On a cool summer’s afternoon, you decide on a comfortable jog in the mountain.  Less than a kilometre into your run, you suddenly step into a hole emerging out of nowhere. With a nasty twist and a jerk, you drop down to the ground with a sharp pain shooting from your ankle.  One hour later, you are lying on the couch with a blue, swollen foot elevated on a pillow.  The icy sharpness and burning of the cold pack tightly wrapped around your poor lower leg makes you feel even more sorry for yourself.  Your son’s crutches from last year’s rugby injury are on standby right next to you, and you will soon be hobbling back to the fridge to put the ice pack back to prepare for another torturing session in two hours’ time.  But you know that this is what you need to do, right?  In acute injury follow the RICE principle: Rest, Ice, Compression, Elevation.  Surely this should resolve in no time then?
Well… no.  In fact, you may be doing more harm than good to your recovering ankle.  New research is bringing about a total revolution at how we treat acute injury.  To understand the newer rationale, we first need to understand what happens when we hurt ourselves.

What happens to the body during injury?
Acute injury brings about tissue damage, and the body’s protective and recovery mechanisms immediately kick into place.  Fighter cells are sent to the area to remove and digest dead tissue cells, and to kill off any potential foreign objects that may threat the body.  Tissue healing starts immediately, and more oxygen and nutrients are needed in the area.  All of this brings about a rapid increase of blood flow to the injured area, causing swelling, increased temperature and redness – all signs of acute inflammation.  We need to realise that inflammation is a good thing.  Without it, normal recovery will not be able to take place.

How can we help our bodies to recover optimally?
Firstly, we should not interfere with the body’s natural inflammatory process.  Allow for normal regulated blood flow to the area, keep it moving and keep the tissue loaded.  Secondly, we should respect pain and use it as an indicator of how much our bodies are able to do.  Movement and relative loading of the joint is important, but should not be done to an extent where more tissue damage will occur.

So what’s wrong with the use of ice and crutches…?
Ice slows down the blood movement to the injured area, thereby delaying the process of inflammation and healing.  Ice exposed directly to the skin often also causes damage to the skin and tissue.  Although it may improve your pain on the short term, it causes stiffening of the surrounding joints, making movement more difficult and painful.
Complete immobilisation by means of crutches takes away normal joint movement.  Healing tissue is dependent upon normal joint movement in order to produce the correct type of fibres, aligned in the correct direction.  Movement of the injured part also stimulates normal blood flow to the area, thereby assisting with inflammation and healing. Important: crutches are not altogether bad. If you can only take partial weight on the foot without pain, you should be using crutches to make sure that you have an optimal available movement.

What is the new direction of thought?
The acronym RICE (Rest, Ice, Compression, Elevation) is popularly replaced by MEAT (Movement, Exercise, Analgesics, Treatment).  Let us look at this new kid on the block in more detail:

• Movement is anything opposed to immobilisation.  This can be slow, graded movements of the foot, or pendulum swinging of the shoulder, or it can be active neck flexion or brisk bending of the knee – as long as it is done within limits of pain. Movement allows for normal tissue healing and improved blood flow to the area, all aiding the recovery process.
• Exercise may be explained as movement with function which poses some amount of challenge.  It can range from rehabilitation activities such as resisted movement or stationery muscle contractions, to functional activities such as walking, hanging laundry or climbing stairs.  Exercise strengthens the muscles and soft tissue structures within their functional capacity, and gets you integrated into normal activities.  Exercise should be introduced and controlled by a health care professional.
• Analgesics decreases the pain element to allow for movement to take place.  Although dampening of pain may help with optimal movement, proceed with caution.  Pain medication should never be used as a quick fix to get back into your exercise routine as soon as possible – if you simply kill off pain and carry on without properly conditioning the injured muscle, you are highly prone to re-injury.
• Treatment underlines the importance of having your injury monitored by a health care practitioner, such as a medical doctor or physiotherapist, who will treat you according to the grade of injury and the phases of healing and rehabilitation.  Strictly comply with the suggestions made by your health care practitioner in order to ensure optimal recovery of the structures.

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Is this a final goodbye to RICE?
No, not necessarily. Fractures, ligament tears and many other serious injuries still needs to be splinted and immobilised; ice applied once or twice directly after injury will still help to ease the pain; and compression stockings will still assist those with chronic swelling of the legs. Crux of the matter is that, as health care practitioners and patients, we should shift our focus from simple recipe following to critical thinking. Careful evaluation is necessary, after which appropriate treatment modalities should be selected that will best address the specific injury.
So whether using ice, exercise, pressure or painkillers, always think about why you are doing what you are doing.  At the end of the day, treatment should always rest on the big rule of medicine: first do no harm.

A bit of background on movement:
Active motion is performed voluntarily using your own muscles (e.g. actively bending forward or turning your neck). Passive motion involves no active muscle input – the body part in play is passively being moved around the joint by an external force. Passive motion can take place through typical active movement patterns (passive physiological) or involve movements that cannot be performed actively at all, such as pulling your finger joints apart (passive accessory).
Joint popping may sometimes occur during non-forceful active movement (for example, looking over your shoulder). As long as the popping is NOT PAINFUL in any way, there is usually little risk for long-term harm. If the popping is becoming increasingly uncomfortable or painful, have it checked out. Research on passive joint manipulation has different outcomes, however. Knuckle cracking, for example, has been shown not to be associated with joint degeneration as is popularly accepted.
In my personal opinion, any force applied to your body that you do not have muscular control over, needs to be handled with extreme care. As a rule of thumb, I always advise my patients not to do any forceful passive motion of any part of the spine (like, for example, forcing your neck through extreme angles of rotation and giving it an extra pull at the end of range). Especially in the vertebral column, uncontrolled joint manipulation may lead to a whole lot of bad things:
· Reactive muscle spasm
· Joint irritation and Inflammation
· Overstretching of ligaments, potentially leading to
· Joint instability
· Spinal disc injury
Uncontrolled spinal manipulation can have very serious effects, including vertebral fractures, stroke and even death. Therefore: NEVER allow any person to attempt any cracking of your spine if he/she is not a registered medical professional with training in joint manipulation

​Joint manipulation is done by carefully graded, passive accessory movement of a skeletal joint, performed to achieve a therapeutic effect.
Scientists believe that manipulation of the spine has the following effects:
· Stimulate and mobilise joints in the vertebral column, which is covered in a extensive network of nerve tissue;
· Pain-stilling response due to the alteration of the way the joint senses pain;
· Reflexive relaxation of the muscles surrounding the joints;
· Reduces joint stiffness

​Yes, certainly. Not all joints will necessarily be ready for cavitation. For this reason, physiotherapists will first do slow, gentle mobilisation techniques to assess and treat the joint in the available pain-free range of motion. If the tissue won’t allow for a manipulation, the mobilisations done in preparation would have already been of great benefit for the structure treated.

​It is important to understand that joint manipulation is not a quick-fix once-off solution for your pain – in fact, it may not even be indicated as technique at all to treat your condition. The human body is an extremely integrated system, and no part of it can ever be treated in isolation. The road to recovery is a multi-level process, of which joint manipulation may only form a part. Other concurrent treatment techniques and rehabilitation are of great importance to obtain optimal recovery.

Manipulation is a very effective method in the treatment of spinal joint pain. But remember, always respect your medical professional’s opinion if he/she is not comfortable to manipulate. They are probably following the most important rule of medicine: First do no harm.

What is “bamboo spine”?
Ankylosing spondylitis (AS) is a lifelong disease which causes inflammation in the spine on an ongoing base. It varies in severity from patient to patient.  In the worst (but not all) cases, it can cause extra bone growth on the spine, leading to severe stiffness and immobility, often creating a forward-stooped posture.

Who is at risk?
Men and women of all ages can get AS, but the disease is more common in males in the age group of 17 to 45 years. AS also has a strong genetic link and may run in families.

What are typical symptoms?

• Back pain – usually starts in the lower back and sacrum, and can eventually spread to the rest of the spine.
  
• Pain in other areas, particularly the shoulders, hips, ribs, heels and small joints of the hands and feet.
  
• Episodes of pain – the pain will flare up for certain time periods, after which a period of relieve of symptoms will follow.
  
• Stiffness of the back – immobility of spinal sections, and in severe cases, fusion of the vertebrae can take place.
  
• General fatigue is a common symptom which accompanies chronic inflammation
  
• Eye infections occur in about one third of AS patients

How is it diagnosed?
A diagnosis is made on the grounds of medical history, clinical symptoms, blood tests, X-rays and/or MRI.

Cause and cure?
The cause of AS is still unknown.  Although no cure has been found, methods exist to slow the course of disease.  Treatment focuses on pain management and maintenance of mobility and functionality. Regular visits to the rheumatologist and physiotherapist is important.

What is the prognosis?
AS is a slow-progressing disease.  The course of disease varies greatly from person to person. Some patients only experience mild lumbar pain from time to time which is easily resolved with the use of anti-inflammatory medication.  In other people, symptoms can become much worse with time, eventually leading to disability and postural deformity.  

You can lead a normal life!
Although symptoms of AS can cause great discomfort at times, it is a condition that can be well managed with the correct medication and regular physiotherapy. Many patients with AS have excelled to great heights.  Famous sport stars with AS include Australian cricketer Michael Slater, professional surfer Shane Wehner, US powerlifter Randy Gallan and British golfer Michael King.

Source: www.spondylitis.org

You know the feeling when your pubic pinchers just won’t co-operate, and a sudden sneeze or giggle leaves you red-faced and uncomfortably wet…? Think it’s only you? Think again. Recent studies have shown that up to 49 % of women suffers from stress incontinence.Unfortunately, even in today’s streetwise society, a shocking amount of ladies accept this as part of normal aging that nothing can be done about.  Guess what – there is hope! There is no need for you to be a victim of incontinence.

Understanding why

The pelvic floor muscles support and hold all the organs in your pelvis and abdomen.  Think about it as a sling stretching from your tailbone to your pubic bone.  During pregnancy, a massive amount of weight from your growing uterus create constant pressure on these muscles, causing them to stretch out and weaken. Pregnancy hormones will also cause the ligaments in the area to become lax.  With childbirth, the already taut muscles need to stretch even more, with many ladies ending up having them torn or cut as well.  Then, as we age, our muscles loses elasticity, and keeping in wees and winds become more of a challenge.  Menopause brings about hormonal changes that contribute to the problem. When this situation worsens, a prolapse may occur, and organs may literally start to protrude from, or “hang” out of the body.

What can be done?

The pelvic floor muscles can and should be retrained and strengthened. Unfortunately, once you have a prolapse, surgery is often the only option.  It is therefore a good idea to prevent rather than to cure, and by doing regular pelvic floor strengthening exercises, you should be able to avoid surgery, and improve your quality of life considerably.  

For a proper assessment and assistance, visit a physiotherapist with special training in women’s health.  Apart from advice and rehabilitation, they also use physical modalities to help improve your control and muscle strength.  Like with any other muscle, the more you train it, the stronger it will become and the better your results will be.


Who should proceed with caution?

If you struggle with a spastic bladder, difficulty to urinate (micturition), experience pain during intercourse, or have any other chronic medical condition in your pelvic area, you should visit a healthcare professional to assist and monitor your retraining.

How do I contract my pelvic floor muscles?

The female pelvic floor has three openings: the ureter, the vagina and the anus.  You should be able to contract these three separately, and then in conjunction.  Contract the ureter by imagining “pinching” back urine. (Important: This should only be done once or twice when doing your pelvic floor exercises, especially if you struggle with a spastic bladder.)  To contract the anus, you can imagine holding back a wind.  The most important is the contraction of the vagina, as this is the area that takes the most strain. Contract by visualising the centre of your pelvic floor closing up and lifting towards your belly button.  Simultaneously, visualise two magnets fixed on the insides of the palpable pelvic bones in the front waist area, and imagine them gently “pulling” towards each other.  Hold this contraction for 5 to 10 seconds, and relax.

If you can manage all contractions of the ureter, vaginal and anal areas separately, do them consecutively, starting from the tailbone, through to the pubic bone.  Hold the contraction for 5 to 10 seconds, and relax.

…and then what?

Do the combined contraction as often as possible. Make it part of your daily routine, do it every time your phone rings, or when stopping at a red traffic light, or when hitting the “print button”, whatever it is that you do on a regular basis. You do not only strengthen the muscle itself, but also teach the brain to contract these muscles involuntarily in the long term.  

If you struggle with occasional incontinence, pelvic floor strengthening can make a dramatic difference in time.  For mommies-to-be, a stronger pelvic floor will heal much quicker after birth.  And for those of us that have already given birth – get them pelvic floors firmed up now!

Winter has officially arrived! Unfortunately, so has a whole bunch of germs bugging our airways. Children are much more susceptible – as a new parent, I found that out the hard way. A bronchiolitis turned pneumonia recently sent my 3-month old straight into ICU in no time – an experienced that I would prefer never to have again...! 

As parents, we want to be vigilant for any threatening signs of disease, but are also (much too often) afraid of being paranoid. How should I know if my child’s cough and runny nose is simple a minor ailment, or if I should seek medical attention? Below are some symptoms to watch out for. The more of these occurring in combination with your child’s apparent flu, the more serious it may be.

Fever: any fever recurring after fever medication has worked out is a sign that the body is fighting off something significant. Especially in infants younger than 3 months, rather visit the paediatrician sooner than later. Don’t wait too long with older babies either – even a mild-degree fever can lead to convulsions if not resolved timeously.

Lethargy: When your quaint little busy-body toddler is suddenly just a passive heap of misery and grumps, something is wrong. Ill infants may be sleepier in general, and more irritable when awake. 

Appetite issues: A usually munchy munchkin who refuses to eat or drink, may indicate illness. Apart from the risk of dehydration, your little one will not gain sufficient energy for his body to resist the disease. In toddlers, differentiate between true symptoms and possible manipulative behaviour.

Faster breathing rate: Babies breath faster and often more superficial when having airway trouble. To make sure, count the amount of breaths that your healthy child takes in a minute while she is sleeping. This will give you a standard to compare it to when she is ill. Just remember, babies’ normal amount of breaths per minute will decrease with age.

Paleness: An unusual pale colour should get you on alert. No need to run to the doctor if there are no other symptoms though – just monitor her closely. If uncertain whether you are imagining paleness, take a photograph and compare it to one taken quite recently.

Poor sleeping: A child who struggles to breathe, may not be sleeping well. If the sleeping pattern is more disturbed than usual, be on alert.

Nasal flaring: This usually occurs in the more advanced stages of airway disease. Seek medical attention if you haven’t yet done so.

Rib recession: Rib recession refers to a sharp inward pull of the muscles on the sides of the thorax/abdomen, just below the ribcage when breathing – you would almost see a “dent” when she inhales. This is also a sign of respiratory distress, and should be monitored by a medical practitioner.

Blueness around the mouth: If you see a blueish colouration around your child’s lips, this may indicate an oxygen deficit. Also check her tongue, fingernails and toenails for a blueish colour. Seek medical attention.

Painful coughing: This may be indicative of a number of conditions affecting the upper- or lower airway conditions. If your child cries with pain when coughing, have it checked out.

Remember, early intervention is key – the sooner a disease is picked up and treated, the better. 
Rather be grateful for an “unnecessary” trip to the doctor, than regretting not going in time. And above all, trust your motherly instincts – they are more than often spot-on.