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    GP-plan.jpg
    Lisa Bywaters
    18/Nov/2021
    Health InformationMSK articles

    Chronic disease management

    Ever notice how much governments love acronyms?? Unfortunately, this article is full of them, but we’ll explain what they mean and try to clear up the murky area of chronic disease management (CDM) plans, formerly called Enhanced Primary Care (EPC) plans.

    Note: The primary sources for this article is the Australian Government, Department of Health’s chronic disease management resources. Unfortunately this information has not been updated since 2014. Please treat this as general information only, and discuss your specific needs with your GP.

    What are CDM plans?

    In a nutshell, these plans are a proactive way for you and your general practitioner (GP) to manage your chronic, complex or terminal medical condition/s. The Department of Health defines a chronic condition as ‘one that has been (or is likely to be) present for six months or longer’.

    Chronic musculoskeletal conditions fit under this definition.

    These plans are prepared by a GP to help eligible people manage their condition/s. The plans set goals to help people manage and hopefully improve their health and wellbeing.

    There are two types of CDM plans:

    • GP Management Plans (GPMP) and
    • Team Care Arrangements (TCAs).

    GP Management Plans (GPMP)

    A GPMP can help people with musculoskeletal conditions by providing an organised approach to their care. It’s a plan that you’ve worked out with your GP that:

    • identifies your health and care needs
    • sets out the services to be provided by your GP
    • lists any other health care and community services you may need
    • lists the actions you can take to help manage your condition.

    For example, if you have osteoarthritis in your knees that’s causing you lots of pain, and you’re no longer able to comfortably play tennis or go bushwalking, you and your doctor might decide that losing some weight will improve this situation. However, rather than just agreeing that weight loss is a good idea, a GPMP is an action plan that sets out your clear aims and objectives.

    Once this plan has been developed, you should receive a copy to take with you.

    Team Care Arrangements (TCAs)

    If you need help from other healthcare providers to achieve your goals, your GP may also suggest a TCA.

    TCA’s include 5 visits per calendar year to other health care providers. These 5 visits can be to one healthcare provider or spread between several providers.

    On the first of January you become eligible for 5 new visits. You’ll need to see your GP about this.

    You should also receive a copy of this plan.

    Eligibility

    This is one of the areas that’s a little complicated, so if you think you might be eligible, it’s best to speak with your GP directly. When you call to make an appointment, let the receptionist know that you’d like to discuss a chronic disease management plan. You’ll need a longer appointment for this.

    The Department of Health states that while there’s ‘no list of eligible conditions…these items are designed for patients who require a structured approach and to enable GPs to plan and coordinate the care of patients with complex conditions requiring ongoing care from a multidisciplinary care team. Your GP will determine whether a plan is appropriate for you’. (1)

    Costs

    Also a tricky area. If a healthcare provider (e.g. dietitian) accepts the Medicare benefit as full payment for the service, you’ll be bulk billed and there’ll be no out-of-pocket costs. However if they don’t, you’ll have to pay the difference between the fee charged and the Medicare rebate. This is often called the ‘gap’.

    When you’re making an appointment, be sure to ask what your out-of-pocket costs will be. If the cost isn’t something you can afford, discuss your options with your doctor.

    Reviewing your plan

    Your plan will need to be reviewed regularly. These reviews allow you to see how much progress you’ve made. If you’re meeting your goals – e.g. losing weight, increasing your fitness – that’s great. If you’re not getting there or having difficulties, a review will allow you to discuss this with your GP and work on solutions or adjust your goals.

    Help!

    It can seem overwhelming, but your GP and the practice nurse are there to support you on this journey.

    Contact our free national Help Line

    If you have questions about managing your pain, your musculoskeletal condition, treatment options, mental health issues, COVID-19, telehealth, or accessing services be sure to call our nurses. They’re available weekdays between 9am-5pm on 1800 263 265; email (helpline@msk.org.au) or via Messenger.

    More to explore

    Reference

    (1) Chronic Disease Management Patient Information, Australian Government, Department of Health, 2014.

    CONTINUE READING
    pain-management-blog.jpg
    Lisa Bywaters
    28/Oct/2021
    Health InformationMSK articles

    Support for managing persistent pain

    When you live with persistent or ongoing pain, it can sometimes feel like it’s taking over your life. And the usual things you do to manage your pain don’t seem to have the same effect.

    This can significantly impact your ability to do your daily tasks, work, be social, and be active. It can also affect your sleep quality, your emotions and mental health. This can then exacerbate your pain and become a vicious cycle.

    The good news is that there’s lots of support available to help you break this cycle.

    Breaking the pain cycle

    There is a range of different health professionals who can work with you to manage your persistent pain. You may see them on an ongoing basis, or you may visit them from time to time as needed.

    Your general practitioner (GP) is central to your care and will help you access other health professionals and services. Make sure you have a doctor who knows you, at a practice that can see you when you need to be seen. Having the same doctor, rather than moving from one doctor to another, means that your care will be consistent and organised. This will lead to the best possible outcomes for you.

    Physiotherapists (or physios) use a variety of techniques (e.g. exercise, massage, heat and cold) as well as education and advice to reduce pain to allow you to gradually increase your activity levels. They can also show you how to increase mobility, strength and functioning by developing an exercise program for you. Find a physio.

    Exercise physiologists can help you improve your health and fitness through clinical exercise programs tailored to your specific needs and support to live a healthy lifestyle. Find an Accredited EP.

    Occupational therapists (or OTs) help you learn better ways to do everyday activities such as bathing, dressing, working or driving. They can also provide information on aids and equipment to make daily activities easier. Find an OT.

    Psychologists, psychiatrists and other mental health professionals can help you work through your feelings, particularly if you’re feeling anxious or depressed. They can also assist you with goal setting, prioritising activities and coping strategies.

    Pharmacists can help you with information and advice about medications – both prescription and over-the-counter.

    Pain specialists are doctors who’ve undergone additional training to diagnose and treat pain. They come from a variety of different medical specialties such as psychiatry, anaesthetics and general practice. They often work with a team of other health professionals to treat all aspects of your pain, from the physical, to the mental and emotional aspects

    Pain management services and multidisciplinary pain clinics provide a holistic and coordinated approach to managing pain. Their programs are designed to specifically address the range of factors affecting your recovery, including:

    • physical factors
    • psychological issues, including your mood, stress or poor sleep
    • social factors including how you manage your activities at home and how you can return to work safely.

    You’ll learn from health professionals such as doctors, physiotherapists, psychologists, occupational therapists and nurses how to manage your pain more effectively with the least side effects.

    Talk with your doctor about whether a pain management program would be helpful for your situation. And check out the National Pain Services Directory by Pain Australia. It provides more information about the different types of pain services and a handy search function to find a service near you.

    Family and friends can be a great source of support and encouragement, so keep them involved. How much or how little you tell them about your pain issues is up to you, but just knowing they’re there if you need them can be a great source of comfort.

    Contact our free national Help Line

    If you have questions about managing your pain, your musculoskeletal condition, treatment options, mental health issues, COVID-19, telehealth, or accessing services be sure to call our nurses. They’re available weekdays between 9am-5pm on 1800 263 265; email (helpline@msk.org.au) or via Messenger.

    More to explore

    CONTINUE READING
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    Lisa Bywaters
    15/Sep/2021
    Health InformationMSK articles

    Specialists and you

    This is the third in our series exploring the different groups of health professionals and therapists who’ll help you live well with a musculoskeletal condition.

    Managing a chronic musculoskeletal condition – or multiple conditions – can be complicated. To help you get the best health outcomes and maintain (or improve) your quality of life, you’ll probably see a variety of different health professionals and therapists.

    Who you see and how often will depend on your condition/s, symptoms and how they affect your life.

    What is a specialist in healthcare?

    A specialist is exactly what it sounds like. A person – in this case, a medical doctor – who has undergone additional training to become a ‘specialist’ or an expert in a specific area of medicine.

    Specialists work in clinics and in hospitals, both in the private and public health systems. To see a specialist, you’ll need a letter of referral from your general practitioner (GP) or another specialist doctor.

    As far as musculoskeletal conditions go, the most common specialist that people will see is a rheumatologist. But many other specialists help people manage their condition. Let’s explore each of them.

    Whether you see any of these specialists will depend on your condition, symptoms, and their effect on your overall health and wellbeing.

    Seeing a specialist

    To see a specialist, you’ll need a referral letter from your GP or another specialist doctor. This will include information about your symptoms and test results.

    You can visit a specialist in a clinic or a hospital. Depending on various factors such as where you live, the number of specialists available, the urgency of your situation, and if there’s a waiting list, you may see a specialist quickly, or you may have to wait.

    Talk with your GP about the costs involved when discussing your referral. Medicare will cover part of the fee to see a specialist but not all of it. Specialist fees can be high, and depending on your circumstances and eligibility, this may influence whether you see a specialist at a bulk-billing hospital or in a private clinic. If you have private health insurance, this may also cover some of your costs. However, it’s essential to ask about fees and your choices before seeing a specialist.

    The Better Health Channel suggests asking the following.

    Does the specialist:

    • work within the public or private health system?
    • bulk-bill via the Medical Benefits Scheme (MBS)?
    • require gap payments?
    • have a payment plan?
    • accept my private health cover?

    Before your first appointment

    When making your appointment, ask what information or test results you need to bring with you. The specialist may already have access to all or some of this information via your health records, but it’s a good idea to double-check.

    You can also be proactive and create a file containing all of your results, records, medications and other treatments. Take it with you when you visit the specialist. That way there’ll be no potential delay in your assessment and treatment if your specialist can’t access some of your information. And make sure you include your referral letter.

    Write down a list of questions about the things you want to know. This may be about diagnosis, treatment options, the benefits and risks of different treatments, costs, things you can do to manage better etc. Put them in order, with the most important questions at the top of the list. That way, if you run out of time, they’ll have been answered first.

    Make sure you have an up-to-date list of your meds to take with you. This can be extremely helpful if your specialist hasn’t been able to access this information through online channels. You may want to use an app to keep track of your medicines so you always have this information with you. The MedicineWise app from the National Prescribing Service is free to download. You can create a list of your medicines by scanning their barcodes, set reminders for when to take medicines, store your test results and much more.

    Consider taking a family member or friend with you. Healthcare appointments can be stressful, and having an extra set of eyes and ears can help you take it all in. They can also provide emotional support before, during and after your appointment.

    During your appointment

    The specialist will ask you about your symptoms and examine you.

    Be open and honest when answering their questions. The specialist needs all the relevant information about you and your health to have an accurate idea of what’s happening and how best to treat you. They’ll need information about your medical history, other health conditions, treatments (both conventional and complementary) and lifestyle factors (e.g., how often you exercise, if you smoke, your diet etc.).

    You may have one or more visits to your specialist before they have all the information they need. They may also send you for further tests. Once they have all the necessary information, they’ll explain your condition to you and what treatment they think you should have.

    If you don’t understand what they’re suggesting, or you need more information, ask the specialist to explain further. Don’t be embarrassed to ask for this. Musculoskeletal conditions and treatments are complicated, so the more you understand, the better. And don’t be afraid to ask them to write things down for you.

    After your appointment

    Follow the treatment plan that you and your specialist have agreed upon. If they’ve requested you have further tests or book more appointments, make sure you do this as soon as possible.

    If you’ve been prescribed medication, take it as instructed. If you can’t remember, or you’re not sure how to take it, talk with your pharmacist or call your specialist.

    And for information and support between visits to your healthcare team, call our national Help Line on 1800 263 265 weekdays.

    Contact our free national Help Line

    If you have questions about managing your pain, your musculoskeletal condition, treatment options, mental health issues, COVID-19, telehealth, or accessing services be sure to call our nurses. They’re available weekdays between 9am-5pm on 1800 263 265; email (helpline@msk.org.au) or via Messenger.

    More to explore

    CONTINUE READING
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    Lisa Bywaters
    15/Sep/2021
    Health InformationMSK articles

    Myotherapy: Experience the difference

    Guest blog written by: Polly Bongiorno and Mathew Richardson

    Have you heard people talking about myotherapy but don’t know what it is?

    You’re not alone. Myotherapy is a relatively new treatment method for pain which has been rapidly growing in popularity in recent years.

    What is myotherapy?

    Myotherapy is a health care profession that focuses on assessing, treating and managing pain associated with musculoskeletal conditions.

    Myotherapists are known for being hands-on with their treatments, and one of their great strengths is their soft tissue skills.

    The treatment skills of a myotherapist can be classified broadly as either ‘active’ or ‘passive’.

    Passive treatments are those that are ‘done to you’, providing short-term relief of pain to restore preferred movements. These can be incredibly helpful when working to change protective muscle spasms, movement patterns, fears and stress.

    Active treatments are longer lasting, and involve you changing behaviours that will lead to long-term health benefits. These include exercise, education, lifestyle modifications and exploring the many different contributors to your pain.

    In essence, myotherapy helps people in pain move better and live their best life. A myotherapist will foster a relationship of respect, care and trust with you to form a unique plan to get you back to doing the things you love.

    So, what sets myotherapy apart from the rest?

    Myotherapy treatment sessions are often longer than those of other allied health providers. This gives the therapist time to develop and implement a comprehensive, individualised plan for care and recovery and still have ample time for strong hands-on therapy and exercise rehabilitation. It also allows time to nurture the relationship with you.

    Myotherapists are uniquely placed to offer a wide range of personalised treatments that can help to reduce pain and get you moving again. Myotherapists understand that no two people are the same, and so no two people should be treated the same when it comes to pain.

    What does a typical session with a myotherapist look like?

    One of the greatest benefits of a myotherapy session is longer treatment time. Time that is essential to ensuring your myotherapist will listen to you and your personal pain story. The myotherapist will ask you lots of questions to get a complete picture of your medical history and to understand your expectations and treatment goals.

    They’ll listen carefully to understand the nature of your problem and its impact on your life. This will include all aspects affected by your pain. These can be:

    • physical – e.g., work, exercise, lifestyle
    • psychological – e.g., anxiety, stress, beliefs
    • social – e.g., access to health care, support system, family relationships.

    The myotherapist will then assess your body – muscles, tendons, nerves, ligaments, joints – and movements, to rule out serious conditions that may require referral to another healthcare professional, before moving ahead with treatment.

    They’ll use a range of interventions, tailored to you and your goals. This may include soft tissue therapy to calm an over-protective nervous system, as well as exploring lifestyle and stress reduction strategies, exercise and movement interventions. They’ll also help you find ways of getting back to doing the things in life, that pain may have disrupted or affected.

    Finally, they’ll help you make sense of why you hurt, and what to expect on your journey of recovery. Understanding what’s happening to you and why, can be a powerful pain reliever.

    How is myotherapy different from physio or osteo?

    By definition there isn’t a lot of difference between musculoskeletal health professionals. Myotherapists use many of the same orthopaedic assessment techniques as physiotherapists and osteopaths, and many of the same treatment techniques. Apart from minor differences in approach, the differences mainly lie in the scope of practice, rather than the quality of treatment.

    For example myotherapists commonly treat general musculoskeletal pain and movement dysfunction, whereas physiotherapists also extend their treatment to cardiovascular and serious neurological pathologies.

    Accessing a myotherapist

    You don’t need a letter of referral from your doctor to see a myotherapist.

    They typically work in settings such as private clinics, sporting clubs or community health services.

    Myotherapists may work closely with other allied health professionals, general practitioners and specialists to get the best outcomes for people living with pain, regardless of the complexity of their problems.

    Cost

    The cost to see a myotherapist may vary, so ask about costs when you’re making enquiries about booking an appointment. You may be able to claim your treatment through your private health insurance. Check with your health fund to find out if myotherapy is covered, and if so, how much of the treatment is covered and how many sessions you can claim.

    In summary

    Myotherapy treatment aims to help you become confident that you can return to moving your body in ways that best support your lifestyle and what you value. It’s all about you.

    Consider myotherapy the next time you’re in pain. Myotherapists are health professionals with a deep understanding of the human body and can help you on your journey to wellness and vitality. If you’re in pain and want to try myotherapy, contact your local myotherapist or visit www.myotherapy.org.au to experience the difference.

    Contact our free national Help Line

    If you have questions about managing your pain, your musculoskeletal condition, treatment options, mental health issues, COVID-19, telehealth, or accessing services be sure to call our nurses. They’re available weekdays between 9am-5pm on 1800 263 265; email (helpline@msk.org.au) or via Messenger.

    More to explore

    CONTINUE READING
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    Lisa Bywaters
    26/Aug/2021
    Health InformationMSK articles

    Support for mental and emotional wellbeing

    This is the second in our series exploring the different groups of health professionals and therapists who’ll help you live well with a musculoskeletal condition.

    Managing a chronic musculoskeletal condition – or multiple conditions – can be complicated. To help you get the best health outcomes and maintain (or improve) your quality of life, you’ll probably see a variety of different health professionals and therapists.

    Who you see and how often will depend on your condition/s, symptoms and how they affect your life.

    Mental and emotional support professionals

    Being diagnosed with a musculoskeletal condition can be overwhelming. You may feel a range of emotions such as fear, anxiety, stress, loss, worry and anger.

    And living with a condition that causes ongoing pain and fatigue, and has the potential to change the way your body moves and functions can cause you to feel an array of emotions too.

    If you feel these ups and downs, you’re not alone. Many people living with musculoskeletal conditions find that their emotional and mental health is affected from time to time. In fact, anxiety and depression are more common in people with musculoskeletal conditions than in the general population.

    It’s important to recognise signs of these conditions and seek help as early as possible. Together with your healthcare team, you can develop a treatment plan that fits your needs physically, emotionally and mentally.

    Your support team

    Depending on your needs and whether you’ve been diagnosed with a mental health condition such as anxiety or depression, or you’re seeking support to help manage your emotions, you may see one (or more) of the following professionals:

    Your general practitioner (GP) – is usually the first person you see when you have a health issue. As well as helping you manage your musculoskeletal condition, they coordinate your care and help you access other health professionals and services. If you require specific support for your mental health, they’ll work with you to create a mental health treatment plan. This plan entitles you to Medicare rebates for certain mental health professionals and care via the Better Access initiative.

    A psychologist – can help you work through your feelings, particularly if you’re feeling anxious, stressed or depressed. They can also help you set goals and work through any problems that may be preventing you from achieving your goals.

    A psychiatrist – is a medical doctor who’s undergone further study to specialise in diagnosing and treating mental illness. They tend to treat severe and complex illnesses. They’re able to prescribe medication, such as anti-depressants, if appropriate.

    A mental health nurse – is a registered nurse who’s undertaken additional training to care for people with mental health issues. They work in the community and hospital settings to support people in managing their mental health and treatment.

    A mental health occupational therapist (OT) – OTs help people learn better ways to do everyday occupations (or activities). Those working in mental health help people lessen the impact their condition has on their quality of life and their ability to do their everyday activities.

    An accredited mental health social worker – specialises in assessing, treating, and preventing mental health conditions. They help people manage their condition and its impact on their family, friends, work, and education.

    A counsellor – is someone you can talk through your problems with. They can help you find clarity and solutions. A trained counsellor has usually spent three or more years studying counselling; however, there’s no requirement in Australia that counsellors have any qualifications or experience.

    Wow, that’s a lot of support! How do you choose who to see?

    Several factors will influence your decision:

    Your mental health issues/condition. It can be challenging to know what to do or where to go when you’re struggling with mental health issues. This is where your GP comes in. They’re trained to help people with their mental health issues. By talking with you about your situation, they’ll be able to refer you to the appropriate specialist to get the care you need. They can also assess whether you’re eligible for a mental health treatment plan.

    Your history. Have you seen a mental health professional before? Do you have a good relationship with them? Have you experienced good outcomes from your sessions with them? If so, you may decide to go back to them. If not, discuss your options with your GP.

    Cost. If you’re able to access subsidised treatment via the Better Access initiative, you’ll be able to see a mental health professional at a reduced cost. However, health professionals set their own fees, so be sure to ask about out-of-pocket costs when you’re booking your appointment. If these costs are an issue for you, even with Medicare rebates, talk with your GP.

    Access. If you live in a rural or remote area, you may not be able to see a mental health professional in person. In this case, you may be able to access them via telehealth. Telehealth enables you to consult with your health professional over the phone or through a videoconferencing app (e.g. Zoom, FaceTime, WhatsApp) on your smartphone, tablet or computer. You can choose phone or video consultations, depending on the technology you have available, and how comfortable you are using it.

    Treatments

    There’s no ‘one size fits all’ when treating mental and emotional health issues. Treatment will be tailored to your unique situation and the goals you have. But treatment will commonly include:

    Lifestyle factors – regular exercise, eating a healthy diet, getting enough good quality sleep, managing your stress and limiting your use of alcohol and drugs are practical things you can do to improve your physical, emotional and mental health.

    Psychological therapies – also called psychotherapy or talk therapies – explore the feelings, thoughts and behaviours that are distressing you, and work towards changing them. It can be used by people with mental health conditions and people who want to understand themselves better.* There are many different forms of psychological therapies, including:

    • cognitive behavioural therapy (CBT) – this helps people learn to identify and change negative or unhelpful thoughts that have a harmful effect on behaviour and emotions, and replace them with more objective, realistic thoughts. People learn practical coping strategies such as goal setting and problem-solving that they can use in the current situation and in the future.
    • mindfulness-based cognitive therapy — combines cognitive behavioural therapy and mindfulness strategies.
    • acceptance and commitment therapy – focuses on acceptance to deal with negative thoughts, feelings, symptoms, or circumstances. It also encourages a commitment to positive, healthy attitudes.

    Medication. For some conditions, such as moderate to severe depression, you may be prescribed anti-depressant medication. This will work alongside treatments such as lifestyle changes and psychological therapies. Find out more about anti-depressant medications.

    Other support is available

    • Your family and/or close friends can be a great source of support and understanding.
    • Peer support groups, or people in similar situations, can also be a valuable resource. Talking with someone who really understands what you’re going through and has lived experience and practical info is priceless. Groups meet in person and online. For specific mental health groups, check out this list by the Black Dog Institute. https://www.blackdoginstitute.org.au/resources-support/support-groups/
    • Mental health organisations provide a considerable amount of information and support to help you manage your mental and emotional health. See the list below for details of these groups.
    • Online therapy. There’s also a lot of information online that you can access whenever and wherever you want. Healthdirect has some information to help you find out more about eTherapy, including links to useful sites.

    Contact our free national Help Line

    If you have questions about managing your pain, your musculoskeletal condition, treatment options, mental health issues, COVID-19, telehealth, or accessing services be sure to call our nurses. They’re available weekdays between 9am-5pm on 1800 263 265; email (helpline@msk.org.au) or via Messenger.

    More to explore

    Mental health organisations and resources

    Reference

    * Psychotherapy, healthdirect, September 2019.

    CONTINUE READING
    physical-therapies_blog.jpg
    Lisa Bywaters
    05/Aug/2021
    Health InformationMSK articles

    Physical or manual therapies

    This is the first of a series of blogs that will explore the different groups of health professionals and therapists who’ll help you live well with a musculoskeletal condition. For ease of reading, we’ll be referring to them all as practitioners.

    Managing a chronic musculoskeletal condition – or multiple conditions – can be complicated. To help you get the best health outcomes and maintain (or improve) your quality of life, you’ll probably see a variety of different health professionals and therapists.

    Who you see and how often will depend on your condition/s, symptoms and how they affect your life.

    Physical or manual therapies

    These therapies provide a hands-on approach to help relieve your pain and stiffness and improve your mobility, movement and joint function.

    They’re often referred to as physical, manual, manipulative or hands-on therapies. The most common are:

    • Chiropractic – this involves manipulation and manual adjustment of your spine. It’s based on the premise that if your body, especially the spine, is out of alignment, it can affect the health and function of other parts of your body.
    • Massage – involves rubbing and manipulating the soft tissues of your body, especially your muscles. Massage can improve blood circulation, ease muscle tension and help you feel more relaxed. There are a variety of different types of massage available.
    • Myotherapy – involves assessing, treating, and managing the pain associated with soft tissue injury and restricted joint movement caused by problems with your muscles and the tissue surrounding your muscles (the fascia).
    • Occupational therapy – helps you learn better ways to do everyday activities such as bathing, dressing, cooking, working, eating or driving. An occupational therapist can also provide information on aids and equipment to make everyday jobs easier.
    • Osteopathy – is based on the premise that your body’s wellbeing depends on your bones, muscles and other soft tissues functioning smoothly together and correctly aligned. It uses physical manipulation, massage and stretching.
    • Physiotherapy – uses physical means (e.g., exercise, massage, heat and cold) as well as education and advice to help keep you moving and functioning as well as possible. Physiotherapists can also show you pain relief techniques and design an individual exercise program for you.
    • Reflexology – involves pressure applied to specific points of your feet or hands. These points are believed to match up with other parts of your body.

    All of these therapies will provide additional support apart from the hands-on treatment. This may include specific exercises for you to do at home, relaxation techniques and pain management strategies. Some practitioners (e.g., chiropractors, physiotherapists and myotherapists) may also use medical devices such as ultrasound, transcutaneous electrical nerve stimulation (TENS) or dry needling alongside their hands-on treatment.

    Talk with your GP and/or specialist

    Before seeing any new practitioner, it’s best to discuss the treatment with your GP and/or specialist (e.g. rheumatologist). They may have some cautions about a treatment as it relates to your specific health condition/s. For example, they may recommend that you not get a treatment if you’re going through a flare or have active inflammation. Or, if you have fused joints or osteoporosis, they will likely advise against treatments that manipulate or adjust your joints or spine.

    On the flip side, they may also provide you with recommendations of practitioners they’ve worked with or who have a particular interest in your condition.

    Do your research

    When making enquiries about a potential practitioner, ask lots of questions. For example:

    • How does the treatment work?
    • What are the possible side effects or risks?
    • Have you treated other people with my condition or health issues?
    • Do you need to see any of my recent medical tests (e.g., x-rays)?
    • How long does it take for this treatment to work?
    • How will I know if it’s working?
    • What can I expect during a treatment session?
    • How often will I need to see you?
    • How much does it cost?
    • Can I claim this treatment on my private health insurance?
    • What are your qualifications?
    • Do you receive regular training and updates?
    • Are you a member of the professional association for this treatment/practice?

    You can also contact the professional association and check their list of members to ensure the practitioner is registered. Or visit the Australian Health Practitioner Regulation Agency website and search for the practitioner.

    What to expect at your first appointment

    Regardless of the type of practitioner, you can expect to have a detailed discussion about your musculoskeletal condition and medical history, symptoms and what you hope to get out of the treatment.

    Be wary of any practitioner that doesn’t give you this time and attention to understand your situation and your needs. There’s no ‘one-size-fits-all’ when it comes to healthcare.

    Keep track of your progress

    It can be helpful to keep a daily diary tracking your symptoms so you can see if the therapy is working for you. Write down any changes in your pain levels, fatigue and other symptoms for a period (e.g., a month). Also include any changes to your medications, exercise routine, the amount of sleep you’re getting and anything else that could affect your symptoms. After a month of tracking, you’ll have a clearer picture of whether or not the therapy is working.

    And keep your GP and/or specialist informed about how you’re going with the physical therapy.

    Be careful

    All treatments – from hands-on physical therapies to medications and vaccines – have benefits and risks. You need to weigh these up to make an informed decision as to whether or not the benefits outweigh the risks for you.

    And if you have conditions such as osteoporosis or inflammatory arthritis, you should avoid manipulative treatments such as chiropractic and osteopathy.

    Contact our free national Help Line

    If you have questions about managing your pain, your musculoskeletal condition, treatment options, mental health issues, COVID-19, telehealth, or accessing services be sure to call our nurses. They’re available weekdays between 9am-5pm on 1800 263 265; email (helpline@msk.org.au) or via Messenger.

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    Professional associations

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    comp-therapies.jpg
    Lisa Bywaters
    17/Dec/2020
    Health InformationMSK articles

    Do your research

    …when it comes to complementary, alternative and ‘natural’ treatments

    Many Australians use complementary or alternative treatments to manage their health condition (e.g. arthritis, anxiety) or to improve their overall health and wellbeing. But what are these treatments and what do you need to consider before trying them?

    Complementary and alternative treatments include a wide range of therapies, medicines, products or practices that aren’t currently considered to be a conventional or mainstream medical treatment. They include acupuncture, meditation, massage, herbal treatments, yoga, aromatherapy and naturopathy.

    The word complementary usually refers to treatments that are used alongside conventional medicine, whereas alternative usually means the treatment is used instead of conventional medicine.

    To make things easier (and less wordy), we’ll use the term complementary treatment when referring to all types of complementary or alternative treatments in this article.

    Why do we use complementary treatments?

    People are attracted to these treatments because they often have a more holistic approach and treat the entire person, rather than just their condition or symptoms. They also appear to be more natural and safer than conventional medicine.

    But it’s important to understand that as with any treatment, complementary treatments may cause harm and make you unwell if they’re not taken correctly, if they interact with one of your other medications, or if the practitioner you see isn’t properly trained or qualified. That’s why you should discuss your use, or intended use, or any complementary treatments with your doctor.

    Do they work for musculoskeletal conditions?

    While many people feel that using complementary treatments has been beneficial for their health and wellbeing, there isn’t as much evidence to support its use for musculoskeletal conditions as there is for conventional medicines.

    For many complementary treatments there just aren’t enough well-designed randomised controlled trials to show whether or not these therapies are effective. And if they are effective, for which conditions or symptoms.

    However some types of complementary treatments show promise and may be helpful for managing your condition. More and more research is now focusing on these treatments. But at the moment the evidence is still lacking so it’s best to take your time, do your research and make sure the treatment is right for you.

    Tips for starting a new complementary treatment

    Let your doctor know what you’re doing. Keep them informed about any things you’re taking or considering taking (e.g. supplements, homeopathic treatments, herbal medicines) as well as any other therapies you’re trying or considering trying (e.g. acupuncture, yoga).

    Continue taking your medications as prescribed. Don’t stop taking any medications without first discussing it with your doctor. Some medications need to be gradually reduced, rather than simply stopped, to avoid side effects.

    Think about what you want to get out of the treatment. Are you hoping to control symptoms like pain or fatigue? Sleep better? Reduce or stop taking certain medications? Manage your anxiety? When you have a clear goal from the beginning of your treatment, you can monitor your progress and see if there are any improvements. After starting a new treatment, write down any changes you notice for a month – remember to include any medication changes, changes in your exercise program, the amount of sleep you’re getting and anything else that could affect your symptoms. At the end of the month, you’ll have a clearer picture of whether or not the treatment is working. If it’s not, it may be time to look for an alternative.

    Do your research and ask lots of questions. Some treatments may help you manage your condition or symptoms, while others will have no effect. Visit websites such as MedlinePlus and The Cochrane Library to learn more about the treatment. And talk with your doctor and the therapist. Find out if:

    • there’s any current evidence that the treatment is effective and safe for people with your condition?
    • the treatment’s been shown to be effective in repeated scientific studies with large numbers of people?
    • the research used a control group? A control group is a group of people who don’t have a particular treatment compared with a group of similar people who do. This helps to show that any results are due to the treatment and not some other factor.
    • potential risks, side effects and interactions with other treatments are clearly identified?
    • you can continue to use your current effective treatments, as well as the complementary treatment?
    • the treatment’s something you can afford and can access easily?

    If you answered no to any of these questions, you should be wary of the treatment. Discuss it with your doctor or specialist before you go any further.

    Check the qualifications of the person providing the treatment.

    • Do they receive regular training and updates?
    • Have they treated other people with your condition or health issues?
    • Are they a member of their peak body?
    • Are they accredited?

    Buy Australian. Australian complementary medicines are subject to strict safety and quality regulations. This may not be the case in other countries. In Australia the Therapeutic Goods Administration (TGA) ensures the safety of medicines and other therapeutic treatments.

    Call Medicines Line on 1300 MEDICINE (1300 633 424). As well as information on your prescription and over-the-counter medicines, they can also help you find out more about herbal medicine, vitamins and minerals.

    After doing your research, if you have any doubts about the treatment, don’t use it.

    Talk with your doctor or contact our MSK Help Line weekdays on 1800 263 265 helpline@msk.org.au for information about other treatment options.

    Call our Help Line

    If you have questions about things like managing your pain, your musculoskeletal condition, treatment options, COVID-19, telehealth, or accessing services be sure to call our nurses. They’re available weekdays between 9am-5pm on 1800 263 265; email (helpline@msk.org.au) or via Messenger.

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    Lisa Bywaters
    30/Jul/2020
    Health InformationMSK articles

    Put your best foot forward

    Looking after your feet

    Our feet are amazing ‘feats’ of engineering (sorry, I just couldn’t resist that one).

    Each foot has 26 bones, 33 joints, and more than 100 tendons, muscles, and ligaments. They support us through thick and thin – whether we’re walking, running, jumping, dancing, skipping or hopping. We cram them into ill-fitting shoes, torture them in high heels and stub them against the bedside table in the middle of the night (or is that just me?).

    As well as the many injuries and calamities that befall our feet, many musculoskeletal conditions, such as osteoarthritis, rheumatoid arthritis and gout can affect the feet.

    They’re the unsung heroes of this pandemic as we hit the streets, parks and trails for exercise. Walking has become the exercise of choice for people at the moment. Many of us can’t – or don’t feel safe to – return to gyms or exercises classes. And lots of people are walking instead of catching public transport to avoid being in close contact with others. As a result we’re all walking many more steps than we did pre-COVID.

    So we need to stop taking our feet for granted. We need to look after them so we can continue to do the things we want and need to do as pain-free as possible.

    So what can we do?

    Give your feet the TLC they deserve. It’s really important to look after your feet. Wash and dry them regularly. Inspect them for anything unusual such as cuts, blisters, changes to the nails and skin. By being aware of your feet and any changes that occur, you can seek advice sooner. And if they’re sore after a day of walking, maybe give them a warm soak in the bath, or in a bucket or a foot spa (if you have one) while you watch TV. Then dry them thoroughly and rub a moisturising foot cream into your skin. Take your time and give your feet a nice massage. Better yet, see if you can talk someone else into giving them a massage while you relax on the couch.

    Manage your condition. If you have a musculoskeletal condition that affects your feet, it’s important that you work with your doctor and healthcare team to look after your feet and manage your condition effectively. The treatments used for foot conditions will vary from person to person, depending on your condition and how it’s affecting you. And this may change over time as your condition and your feet change.

    See a podiatrist. If you have foot pain, or a condition that affects your feet, visit a podiatrist. They’re feet experts and can assess, diagnose and treat foot and lower limb problem, including skin and nail problems, foot and ankle injuries, foot complications related to medical conditions and problems with your gait or walking. Podiatrists can also give you advice on appropriate footwear, and can prescribe custom foot orthotics.

    Consider orthotics. Orthotics are corrective insoles that can help alleviate pain by redistributing pressure away from the painful area and support your arches. You can buy off-the-shelf orthotics or you can have orthotics made that are specifically fitted to your feet by a podiatrist.

    Fit your feet with appropriate footwear. With our worlds turned upside down due to COVID, and many of us having to stay home, it’s tempting to stay in our slippers all day. There’s something so comforting about warm, fluffy slippers. However our feet and ankles need proper support. Wear the right footwear for whatever you’re doing. Going for a walk? Put on your sneakers. Working at home? Wear your casual shoes/boots that support your feet and keep you warm. And lounging around in the evening? Get those slippers on.

    If you’re buying new shoes, make sure they fit properly, support your feet and are comfortable. Look for shoes that are light, flexible at the toe joints and are hard wearing. Shoes made of leather are preferable over synthetic materials as they breathe better. Avoid slip-on shoes and if laces are difficult to fasten due to arthritis in your hands, Velcro or elastic laces may be an option.

    Let them breathe. Did you know you have about 250,000 sweat glands in each foot? That’s a lot of sweat! So let your feet breathe to avoid smelly feet and fungal infections. Change your socks and shoes at least once a day. Wear shoes that allow air flow around your feet: leather, canvas, and mesh are good options, avoid nylon and plastic. And avoid wearing the same shoes two days in a row. Give your shoes time (at least a day) to dry and air out. And if the weather’s warm, set your feet free and let them go au naturale. There’s nothing better than walking barefoot on warm grass on a sunny day.

    Exercise your feet. I’m not talking about walking here…but other exercises that keep your joints moving. Try non-weight-bearing exercises such as swimming, especially if you have foot pain, as they take the pressure away from the painful areas. You can also do exercises while sitting in a chair. NHS Inform (Scotland) has some foot exercise videos you can try. If you want exercises tailored specifically for you, visit a podiatrist or physiotherapist.

    Medications might help. If you’re having a lot of foot pain, speak with your doctor about whether medications may be an option. Depending on the underlying condition causing the problem, your doctor may prescribe a short-term course of pain relievers or anti-inflammatory medications, or they may prescribe other medications, such as a cortisone injection into a joint for rheumatoid arthritis or medication for acute attacks of gout.

    Diabetes and feet. Many people with musculoskeletal conditions also have diabetes. So it’s really important if you have diabetes that you take care of your feet every day because of the increased risk of developing nerve damage, ulcers and infections. Talk with doctor about how to look after your feet properly if you have diabetes.

    Surgery may be required. For some people, surgery may be needed if other conservative treatments haven’t helped. A referral to an orthopaedic surgeon who specialises in feet is usually required.

    Contact our free national Help Line

    If you have questions about things like managing your pain, COVID-19, your musculoskeletal condition, treatment options, telehealth or accessing services be sure to call our nurses. They’re available weekdays between 9am-5pm on 1800 263 265; email (helpline@msk.org.au) or via Messenger.

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    Lisa Bywaters
    16/Jul/2020
    Health InformationMSK articles

    Massage your pain and tension away

    For many of us, massage is an important tool for managing the aches, pains and muscular tension associated with having a musculoskeletal condition. It complements the other things we do to manage our condition such as exercise, medication and mindfulness.

    What is massage?

    Massage is a hands-on therapy that involves rubbing and manipulating the soft tissues of your body, especially your muscles. There are many different types of massage including relaxation, shiatsu, sports, deep tissue, hot rock and remedial.

    Massage can improve circulation, ease muscle tension and help you feel more relaxed. A massage can also help relieve stress and help you sleep.

    In this blog our focus is remedial massage and self-massage.

    What’s a remedial massage?

    Remedial massage treats muscles that are knotted, tense, stiff or damaged. (1)  In consultation with the client, a remedial therapist will assess and identify which areas of the body require treatment, and use a range of massage-based techniques to optimise muscle function.

    Remedial massage helps loosen tight muscles and ease your pain and stiffness. And for many people with musculoskeletal conditions such as arthritis or back pain, this type of massage is essential to keep you moving.

    Seeing a remedial massage therapist

    A qualified remedial massage therapist is trained to “assess and treat muscles, tendons, ligaments and connective tissue and treat injuries and soreness”.(2) 

    Seeing a massage therapist regularly can help prevent a build-up of muscle tension caused by chronic pain, inactivity and injury. They can also help you manage your pain, maintain joint flexibility and function, and provide you with exercises and stretches to do between visits.

    Questions to ask a massage therapist

    Before seeing a therapist, you should do your homework and find out as much as possible. Ask questions such as:

    • What type of massage do you provide?
    • What are your qualifications?
    • Are you accredited with the peak massage body in Australia?
    • Have you successfully treated people with my condition?
    • Do I need to take all my clothes off?
    • How long are the massage sessions?
    • What is the cost?
    • Can I claim this on my health insurance?

    When you see the therapist you should:

    • Be open with them and communicate your needs and any health issues – whether they’re ongoing or new.
    • Make sure you’re comfortable before they start massaging. They may have placed your arms in a position that aggravates a neck or back condition, or have you lie in a way that causes pain or discomfort. If this occurs, explain to the therapist that the position doesn’t work for you. They can then make changes to ensure you’re comfortable and that you get the most benefit from the massage.
    • Ask for extra support if you need it. If you need a pillow or cushion to support your neck, knees or back, let them know so they can accommodate you.
    • Let your massage therapist know if the pressure is too hard, too soft or if anything hurts. Don’t suffer in silence.
    • Ask yourself whether it matters if you see a male or female therapist. Massage therapists are professionals who want to help you. They’ve seen people of all shapes and sizes and will use towels and sheets to cover you. However you do need to be relaxed during a massage, and if you feel uncomfortable or self-conscious you won’t fully relax. So if you think this will be an issue for you, ask for a massage therapist that suits your needs.
    • Try not to feel embarrassed if you fall asleep or pass wind during your massage. It happens – especially when your body relaxes.

    After your massage

    • You may feel a little sore or tender after your remedial massage. This may last up to a day. The massage has worked and stretched your muscles, much like exercise does. If you’re not used to this or it’s been a while since your last massage, you may feel some pain. A warm shower or heat pack can help alleviate this.
    • Do some gentle stretches, as you would after exercising. This helps you maintain some of the benefits of your massage – such as increased flexibility and reduced muscle tension.

    Giving yourself a massage

    You can relieve many of your own aches and pains by giving yourself a massage. You may even find that you do this unconsciously – when you’re sitting at the computer and you rub your neck, when you have a headache and you gently rub your temples, or when you’re applying a heat rub to your sore knee.

    It’s a simple easy way to relieve pain and tension. The good thing about self-massage is you can do it almost anywhere and it’s free! Try it next time you feel tense and sore.

    Self-massage tips

    • Warm up first – ease some of your muscle tension with a warm shower or by applying a heat pack (warm not hot) to the painful area.
    • Use smooth, firm strokes. You’ll feel the difference between strokes that are relieving muscle tension, and those that are adding to it. Adjust the pressure, from hard to gentle, based on your pain.
    • Add some massage oil (or lotion) – it can help your hands move smoothly over the skin. This isn’t essential, but can add to the soothing feeling of the massage.
    • Don’t massage over bony areas. This can be painful and may cause an injury.
    • Try using massage aids – such as a foam roller, massage balls or other massage aids; e.g. use a tennis ball or a golf ball to massage the soles of the feet. Simply place the ball on the floor, place your bare foot on top of it and gently roll the ball along the length of your foot. If you’re unsteady on your feet, sit down while you do this. You can also use the shower to provide a massage, especially on your neck, shoulders and back.
    • Massage regularly – this’ll help prevent muscle pain and tension building up.

    Get help with self-massage

    Sometimes you need help when you’re giving yourself a massage. Reaching a sore spot in the middle of your back is tough. Or being able to apply firm, consistent strokes to your neck and shoulders may be impossible if you have a musculoskeletal condition that affects those areas. So ask for help. From your partner, a close friend or even the kids. Just be sure to clearly explain what you need.

    You can remain fully clothed and have them massage those areas over your clothes. Combined with using a heat pack, a home massage can provide some relief from your pain.

    Massage during COVID

    Many of us are finding our muscular aches and pains are worse at the moment and the need for a massage is even greater. Working from home and not having access to a proper desk or chair, trying to home school kids, not being as physically active as we’d like, and general stress about what’s happening in the world can all add to our pain levels and muscle tension. A massage – whether by a qualified therapist or a self-massage can help.

    The good news for people locked down due to stage 3 restrictions, is you can still access remedial massage therapists. Yay!

    Remedial massage and other allied health services like podiatry, mental health counselling and physiotherapy are essential to support health and wellbeing. So they’re not a restricted at this time. So wherever you are in Australia, you can get a remedial massage if you choose to.

    Just make sure you don’t see a massage therapist if you’re feeling unwell. If you feel at all sick, get tested for COVID-19 and stay home. Find out more about COVID symptoms on the Australian Government website or call the National Coronavirus Helpline on 1800 020 080.

    Take care, stay safe and give massage a go.

    Contact our free national Help Line

    If you have questions about things like COVID-19, your musculoskeletal condition, treatment options, telehealth, managing your pain or accessing services be sure to call our nurses. They’re available weekdays between 9am-5pm on 1800 263 265; email (helpline@msk.org.au) or via Messenger.

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    poppy_web.jpg
    Lisa Bywaters
    04/Jun/2020
    Health InformationMSK articles

    More changes to opioid access

    The opium poppy is such a pretty, delicate looking flower. And humans have been actively growing them and enjoying their medicinal benefits since at least 3,400 B.C. The Sumerians referred to it as Hul Gil or the “joy plant.”

    It’s from these delicate plants we get opioids, a group of medications with which we have a long and complex relationship. They can provide great pain relief, but can also cause great harm.

    That’s why on 1 June 2020 the Australian Government introduced some changes which affect how we use and access opioids. So let’s look at what opioids are, how they work, and why these changes have been brought in.

    What are opioids?

    Opioids are pain relieving medications that come in a variety of formulations, dosages and strengths. They include: tramadol, codeine, morphine, oxycodone and fentanyl. You need a prescription from your doctor to buy any medications containing opioids.

    Opioids may be:

    • natural – created using the milky substance found inside the pods of the opium poppy, or
    • synthetic – created in a lab to have a chemical structure similar to natural opioids.

    How do they work?

    Opioids attach to opioid receptors in brain cells and dull our perception of pain. The pain isn’t gone, nor is the cause of the pain. It’s simply been dampened so that we can function with less discomfort. They also cause the brain to release the hormone dopamine, which can make us feel happy or relaxed.

    Opioids are used to treat severe pain associated with cancer or for acute pain – e.g. following surgery.

    They’ve also been used for many years to help people with severe, persistent non-cancer pain, like the pain associated with musculoskeletal conditions. However their long-term benefit is controversial for persistent pain or chronic pain. This is mainly due to the large body of evidence that shows that opioids have a limited effect on this type of pain. In addition they can also have serious side effects particularly with long term use, including breathing difficulties, addiction, overdose and death.

    We also know that our body adapts to opioids when we use them long-term. We have to increase the dosage to get the same effect, and an increased dose brings an increased risk of harm.

    Every day in Australia there are nearly 150 hospitalisations and 14 emergency department admissions due to opioid use, and three people die from drug-induced deaths involving opioids. (1)

    Because of these alarming statistics the Australian government has been changing the way we access opioids. Last year we saw all opioids, even the lowest dose available, requiring a prescription from your doctor. You can no longer buy them over-the-counter.

    The latest changes are a continuation of this plan to reduce the harm that opioids can do, and ensure that we use them cautiously and safely.

    What’s changing?

    From 1 June 2020 changes include:

    • smaller medication packs containing fewer opioids will be provided for short-term opioid use – for example after surgery or an injury,
    • improvements in medication information so people are better informed about the potential risks of opioids and how to reduce them, and doctors are following best-practise when prescribing opioids,
    • updating prescribing ‘indications’ (or when they’re used) to ensure opioids are only prescribed where the benefits outweigh the risks. (2)

    Can I still use them for my musculoskeletal pain?

    If you’re using opioids to manage the pain associated with your musculoskeletal condition, continue taking them as prescribed and talk to your doctor.

    We do know some people experience pain relief using opioids for persistent pain, so if they’re proving to be clinically effective for managing your pain, your doctor will be able to continue to prescribe them. However these new changes will require your doctor to weigh the risks and benefits of these medications, and to explore possible alternatives with you, including enrolling in a pain management program. Also, where opioid use exceeds twelve months or is expected to exceed this time, a second opinion will be required to renew ongoing prescriptions.

    Opioids aren’t a magic bullet and should be used in conjunction with other pain management therapies such as physiotherapy, exercise, weight management, cognitive behavioural therapy and mindfulness.

    What now?

    Living with persistent pain is exhausting. And the possibility of changing your medication can be stressful, especially if you feel like you’re managing your condition and your pain effectively. If you’re worried about these changes, talk with your doctor. Be honest about how you feel, but also be open to the possibility of trying new things to manage your pain. The aim is to keep your pain at a level that allows you to live your life and do the things you want and need to do. Opioids may be part of that, or they may be something that you’ll be able to phase out. It’s something that you and your doctor will need to discuss so that you get the best and safest outcomes.

    Contact our free national Help Line

    If you have questions about things like COVID-19, your musculoskeletal condition, treatment options, telehealth, managing your pain or accessing services be sure to call our nurses. They’re available weekdays between 9am-5pm on 1800 263 265; email (helpline@msk.org.au) or via Messenger.

    More to explore

    References

    (1) Prescription opioids: What changes are being made and why
    Therapeutic Goods Administration, 29 May 2020 

    (2) Prescription opioids: Information for consumers, patients and carers
    Therapeutic Goods Administration, 29 May 2020 

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