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30/Jul/2020

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.

More to explore


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16/Jul/2020

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”.(2)

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”.(3) 

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, telehealthmanaging 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


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25/Jun/2020

Living with a chronic musculoskeletal condition costs us physically, mentally and emotionally. But what many people don’t understand are the substantial financial costs associated with having chronic conditions. They’re expensive 😒

Healthcare costs

These are the most obvious. Medications, lots of trips to your doctor, your specialist/s, allied health professionals, tests, exercise classes, surgery, orthotics….they all add up. A lot!

People who don’t have a chronic condition may assume that a lot of this is covered by government subsidies, GP Management Plans, health insurance, the Pharmaceutical Benefits Scheme, with a little sprinkling of magical fairy dust to cover the rest. Depending on a person’s situation some of this may be covered. But much isn’t.

There’s significant cost in seeing allied health professionals such as physiotherapists, podiatrists, occupational therapists, hand therapists, dietitians and psychologists. While GP Management Plans assist with the cost, there’s mostly only five visits provided and these are used up very quickly. There may also be a gap payment over the Medicare Rebate. And there are also often considerable out of pocket expenses to see a specialist privately or longer waits when you see them publicly.

This can put a significant strain on a person’s finances.

Employment

Living with a chronic musculoskeletal condition is varied and episodic. That means you often don’t know how you’ll wake up. Your pain and stiffness may have been under control and manageable for some time, but then one day you wake up feeling crap. Your joints are swollen, it hurts to move, and you’re soooo exhausted. This makes it difficult to get up and move around, let alone get to work and put in a full day, as well as all the other things you have going on – family, friends, studying, chores, and a social life.

This may lead to time off work, and using up all your sick and personal leave. But if the situation (or workplace) becomes unmanageable it may result in someone having to permanently reduce their hours, change jobs, become unemployed or retire early.

Any of these things will obviously affect your everyday finances. However it can also affect your future finances as superannuation is impacted by reduced or lost income.

Wow. This became really depressing really quickly 😒.

The good news is there are services to help you if you need to change careers, or need financial assistance while you re-evaluate what you can or can’t do. We’ve added a bunch of these to the More to Explore section below.

And while we know none of these services are perfect, they can provide you with many of the tools and resources to help you through this tough time.

Hidden costs

Lost employment and medical costs – check. They’re probably the most visible costs. But there are many hidden costs. We’ve listed just a few.

  • Home and car modifications – so that you can continue to do the things you want and need to do as easily and pain-free as possible you may need to make changes to your home and/or car. They may be simple and relatively inexpensive – e.g. adding a swivel seat to your car to help you get in and out, or more complicated and pricey – e.g. installing a chair lift to help you get up and down the stairs in your home. An occupational therapist can help you work out what modifications will assist you, and can also advise you of any available schemes or assistance programs you may be eligible for.
  • As well as changes to your home or car, you may also need to buy various gizmos and gadgets that: protect your joints (e.g. tap turners, pick-up reachers), help you manage your pain (e.g. heat packs) and generally make life a little easier (e.g ergonomic mouse for your computer, walking aids). Again these can range in price.
  • Getting out and about if you’re in pain, or dealing with serious brain fog, can be tricky if you don’t feel up to driving. It’s only made worse with the COVID pandemic, when many of us feel vulnerable catching public transport. So you might have to resort to catching a taxi or using a rideshare company. But over time this does add up. You may be eligible for a taxi subsidy – each state/territory has their own scheme – so it’s worth checking to see if you can access this.
  • Food, glorious food 😋. Let’s face it there are many times you feel flattened by your condition and cooking is the last thing you want to do. And now with the convenience of delivery apps, you can get almost anything delivered to your door. Unless like me you live in an outer suburb in which case it’s fish n’ chips, pizza or burgers – yum, but not the healthiest options 😁 These deliveries can be a lifesaver, but the cost can also very quickly add up.
  • Events and holidays. This’s a tough one. Because of the nature of chronic conditions and often not knowing how you’ll feel from day to day, you can pay for future events and then have to cancel or change at the last minute. Like tickets to a concert (remember those??) – you often buy them so far in advance and you’re excited for literally months! And then the night comes and you know you can’t go – you’re too tired, too sore, too whatever. So you have to forfeit your ticket, or give it away to a friend. Or you’re on holiday, but you end up having to pay to make changes because you’ve had a flare and you need an earlier flight home, or you need to catch more taxis than you’d planned to, or you need to buy a pillow because the one at your hotel is a rock. It’s the crazy, unpredictable stuff like this that’s hard to plan for and adds to financial stress.

Pandemic pain

And then came COVID.

Many of us are having to manage to do more on less, with fewer hours, less pay, or no pay. It’s the unpredictability of this pandemic that adds to financial stress, especially if things were already tight before COVID came along.

The best thing to do if you’re feeling anxious about your financial situation is to be proactive and sort it out ASAP. Ignoring the problem won’t make it go away, and may make the situation worse. Choice has written a useful article that provides lots of handy info and tips: Making the right financial moves during the COVID-19 coronavirus outbreak.

And check out the More to Explore section below for more resources to help you.

Contact our free national Help Line

If you have questions about things like COVID-19, your musculoskeletal condition, treatment options, telehealthmanaging 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


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04/Jun/2020

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, telehealthmanaging 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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21/May/2020

For many of us our pain is always there – sometimes in the background and at other times it’s very much in the front of our minds. It’s a constant – just like taxes 😒 Even with a pandemic causing so much chaos and uncertainty, our pain persists, it’s always there.

And quite frankly it’s a pain in the arse. It hurts. It’s exhausting. And it’s invisible.

The Australian Institute of Health and Welfare last week released their latest report Chronic pain in Australia. It highlights that 1 in 5 of us lives with chronic pain. So next time you’re standing in a physically distant queue at the shops or taking a walk around the park – consider the fact that 1 in 5 of the people see you around you is also living with pain. It’s a massive problem, but there are things we can all do to manage our pain effectively.

Know your pain and yourself

It’s so important when you live with a chronic condition that you understand it. Learn as much about your condition as you can so that you can take an active role in managing it, including the pain associated with it. For example, what makes your pain better? What makes it worse? Do you tend to overdo things when you’re feeling great and end up paying for it over the next couple of days with increased pain? Or when you’re experiencing a flare and your pain is worse – do you get anxious, and everything becomes negative and too hard?

Knowing these things – really understanding how your pain affects you physically, emotionally and behaviourally – will help you manage your pain and your condition better, even in this time of crazy COVID.

Tackle the big three – exercise, eat, sleep, repeat

I don’t know about you, but I’m finding my exercise, diet and sleep have all taken a hit due to the pandemic and iso. Not being able to get to the gym, changes to work and my normal routine and stress has really impacted how and when I’m eating, sleeping and exercising. And not in a positive way.

This has had a very noticeable effect on my pain levels. If you’re experiencing this too, acknowledging it is the first step to changing things. So I can’t get to the gym – there are other ways to be active. So my routine has changed and as a result so has my diet. I can manage that. Stress and pain is impacting my sleep? I’ve managed that before – I can do it again.

It’s all about finding the right mindset. This is a strange, new normal we’re living in. And it’s going to change and evolve as we continue through 2020. We have no roadmap for what’s been, and what’s to come – so we need to do the best we can to change and adapt to the constantly shifting landscape.

Get help

OK, that all sounded sooooo easy, right?? Nope.

We may be able to change and adapt to some things but there will be times when we need to ask for help. From our family and friends, from our doctor, physio, psychologist. Whether it’s medications or physiotherapy to directly manage the pain, or asking a family member to carry the heavy laundry basket to the clothesline, or talking with a friend about your frustrations – whatever it is, there’s help available. You just need to acknowledge the fact that you need it and reach out. And remember the nurses on our Help Line are just a call or email away.

Use your mind

It’s a powerful tool. You can use it for distraction, mindfulness, relaxation, visualisation and guided imagery. None of these things will take your pain away completely, but they can provide temporary relief while you do a painful task, try to fall asleep, or wait for your pain medication to kick in.

‘P’ yourself – plan, prioritise and pace

We’re often our own worst enemy. We do too much when we’re feeling great, and end up feeling rubbish for hours/days afterwards. Something ‘simple’ we can do to prevent this from happening time and again is to plan, prioritise and pace ourselves. First plan – what do you need to do today? Write it down. Now prioritise. How much of those zillion things do you really need to do? Often things we see as hugely important aren’t. And do you need to do them yourself? Can someone else do it? Now pace yourself. It’s not a race – so be generous with your time, spread your jobs over the day and build in space for rest breaks.

Look after your mental health

Living with persistent pain can sometimes be a roller-coaster of emotions. It’s perfectly natural that from time to time to feel sad, worried, angry, anxious, depressed or frustrated. Add a pandemic, and it’s no wonder many of us are feeling as if our worlds have turned upside down and inside out. It’s important that you acknowledge these feelings. You may want to write in a journal, talk with a family member or close friend or talk with a counsellor or psychologist. Don’t ignore these feelings or keep them bottled up.

Your GP can refer you to a psychologist if needed on a GP Mental Health Management Plan. At the moment because of COVID-19 you can arrange to speak to a psychologist via telehealth (over the phone or a video call).

Be kind

To yourself and to others. It’s an unprecedented, really strange time and we’re all doing the best we can. So be kind to yourself – you’ll experience ups and downs, stumbling blocks, and barriers that get in your way. And some days you’ll need to work really hard just to keep moving. So give yourself a break. And remember 1 in 5 people are living with invisible chronic pain. And even more people are dealing with all kinds of stuff we can’t even imagine. So be kind to the people you encounter. It makes us all feel so much better than the alternative.

More to explore

Our nurse Clare discusses some simple things you can do to manage pain while at home in isolation, including pacing activities, exercise, getting a good night’s sleep and heat and cold packs.

We also have some great blogs to give you more tips and info about managing pain:


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13/May/2020

Thanks to one of our MSK Kids parents who has written this blog for us. They have chosen to remain anonymous. 

When our world changed rapidly at the end of March due to COVID-19 social distancing regulations and remote learning, I was amazed that my child wasn’t freaking out about all the changes taking place. I put it down to her wonderful teachers and the fact that she has dealt with a major event in her life already, a chronic health condition and immunosuppressive treatment. Here are some of the ways my child has had the dress rehearsal to COVID-19, and so have we as parents.

Experienced at social distancing

When you have an immune suppressed child you have already had to cancel play dates, sleepovers and extra-curricular activities. Your child has already stopped sport at some stage, and has probably missed important days at school or with friends. You have already been fearful of every cough and sneeze in the classroom and you know the times of the year when chicken pox cases increase.

We’ve been using hand sanitiser already

Ask any parent who has spent time with a child in hospital, and chances are they know the smell of Microshield® very well (the brand of hand sanitiser in most Australian hospitals). We’ve been used to having good hand washing habits and know the importance of alcohol-based agents to clean hands. You probably already had a decent amount of hand sanitizer at home before COVID-19, as well as alcohol-based wipes (especially if you have to administer subcutaneous injections).

We know and appreciate our healthcare workers

It didn’t take this pandemic for us to appreciate our wonderful healthcare workers. We’ve known this for years through our regular interactions with doctors, nurses and allied health workers. Hopefully everyone else now recognises the importance of good health in our lives and our amazing healthcare workers.


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07/May/2020

In the last couple of weeks pop-up and drive through testing centres for COVID-19 have been appearing in places like shopping centre carparks, town halls and community centres.

Testing in Australia has now been expanded to include anyone with COVID-19 symptoms. At the beginning of the pandemic we were focused on mainly testing people who’d been overseas, on cruise ships or had been in direct contact with someone diagnosed with the virus.

Now focus has moved to community transmission. This is when someone develops COVID-19 for no obvious reasons. They’ve not been overseas or in contact with someone with the virus…that they know about.

Symptoms

As we know some people may have the virus without having obvious or severe symptoms. If they’re out and about they may unwittingly spread this highly infectious virus to others.
That’s why testing is being broadened to anyone who has symptoms such as:

  • fever, chills or sweats
  • cough
  • sore throat
  • shortness of breath
  • runny nose
  • loss of sense of smell.

For more information about symptoms and to see if you or someone you care for may have the virus, use the healthdirect Coronavirus (COVID-19) Symptom Checker. Answer a few simple questions to find out if you need to seek medical help or be tested. Or call the National Coronavirus Helpline on 1800 020 080, 24 hours a day, seven days a week.

It’s important to be aware that there are currently some slight differences in the testing criteria for states and territories.

For example Victoria has started a two week testing blitz. As well as people with symptoms, some people can be tested even if they don’t have symptoms. This includes people with chronic conditions, Aboriginal and Torres Strait Islanders and people who can’t work from home (including healthcare workers, police, construction workers).

Visit your state/territory health website for information about testing criteria relevant to where you live or call the National Coronavirus Helpline on 1800 020 080.

So what are the tests and how do they work?

First, it’s important to note that all tests for COVID-19 are performed by health professionals. You may have seen information about home tests on social media. In Australia it’s illegal for anyone to sell a home testing kit and claim that you can test yourself for COVID-19. Supply of these kits is also prohibited under the Therapeutic Goods (Excluded Purposes) Specification 2010. Testing for COVID-19 is complicated and requires the specialised knowledge and training of health professionals. As well as the actual testing and interpretation of results, they’re also able to give you expert information and support. So if you see these home tests advertised, ignore them.

The main test currently used for COVID-19 is a swab test.

A swab (similar to a long cotton bud) is inserted into your nose or back of your throat to collect fluid and cells. Once the sample has been collected it’s sent to a lab for testing.

At the lab, technicians will look for genetic material from the virus. They will then send the result to the health professional who took the sample. This usually takes between 1-3 days. You’ll be contacted with the results – whether you have the virus or not.

The swab test can only tell you if you have an ongoing infection, it can’t tell if you’ve had COVID-19 in the past.

While this test is considered to be very accurate, especially in a laboratory setting, there can be errors. People may be told they aren’t infected when they are. This is called a false negative. It can happen if a sample hasn’t been taken correctly or if the virus hasn’t replicated in your body to a level that can be detected. There’s also the possibility of a false positive, when a person has been told they have the virus, but they don’t. This can happen if the sample becomes contaminated in the lab. However these are not common occurances.

Another test that may be used in some situations looks for antibodies in your blood. If you have the virus, your body will create antibodies to fight it. The blood test will look for this. However it takes time for your body to create antibodies, so you may have already recovered from the virus before antibodies appear. So this test can’t tell you if you still have the virus, or when you may have had it – only that you have had it.

Testing as we go forward

As well as testing for COVID-19 in people who have symptoms or suspect they may have the virus, testing may begin to be carried out on the community at random.

Called sentinel testing or sentinel surveillance this mode of testing will look for cases of COVID-19 in people that aren’t displaying symptoms.

It’s likely that sentinel testing will be happening in the near future as we begin to relax restrictions. We just have to wait to hear from the Federal Government as to how and when it’ll happen.

For more info, read What is sentinel surveillance and how might it help in the fight against coronavirus? 

Contact our free national Help Line

If you have questions about things like COVID-19, your musculoskeletal condition, treatment options, telehealthmanaging 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


upside-down.jpg
01/Apr/2020

Our worlds have turned upside down and inside out. Just when you think you’re getting the hang of the new normal of isolation and staying at home, a new restriction comes into place. These restrictions are vital to help prevent the spread of a highly infectious virus, but they do make it hard to find your balance.

It’s no wonder most of us are feeling anxious, stressed, upset, angry, vulnerable and a whole host of other emotions. When you also have a musculoskeletal condition, especially if you’re immunocompromised, all of these emotions may be heightened.

That’s why as well as looking after our physical health, it’s really important we look after our mental health.

We’ve put together a list of many practical things you can do to look after your mental health during the pandemic.

A quick warning, this is a ridiculously long blog 😉 but there’s so much we wanted to share with you!

Read it all, or just read the bits that are relevant to you at the moment and revisit as things change.

Find a new routine

This will obviously depend on what you need to do in your day, if you have people depending on you, if you’re working from home, have school work (or need to help others with school work) etc.

It might help to sit down with the members of your household and create a calendar that includes everyone’s commitments and needs. Things to think about when creating your calendar:

  • Get everyone involved. We’re living together in close quarters at the moment, without many of our usual distractions, sports and our friends, so it’s vital that everyone feels that their needs matter and they’re being heard.
  • Include specific time for fun stuff, exercise and connecting with family and friends. Dust off the board games – who doesn’t like a good game of Twister, Monopoly or Yahtzee?
  • Keep your weekends separate – this is really important so that you can get your chores done (sadly the laundry doesn’t stop because of a pandemic) and you have time to do creative stuff, exercise, and get a break from the workday routine.
  • Be very clear on your hours. It’s really easy to lose track of time. If you find this happening, set reminders on your phone to alert you.

Stay informed

There’s a lot of information out there about COVID-19, which can add to our anxiety and stress. But we need to stay up-to-date with factual, current information. Visit the Australian Government website for the latest from the government. Visit our website, follow us on Facebook, and/or call our Help Line weekdays on 1800 263 265 or email our nurses helpline@msk.org.au for info and support.

And once you’re up-to-date, put the news away for a while. It really doesn’t help our mental state to continually check what’s happening. Consider having a specific time (or two) when you check the latest news, and then go back to doing other things.

Get some sleep

We often struggle with sleep at the best of times, because we live with chronic pain. Unfortunately anxiety and stress can make this worse. But it’s important that we do all we can to get some decent sleep. Our physical and mental wellbeing is inextricably linked to good quality sleep – and getting enough of it. Read our recent blog for some practical tips on getting a good night’s sleep.

The Conversation has also recently written a useful article about the importance of sleep, especially now: Sleep won’t cure the coronavirus but it can help our bodies fight it.

Exercise regularly

We’ve talked, and will continue to talk about the importance of staying active – both during a pandemic (still blows my mind to say that) and during normal times. It helps us sleep better, maintain our weight, manage our pain, reduces our risks of developing other health conditions, and it improves our mood. There’s very clear evidence that regular exercise reduces stress, anxiety and feelings of depression and boosts our self-esteem. So exercise outdoors if you can (while maintaining physical distancing), and exercise in and around your home. Read our blog about exercising during the pandemic.

Eat well

Hands up who’s eating more often, and more unhealthy food choices at the moment? 🙋‍♀️🙋‍♂️ Food is a comfort to us all…and when we’re feeling a bit lost many of us reach for the food that makes us happy. But remember this gratification is short lived. Try to stick to your usual meal times, and gather everyone together and discuss your day (as long as you’re all well). If you live alone, use one of the many apps available (e.g. House Party, Hangouts) and share a virtual meal with a friend or your family.

Be careful with alcohol and other drugs

The temptation may be there to drink a little more, or use other drugs to make you feel better. But any mood changes you may experience are temporary, and drugs and alcohol have a negative effect on our mental health and our wellbeing.

Stay connected

Many of us are feeling the effects of being isolated, even if we live with others. We’re missing our circle of friends, our various social groups, our workmates and our extended families. There are many ways we can stay connected and keep up with each other’s lives. The simplest way is to pick up the phone and call. Avoid discussing the doom and gloom of the news cycle if you can. Instead focus on the new things you’re doing, your triumphs, how you’ve been able to work through challenges. And if there is something really worrying you, or making you anxious or upset, discuss it with someone you trust. Don’t ignore it. Get it out in the open so you can deal with it. As well as calling people, use tech to connect. There are a ridiculous number of ways to connect with others using social media platforms and apps. If you’re not sure where to start, read From Houseparty to Hangouts, these apps can help you stay social in coronavirus isolation by ABC News.

Create something

Channel your inner creativity. It’s a great way to relieve stress, and distract yourself from the worries of the world. There are a lot of online tutorials and info to help you: write a poem/song/novel/blog; learn a craft/language/skill; grow a flower/herb/vegie garden; paint a landscape/portrait/abstract; organise your home/office/life; cook a new recipe.

The sky really is the limit. So ask yourself – what have you always wanted to do if you just had the time??

Turn off the screens/limit news

Although a lot of the tools we’re using to deal with this pandemic are online, we need to set ourselves limits. Too much screen time, too much news – it’s just not good for us. As with everything, moderation is key. Turn off the electronics and pick up a book, or go for a walk, weed the garden, do some deep breathing exercises, talk with someone, try mindfulness. Do anything else but look at your screen or the news…at least for a while.

Give yourself a break

Our world really is crazy at the moment, so it’s important to recognise that and give yourself a break. We’ve not had to deal with a pandemic on this scale before, so be kind to yourself, and if you have a bad day, or a meltdown, that’s ok, we’ve all done it. You’ll brush yourself off and keep on going. And if you feel like you’re not finding it as easy to move on, or get past these moments, it might be time to talk with your doctor about getting professional help.

Get help when you need it

This may be psychological help if you feel like you’re not coping emotionally, financial help if you’re worried about your money situation or legal help if you have some concerns about your employment rights, or you have questions about writing your Will or setting up Powers of Attorney. Getting expert advice can help relieve some anxiety.

Take heart

🧡We’ll get through this. We may have to change and adapt, but we will come out on the other side of this pandemic. We just have to be patient, follow the advice and guidance of our health professionals and the government, look after each other and be creative with how we live during these crazy times.

More to explore


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01/Apr/2020

This blog was updated 17 July 2020 in response to changes to telehealth. 

“From July 20, telehealth GP providers will be required to have an existing and continuous relationship with a patient in order to provide telehealth services.

This will ensure patients continue to receive quality, ongoing care from a GP who knows their medical history and needs.

A relationship is defined as the patient having seen the same practitioner for a face-to-face service in the last 12 months, or having seen a doctor at the same practice for a face-to-face service during the same period.

In areas under stage three restrictions in Victoria, this requirement will not apply to those living under new restrictions in Victoria.” (1)

Read the full media release from Greg Hunt, Minister for Heath, for more information.

And read the rest of our blog for more info on telehealth – what it is, how it works and the costs (if any) involved.

“We’re not in Kansas anymore Toto. Welcome to our brave new world”.

OK, so I’ve mixed my classic Hollywood movie and a classic Huxley novel, but we really are in unchartered waters!

At the end of March 2020 the Federal Government announced that telehealth would be available for everyone. It’s one of the many measures the government is introducing, to enforce physical distancing and slow down the spread of the virus.

So what is telehealth and how does it work? 🤔

Simply put telehealth enables you to consult with your health professional over the phone or through a videoconferencing app (e.g. Zoom, FaceTime, WhatsApp).

Depending on the technology you have available, and how comfortable you are using it, you might have a conversation over your phone with your doctor (like any other phone call), or you may interact face-to-face through a videoconferencing app.

Don’t worry though – if you’re only comfortable talking on your phone, that’s fine. You don’t have to download apps and learn how to use them. But if you’re interested, they’re easy to use. They just take a little practice.

Will I have to pay more for telehealth?

It depends. The Health Department has recently made some changes around telehealth.

From 6 April 2020 telehealth services must be bulk billed for “Commonwealth concession card holders, children under 16 years old and patients who are more vulnerable to COVID-19”. (2)

The good news is that ‘vulnerable’ includes people being treated for a chronic condition and people who are immune-compromised. For all other patients, health professionals may set their own fees for the new temporary MBS telehealth items.

Confused? You’re not alone! Read this fact sheet (PDF) from the Department to find out more: COVID-19 Telehealth Services: Consumer Factsheet, Last updated: 8 May 2020

With any new system we need time to adjust

As many of us have discovered as we’ve started working, schooling and just trying to entertain ourselves at home, there may be some teething issues.

If you’re calling over the phone you’ll need to adjust to not seeing your doctor face to face; if you’re using an app you’ll need time to adjust to using new technology.

And if you’re using an app you may also experience slower internet speeds, which may affect your consultation. This is more likely to happen during busy times when everyone’s trying to get online (streaming their favourite shows, catching up with friends, watching cat videos).

As with any appointment, there can also be issues with time. Your health professional may be running late, they could be having tech issues, other patients needing more time, a medical emergency, or because they’re human and also need to adjust to working from home. You may be running late too. So it’s vital we all try to be patient, and give ourselves and others some leeway as we navigate this new ‘normal’.

But we can make it easier

We’ve identified these potential issues not to freak you out, but to prepare you. So here are our top tips to telehealth harmony.

Be patient – if your doctor is running late, if your internet is slow, if your appointment is rescheduled due to an emergency, be patient. This can be really hard to do when you’re unwell or in pain. You can feel vulnerable and worried, and being stuck at home can be frustrating. But becoming impatient won’t change the situation and will only make you feel worse – both physically and emotionally. Make a cuppa, read a book, do a crossword, talk with your partner/cat/dog/kids – distract yourself while you wait.

However if you have chest pain or difficult breathing, or have a medical emergency, call 000 immediately.

Don’t wait for your telehealth appointment.

Be prepared – before your appointment, make a list of the things you want to discuss with your doctor. Put them in order from the most important to the least. That way you won’t finish your consultation and then kick yourself for not asking X. Also – be aware that your appointment may end earlier than you anticipate if there’s a tech issue or an emergency. So lead with your most pressing questions or concerns, and if you have time, follow with the ones that are less important.

Be kind – our health professionals are doing the very best they can, often under very stressful, trying circumstances. They’re our frontline during this crisis, so please be kind to them. And be kind to yourself. You’re learning new technology or new ways to do things and just trying to stay sane during an insane time – recognise that you’re also doing the best you can. So hang in there.

Talk with someone who cares

Call the National MSK Help Line – our nurses are available weekdays from 9am to 5pm on 1800 263 265 or you can email helpline@msk.org.au. They can help you with info and support about musculoskeletal conditions, managing pain, treatments, accessing services, COVID-19 and much more.

Call the National Coronavirus Helpline – if you want information on coronavirus (COVID-19). It’s available 24 hours a day, seven days a week on 1800 020 080.

More to explore

Expert advice matters
Royal Australian College of General Practitioners
This new website from the RACGP provides information on the importance of continuing to see your GP – especially if you live with a chronic condition or you develop new symptoms or illnesses. It also provides lots of useful info about telehealth.

What is telehealth and is it right for you? 
NHMRC Partnership Centre for Health System Sustainability, March 2020
This guide explains the basics of telehealth and describes how to find telehealth services. 

Attending a video consultation 
NHMRC Partnership Centre for Health System Sustainability, March 2020
This guide explains how you should prepare so you can get the best out of your video consultation.

What can you use a telehealth consult for and when should you physically visit your GP?
The Conversation, 1 April 2020
Some info to help you work out when you should or shouldn’t use telehealth, with a handy infographic to clarify it even further.

References

(1) Continuous care with telehealth stage seven
Australian Government, Department of Health, 10 July 2020

(2) COVID-19 telehealth services: Consumer fact sheet
Australian Government, Department of Health, 8 May 2020


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22/Jan/2020

Written by Steve Edwards

“A cortisone injection? You want to stick a needle in my sore foot?”

Your health care clinician has suggested you have a cortisone injection into your foot. As with any medical procedure, both of you are best advised to discuss the benefits and risks before proceeding. It helps to know what cortisone is, what it does, and why it’s been offered to you.

Cortisone is an anti-inflammatory medication that’s often used to treat musculoskeletal conditions. It’s a synthetic version of cortisol, a hormone that naturally occurs in your body. Injected into the affected area, cortisone can lower inflammation and pain, remove fluid, and thin scar tissue or adhesions. So if your clinician diagnoses a musculoskeletal condition affecting your foot or ankle – such as arthritis, bursitis, neuroma, or tendinitis – a cortisone injection is commonly raised as an effective treatment option.

Cortisone injections also contain a local anaesthetic. For certain conditions an injection can be painful, so the anaesthetic may be injected separately before the cortisone to block this pain.

The clinician may or may not use ultrasound technology to guide the injection. For pain relief in the foot or ankle, research finds no statistically-significant difference between procedures conducted with or without ultrasound. Interestingly, trials on cadavers injected with dyed cortisone show how it rapidly spreads from the injection-point to adjacent tissue, indicating that pinpoint accuracy is not key to effectiveness.

There are several types of cortisone. In most cases the clinician will administer a long-duration cortisone, taking effect within 1-3 weeks, with benefits lasting between 1-9 months, depending on the condition and its severity. There’s a clinical consensus that no more than 3 injections should be administered to the same body-part within a 12-month period, though there’s no research literature to clearly support this belief.

After the injection, you can quickly return to most activities. The clinician may recommend you avoid strenuous physical exertion such as gym workouts or running for a few days, so the cortisone isn’t displaced from the target tissue.

As for risk-factors, there’s been research into whether the injection may risk tearing tendons in the target area. There’s no recorded case of this in human trials, though it has occurred in trials on dogs and horses. There were cases of more general tissue damage recorded in early trials on American gridiron players, but various factors could have produced this result – the needle used, the amount of fluid injected, and the subjects receiving multiple injections within a short period.

No medical procedure has a 100-percent success rate, but a single cortisone injection administered by a trained clinician is both safe and effective in providing medium-term pain relief. Side effects are minimal, and the benefit to your musculoskeletal condition is potentially vast. And for some foot-specific conditions – such as a neuroma (pinched nerve), or plantar fasciitis (heel pain due to scar tissue) – a cortisone injection can often be a cure.

Our guest blogger

Steven Edwards is a trainee foot and ankle surgeon with the Australasian College of Podiatric Surgeons. He also teaches pharmacology and foot surgery to undergraduate podiatry students at La Trobe University.




Musculoskeletal Australia (or MSK) is the consumer organisation working with, and advocating on behalf of, people with arthritis, osteoporosis, back pain, gout and over 150 other musculoskeletal conditions.

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