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Osteoporosis - How to keep your bones healthy and strong

12/15/2016

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Osteoporosis is a common skeletal condition, particularly affecting women over the age of 55, in which bones become brittle and weak making a person more susceptible to bone fractures. It occurs when bones lose minerals, such as calcium, a lot quicker than what the body can replace them and this causes the bones to lose their thickness (density or mass) and overall strength. Osteoporosis means ‘porous bones’ or ‘bones with holes’. If you compare a healthy bone to an osteoporotic bone, you will see numerous holes and large spaces within the bone as opposed to the bone being very dense and compact, as seen in the image below. This is what causes the bones to become so fragile and prone to breaking. Any bone can be affected, but bones of the spine, hip, and wrist are the most commonly affected sites.








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Osteoporosis affects approximately 1 million Australians - eight out of ten being women. Some risk factors include;
  • Cigarette smoking
  • Family history of osteoporosis
  • Sedentary lifestyle
  • Menopause (when oestrogen levels decrease, bones lose calcium at a much faster rate)
  • Low testosterone (testosterone keep bones strong and testosterone levels fall in men as they age)
  • Low calcium intake
  • Low vitamin D levels

Great news is that osteoporosis is largely preventable. Although some risk factors can’t be changed, men and women can take numerous steps to ensure adequate bone health and decrease the likelihood of developing osteoporosis.
  • Regular weight-bearing and strength building exercises
  • Eat a well-balanced diet with plenty of calcium rich foods
  • Get healthy levels of vitamin D (vitamin D helps absorb calcium). The sun is the best natural source of vitamin D but you need to balance sun exposure with skin cancer risks. Daily exercise also assists with the body’s ability to produce vitamin D
  • Avoid smoking and limit alcohol and caffeine intake.

How can your Chiropractor help?
It is important to note that Chiropractic cannot treat or cure osteoporosis, but, your Chiropractor will work with you and alongside your team of health professionals to help you manage adequate joint, spinal, and muscle function - allowing the musculoskeletal and nervous systems to function at their best. This will help improve your overall strength, balance, and proprioception, and therefore decrease the likelihood of falls and bone fractures. Fractures can lead to chronic pain, disability, and a loss of independence - so managing bone and overall body health and awareness to avoid fractures is a priority. Your Chiropractor will do a combination of soft tissue therapy, mobilisations, and weight-bearing/proprioception exercises to help promote mobility, stability, and strength. They will work alongside other health professionals to ensure you are getting adequate care and have all of the tools and knowledge you require to help you live a healthy and pain free life, managing this condition as best as possible. Osteoporosis is not a painful condition until a fracture does occur but if you do experience and chronic pain post fracture, or any pain or discomfort associated with any biomechanical changes your body may experience, your Chiropractor can help ease any aches and pains to ensure you can keep moving, exercising, and functioning to the best of your ability.

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Dr Melanie Xabregas is an experienced and passionate chiropractor with a special interest in helping children experience optimal performance and longeviety in dance and gymnastics. She brings a gentle, caring and friendly approach to her examination and treatment. Learn more about Dr Melanie

Available for consultations Tuesday & Friday between 2pm - 6pm ​

Book with Melanie
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What are orthotics and do you need them?

12/15/2016

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26 bones. 33 joints. 107 ligaments. 19 muscles and tendons. The feet are indeed very complicated structures that rely on a delicate interaction between a number of structures. Contrary to what we see being advertised on television, a very small portion of the population has what would be deemed ‘perfect feet’. In fact, most people at one point or another find themselves in a situation where their feet become problematic because of alignment issues or overuse. This is where orthotics can come in to assist in maintaining the feet in as perfect working order as is possible. Not everyone is suited for orthotics and not everyone would benefit from them, which is why a biomechanical assessment needs to be performed by a qualified podiatrist to determine if orthotics are appropriate for the individual. Most people can follow 3 basic questions though to guide them to deciding whether or not the options of orthotic should be pursued further.

Firstly, what are orthotics?
Orthotics are basically custom made footwear inserts that aim to support the foot and maintain the foot in a ‘neutral’ position. This neutral position is one where the ‘rolling in/pronation’ and ‘rolling out/supination’ of the foot is at a relatively equal level, thereby reducing any excessive strain on the tendons and ligaments needed to maintain this position naturally. Orthotics can be made of hard plastic (polypropylene) or softer rubber material (EVA). They are usually designed to be able to be moved between appropriate pairs of footwear.

So how can you tell if orthotics are for you? Below I have come up with 3 questions that can help guide you on making a choice. This is by no means an exhaustive list and I firmly suggest to patients who have concerns or questions to seek guidance of professionals to ensure the steps taken are appropriate for the patient in question. Remember, everyone is unique.



Are you concerned about your foot or body alignment?
As already mentioned, orthotics work to maintain the feet in a neutral position and reduce the stressed that may result. However there are a number of things to look out for in the alignment of the feet and body that may be setting a stage for further problems. Some things to look out for include:
  • Feet that roll in excessively (pronated feet)
    • Are often linked to heel, arch, ankle and shin pain as well as knee and hip osteoarthritis.
  • Feet that roll out excessively (supinated feet)
    • Can lead to recurring ankle sprains, ankle instability, tendon inflammation and excessive shoe wear.
  • One leg longer than another (limb length discrepancy)
    • Can lead to a ‘limp’ when walking and in the long term can mean structural issues that can lead to pain and dysfunction.
  • Bunions
    • Bunions alter the way pressure is distributed in the feet resulting in excessive force on the bunion region. Orthotics can help reduce this.​

Do you have foot or lower limb pain?
Pain is an important stimulus. It is the body’s way of telling us that something is not quite right. In terms of the feet and lower limbs, this can be from stressed ligaments and tendons to potential stress fractures of bones. Orthotics may assist in treating:
  • Heel and arch pain.
  • Toe pain.
  • Achilles and muscle pain.
  • Ankle pain.
  • Shin and calf pain.
  • Knee pain.
  • Hip pain.
  • Lower back pain.
Are you noticing unusual wear patterns on your footwear?
Wear patterns on shoes can tell a story. They can also give clues as to how the foot is functioning and can indicate sites of abnormality that may been to be corrected. All footwear will wear out over time with use and regularly replaced, however understanding what wear patterns can mean can identify what the feet are doing when you are walking. The particular areas of interest for podiatrists can be separated into the rearfoot, midfoot and forefoot.

Excessive wear on the outside of the heel may be indicative of a foot that tends to ‘roll out’ more when initially coming into contact with the ground. This can be a precursor to injuries to the outside of the ankle (rolling your ankle). Excessive wear on the inside of the heel may indicate a foot that pronates a lot more and may be in need of more supportive footwear to counteract it.
If a shoe undergoes a lot of pressure through the middle of the foot such as seen with flatter feet, the cushioning and support along the middle of the shoe will compress a lot quicker. This would render the shoe next to useless in providing support. Finally, by observing pressure points on the underside of the shoe at the area of the toes, we can identify if there is too much pressure going through the front of the foot. Ideally, pressure should be evenly distributed along the 5 metatarsal heads but the majority would be handled by the big toe. Deviations from this may indicate structural and/or functional problems with the forefoot.

All of the above points can be assisted by using an orthotic since the devices will maintain the foot in the neutral position and resist excessive forces which would be responsible for the observed wear patterns.
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Dr Anel Kapur delievers an outstanding clinical podiatric care to all clients. He has earnt himself an exceptional reputation among his clients for his attention to detail, gentle approach and depth of knowledge.
Dr Anel Kapur is available for appointments Monday and Saturday.
Bookings are available online or contact receptions on 9542 3330 


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Spinal Insights- Diagnosing Discs Concerns . By Chris Bowles

12/12/2016

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​Slipped disc, herniated disc, disc bulge, disc protrusion, disc extrusion, disc sequestration, torn disc, disc prolapse, squashed disc…… wow so many different names that are used for lots of different injuries interchangeably and often incorrectly. Lets clear up the naming first and then I will discuss how each may give rise to different symptoms.

A normal healthy intervertebral disc provides a cushion between the vertebrae in the spinal column.
In order of progression - the correct naming of different disc injuries are as follows.

Annular Tear
An annular tear is a rupture or tear of the fabric of the disc itself. If the disc tears and no nuclear material escapes and the disc remains the same shape it is called an annular tear and can be extremely painful as the nerves that transmit pain are located in the outer portion of the disc. Indeed there are no or limited nerve fibres in the central portion of the disc and thus non - painful. It is generally accepted that nerve fibres extend into ⅓ of the disc. Thus if an annular tear is painful we know it has reached the outer ⅓ of the disc. Below we can see the three different types of annular disc injuries.
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  • Rim Lesions - occur at the edge of the vertebrae from the outside in. Predictive of joint arthritis and possible future radial tear
  • Concentric Tear - is a tear between layers of the disc lamellae
  • Radial Tear - most common type and start from the painless inside of the annulus and progress outward toward the pain sensitive outer one third

Disc Herniation
Disc herniations are classified in different ways. Firstly they are named by the degree of nuclear migration - i.e how the softer middle bit has pushed out or pushed out and ruptured or pushed out and ruptured and then broken away.

  • Protrusion also known as a contained herniation or subligamentous herniation
  • Extrusion also known as a non - contained disc herniation or transligamentous
  • Sequestration - free fragment broken away

The image below is a guide only but my experience is consistent with this type of correlation between disc herniation types and back and leg pain distribution. I believe it should be worded - referred symptoms - rather than leg pain - as the pain can be in the hip, groin, genitals, buttock, leg or foot (in reference to lower back disc injuries).  










​Secondly, disc herniations can be named by describing the location of the herniation.
  • Central disc herniation
  • Paracentral disc herniation
  • Foraminal disc herniation
  • Far Lateral disc herniation​

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​As you can see disc injury and subsequent diagnosis can become quite involved. I must admit this is a highly minimised version of what I would like to discuss. In a future post I will discuss the symptoms at greater depth and the various management options available. In my humble opinion the single most important step is achieving an accurate diagnosis. This will inform the most well directed treatment strategy and prevent inappropriate treatment. This process can be very drawn out for some patients and indeed many people never receive an accurate diagnosis.

If you have any questions please do not hesitate to email me on chris@healthassociates.com.au or comments are welcomed here.  

Please remember this information is educational only and does not serve to provide clinical advice to any individual. Please always seek the advice of a registered health professional.
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Dr Chris Bowles
After suffering a spinal injury that resulted in the fusion of 3 vertabra and ended his rugby career Dr Chris dedicated his professional career to helping ease pain and suffering and creating an environment that keeps people doing the things they love. 
Dr Chris is available for consultations on Monday, Wednesday, Thursday and Saturday.

Book with Dr Chris
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Scoliosis and your child  - by Dr Melanie

12/12/2016

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​The spine is what holds your body upright and provides the main support for your body. When viewed from the side, a healthy spine will have three natural curves that form a loose ‘S’ shape - two concave curves found in the neck (cervical) and lower back (lumbar), and one convex curve found in the mid-back (thoracic). From the rear, a normal spine should look straight, from the neck, all the way down to the tailbone (coccyx). When a person has a scoliosis, their spine has an abnormal sideways curves which makes the spine looked deviated in either an ‘S’ or ‘C’ shape when viewed from the rear. Any abnormal curve observed in a child’s spine should be assessed and investigated, regardless of whether or not the child feels any pain.     

Scoliosis can affect many people of all ages, with 80% occurring between the ages of 10-18. It is one of the most common spinal deformities presenting to orthopaedic surgeons today. The most commonly seen scoliosis presenting to health clinics, eight out of ten times, is idiopathic scoliosis. The causes of idiopathic scoliosis are largely unknown, however, scientists have discovered that the onset often coincides with puberty and periods of rapid growth, and it affects seven girls for every one boy. 38% of scoliosis patients have a familial history and therefore children who have parents, grandparents, or siblings with the condition should be assessed.

Initially, a scoliosis is always almost pain free but later symptoms can range from mild to severe. Symptoms may include:
  • Uneven shoulders or hips
  • One leg shorter than the other
  • Prominent ribs on one side
  • Protruding shoulder blade
  • Back pain or discomfort, particularly during physical activities
  • In sever cases, trouble breathing due to the reduced lung space

A scoliosis is diagnosed via X-ray and careful physical examination. A health professional evaluates the spinal curvature by observing the child bend forward to reach his or her toes to assess for the presence of rib humping and a postural assessment. An X-ray is then used to confirm the diagnosis and to measure the degree of your child’s spinal curve. During the X-ray examination, the factors that are assessed include:
  • The shape of the curve (whether it is a ‘C’ or ‘S’ shape)
  • The location of the curves (thoracic spine, lumbar spine, or both)
  • The degree of the curve
  • What direction the spine curves towards

A scoliosis diagnosis can be scary for parents and children, particularly when Doctors mention back braces and spinal surgery. Treatment depends on many factors including the child’s age, their stage of development and if they are still growing, the location of the curve, and the degree of the curve. The good news is that informed parents are far more likely to achieve a positive outcome for their children. Understanding scoliosis and knowing what to expect will help with proper care and outcomes.

Approximately 50% of the population are said to have some degree of scoliosis. A large majority of the time, it’s mild and either requires no treatment or exercise treatment. A small percentage of the time, approximately 3%, the curves progress enough to require bracing or surgical intervention. While most scoliosis cases will not continue to advance, the odds of progression increase as the child ages and the curve grows, which will help determine what stage the scoliosis is in:

0°-10°: No scoliosis detected
10°-20°: At this stage, a scoliosis is considered as mild. Within this range, conservative therapy and scoliosis-specific exercises is recommended to help improve postural alignment and muscular asymmetries.Exercise helps your child strengthen the muscles required to hold the body upright and increase flexibility.
20°-50°: If the child’s spine is still growing when the curve reaches this range, Doctors may recommend bracing to help slow or prevent further progression of the curve.
50°>: Spinal surgeons may recommend spinal surgery at this point.

The best form of treatment involves early detection of the condition. Every scoliosis curve is different. There’s no one-size-fits-all treatment, and no two curves present and behave in exactly the same way. The best time to detect scoliosis is between ages 12-15. If this condition is left unassessed or treated it may lead to a variety of problems later in life.

Chiropractic and physical therapy can help identify and treat muscle asymmetries and postural issues in children with a mild scoliosis. An exercise program can be developed to include techniques to encourage good posture, increase flexibility, increase trunk muscle strength, and decrease discomfort. It is important to note that currently, there is no evidence that supports exercise in substitution of bracing, nor on the impact that exercises and conservative therapy has in decreasing or slowing the progression of a scoliotic curve.The most beneficial method for the management of scoliosis is an early detection and a team approach involving multiple health professionals to assist with management and providing the best care for your child.
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If you suspect that your child may have scoliosis, book an appointment with your family Doctor and Chiropractor.
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Dr Melanie Xabregas is an experienced and passionate chiropractor with a special interest in helping children experience optimal performance and longeviety in dance and gymnastics. She brings a gentle, caring and friendly approach to her examination and treatment. Learn more about Dr Melanie
Available for consultations Tuesday & Friday between 2pm - 6pm ​

book with Melanie
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Are your feet summer ready?

12/2/2016

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Summer is here!!

And with the hotter, longer days, most people take the opportunity to bring their feet out of exile and enjoy the sunshine, the feeling of sand and water in between their toes. This all seems all well and good but with so many advertisements broadcasting well maintained, ‘summer ready’ feet, most people end up asking themselves “Are my feet actually ready for summer?” The truth to that question may be a difficult dawning of reality when people realise that their heels are callouses, cracked or the skin on their feet is dry.

I often see people who come to me for both treatment on their hard and dry feet as well as for advice on what can be done at home to keep them happy and healthy. In order to be able to understand how you can get your feet looking their best it is important to understand some things that may be causing your feet to develop dryness and hard callouses.
  • Walking around barefoot on hard surfaces.
    • Stresses the soft tissues of the underside of the feet. The constant pressure along at these structures will result in hardening of not just the skin but also of the structures themselves.
  • Insufficient moisturising of the feet
    • Often the feet are neglected when applying moisturisers, however when you consider how much work they do, it is easy to see why they would need it.
  • Wearing tight fitting or improper footwear.
    • Constant use of heels or unsupportive shoes can expose the feet to pressures which may result in a similar effect on then as if you were walking on tiles barefoot.
  • General neglect
    • In some cases, the feet are the last things people think about. The reality however, is that they put up with a lot on a daily basis and require regular TLC. Neglecting callouses for example, can lead to cracks to form in the skin which can become deep enough to become not only painful but also infected.

It does become very worthwhile to see a podiatrist for help in removing any callouses, reducing splits in the skin and for advice on shoes and moisturising creams suitable for your skin type. Podiatrists are able to determine how much hard skin would need to be removed safely whilst also buffing the skin to make it silky smooth to touch and eye catching to witness in a pair of sandals. Outside of seeking professional guidance, there is a number of things that people can do at home to keep their feet looking good.Foot soaks
  • A daily foot soak using warm water and salts may not only ease tight foot muscles but can also control the presence of bacteria and fungus. Using warm water will also cause the skin to become softer over time.
  • As an addition, try adding marbles in the bottom of the soaking dish/basin and you will have an instant foot massage and soaking machine in your own home.
Filing down of hard skin
  • I will often encourage people to regularly use a foot dresser, pedi-egg, pumice stone or even buffing wheels (such as the Scholl wheel) to keep their callouses under control between appointments. The important part to note it callous is a protective mechanism of the body and removing too much too quickly will leave the skin raw and exposed, meaning painful feet. Less is definitely more!
  • Filing your feet in the shower or immediately afterwards is preferred as the skin will be softer and more easily treated.
  • NEVER ATTEMPT TO USE BLADES OR RAZORS TO REMOVE HARD SKIN. YOU WILL DO MORE HARM THAN GOOD.
  Moisturising of the feet regularly    
  • Different skins will respond differently to all the creams available. It is important to seek a podiatrists guidance for what will work best for you. In most cases however, simple Sorbolene, Vitamin E or PawPaw creams are good to use. A nice dollop of cream should be applied after a shower or foot soak focusing on the heel borders and underneath the balls of the feet.
  • Moisturing the skin will reduce dryness and also improve the skin's ability to resist callouses being formed.
  • If your heels are cracked, the skin will need to be treated professionally for best results, however Eulactol Heel Balm creams work really well at reducing these cracks.​
 Avoid walking barefoot on hard surfaces or wearing inappropriate footwear
  • Reducing the amount of punishing forces acting on the feet goes a long way to reducing the hardness and dryness that may result.

There is no magic bullet for maintaining healthy feet and in reality it requires work. However, with commitment and the right advice everyone can have feet they will be happy to show off this summer.
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Dr Anel Kapur delievers an outstanding clinical podiatric care to all clients. He has earnt himself an exceptional reputation among his clients for his attention to detail, gentle approach and depth of knowledge.
Dr Anel Kapur is available for appointments Monday and Saturday.
Bookings are available online or contact receptions on 9542 3330 

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