Felicity Moore physiotherapy

08/07/2023

03/05/2022

It’s finally here - 45min long recovery sessions in the Normatec Boots (and additionally the Venom Back heat and vibration wrap around) available for online booking!

Head to the Excell Physio website for details 🥳

27/02/2022

🧩 Case Study 🧩

No, this is not my own MRI scan - but actually one of my current clients who is going through their own trial of non-surgical management for an ACL rupture.

Their particular situation:
- ACL rupture from a non-contact change of direction movement in a netball game
- No concurrent meniscal damage
- No previous knee injuries
- No time pressure to return to sport
- Nil incidences of giving way/instability
- Read through the information thoroughly and made their own educated decision to trial an extended pre-hab (now 5 months post initial rupture)

The MRI is clearly starting to show some elementary healing of the ACL without any surgical or bracing interventions, which seems to correlate well with some of the emerging evidence on non-surgical management!

The MRI is only part of the picture though, and their progress is also being monitored through regular strength assessments, hop/jump assessments, subjective questionnaires, normative data comparisons, as well as consultations with a surgeon who is monitoring their journey closely as well.

Very cool to see some more case studies emerging, fingers crossed for some higher level research coming through over the next few years!

*************
Filbay, S., Roemer, F., Lohmander, S., Turkiewicz, A., Roos, E. M., Frobell, R., & Englund, M. (2022). 32 Spontaneous healing of the ruptured anterior cruciate ligament: observations from the KANON trial.

23/01/2022

The Australian men’s team forfeited their second consecutive game today, at the Asian Men’s Championship, due to a high number of players forced into quarantine after returning positive Covid-19 tests. The Aussies were due to meet Hong Kong in the placement rounds of the championship but were un...

13/01/2022

🤾‍♂️ Australian Mens Handball 🤾‍♂️

Especially in these crazy COVID times, it has been a miracle to actually make it overseas to travel with a team again.

In under supported sports - such as handball in Australia - being a sports physiotherapist is so much more than the usual job description.

It means being part of team community: helping out with meals, team laundromat adventures, attending all trainings, having feedback about on court performance, knowing who makes the best coffee, sight-seeing through different countries and knowing the card games (for when you occasionally get a break from treating).

However, time and time again, the sense of community and gratitude from these teams keep you coming back every year.

It’s great to be back, and once we finish up our training camp in Dubai - we are headed to Saudi Arabia for the big show 🇦🇺

13/09/2021

✂ Surgical or Nonsurgical Management ✂

This is a hotly discussed topic within the physiotherapy/allied health profession. When looking into the research, there has been some key points that stood out to me:

🦵 Emerging evidence around minimal difference in OA changes comparing ACLR, delayed ACLR and exercise alone groups

🦵 Good outcomes in knee function in pain with both ACLR and nonsurgical management

🦵 Varying reported levels of return to sport after exercise therapy alone, if they continued with exercise therapy and identified as a 'coper'

🦵 Some lower level evidence suggesting that the ACL can have some healing without surgery

🦵 If I continue to have knee instability with exercise based treatment, I can opt for a delayed ACLR

The main aspects I considered when looking at my particular case were:

🔘 Making sure I did not meet the exclusion criteria for the KANON trial: meniscal lesions, osteochondral lesions, smoker, elite athlete, rupture of other cruciate ligaments

🔘 When considering bracing protocols to assist with nonsurgical ACL healing, I was looking predominately at whether I would be able to continue working/functioning with these restrictions (and sorry, props to you if you can work for 4 weeks with your knee in a 90 degree non-weight bearing brace, but at this stage I could not)

🔘 Taking into consideration the fact that I am quite hypermobile, and there is limited research around this and nonsurgical ACL management. Most surgeons who I have worked with previously have suggested that ACLR with the lateral extra-articular tenodesis would be the best option for similar patients.

🔘 Discussion around all of these factors with my Sports Physician and Sports Physiotherapist, to make sure that I take my ego out of the equation and ask for help when needed!

Therefore, as I am sure many of you have deduced, I am leaning towards nonsurgical management with the option for delayed ACLR should I prove to be a non-coper.

I would highly recommend the .physio Non-Operative Masterclass for more information and a very detailed discussion of the research.

08/09/2021

🤕 🤕

In an unfortunate turn of events, I ruptured my ACL playing netball last week.

As a physiotherapist who has always promoted an active lifestyle and strength training, this initially felt like a fail on my behalf.

However, we cannot control everything about our training and competition prep - and COVID has really thrown a spanner in the works for myself and many of my clients.

Although I rode the wave of emotions at first, I have come to the conclusion that this is a great opportunity for me to experience ACL rehabilitation first hand.

My inner nerd has had a field day, having filled my weekend watching the ACL masterclasses from .physio discussing surgical management vs non-surgical management, and whether this will have implications with return to sport and long term development of osteoarthritis.

Enjoy a happy snap of my MRI for those that are interested! And don't worry, I will still be continuing active treatment in clinic, and endeavouring to keep you all informed along the way.

06/09/2021

🥨 Hypermobility 🥨

Its my experience that hypermobility is a poorly understood concept within the allied health community and literature, or maybe that's only because I am a little sensitive due to ticking off quite a high score myself!

The literature surrounding hypermobility seems to be quite confusing. There are multiple suggestions of which Beighton scores suggest a diagnosis of joint laxity (generally ranging from 3-5), as well as other symptoms that add diagnostic value such as:
⚪ History of joint dislocation
⚪ History of varicose veins, hernia, visceral prolapse
⚪ Soft tissue lesions
⚪ Eye signs, lid laxity
⚪ Arthralgia in 1-3 joints (joint pain)

In my eyes, while the research is constantly emerging and developing, I see hypermobility as a broad range of symptoms seemingly on a scale.

However, each patients presentation is different. When some joints are hypermobile, it seems inevitable that other joints/spinal sections are hypomobile. I find it invaluable to know these aspects when approaching treatment plans for my patients, and understanding how they move.

A quick check of joint laxity that I use within clinical practice is The Beighton score - quick to check, and I find it gives me an understanding of where this particular patient is along the scale. (Without going into detail of other conditions such as Ehlers-Danlos syndrome and Marfan syndrome)

Do you also use this score within clinical practice?

08/08/2021

😷 Post Lockdown Update 😷

Can't wait to see you all back in clinic, please don't hesitate to get in contact with us if you have any questions about your upcoming booking!

15/07/2021

🚣 Lower Back Pain in Rowing: On Water Considerations 🚣

As physiotherapists managing injuries in other sports such as running or cycling, I think we have become quite proficient in asking about changes in external and internal loads that may have contributed to the "overload" injury presenting in front of us. For example, changes in shoes, training load spikes in volume or intensity, different running surfaces or changes in nutrition/fuelling.

Do you regularly consider this with rowers as well?

Specific to their on water training, a few factors have been linked to the development of lower back pain, specifically:
🔘 Recent boat setup changes - foot plate adjustments, oar length, height of the gates etc
🔘 Rough water for training - increasing loads through lower backs to assist with balancing the boat
🔘 Changes in crew members - contributing to altered loads through the stroke and may contribute to balance setup of the boat
🔘 Changes in sides through sweep boat - however this technique may be used to relieve unilateral back pain occasionally

Understanding the sport and its demands will assist with being more specific in your diagnosis, management and return to performance. As well as prevent re-injury!

Wilson, F., Thornton, J. S., Wilkie, K., Hartvigsen, J., Vinther, A., Ackerman, K. E., ... & Ardern, C. L. (2021). 2021 consensus statement for preventing and managing low back pain in elite and subelite adult rowers. British Journal of Sports Medicine.