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Conditions we treat

Plagiocephaly (flat head)

Plagiocephaly (flat head)

GREEK plagios + LATIN cephal [noun]

Definition Misshapen head in infants. Prevalence Estimated between 10-30%. Symptoms Uneven head shape, flattened spot on back of head, uneven ear appearance, prominent forehead. Diagnosis Physical examination. Prevention Supervised tummy time, alternating head positions during sleep, varying holding positions. Treatment Usually improves on its own, physiotherapist education and prescribed movements/positioning, helmet therapy if severe.

Torticollis (muscle spasm)

Torticollis (muscle spasm)

LATIN tortus + collum [noun]

Definition Contracting of neck muscles causing twisting of the head to one side. Prevalence Ranges from 0.3 – 20%. Symptoms Pain on one side of neck, inability to turn the head, one shoulder higher than the other, neck muscle stiffness or tightness, swollen neck muscles. Diagnosis Physical examination, diagnostic tests (ultrasonography, MRI). Prevention None. Treatment Manual therapy, strengthening exercises, repositioning, helmet therapy in severe cases.

Hip Dysplasia

Hip Dysplasia

LATIN dys- (abnormal) + -plasia (formation) [noun]

Definition Abnormalities in the femoral head and/or the acetabulum. Prevalence Occurs in every 1 in 1000 births. Symptoms Clicking hip joint, different leg lengths, late sitting or walking, uneven walking, uneven distribution of weight on legs. Diagnosis Paediatric assessment. Prevention Avoiding tight swaddling or wrapping newborns. Treatment Massage, stretching and strengthening alongside medical treatments.

A critical look at helmet therapy and its inefficacy in treating misshapen heads in babies

Babies’ heads commonly have flat areas which often correct themselves by the time they can sit unassisted.

Our approach
is simple

listen. assess. diagnose. educate. treat.

The road to recovery is an exercise in resilience and responding to challenges. Life may pull us in different directions but we can always make our way back. 

Nip it in the bud

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Paediatric Health | The CO-OP Approach

1 Why do some people struggle?

An everyday task that feels like one fluid motion to one person can feel like a multistep process to another, and that’s because, technically, it is. Motor learning is not a one-size-fits-all journey and for some, it requires a deeper look.

2 What is the COOP Approach?

COOP is an evidence based practice (EBP) developed by Polatajko & Mandich (2004) that helps individuals acquire and perform everyday activities that are important to them. And what’s important to children are the little things – tying shoelaces, partaking in sports, writing their name – that allow them to be involved in life.

Who is it for?

Children with coordination difficulties due to Developmental Coordination Disorder, Autism Spectrum Disorder, Cerebral Palsy, ADHD, Dyslexia, Acquired Brain Injury or other conditions.

3 Objectives

  • Skill acquisition – the child’s ability to acquire, perform and retain a skill
  • Development of cognitive strategies – tailored learning methods (like repetition, imagery, memorisation) that the child can use in their problem solving
  • Generalisations of skills – the child’s ability to perform the skill under different conditions
  • Transfer of learning – the child’s ability to apply their learning strategies and skills in new contexts or situations

4 Structures Intervention Format

Pre-intervention – Setting goals, baseline of performance (PQRS), Dynamic Performance Analysis (DPA)

Intervention – Cognitive strategies via guided discovery, teach GOAL-PLAN-DO-CHECK, apply GOAL-PLAN-DO-CHECK in domain specific strategies

Homework – Generalisation and transfer through caregiver support for tasks carried out at home/school/leisure

Post-intervention – Evaluation of goals

5 GOAL-PLAN-DO-CHECK

Introduced by the therapist in the intervention stage.

Goal: What does the child want/need to achieve

Plan: Ask (don’t tell) the child how they plan to achieve their goal

Do: Get the child to do the task

Check: Reflect on how the plan worked, make adjustments

The COOP Approach has informed the practice of all Physiotherapists at The Collective.

Conditions in Babies | Helmet therapy and its inefficacy in treating misshapen heads

1 Plagiocephaly Helmets

Historically used in the treatment of moderate to severe plagiocephaly.
Recent evidence has called for a revision of this advice and treatment.
There is a lack of evidence to support the efficacy of helmet therapy beyond cosmetic symmetry.

** Image courtesy of Talee

2 Phyiso Recommendations

Physiotherapists recommend repositioning strategies, including:

  • Altering head positions when baby sleeps on their back (*unless it impacts on the baby’s or parents quality of sleep)
  • Alternating the baby’s body orientation in the bassinet with each sleep
  • Switching sides during breastfeeding
  • Transporting baby in a front-facing carrier or upright stroller to take pressure off the head (*unless under 6 months of age, where babies should always be facing towards their guardian)
  • Use of pillows are never recommended in accordance with SIDS guidelines

3 Tummy Time

Early tummy time can serve as a preventative measure for conditions like plagiocephaly and torticollis. It is recommended to start in short increments and build up to 60 minutes per day in total.

Pregnancy Health | Exercises for pregnancy related pelvic girdle pain

1 The belief that your pelvis is inherently unstable during pregnancy is unhelpful in managing pain and pursuing progression.

Pain is multifaceted and unique to each pregnancy.

Movement and adaptability are essential in pregnancy for effective pain reduction and pelvic progress.

The strongest predictor of pregnancy related pelvic girdle pain resolution is belief that it will go away.

2 Maintaining movement *with modifications

It’s important to keep moving…but modify the exercises

  • rather than single legs – go double
  • turn lunges into squats
  • reduce step length and width when walking
  • keep your knees together when rolling in bed
  • hydrotherapy – opt for pool based exercise rather than land based

3 Support from Serola

The Serola sacroiliac belt stabilises the base of spine and helps restore the Sacroiliac Joint to normal range of motion.

Provides pain relief, compression and a stop point at the end of normal range of motion.

Helps maintain correct posture.

4 The modified squat

  • Keep your knees together 
  • Don’t squat too deep
  • Make sure to weight bear equally between both legs 
  • Minimise single leg loading
  • Maintain a pelvic tilt

5 Circle Challenge

 

6 Elevated Bridge

Postnatal Health | Exercises for Pregnancy

1 Reconditioning starts now

Regardless of how you delivered your baby, these exercises are recommended for reconditioning muscles following the stress of pregnancy and delivery. They can be:

  • Commenced from 24 hours post-delivery/when catheter (if you have one) has been removed
  • Practised from lying, sitting or standing, but the former may be easier

2 Exercises after delivery; a guided tour

Follow these steps:

  • Gently squeeze the muscles from your pubic bone to tailbone as you breathe out
  • Lift up through your pelvic floor – imagine you are resisting a tampon being pulled out
  • Hold for a few seconds, then release
  • Rest for 5-10 seconds
  • Repeat this a few times, working up to 10 second holds and 10 repetitions

Notes on exercise execution

  • Try not to squeeze your bottom or upper tummy muscles during this exercise
  • A gentle tightening across your lower tummy is good – this signals the beginning of core (deep abdominal muscles) strengthening
  • Make sure you breathe as you hold the contraction
  • Struggling to feel the contraction while sitting? Try lying on your back or side

Download our complete Postnatal Exercise Program here +

Breast Health | The Spectrum of Mastitis

1 Previously thought to be caused by a blocked duct, a recent Academy of Breastfeeding Medicine (ABM) protocol shows mastitis results from duct swelling, causing inflammation and a backlog of milk. It is considered a spectrum of conditions caused by inflammation of the mammary gland, including:

  • Ductal narrowing/plugged ducts
  • Inflammatory mastitis
  • Bacterial mastitis
  • Phlegmon
  • Abscess
  • Galactocele

2 Common contributing factors to mastitis

Contributing factors to mastitis include:

  • Hyperlactation (oversupply)
  • Disruption of the milk microbiome (mammary dysbiosis)

 

To avoid these:

  • Feed baby on demand from the unaffected breast first, hand express small amounts of milk for relief
  • Preserve the milk microbiome by limiting antibiotics, direct feeding for bacterial exchange and taking specific strain probiotics as required

3 Spectrum-wide recommendations for at-home relief

Treating mastitis is about reducing inflammation and preventing or addressing contributing factors of hyperlactation and a disrupted milk microbiome. The following at-home recommendations can help:

  • Where possible, breastfeed physiologically (without pumps or nipple shields) to maintain bacterial exchange
  • Use pain relief (NSAIDs or Paracetamol) and ice
  • Treat nipple blebs with oral lecithin and topical steroid cream
  • Feed baby on demand but no more, or milk production increases and worsens inflammation
  • Wear a supportive bra
  • Treat hyperlactation (oversupply) with block feeding, medication and consultation with a lactation consultant

4 Treating mastitis with therapeutic ultrasound

Mastitis may be treated with therapeutic ultrasound. It emits sound waves in the breast tissue to move built-up fluid away from the affected area. This helps:

  • Reduce inflammation
  • Relieve oedema

** image courtesy of Yes Medical

5 Antibiotics and bacterial mastitis

Antibiotics are only appropriate for treating bacterial mastitis. They can worsen other cases by disrupting the microbiome, and overuse can lead to resistance.

6 Updated conservative management of mastitis

Best practices are always changing; only 4 years ago, physiotherapists advised massage and warm compresses for mastitis treatment, which are now not recommended. For up-to-date, personal advice, see your physiotherapist.

Sexual Health | Vaginal Trainers; Tools of the Trade

1 Dilators are medical-grade tools suitable for anyone experiencing pelvic pain conditions like vaginismus, vulvodynia or dyspaurenia.

Designed to acclimate the user to pain-free insertion of objects like tampons, or to pain-free penetration.

Available in incrementally sized sets.

* image courtesy of BIEN Australia

2 Guidelines for use of vaginal dilators are condition specific, and individually determined by specialists. 

  • Generally used for 5-15 minutes, as comfortable, 4-7x per week.

  • Maintenance goals will vary.

  • Higher frequency leads to better outcomes.

3 Sexual pain is measured subjectively, with a focus on each patient’s personal experience.

The emotional component of processing pain is important, as well as the impact of the symptoms on their life.

4 Methodology

Dilators cause a therapeutic stretching of the tight fibrotic tissues of the vaginal lining. By

gradually exposing the pelvic floor muscles to a stretch stimulus, the tissues acclimatise to stretch in a controlled context (before returning to sex). Overall it leads to significant muscle relaxation.

The patient has to work simultaneously on breaking old pain cycles, unlinking the association between penetration and pain, building new neuroassociations as they stretch and relax their pelvic floor. Breath work has a role here.

PERTH PHYSIO COLLECTIVE

Upfront cost

ITEM NO. Check your rebate with your health fund

Pelvic Health/Postnatal Body Check Consultation 1hr

$240

500

Breast Care

$110

500

General Care

$110

500

Exercise Assessment 1hr

$175

500

Breast Care follow-up

$110

505

General Care follow-up

$110

505

Long 2 Area Initial 

$175

506

Pensioner Pelvic Floor

$155

593

Pilates Assessment 1hr

$240

500

Exercise classes

$45

506

Paediatric Continence Physiotherapy

Initial appointment  1hr

$220

500

Follow up appointment 30 min

$130

505 (HBF 514)

Follow up appointment 45 min 

$165

505

Paediatric Physiotherapy 

Initial appointment 1hr

$220

500

Follow up 1hr 

$190

505

Follow up 45min 

$150

505

Follow up 30 min

$110

505