September 10, 2018
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LifeCare Southcare and Australian Doctors for Africa

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Welcome back to Max. He has just returned from Ethiopia, where he represented LifeCare Southcare and Australian Doctors for Africa. Here he is helping teams in a public trauma hospital in Bahir Dar, to promote active mobilisation and successful early discharge in the orthopaedic wards.

These expeditions are extremely important as they not only provide care to nations with limited resources, but they help to educate medical support teams that have limited access to new methods of treatment.

If you’re interested in learning more about Australian Doctors For Africa, please click here.

August 7, 2018
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Let’s overcome incontinence

Written by Michelle Hall, Continence and Women’s Health Physiotherapist at LifeCare Cockburn

It may surprise you that approximately one in four Australians, over the age of 15, suffer from bladder leakage, also known as urinary incontinence – that equates to nearly 5 million of us! 

This most commonly occurs with coughing, sneezing or other exertion, which is referred to as stress urinary incontinence. What you may not be aware of is that there is now a wealth of evidence that this common and sometimes embarrassing condition can be effectively treated with pelvic floor muscle training, taught by a qualified Continence and Women’s Health Physiotherapist. 

More common than you think

There are some misconceptions about urinary incontinence. It is usually seen as a ‘women’s issue’, and while it is more common in females, with a third of women suffering from incontinence, men still make up a large proportion of those affected. Many people also assume that this is only an issue for the elderly, however half of women who report incontinence are aged under 50 years.  

Improve your situation. No referrals needed

Fortunately, incontinence doesn’t have to be a lifelong problem and for the majority of people who experience incontinence, physiotherapy treatment can help manage or cure symptoms. A large study done at the University of South Australia has shown that physiotherapy proved effective for 84% of women who received pelvic floor muscle training and lifestyle advice with a qualified Continence and Women’s Health Physiotherapist. The 'cure' rate was still approximately 80% after 1 year, which is comparable to, or even better than, the 'cure' rate reported with surgery.

Continence and Women’s Health Physiotherapists have extra qualifications in treating issues related to incontinence and other pelvic floor muscle dysfunction. Unlike seeing a specialist doctor, seeking help from a specially qualified Physiotherapist does not require a referral. To ensure that you are booked in with an appropriate practitioner, make sure that the receptionist is aware that your appointment is for incontinence or pelvic floor muscle training.

What to expect during your assessment

Your initial consultation will take about 45minutes. To assess your condition your Continence and Women’s Health Physiotherapist may do a postural and movement assessment and an external pelvic examination. Sometimes an internal examination may be advised to achieve an accurate diagnosis, however if you are not comfortable with this, your physiotherapist can assess your pelvic floor using an external, real-time ultrasound.

Make a change

While common, urinary incontinence is not just a normal part of aging, it can be treated! Get in touch with one of LifeCare’s Continence and Women’s Health Physiotherapists for an assessment and management program.

 

References:

Neumann PB, et al (2005) Physiotherapy for female stress urinary incontinence: a multicentre observational study. Australian and New Zealand Journal of Obstetrics and Gynaecology. Volume 45, Issue 3, pages 226–232

Continence Foundation of Australia. https://www.continence.org.au/

August 7, 2018 -->

Your pelvic floor, pregnancy and physiotherapy.

Written by Michelle Hall, Continence and Women’s Health Physiotherapist at LifeCare Cockburn

You’re told to do your Kegel exercises to prepare your body for having a baby; but what does that really mean? How do you know whether you’re doing them properly? It’s one of those things that can be embarrassing to talk about, and yet a conversation and training session with the right person can be extremely beneficial for your long-term health.

 What happens to my pelvic floor muscles during pregnancy?

One of the main reasons we encourage women to have their pelvic floor checked during pregnancy is to determine what type of pelvic floor they have and best prepare their pelvic floor for childbirth. A weak pelvic floor will require a different type of exercise program to an overactive or hypertonic pelvic floor.

Typically, pregnancy hormones cause a ‘softening’ of the ligaments and muscles, which can lead to reduced joint support. This, along with changing posture and the extra weight of a growing baby, can weaken your pelvic floor muscles.

When these muscles weaken during pregnancy, it can often lead to incontinence (accidental leaks of urine when you exercise, laugh, lift, cough or sneeze). It can also lead to lower back pain or pelvic organ prolapse symptoms such as an ache or heaviness, or a lump or bulge inside your vagina that occurs when your bladder, bowel and uterus aren’t receiving enough support.

How can physiotherapy help?

Research shows us that women who do their pelvic floor exercises, “kegels”, during pregnancy have a quicker recovery of their pelvic floor after childbirth, with a reduced risk of bladder and bowel problems. By seeing a Women’s Health Physiotherapist during your pregnancy, you can make sure you are exercising your pelvic floor correctly with pregnancy appropriate exercises. Believe it or not, studies have shown that 50% of women do not do these correctly.

After giving birth, as a busy mum, it sounds onerous to have to make time to do pelvic exercises. The good news is ‘Kegels’, also known as pelvic floor muscle exercises, generally can be done in minutes and you don’t have to go to a gym to do them.

It is highly recommended that every woman has a postnatal assessment with a Women’s Health Physiotherapist around 6-8 weeks post birth to gradually regain strength in the abdominals, trunk and pelvic regions.

Many women are keen to return to sport and recreational activities after having a child, and that requires a strong pelvic floor. So, if you’re planning to get active and hit the gym or are prone to sneezes from hay fever in the spring, make your pelvic floor a strong and resilient friend.

Learn how to exercise your pelvic floor muscles correctly and safely before, during and after your pregnancy by asking to speak with one of our trained Continence and Women’s Health Physiotherapists at LifeCare.
 

  

References:

Morkved S, Bo K. Effect of pelvic floor muscle training during pregnancy and after childbirth on prevention and treatment of urinary incontinence: a systematic review. Br J Sports Med 2014;48:299–310.

Neumann PB, et al (2005) Physiotherapy for female stress urinary incontinence: a multicentre observational study. Australian and New Zealand Journal of Obstetrics and Gynaecology. Volume 45, Issue 3, pages 226–232

Continence Foundation of Australia. https://www.continence.org.au/

August 1, 2018 -->

The truth about osteoarthritis

Written by Olivia Clarke, physiotherapist at Northern Sports Physiotherapy Clinic

We all know someone who suffers from arthritis, hence it won’t come as a surprise when we say that osteoarthritis is the most common form of arthritis. With such an aging population, osteoarthritis will continue to become more prevalent. Therefore, how we manage this becomes even more important.

Osteoarthritis is a degenerative joint condition, where the surface layer of the cartilage slowly ‘wears away’ over time. This affects the joints ability to absorb shock and as a result usually affects weight bearing joint such as knees and the spine. 

osteoarthritis knee.jpg

OA is caused by increased mechanical stress on a joint. This can occur from:

  • Repetitive workloads
  • Occupational factors
  • Postural changes
  • Obesity/overweight
  • Prior injury
    Most common symptoms
  • Joint pain
  • Inflammation
  • Joint stiffness
  • Painful cracking, grinding, clicking
  • Pain after prolonged periods of being stationary

So, if it’s common and degenerative, what’s the good news?

The good news is that just because a joint had OA, doesn’t mean it will necessarily become painful. If it does become painful there are several things you can do to help settle the pain. 

1.    Exercise and strengthening

This is the gold standard for treating OA. The joint will absorb load better if there is adequate strength and mobility in the joint. Therefore, doing the correct style of exercise will improve strength and reduce pain in the long term. Your physiotherapist can help with identifying the best exercise to suit your needs. 

2.    Lifestyle changes

OA can affect your quality of life, but it doesn’t have to. Try things like weight loss, increasing your low intensity exercise and limit prolonged sitting to short periods to help reduce the pain. Your physiotherapist can also guide you on items which may help reduce pain such as JOYA shoes for knee OA. 

3.    Medications

Pain relief can be used when required to reduce inflammation and get you moving again. See your GP about the medication that is right for you. 

If your suffering from OA and want to get back to your best, then give your local physiotherapist a call.

July 3, 2018 -->

Time to hit snooze - the impacts of poor sleep

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

Sleep is known to be important for learning, memory and cognition. The function of sleep is still not completely understood, however it appears sleep assists with recovery from the previous day and helps prepare for the upcoming day [1]. Sleep has been shown to be a vital component of recovery from sport and activity [2], along with having a consistent association to lower risk of illness and even death [3]. The recommendation is that adults obtain eight hours of sleep per night [1], as periods of sleep deprivation or poor-quality sleep can impact negatively on cognitive and physiological function.

The causes of poor sleep quality

The cause of poor sleep can be multifactorial and with the pressures of daily life leaving most people poor of time, it has become more common for people to be lacking in vital sleep. Some contributing factors that impact sleep quality include personal choice, work, illness/injury, young children, medication, medical conditions, stress/anxiety, caffeine, alcohol, and the environment (e.g. noise levels) [4]. Studies [2, 5] show athletes are often at risk of having poor sleep. The reasons affecting sleep quality in athletes are thought to include the timing of competition (e.g. night games), environmental conditions (e.g. light exposure from stadiums), caffeine ingestion, travel schedules, and heavy training schedules. Concussions have also been reported to cause increased symptoms of sleep disturbance [3]. Adolescent athletes are particularly at risk of poor sleep, with sport and school both factors impacting sleep quality, subsequently increasing their risk of injury [6]

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The impact of poor sleep

Poor sleep (sleep loss, deprivation, insomnia etc) affects a multitude of different body functions and systems. Neurocognitive function (e.g. memory, attention), athletic performance, and physical health are all adversely affected [5]. The adverse impacts of poor sleep are displayed visually in figure 1, and include [1, 2, 3, 5, 7]:

  • Impaired cognitive function & performance: memory, attention, alertness, learning, response time, emotional regulation, cognition and vigilance are all impaired or reduced.
  • Reduced muscle repair & regeneration: down regulation of protein synthesis pathway that repairs muscle damage, adversely affecting recovery.
  • Increased exercise induced injuries.
  • Increased risk for chronic health diseases: higher risk of type 2 diabetes, obesity, cardiovascular diseases.
  • Increased perceived exertion: higher RPE (rate of perceived exertion) reported during activity, sport and exercise.
  • Increased inflammation: increased pro-inflammatory cytokines (proteins which are secreted by certain cells of the immune system and have an effect on other cells) (TNFa, PGE2).
  • Altered endocrine function: increased cortisol (stress hormone), with reduced growth hormone and testosterone.
  • Reduced immunity: increased risk for infections (e.g. upper respiratory tract infections).
  • Increased pain sensitivity: higher risk for chronic pain, especially back, shoulder and neck.
  • Impairs nervous system activity: increased sympathetic nervous system activity.
  • Impacts mental health: increased mood disorders and risk of depression.
  • Impaired muscle glycogen repletion: this affects energy stores and recovery.
  • Reduced appetite: this then subsequently affects muscle repair, recovery and performance.
     
 Figure 1. Impact of poor sleep (sourced from  @kywynnephysio )  [8]

Figure 1. Impact of poor sleep (sourced from @kywynnephysio) [8]

Improving your sleep quality

  • Exercise: Regular exercise of moderate intensity is recommended to assist in improving sleep quality [3]
  • Sleep Environment: optimising your sleep environment through factors such as noise and light control can be beneficial [5].
  • Nutrition & Diet: high protein diets may improve sleep quality, whilst foods high in melatonin (e.g. tart cherries) may assist in decreasing sleep onset time. Minimal calorie diets can impair sleep quality if too low [1].
  • Sleep Duration: expanding the amount of sleep time [5].
  • Monitoring: regular monitoring of sleep quality, mental health, physical function and other wellness measures can be important, especially in athletic populations [3].

Need to improve your sleep and want to know how a physiotherapist can help? Get in touch with your local LifeCare clinic by clicking the button below. 

References
[1] Halson, S. L. (2014). Sleep in elite athletes and nutritional interventions to enhance sleep. Sports Medicine, 44(1), 13-23.
[2] Nédélec, M., Halson, S., Abaidia, A. E., Ahmaidi, S., & Dupont, G. (2015). Stress, sleep and recovery in elite soccer: a critical review of the literature. Sports Medicine, 45(10), 1387-1400.
[3] Chennaoui, M., Arnal, P. J., Sauvet, F., & Léger, D. (2015). Sleep and exercise: a reciprocal issue?. Sleep Medicine Reviews, 20, 59-72.
[4] Better Health (2018). Sourced from https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/sleep-deprivation.
[5] Simpson, N. S., Gibbs, E. L., & Matheson, G. O. (2017). Optimizing sleep to maximize performance: implications and recommendations for elite athletes. Scandinavian Journal of Medicine & Science in Sports, 27(3), 266-274.
[6] Milewski, M. D., Skaggs, D. L., Bishop, G. A., Pace, J. L., Ibrahim, D. A., Wren, T. A., & Barzdukas, A. (2014). Chronic lack of sleep is associated with increased sports injuries in adolescent athletes. Journal of Pediatric Orthopaedics, 34(2), 129-133.
[7] Fullagar, H. H., Skorski, S., Duffield, R., Hammes, D., Coutts, A. J., & Meyer, T. (2015a). Sleep and athletic performance: the effects of sleep loss on exercise performance, and physiological and cognitive responses to exercise. Sports Medicine, 45(2), 161-186.
[8] Figure 1. Sourced from: https://www.instagram.com/p/BjgeGedFt_t/?taken-by=kywynnephysio
 

July 3, 2018 -->

What is Clinical Pilates and how can it help you?

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

Are you interested in Clinical Pilates but are unsure what it involves or if it’s right for you? You've come to the right place, here's a run down of what Clinical Pilates is and how you can benefit. 

Clinical Pilates is functional, targeted, individualised rehabilitation with a focus on movement control. The principles and method were originally created by Joseph Pilates to rehabilitate injured patients in World War One (WWI). Joseph was a nurse in WWI and was looking for ways to rehabilitate patients who were bed bound or impaired functionally, thus he devised a training approach later labelled as Pilates. Whilst some of the original principles remain, the method has generally been adapted over the years for rehabilitation and training.

Clinical Pilates is advocated for many injuries and types of pain, along with general health and well-being. This method of training is often encouraged for lower back pain rehabilitation and postpartum, however it is much more diverse. Pilates is utilised by clinicians and individuals all over the world, including elite athletes such as dancers. This method has also been endorsed by AFL players like Geelong Football Club's Captain, Joel Selwood.

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The evidence states that Pilates is more effective in reducing pain, disability and improving function in lower back pain in comparison to education alone or no intervention/rest at all [1, 2]. Additionally, the evidence demonstrates that two or more sessions per week had better outcomes and was more cost effective in the long-term than one session a week [2].  Clinical Pilates is also effective at improving pelvic floor muscle strength [3], and thus can be utilised prior to, during and post pregnancy. Pelvic floor strengthening is also beneficial for individuals with lower back pain, pelvic pain and incontinence.

Research has shown that Pilates training increases core muscle endurance [4], flexibility [4], and is recommended as an option for the treatment of gluteal tendinopathy (hip tendon injury) [5]. Evidence also proves large improvements in mental health, specifically depressive symptoms, anxiety, energy levels and fatigue [6]. A recent study also presented improvement in the functional movement of recreational runners [7]. Participants involved in the study completed 6 weeks of Clinical Pilates training, which resulted in improved hip and knee control, along with reduced knee valgus (inward) movement. Improving these factors reduce the risk of an athlete suffering a running related injury.

Generally, the evidence suggests that for best results, Clinical Pilates should be completed a minimum 1-3 times per week for 6-12 weeks. It can also be incorporated as an ongoing form of maintenance exercise to prevent injury, increase function and improve overall well-being.

If you're interested in knowing more about Clinical Pilates at Lifecare or would like to book a Pilates assessment, you can contact your local clinic by clicking the button below.

References
[1] Yamato, T. P., Maher, C. G., Saragiotto, B. T., Hancock, M. J., Ostelo, R. W., Cabral, C., ... & Costa, L. O. (2016). Pilates for low back pain. Sao Paulo Medical Journal, 134(4), 366-367.
[2] Miyamoto, G. C., Franco, K. F. M., van Dongen, J. M., dos Santos Franco, Y. R., de Oliveira, N. T. B., Amaral, D. D. V., ... & Cabral, C. M. N. (2018). Different doses of Pilates-based exercise therapy for chronic low back pain: a randomised controlled trial with economic evaluation. Br J Sports Med, bjsports-2017.
[3] Culligan, P. J., Scherer, J., Dyer, K., Priestley, J. L., Guingon-White, G., Delvecchio, D., & Vangeli, M. (2010). A randomized clinical trial comparing pelvic floor muscle training to a Pilates exercise program for improving pelvic muscle strength. International urogynecology journal, 21(4), 401-408.
[4] Kloubec, J. A. (2010). Pilates for improvement of muscle endurance, flexibility, balance, and posture. The Journal of Strength & Conditioning Research, 24(3), 661-667.
[5] McNeill, W. (2016). A short consideration of exercise for gluteal tendinopathies. Journal of bodywork and movement therapies, 20(3), 595-597.
[6] Fleming, K. M., & Herring, M. P. (2018). The effects of pilates on mental health outcomes: A meta-analysis of controlled trials. Complementary Therapies in Medicine, 37, 80-95.
[7] Laws, A., Williams, S., & Wilson, C. (2017). The Effect of Clinical Pilates on Functional Movement in Recreational Runners. International journal of sports medicine, 38(10), 776-780.
 

July 2, 2018 -->

Hip and knee osteoarthritis: why exercise is the best treatment

Written by Ky Wynne, physiotherapist at LifeCare Prahran Sports Medicine

Osteoarthritis (OA) is a highly prevalent condition worldwide, and has a significant impact on the people who suffer from the condition. OA results from the breakdown of articular cartilage which can lead to swelling, pain, stiffness, and excess fluid in the surrounding tissue. The most common joints affected by the condition are the hips and the knees [1]. When discussing the impact of knee and hip OA, it is important to look at a number of factors including pain, quality of life and the ability to work.

Studies conducted on rates of sick-leave show significant differences between people with and without osteoarthritis [2, 3], which is displayed in the figures below (figure 1).

People without OA_Sick Leave.png
People with OA_Sick Leave.png

Figure 1. Statistics comparing working and not working percentage in people with and without OA.

Furthermore, individuals with OA saw a 28% increase in pain (figure 3) and severe pain was reported 4.3 times greater than those without [4]. Figure 3 highlights this disparity.

People without OA_Pain.png
People with OA_Pain.png

Figure 3. Statistics comparing levels of pain experienced in people with and without OA.

Qualified research, clinical practice guidelines, and the Australian Physiotherapy Association all advocate for exercise and education as cornerstones of hip and knee osteoarthritis treatment [1, 5, 6]. Recently, there has been a number of news articles about knee and hip osteoarthritis published on sources including ABC and the Sydney Morning Herald. These publications provide information in the mainstream media reflecting the current research evidence regarding appropriate management and treatment. Links to the aforementioned articles are provided in recommended reading below.

One of the current forms of evidence-based exercise rehabilitation for knee and hip osteoarthritis is the GLA:D® program. GLA:D® stands for Good Life with osteoArthritis in Denmark, and is an education and exercise program developed by researchers in Denmark for people with hip or knee OA symptoms [7]. The program is based upon the best available evidence in how to manage hip and knee osteoarthritis. Data from over 10,000 participants in the GLA:D® program in Denmark showed some of the following results [8, 9]:

  • 59% reduction in fear of physical activity and exercise
  • 39% reduction in sick leave
  • 34% reduction in analgesic / anti-inflammatory medication usage
  • 32% reduction in symptom progression
  • 26% reduction in pain at the 3 month follow-up

These statistics show that GLA:D® is a beneficial approach to hip and knee osteoarthritis treatment. GLA:D® has recently become available in Australia, with a number of LifeCare clinics offering the program.

Experiencing hip and/or knee pain? Book an appointment today with one of our qualified physiotherapists, simply click the button below. 

Recommended Reading

References

[1] Bennell, K. (2013). Physiotherapy management of hip osteoarthritis. Journal of physiotherapy, 59(3), 145-157.
[2] Schofield, D. J., Shrestha, R. N., Percival, R., Passey, M. E., Callander, E. J., & Kelly, S. J. (2013). The personal and national costs of lost labour force participation due to arthritis: an economic study. BMC Public Health, 13(1), 188.
[3] LaTrobe University (2016). The cost of arthritis to Australia’s workforce. http://semrc.blogs.latrobe.edu.au/cost-arthritis-australias-workforce-time-something/.
[4] AIHW (2017). How does osteoarthritis affect quality of life? Retrieved from http://www.aihw.gov.au/osteoarthritis/quality-of-life/
[5] Australian Commission on Safety and Quality in Health Care (2017). Osteoarthritis of the Knee Clinical Care Standard. Retrieved from https://www.safetyandquality.gov.au/wp-content/uploads/2017/05/Osteoarthritis-of-the-Knee-Clinical-Care-Standard-Booklet.pdf.
[6] McAlindon, T. E., Bannuru, R., Sullivan, M. C., Arden, N. K., Berenbaum, F., Bierma-Zeinstra, S. M., ... & Kwoh, K. (2014). OARSI guidelines for the non-surgical management of knee osteoarthritis. Osteoarthritis and cartilage, 22(3), 363-388.
[7] LaTrobe University (2017). GLA:D – Best first treatment for hip and knee OA. Retrieved from http://semrc.blogs.latrobe.edu.au/glad-training/
[8] Skou & Roos (2015). GLA:D® Annual Report 2015. Retrieved from https://www.glaid.dk/pdf/Annual%20Report%202015%20GLAD.pdf.
[9] GLA:D® Australia (2017). Home – GLA:D AU. Retrieved from https://gladaustralia.com.au/.
 

June 26, 2018 -->

Patellofemoral Pain Syndrome AKA Runner’s Knee – What is it?

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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.