to see that our graduates have made active steps towards maintaining their gains and setting new goals either by continuing with the GLA:D sessions as an ongoing program, or by adherence to a progressive home exercise program of both specific neuromuscular control exercises as well as general exercise.

We have also had a few participants complete the GLA:D program at our center as a result of being referred via the trial currently being conducted by La Trobe University on the delivery of the GLA:D program. This trial is still actively recruiting participants, and if you are interested be sure to check out the following link:

http://semrc.blogs.latrobe.edu.au/knee-pain-clinical-trial/

At Clifton Hill Pilates we are currently running the exercise sessions for this program at the following times:

• Mondays at 10.30am
• Tuesdays at 3pm
• Thursdays at 10.30am
• Fridays at 11am

All GLA:D sessions at Clifton Hill Physiotherapy are currently run by Physiotherapists who have officially trained in the GLA:D program including Cathy Derham, Billy Williams, and Adriane Khablyuk.

Be sure to get in touch with our team at Clifton Hill Physiotherapy to find out more about the program if you experience any hip and/ or knee osteoarthritis symptoms, regardless of severity.

Cathy Derham

Continuing with the successful format from last year, our in-house Masterchef comp has a “lucky dip” for the budding chef to pick the feature ingredient. Each dish is judged on taste, presentation, and how well they showcased the feature ingredient.

For an additional twist this year, some new ingredients have been added to spice things up- anchovies, olives, and lemongrass (yummm!)

As the reigning winner from Masterchef 2018, I kicked off the season with the ingredient almond, and made a ‘Chinese almond jelly with goji berries and lychee’. Unfortunately, this did not turn out to be as delicious as I hoped, so it looks like the Masterchef title is up for grabs!

We have had delicious savoury dishes such as Billy’s ‘Mini Baked Potatoes with Mushroom Topping’ and Adriane’s “Cheese Sable Biscuits’.

Some current front-runners are Debbie’s ‘Passion Fruit Slice’, which was the perfect balance of sweet and tart. Ali’s ‘Lemon Sensation Tart’ (pictured) let lemon be the star. Brendan E also dished up a ‘Salted Caramel Brownie Slice’, which was demolished within seconds. Amanda’s ingredient mint was creatively used in a ‘Mint Slice Cheesecake’, which was presented as a giant replica of a Mint Slice! A mint and chocolate lover’s dream come true!

Strong contenders so far, everyone’s waistlines are looking suspicious and we are looking forward to the upcoming delicious creations!

Sonja Tun 

Physiotherapist

Pilates instructor

Masterchef CHP/CHPR/INP Champion 2018

Passionate supporters in the AFL community will more than likely be familiar with the once frequently used diagnostic term, ‘osteitis pubis’. In the early 2000s, it seemed every second player was reported to be suffering from this troublesome injury of the hip/groin which was responsible for significant amounts of missed game time and a complex, challenging recovery period.

However, in recent times you may have noticed that it is very rarely being reported in the media by elite sports clubs. But why is this? Are therapists better at managing groin pain in sport? Is the term extinct? The answer might surprise you…..

Leading into 2014, there was a large amount of disagreement and uncertainty regarding the use of diagnostic terms for hip and groin pathology within the sports medicine and physiotherapy industry. Osteitis pubis, or OP, was often used as an umbrella term to describe a number of injuries which were potentially co-existing, and as such became easily recognisable by the public. It was widely accepted that an athlete with OP would require a lengthy rest period and a graded rehabilitation back into training and sport.

In November 2014, 24 experts in groin pain from a number of backgrounds and countries (including surgeons, sports physicians and physiotherapists) attended Qatar for a meeting to discuss the inconsistencies in hip and groin diagnostics. Prior to the meeting, each expert was given the same two case study examples. These included descriptions of relevant clinical symptoms, results of clinical tests and imaging findings for an athlete who was experiencing groin pain. They were then asked to independently provide their expert diagnosis.

For case study one;

NINE different diagnostic terms for primary diagnosis were used!

For case study two;

ELEVEN different diagnostic terms were used!!!

Across the two case studies, 22 different clinical terms were used to describe primary, secondary or tertiary injuries of the same two case studies! This clearly highlighted the need for an agreement on what should be considered accurate terminology when describing hip and groin pain. This would be critical in understanding the anatomical details of each athlete presentation and facilitating clear cross-referral between practitioners.

This meeting is known as the ‘Doha Agreement’. It advocated that long standing groin pain be classified under the following clinical entities;

• Adductor-related groin pain
• Iliopsoas-related groin pain
• Inguinal-related groin pain
• Pubic-related groin pain
• Hip-related groin pain
• Other conditions (including non-musculoskeletal diagnosis)

These clinical entities are often broken down with further more anatomically descriptive terminologies for deeper accuracy. However, many terms, including osteitis pubis, were not recommended for clinical use by the group of experts.

Since the Doha agreement clinicians are gradually becoming less comfortable with using the term osteitis pubis, and as such the public are hearing it less often. It is still occasionally used as it is easily recognisable by many sports fans, and this helps with honest translation of information from clubs to their fans.

Next time you hear OP mentioned in the media, understand that it is likely an injury related to one or more of the many tissues around the hip and groin such as the adductor muscles, the pubic bone, the hip joint or other physiological structures. An accurate and correctly descriptive diagnosis of a hip or groin injury can be obtained by collaborating information from reported symptoms, high quality clinical assessment and then complemented by diagnostic imaging findings. Once an accurate diagnosis is achieved, an appropriate rehabilitation and return to activity plan can be prescribed.

This accurate diagnosis is relevant if you are an athlete, if you enjoy non-competitive exercising or even to improve your ability to complete common daily tasks such as walking or shopping. The fantastic physiotherapists at CHP/CHPR/INP are experienced in working with sporting and non-sporting patients, and are your perfect first stop to work towards getting the answers to your troublesome hip or groin…. Hint; It’s not osteitis pubis.

Billy Williams, APAM

Bachelor of Physiotherapy

Graduate Certificate of Sports Physiotherapy

REFERENCE:

Weir. A., Brukner. P., Delahunt. E., et al. (2015). Doha agreement meeting on terminology and definitions in groin pain in athletes. British Journal of Sports Medicine. 49(12). 768-774.

Sport Australia recently released the latest AusPlay data which details sports participation across the nation.

Netball has retained its position as the leading team sport for women and girls in Australia, with over 1 million actively participating in netball and choosing netball as the sport they most closely identify with.

It is fantastic to read that female participation is on the rise in many other sports as well- in particular there has been a surge in women participating in AFL since the introduction of AFLW. In the 2017 survey there were 31,542 women participating in AFL once a week .  This number has risen to 59,504 in 2018.  The number of women participating in AFL twice a week or more has risen by 154% growing from 19,005 to 48,225!

We are also seeing an improvement in the professionalism of women’s sport, and it is fantastic to see so many role models emerging.  As young girls are able to see more and more high level women’s sport, hopefully we will continue to see participation rates increase and girls will be more likely to continue playing sport as they grow through adolescence to early adulthood.
Athletes such as Jo Weston (Australian Diamonds netballer), Alyssa Healy (Australian cricket player), Erin Phillips (AFLW player), and Samantha Kerr (captain of the Matildas soccer team), are becoming more familiar names championing women’s sport and demonstrating high performance behaviours for young girls to aspire towards.  The benefits of sport and physical activity are well known, and the more we can foster our young girls and young women to participate the better.

Netball, as a female dominated sport that has been around for a long time, has a well established pathway for participants.  From NetSetGo for 5-10 year olds, through to club netball and pathways for elite performance, there are also avenues for recreational participation for all ages.  There are many social netball competitions around Melbourne as well as Vic Health and Netball Victoria’s “Rock Up Netball” initiative which enables people to play when they like without the weekly commitment of a club or team.

Hopefully over time we begin to see these similar pathways across many other sports to help bring more young girls and women into sport and keep them involved across their lifespan.

Jane Higgs

Physiotherapist and Pilates Instructor

References
https://www.clearinghouseforsport.gov.au/research/smi/ausplay/results
https://www.sportaus.gov.au/media_centre/news/australias_top_20_sports_and_physical_activites_revealed
www.rockupnetball.com.au
www.netsetgo.asn.au