Welcome to Monty Physio

Peter Dal Lago is a physio who lives locally and loves treating clients in the community from all ages and stages of life.

Peter started Monty Physio is 2018 as a part-time venture, but has now become a full time passion. He currently works with local sporting and community clubs, gyms and other health professionals to assess and treat a variety of injuries and conditions.

He has completed advanced training in shoulder pain, hip pathology, dry needling, strength and conditioning, osteoarthritis and more! He is currently enrolled in a Graduate Certificate of Sports Medicine at Melbourne University, which will be (hopefully) complete by mid 2022!

Read more via the Monty Physio website here:

https://www.montyphysio.com.au/a-b-o-u-t

ARTICLES:

Osteoarthritis - What is it, and What is the Best First Treatment?

How Should My Home Office Be Setup?

Headaches From the Neck

Jumper's Knee

Shoulder Exercises for Strength and Stability

A Spike in Overuse Injury

-   Ensure your screen height is elevated to eye level. When using two screens, setup in the middle of both screens or in front of the one you predominately utilise

-   Arms and shoulders should be relaxed and supported

-   Sit deep into the chair. I am reluctant to say “sit up straighter”. There are many of us who adopt a lumber posture that is hyperlordotic (the opposite of being slumped and slouched). This can be just as detrimental to the spine. Adapt a supported sitting position

-   Keep feet flat on the floor, use a stool if required. Alternatively if you are quite tall, you may need to adjust chair or desk height. A good rule of thumb is knees and hips should be roughly 90 degrees bent.

-   Alternate between sitting and standing positions.

More importantly than any of these things mentioned, is to make sure you are getting up a number of times through the day. No amount of perfect desk setup or good posture can replace movement. Our spine and joints need it to stay healthy!

Going for a brisk walk or run, doing some home gym/pilates/yoga exercises, or your own movement routine each day is great for the body, mind and helps keep you injury free!

If you are experiencing pain or injury from working from home and need either advice or treatment, get in touch today! Physiotherapists can assess your problem, give you the advice and treatment needed for making sure working from home is an enjoyable way to work. 

Peter Dal Lago

Monty Physio

montyphysio.com.au

9424 8887

WHAT IS CERVICOGENIC HEADACHE?

Pain can come from muscles, joints and ligaments at the upper cervical spine that are experience in the forehead or face. An area of dense nerves in the lower brainstem (trigemino-cervical nucleus) receives sensory messages from the upper neck, but also from a nerve (trigeminal) that extends to the face and top of the head. We may have a problem in the upper neck, but the brain cannot distinguish whether the pain is from the neck or the face/forehead. The result is headache, however treatment is targeted at the cervical spine. 

WHAT CAUSES THIS TYPE OF HEADACHE?

Disfunction in the neck leading to headache can come on suddenly, or develop over a period of time. Common issues like sustained desk and computer work, poor postures, reduced strength of neck muscles or stiff muscles or joints may lead to cervicogenic headache.

HOW IS IT TREATED?

Physio treatment like performing hands on therapy using joint mobilisations and soft tissue treatment to surrounding muscles are common ways to improve symptoms and reduce headache. It may be important to improve other contributing factors that may be present such as:

•             Lifestyle - how we work, how we sleep, stress, how sedentary we are etc
 

•             Upper body and neck strength/flexibility
 

•             Sustained positions and postures relating to work or leisure
 

It is important to get a comprehensive assessment performed by the physio if you suffer headache, as the source of this pain can be due to a number of reasons. The most appropriate treatment path can then be taken.

Feel free to reach out if you or someone you know may benefit from physio treatment. Our online booking system is easy! New patients are welcome.

https://www.montyphysio.com.au/appointment

PATELLA TENDINOPATHY

Jumper's knee is a term used to describe patella tendinopathy, pain just below the kneecap

The patella tendon runs from your patella (kneecap) and attaches to the bony prominence around 5cm below the patella. It is a continuation and insertion point of the quadriceps (thigh) muscles.

WHAT HAPPENS IN TENDINOPATHY?

Tendons exist all throughout the body, and they join muscle to bone. They play a crucial role in energy storage and release when we use our muscles, which gives us the ability to move very efficiently. When a tendon (tendin-) becomes disordered or diseased (-opathy), there has been a mismatch between how much work the tendon can do, and how much we have asked it to do. In 'Jumper's knee', it is the patella tendon that is affected. It is not helpful to think of these injuries as "overuse" injuries, as this implies that doing a lot of activity is bad. Our tendons actually love doing work and getting loaded up. It is when our body is not able to adapt to the load we have placed on it that causes a problem.

WHY IS IT CALLED JUMPER'S KNEE?

The patella tendon play a key role in allowing us to jump and land. As the quadricep muscles contract, they help us to propel into the air. When we land, they also contract in order to assist in absorbing shock and transferring energy through the lower limb to the pelvis and trunk. The tendon plays a key role in this process of energy storage and release. This injury is common in sports that involve a lot of repetitive jumping like basketball, volleyball, netball or football.

CAUSES

The causes can be broken down into two categories. It is often not quite this simple, but this allows for a simpler explanation.

Intrinsic Factors - your body and what is unique to you.

We all have variations in the way we move. We may have areas of the body that are weak, tight, inflexible and so on. An action like jumping is not isolated to the knee. We have a foot, ankle, hip, pelvis, trunk (core) and upper body that all contribute to the action of jumping well. If there is a break down anywhere along this chain, structures such as our patella tendon may be asked to compensate and make up for this. Common problems I see related to patella tendinopathy is poor power and strength in the calf muscles, gluteals or core strength. Yes the quadriceps themselves may be at fault also, however it is common that there is a breakdown either below or above the injury site that leads to the overloaded patella tendon.

Extrinsic Factors

These are factors not related to your body specifically but can place excessive load on the patella tendon. This may include a change in activity or a sharp increase in activity. It could also be a change in footwear, or the surface that you're playing sport on

HOW TO TREAT AND MANAGE JUMPER'S KNEE

The list of intrinsic and extrinsic causes of patella tendinopathy can be long. That is why managing this injury is not a one size fits all approach. Management can require patience and a multifaceted approach.

Click below to find out what the best treatment options are for this injury

https://www.montyphysio.com.au/post/what-is-jumper-s-knee

If you have any questions or queries about about knee pain, or any other tendon related pain, get in touch today!

Pete Dal Lago

Physiotherapist

9424 8887

Shoulder Exercises for Strength + Stability
 
The shoulder joint is a highly mobile joint and relies on the strength and stability of its surrounding muscles for good function. We need a nice smooth, controlled movement of the shoulder blade (scapular) and stability at the shoulder joint (glenohumeral joint) for good upper limb function and staying injury free. 
 
You may be aware of the four rotator cuff muscles that are small, important stability muscles at the shoulder joint. They can be prone to tears, strains, tendinopathy or trigger points leading to pain - so ensuring they are strong is important. The less talked about muscles are at the shoulder blade and ensure a smooth movement occurs at the shoulder. Our shoulder joint makes up two thirds of our arm elevation movement, with the other third contributed by the scapular, so dysfunction of these muscles leads to a shoulder joint at risk of injury! 
 
Click on the link below to read 4 great exercises for shoulder stability and strength. 

https://www.montyphysio.com.au/post/4-great-exercises-for-shoulder-stability

A SPIKE IN OVERUSE INJURIES

We have seen a spike in overuse injuries since the reopening of runnings events, community sport and those who are getting back to full time exercise.

Stress fractures fall into this category of overuse injury, where an imbalance exists between bone resorption into the body and laying down new healthy bone, leading to bone stress and eventually fracture. This can be a painful condition, with lengthy rehab and time out activity or sport, so prompt diagnosis and treatment is important. Also being aware of risk factors and implementing injury prevention strategies can be crucial for avoiding these injuries in the future!

Stress Fracture in the Lower Body

2021 has seen a resurgence of people getting back to sport, activity and training. Overuse injuries can occur when there is a sudden change in activity, and stress fractures are no exception.

Stress fractures are a relatively common overuse injury where bone becomes overloaded from repetitive stress. Also called fatigue fracture, it is due to repetitive submaximal loads onto otherwise healthy bone. It is distinguished from "insufficiency fracture", which is cause by normal loads on unhealthy bone. They represent a spectrum of injuries ranging from periostitis (inflammation of the periosteum of bone) to complete stress fracture that includes a break in the bone.

The lower body is a common site of stress fracture as it is exposed to weight bearing forces. Any activity that places repetitive load on the bones of the lower body can lead to stress fracture, and the cause can be from a multitude of factors.

Common injury sites include (but not limited to!):

Tibia bone (leg)

Stress fracture of the tibia is among the more common stress fracture sites, often seen in

  long distance runners. Pain will be on the inside part of the bone (medial) and may be

 painful to palpate, walk, run or hop.

Metatarsals (forefoot bone/s)

The metatarsals are another common site of stress fracture. Often seen in dancers or

 activity involving repetitive movement onto the "tip toes"

Navicular bone (midfoot)

The inside of the midfoot lies an important bone called the navicular. Is supports the

 arch of the foot and is the attachment site of the tibialis posterior muscle. This bone is

 high risk fracture site as blood supply can be poor and lead to insufficient healing after

stress fracture

Femur (thigh bone)

Also common in runners, the large thigh bone has the potential for stress fracture either

 at the neck of the femur, or the shaft. Symptoms may be masked as muscle strain.

HOW DO THEY OCCUR?

Bones are continuously undergoing a process of remodelling, which balances bone resorption with formation of new healthy bone. This process is in response to mechanical stress, which is a normal adaptation to load on bone during activity or daily tasks. When there is an imbalance between bone resorption and new bone formation, microfracture can occur and this is the beginning of bone stress, which may then eventually lead to a fracture in the bone if high loads continue.

CAN STRESS FRACTURES BE PREVENTED?

There are a number of risk factors that may predispose you to a stress fracture such as:

- a sharp increase in training load, or a change to training conditions

- having a low body mass index

- nutrition factors

- being female

- biomechanical factors they may influence load on bone

However, since there has to be an increase in load to the bone for the stress fracture to occur, preventing injury is best done by minimising the rate or degree of change to your training or sport. On top of this, performing regular resistance training and eating well are two effective ways to minimise your risk.

HOW DO YOU MANAGE A STRESS FRACTURE IF ONE DEVELOPS?

Everybody is unique in their experience of stress fracture, and people will have individual factors that determine the cause of the stress fracture.

Most people will require a period of rest from loading the bone to ensure adequate healing can occur. This can sometimes involve a period of non weight-bearing or protected weight bearing such as using crutches if required. On top of this, addressing any underlying biomechanical issues will help with recovery and prevent recurrence. A gradual return to activity can commence when there is adequately reduced pain at the fracture site, determined by a range of tests.

WILL I NEED AN X-RAY OR ANOTHER SCAN?

That will be determined by your treating physio or sports physician. Not all stress fractures (especially when they are recent occurring within the last 2-3 weeks) will show up on an x-ray, however they can be of assistance in diagnosis and add to overall management when appropriate. 

Your physiotherapist can help with assessment, diagnosis and management of stress fracture, as well as ensuring a safe return to activity and injury prevention in the future.

Peter Dal Lago

Physiotherapist

REFERENCES

Kiel J, Kaiser K. Stress Reaction and Fractures. In: StatPearls. StatPearls Publishing, Treasure Island (FL); 2020.

Behrens, S. B., Deren, M. E., Matson, A., Fadale, P. D., & Monchik, K. O. (2013). Stress fractures of the pelvis and legs in athletes: a review. Sports health, 5(2), 165–174. https://doi.org/10.1177/1941738112467423