June 1, 2018
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Petellofemoral Pain Syndrome AKA Runner’s Knee – What is it?

Patellofemoral Pain Syndrome.png

By Ghislene Goh, Physiotherapist at LifeCare Cockburn

How could I have Runner’s Knee? I don’t even run!

Runner’s knee (otherwise known as Patellofemoral Pain Syndrome) got its nickname for a good reason; it’s common amongst runners. However, this painful condition affects people who don’t run too. It’s actually one of the most common knee problems, affecting around 25% of the population.

Why does it happen?

Runner’s knee is a condition that can be caused by general overuse, trauma, such as a direct hit to the knee, bones not lining up correctly, problems with feet or the breakdown of cartilage in the knee.
The kneecap (patella) normally moves along a groove in the thighbone (femur). If the kneecap is not sitting within the groove for the reasons outlined above, the misalignment causes the patella to rub directly against the femur.
Running can irritate the spot where the kneecap rests on the thighbone, as the knee bend action causes increased contact between both the patella and the femur. 
Runner’s knee could also occur as a result of having weak hip and buttock muscle control or poor foot posture.

What are the symptoms?

Most people experience a gradual onset of pain that is noticeable during weight bearing activities, such as squatting, running, jumping and landing, going up and down stairs or sitting with a knee bent for a long time. 
The area around your knee could swell, or you might hear popping or have a grinding feeling in the knee.
The resulting pain in front or behind the kneecap can be sharp and sudden or dull and chronic and this condition can eventually cause joint degeneration. 

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Treatment and management

It’s best to take both a short and long term approach to treat and manage this condition. 
The primary short-term objective is to reduce inflammation and pain. So rest your knee, ice it and elevate it to ease pain and swelling.
While you get better, you need to take it easy on your knee. That doesn’t mean you have to give up exercise, just take a break from high impact activities. Try a lower impact activity that won't hurt your joint, such as swimming or cycling. 
Longer term, working with a physiotherapist or exercise physiologist can help prevent the injury from re-occurring by developing an injury management or rehabilitation plan for you.
As your knee pain improves, you can then gradually return to normal activities.

How can I prevent Runner’s Knee?

If you want to treat or avoid Runner’s knee, add strengthening and stretching exercises into your fitness routine. Wear quality running shoes and ensure you’re wearing the right shoes for your foot type and gait. Make sure your foot is well supported and consider orthotics if your shoes don’t address the issue. Warm up before you work out, try not to run on hard surfaces like concrete, and maintain a healthy weight.

Don’t put up with knee pain when you don’t need to. Click the button below to book an appointment with a LifeCare physiotherapist to start working towards your goal of safely returning to the fitness routine or active lifestyle that you love.
 

June 1, 2018
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Goldilocks knew how to prepare for competition

By Tim Barnwell, APA Sports Physiotherapist at LifeCare Southcare

So, you want to compete in a recreational or competitive sport challenge?
Maybe this is the year you want to complete your first triathlon, or half marathon? Maybe it is the year you want to start running.

Don’t try going from the couch to 10km straight away.

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Like the development of any new skill, the key is to build up gradually and not expect to be an expert on day one. When it comes to training you should try not to max out on too many sessions in one hit. 

There really is a maximum amount of training and exercise our bodies can handle; completing 10 sessions a week is generally too many for an amateur athlete. 

Your first step should be to have a thorough physical examination from either your GP, physiotherapist or an exercise physiologist (EP). This will ensure you understand where you are starting from, and when working with a physiotherapist or EP, you can develop a training program that is tailored for your current condition and fitness/training goals.

Our ability to manage load and to train as much as we want is affected by a variety of factors that need consideration. You need a training load that is effective without resulting in negative consequences, such as injury, fatigue, illness or overtraining. 

Training loads should vary depending on your age and health issues, as recovery times between training can be different. For example, after age 40, tissue repair does not take place as quickly as it once did, so recovery takes longer.

You are more likely to get injured if your training load increases too quickly and you are not accustomed to these changes. If you’ve had a previous injury, you are at greater risk of sustaining a new injury.

For example, if your training load is increased by more than 15% over the previous week’s load, injury risk can rise by up to 50% so for many, it is recommended to only increase training loads in increments of around 10% - run 2km this week, and increase it to 2.2km next week.

Running training programs and the Goldilocks Zone.

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All running training programs, whether for a 5km run or a triathlon, share the same basic three elements; endurance, strength and speed.

  • The endurance element should make up the bulk of your run training at approx. 80% to help you resist fatigue and efficiently burn fat every run.
  • Strength training, weight lifting and running hills, should be limited to once per week, to help you overcome resistance.
  • Short speed sets should be built into training runs once per week on rested legs.

Keep in mind that injuries don’t always occur from overuse; they can also occur with underuse. This means you need a good balance between training and rest to get the most out of your training.

In the lead up to a competition, it is important to train at an intensity that will prepare you well. In other words, too much training is bad and not enough training is bad and so in the middle we find the Goldilocks Zone, where it is ‘just right’!

Physiotherapy and Massage will keep you on track

When training for an event, ensure that you have the right level of muscle, strength and endurance to complete your chosen sport. Without adequate muscle tone, it is impossible to exploit the full potential of arms or legs.

Almost every sport has its own typical injuries. Targeted strength training can help you avoid those injuries. A physiotherapist can or EP can help design a strength training program that supports your fitness/training goals; many strength training exercises can be done with little or no equipment, simply working against your body weight can be effective.

Seek treatment or advice for any niggles that occur during training. Massage can be a useful technique to relieve existing pain or discomfort, as well as to prevent injuries from occurring. It can help you to address muscle imbalances, tightness, and reduce stress.

Good preparation for competitive sport is more likely to lead to an injury-free, more enjoyable experience.

If you're ready to start your competitive journey and are seeking advice from an experienced and local physiotherapist, click the button below.

April 5, 2018 -->

The Ins and Outs of Muscle Injuries

Written by Ky Wynne, Physiotherapist at LifeCare Prahran Sports Medicine

Muscle injuries are one of the most widespread injuries sustained during sporting activity. Across several professional sports, acute muscle injury makes up a whopping 23% to 46% of all injuries – when you think about it, this is a huge percentage. [1, 2, 3] Generally hamstring strains and/or tears are the most common muscle injury, while adductors, quadriceps, and calf injuries closely follow in prevalence. Injury rates vary depending on the sport and the demands of that sport. A great example here would be sprinting, sprinting involves rapid acceleration and deceleration which places high strain on the hamstrings, thus making this the most common sprinting injury, whilst movements associated with change of direction place higher strain on the adductors (groin), so you will see these types of injuries in games of footy. Males generally have a higher incidence of muscle injuries, often thought to be due to the higher-intensity of running and sprinting taking place [1], again these rates vary between sports and the use of different muscles.

The end-to-end muscle process

All muscle injuries undergo similar physiological changes, with early muscle damage and inflammation occurring first, followed by regeneration and renewal of the muscle fibres [3]. See figure-1 below for a more detailed step-by-step breakdown. 
 

 Figure-1

Figure-1

A comprehensive assessment

The assessment and diagnosis of a muscle injury should be completed by a physiotherapist or trained medical professional. Typically the injury incident will point towards a muscle strain, with jumping, running, change of direction and kicking all common causes. The examination of the injury will vary depending on the muscle and area involved, however tests will often include: 

  • Palpation of the muscle and surrounding areas
  • Muscle strength assessment
  • Muscle length tests
  • Functional movements
  • Assessment of other areas to rule out different pathologies or injuries

Imaging, like Magnetic Resonance Imaging (MRI) or Ultrasound, is often not required unless the injury is of a more severe nature. However, it can assist the therapist in determining the grade of injury and the healing time frames needed before the individual can return to play.

What treatment is in store for you?

Treatment involves a number of stages, which includes an early acute phase, followed by rehabilitation and then a graded return to sport. While not appropriate for every situation, as a whole, earlier assessment and commencement of a treatment plan will improve outcomes and will allow the individual to return to activity sooner [3, 4]. Many individuals return to activity or sport when pain resolves and without finishing a full course of rehabilitation; increasing the risk of re-injury. Re-injury post return to activity is a significant risk, especially following hamstring strain [4]. Due to the high rates of subsequent injury, completing a thorough return to sport assessment following rehabilitation is recommended to determine if any deficits still exist in strength or function.

Prevention is key

Prevention of muscle injury is also important to consider. Whilst you can never 100% prevent against muscle damage, completing targeted prehabilitation programs can substantially reduce the chance of injury. If you have suffered a previous injury (especially a muscle strain), completing a comprehensive assessment and targeted exercise program will likely have significant value. If you want to prevent the occurrence of muscle injury or have faced injury before and want to lower the risk of re-injury, book in an appointment with your local physiotherapist – simply click the button below.
 

References

[1] Feeley, B. T., Kennelly, S., Barnes, R. P., Muller, M. S., Kelly, B. T., Rodeo, S. A., & Warren, R. F. (2008). Epidemiology of National Football League training camp injuries from 1998 to 2007. The American journal of sports medicine, 36(8), 1597-1603.
[2] Hallén, A., & Ekstrand, J. (2014). Return to play following muscle injuries in professional footballers. Journal of sports sciences, 32(13), 1229-1236.
[3] Wong, S., Ning, A., Lee, C., & Feeley, B. T. (2015). Return to sport after muscle injury. Current reviews in musculoskeletal medicine, 8(2), 168-175.
[4] Brukner, P. (2015). Hamstring injuries: prevention and treatment—an update. Br J Sports Med, 49(19), 1241-1244.
 

 

March 29, 2018 -->

Thawing a Frozen Shoulder

Written by Tim Barnwell, APA Sports Physiotherapist

What is a Frozen Shoulder?

Frozen Shoulder, also known as Adhesive Capsulitis, is a condition that affects your shoulder joint and usually involves the gradual onset of severe and disabling shoulder pain, coinciding with a loss of range of motion of the shoulder[1].

The condition can last from 12-18 months, with some cases lasting up to four years. In most cases, normal range of motion will return.[2]

With frozen shoulder, the shoulder capsule becomes so thick and tight that it’s hard to move. The shoulder capsule is the tissue surrounding your shoulder joint that holds everything together.

The shoulder is made up of three bones: The clavicle (collarbone), the scapula (shoulder blade), and the humerus (upper arm bone).

The shoulder has a ball-and-socket joint. The round head of the upper arm bone fits into this socket. Connective tissue, known as the shoulder capsule, surrounds this joint. Synovial fluid enables the joint to move without friction.

 Image source: American Academy of Orthopaedic Surgeons

Image source: American Academy of Orthopaedic Surgeons

Symptoms, causes and diagnosis

The main symptoms of a frozen shoulder are pain and stiffness, for no apparent reason, that make it difficult or impossible to move the shoulder. The pain may feel worse at night or in cold weather.

Frozen shoulder is thought to happen when scar tissue forms in the shoulder, which causes the shoulder joint's capsule to thicken and tighten, leaving less room for movement.

The exact cause cannot always be easily identified. However, most people with frozen shoulder experience immobility as a result of a recent injury or fracture.

It’s not clear why some people develop it, but some groups are more at risk.

Females aged 40 to 65 are most likely to be at risk of developing a frozen shoulder, along with anyone who has had a frozen shoulder previously on the other shoulder. It is also more common in those who are sedentary rather than active.[3] The condition is also common in people with diabetes and thyroid disease.

Frozen Shoulder can usually be diagnosed with an examination by a GP or physiotherapist, usually along with an x-ray and ultrasound of the shoulder.

Three phase course of the condition

1. Freezing - You develop a pain in your shoulder any time you move it, and your range of shoulder movement is reduced. It slowly gets worse over time and may hurt more at night.

This can last anywhere from two to nine months.

2. Frozen - The pain might be less but your shoulder stiffness gets worse and moving your shoulder becomes more difficult. This stage can last anywhere from four to 12 months.

3. Thawing - Your range of motion starts to go back to normal. This can take anywhere from five months to two years.

Treatment Options

Though the reasons for the development of frozen shoulder remain unclear, a range of treatment options are available that are suitable for each phase of the condition:

  • An injection of corticosteroid in the shoulder can provide good pain relief and assist function in the early stages but does not treat the cause of the pain[4].
  • Oral steroids can provide short-term pain relief[5].
  • Acupuncture can also be beneficial to reduce pain in the freezing stage and to improve mobility in the thawing stage.
  • A physiotherapy program can help improve mobility.
  • Surgical intervention can help in long-term cases where the other treatments have not successfully resolved the issue.

The benefit of exercise

Physiotherapy is widely recommended as treatment for frozen shoulder. As the scapula can be disrupted due to a frozen shoulder, exercises to correct its movement can be useful. Functional exercises have been shown to reduce the incidence of shoulder pain[6].

This involves physical treatment, with a long-term supervised exercise program incorporating strengthening and stretching exercises and reassurance about the activities you can undertake and continued exercise. A recent study found that patients with a positive expectation of treatment had a better outcome[7].

If you are experiencing the early signs of frozen shoulder, book a consultation now with your local physiotherapist to discuss the treatment options that are right for you - simply click below.

[1] (Kelley et al., 2013)(Neviaser & Hannafin, 2010)

[2] (Kelley et al., 2013)

[3] (Neviaser & Hannafin, 2010)

[4] (Neviaser & Hannafin, 2010)

[5] (Neviaser & Hannafin, 2010)

[6] (Swanik, Swanik, Lephart, & Huxel, 2002)

[7] (Chester, Jerosch-Herold, Lewis, & Shepstone, 2016)

References:

  • Buchbinder, R. (2004). Effect of arthrographic shoulder joint distension with saline and corticosteroid for adhesive capsulitis. British Journal of Sports Medicine, 38(4), 384–385. http://doi.org/10.1136/bjsm.2004.013532
  • Chester, R., Jerosch-Herold, C., Lewis, J., & Shepstone, L. (2016). Psychological factors are associated with the outcome of physiotherapy for people with shoulder pain: A multicentre longitudinal cohort study. British Journal of Sports Medicine, 269–275. http://doi.org/10.1136/bjsports-2016-096084
  • Favejee, M. M., Huisstede, B. M. A., & Koes, B. W. (2011). Frozen shoulder: The effectiveness of conservative and surgical interventions-systematic review. British Journal of Sports Medicine, 45(1), 49–56. http://doi.org/10.1136/bjsm.2010.071431
  • Hickey, D., Solvig, V., Cavalheri, V., Harrold, M., & Mckenna, L. (2018). Scapular dyskinesis increases the risk of future shoulder pain by 43% in asymptomatic athletes: a systematic review and meta-analysis. British Journal of Sports Medicine, 52(2), 102–110. http://doi.org/10.1136/bjsports-2017-097559
  • Neviaser, A. S., & Hannafin, J. A. (2010). Adhesive Capsulitis. The American Journal of Sports Medicine, 38(11), 2346–2356. http://doi.org/10.1177/0363546509348048
  • Swanik, K. a, Swanik, C. B., Lephart, S. M., & Huxel, K. (2002). The effect of functional training on the incidence of shoulder pain and strength in intercollegiate swimmers. J. Sport Rehabil., 11, 140–154. http://doi.org/10.1123/jsr.11.2.140
February 27, 2018 -->

ACL Injury – Are You at Risk?

Written by Ky Wynne, Physiotherapist at LifeCare Prahran Sports Medicine.

The anterior cruciate ligament, or ACL, is one of the primary passive stabilisers of the knee joint. The primary role of the ACL is to resist excessive sliding and rotation movements of the knee, whilst also providing feedback on the joint position to the brain.

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As any follower of sport would know, this injury is common. It is likely that you know someone who has suffered this injury, or seen a player suffer this injury playing sport. A recent high profile example is Robert Murphy of the Bulldogs, who ruptured his ACL in the 2016 AFL season (see below).

  Figure 2. Robert Murphy knee injury (source: heraldsun.com.au)

Figure 2. Robert Murphy knee injury (source: heraldsun.com.au)

Statistics show that ACL injures are the most common knee ligament injury, carrying a significant impact relating to loss of function and playing time. The factors contributing to ACL injury have been well researched, with risk factors considered non-modifiable and modifiable. The figure below lists some of these common factors. While we can’t change the unavoidable variables, for example, the hardness of the pitch you are playing on (1), there is evidence to show some factors can be influenced. Whilst studies differ on the variables which can be modified, a number of them include:

•    Poor quadriceps / hamstring muscle balance: Studies show when athletes have weaker hamstrings in relation to their quadriceps they exhibit a higher risk of ACL injury (1, 2).
•    Knee control when moving is shown as a significant risk factor for ACL injury, particularly movement of the knee inwards with or without rotation inwards (2).
•    Hip muscle strength and control affects knee control (see above), with studies showing reduced activation of some hip muscles alters control and increases ACL injury risk (1, 3).
•    Knee proprioception describes the knee balance and awareness. When this is reduced or impaired for a variety of reasons, this can increase ACL risk (3).
•    Jumping / landing control: Studies show that knee and foot position when landing in particular can affect ACL injury risk (2).
•    Anterior knee / patellar pain: Evidence shows that pain around the anterior knee (e.g. patellofemoral pain) increases the risk of ACL injury (4).
 

  Figure 3. ACL risk factors.

Figure 3. ACL risk factors.

This list is in no way exhaustive; however, these are a number of the key factors which could amplify an individual’s risk of suffering an ACL injury. Positively, the modifiable risk factors can be influenced by completing targeted strength and control exercises. Studies demonstrate positive results in relation to reducing the number of ACL injuries when individuals complete targeted injury prevention programs (1, 5, 6).

If any of the modifiable risk factors mentioned above sounded familiar to you and how you move, it is recommended to consult a LifeCare Physiotherapist with a view of commencing an injury prevention program. Simply click below to book an appointment with your local LifeCare physiotherapist.

February 27, 2018 -->

Are You Suffering From Plantar Fasciitis?

Written by Greg Diamond, Senior Musculoskeletal Physiotherapist at LifeCare Cottesloe.

So you’ve got a pain in the heel or foot that is progressively getting worse. You notice one day some slight niggle which went away but starts occurring more and more often with greater intensity. It’s worst when you’ve been off it for a while and go to stand up or put weight through it. This is often especially noticeable on getting out of bed in the morning, those first few steps are agonising but gradually get easier with walking. Congratulations, you have been admitted into the plantar fasciitis club!

This is not a fun club, this is a frustrating journey that may take time and different treatment options to resolve. So what is it? This is NOT a clear cut answer but bear with me. The standard answer would say something like an inflammation of the insertion (point of attachment) of the plantar fascia (a thick band of connective tissue running across the bottom of the foot from toes to heel). The inflammation may involve the body of the fascia as well. Sometimes a bone spur digging into the fascia may be the source of the irritation or conversely the pull of the fascia on the bone may create the bone spur.

Plantar Fasciitisjpg

Over use may certainly contribute to the chance of having or developing a plantar-fasciitis but at times there appears to be no known contributing factor. A clue may lie in the fact that the body has connective fascial bands that run down and around the body from head to feet and tensing one part can have an effect quite distant to the original site of tension.

Because of this it is important to consider problem areas that are not only at the site of pain. These include soft tissue trigger points, especially in the calf, hamstrings and buttocks. The mobility of the small bones of the foot and ankle joint should also be assessed and treated if found to be abnormal. Often one of the overlooked tissues that provoke these types of problems are the nerves. If the nervous system is out of whack then all parts of interesting problems can ensue. What’s the answer? Get a full assessment from a musculoskeletal expert! Yes that includes us! In the short term:

  • Wear soft soled supportive shoes during the day
  • Keep a pair of slippers beside the bed to slip straight into in the morning
  • Use ice to reduce inflammation
  • Roll your foot over a golf ball for a deep massage effect and
  • Take anti-inflammatory medication.

Stubborn swelling may respond to a corticosteroid injection but save surgery as a last desperate option, even the worst of these can spontaneously resolve given enough time.

For a full assessment, book in with your local LifeCare physio by clicking the below.

 

February 26, 2018 -->

Acute Vs Chronic Back Pain

Written by Anna Gould, Physiotherapist at LifeCare Cottesloe Physiotherapy.

As physiotherapists we see people with back pain almost every day, in my experience it would probably account for about 60% of my caseload. As a result we see lots of people going through their own journey to reaching full function again. Back pain is such a common problem, the healthcare industry and therefore the media has been very invested in this problem and as a result there are many ideas, beliefs and attitudes towards back pain. These beliefs have a large impact on peoples’ disability and recovery. 

One common misconception is the difference between acute and chronic back pain. The word chronic relates to the time frame of the pain, not the severity of the pain. If pain has been experienced for longer than 12 weeks it is referred to as chronic. We refer to acute back pain when the injury or pain is new, in the first 4 weeks and sub-acute pain lasts between 4 and 12 weeks. Chronicity does not relate to the severity of pain as many are lead to believe. 

Why is this important? This changes our management and treatment of the pain vastly. 

If you ever have experienced that sudden, extreme back pain where you're on the phone to the reception staff literally begging for an appointment, we’ll treat it quite differently to your ongoing year-long back pain. 

In the acute stage we usually try to calm the situation down a bit, at this stage your muscles are usually kicking in to protect you from what your body may perceive as a threat. Usually this threat was a sudden increase in load and this tensing of the muscles is usually helpful for a few minutes, however they tend to stay sensitive for longer than needed which actually fuels the pain further. Therefore, we usually massage or dry needle those muscles and we want to limit your movement slightly to prevent this happening again. The most important thing to remember in this stage is that acute inflammation won't last for long, it is very unlikely you have done any serious damage and that if we do tell you to limit a particular movement, this will not usually be for more than a day or two. After this period we will begin to integrate movement into the back and your daily life again. 

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In chronic pain situations we aim to normalise movement and decrease the fear of pain. Chronic pain is a rather complex situation as it is beyond just a physiological response of the body. The brain can continue to submit pain signals long after any damage or inflammation has ceased, therefore we look at chronic pain very differently. We have to look at things like your daily habits, movement patterns, stress, anxiety and your understanding of the pain. We will encourage you to move more, try the things that you are fearful of in a graded and educated manner. Chronic pain can most certainly be resolved however one must remember that it takes active participation and willingness to learn. 

One thing to never forget is that the back loves to move! A common misconception is that the back must be protected as it is easily damaged, the truth is, is that it needs to move to be happy and healthy so don’t be fearful of movement. Your back is not as precious as you might think! I have held cadavers and I can tell you that they are very, very strong structures, it is difficult and borderline impossible to physically push out a disc or misalign a vertebra as it designed to be very durable and last a lifetime. 

If you are experiencing back pain there is so much that can be done to manage it. The most important advice I can give you would to keep calm, keep moving and call us if you need to. We are well equipped to help you deal with your back pain. Personally I love to treat them as they respond quickly to the right treatment and eliminating the pain can have a profound effect on ones’ life. 

We’re here to help!

If you’re experiencing acute or chronic pain and are in need of an experienced physio, click on the button below to book your next appointment. 
 

January 30, 2018 -->

FODMAPs - What Are They, and Are They Causing You Problems?

Written by Paula Christofakakis, Dietitian at LifeCare Malvern.

FODMAPs- what is it?

Abdominal pain, gas, bloating, constipation… do any of these sound familiar? These symptoms may not just be the result after consuming a large meal. More and more people are presenting with gut related concerns and food intolerances which can affect your quality of life.

Where do FODMAPs fit in?

FODMAPs are found in everyday foods and refer to Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols, which are sugars that can often be poorly absorbed in the small intestine. FODMAPs are fermented by intestinal gut microflora resulting in gas production, which contributes to other IBS symptoms such as bloating, wind, abdominal pain and constipation. For most people these sugars don’t cause any problems but some of us don’t digest them well.

The Low FODMAP diet restricts High FODMAP foods (listed below) and was developed by a team of researchers to help reduce and manage these IBS symptoms with one study showing it to provide relief in 56% of patients with Crohn’s or Ulcerative Colitis (Gearry et al JCC 2008).  

Vegetables and spices.jpeg

Examples of some High FODMAP foods include:

FODMAP.jpg

How can a Dietitian help?

Education on the Low FODMAP diet takes time, and an experienced dietitian can provide individualised treatment specific to an individual’s symptoms. Patients can work together with a dietitian to develop meal plans, shopping guides and options when dining out. Reduction or removal of high FODMAP foods from the diet with slow re-introduction to suit each individual’s needs and symptoms, can be managed by a dietitian in the context of achieving a nutritionally adequate diet.

Are you in need of a dietitian after reading this article? Click below to book an appointment with a LifeCare dietitian. Please note that dietitians are only available at selected clinics.