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WHAT IS AN ANKLE SPRAIN?

15.05.20

WHAT IS AN ANKLE SPRAIN?

An ankle sprain is a stretch or tear in one or more of the lateral (outside) ligaments of the ankle. Ankle ligaments are slightly elastic bands of tissue that keep the ankle bones in place. Because the ankle is responsible for both weight-bearing and mobility, it is particularly susceptible to injury. The relatively small joint has to withstand large forces exerted when walking, running and jumping, especially if the surface is uneven. Most ankle sprains happen when the ankle twists or rolls suddenly, usually a rapid and uncontrolled movement. The most common injuries happen when the foot rolls onto the outside of the ankle, straining the outside ligaments of the ankle joint. Symptoms of a sprained ankle include; pain, tenderness and swelling, bruising, trouble moving the ankle, and sometimes an inability to put your full weight on the ankle.

HOW LONG DOES IT TAKE TO HEAL?

Most people recover completely from mild sprains within two to six weeks. More severe sprains can take up to six months before you can return to full activity, or sport. Once a significant sprain occurs, without good rehabilitation the joint may never be as strong as it was before the injury. It is not surprising therefore that many people have a history of repeated ankle sprains. With the correct rehabilitation however, you can help your ankle become even stronger than it was before the injury.

WHAT CAN BE DONE?

Tissue injury usually involves damage to small blood vessels that results in bleeding at the site of injury. This bleeding leads to inflammation, part of the natural healing process. However, the body tends to overreact to sudden traumatic injury and as a result excess inflammatory fluid accumulates which can result in ‘scar’ tissue production. Too much scar tissue may prevent normal function with reduced flexibility and increased risk of re-injury. It is important to get medical advice to gain a positive diagnosis and

ADVICE HANDOUT

Follow the PRICE guidelines immediately after injury and for at least 3 days afterwards before doing anything else. Your local physio therapist as well as most massage therapists can assist you with this: PROTECT - Protect the injured tissue from undue stress and avoid ALL movements in the same direction as when the injury occurred.  REST – Unload the joint (take the weight off it) as much as you can in the first 72 hours after injury. Try and avoid walking on the joint as much as possible. ICE – Ice is an amazing natural healer and a great short-term pain reducer. It is also believed to have a beneficial effect in reducing swelling and promoting healing. The optimal amount of time to apply ice is around 10-15 minutes in bony areas such as the ankle. It can be applied as often as desired to achieve pain relief, ideally every 1-2 hours. COMPRESSION - This is advised for the first 72 hours, but only while your foot isn’t elevated. The compression can be firm if it doesn’t cause pins and needles or any loss of feeling around the joint. ELEVATION - Reduces the flow of blood to the area which helps reduce swelling. Elevation is recommended in the first 72 hours after injury. However, remove any compression while your foot is elevated unless you are wearing just a light compression bandage. When following PRICE it is also important to avoid HARM, hence the saying: ‘Give PRICE and avoid HARM’. HARM is an acronym for Heat, Alcohol, Running, Massage. Following this acute management phase, your physical therapist will start some ‘hands-on’ treatment to mobilise and strengthen the joint. This phase of treatment is crucial to ensure you return to full function and prevent future injury. Adequate preparation for activity is key and weight-bearing should progress gently. Drastic changes in activity level and performing unpractised skills expose your ankle to re-injury. Gradually build up your fitness level. Your ankle, and the rest of your body, will thank you for it!   WHY IMMEDIATE TREATMENT IS IMPORTANT The success of injury healing can be boosted by appropriate, effective and timely action particularly in the early stages of an injury (ie. the first 72 hours). Any ‘soft-tissue’ is subject to injury including ligaments (which join bones to bones), tendons (which join muscles to bones) and to muscles themselves. The immediate reaction of the body to injury is similar irrespective of the soft tissue structure and is known as an inflammatory reaction. Injuries can be caused by overstretching, bruising or crushing. A strain describes overstretching of a muscle, while a sprain describes overstretching of a ligament or tendon. THE INFLAMMATORY REACTION Tissue injury usually involves damage to small blood vessels that results in bleeding at the site of injury. This bleeding leads to the four main signs of inflammation:
  1. Heat – chemicals released from the damaged tissue causes dilation of surrounding blood vessels to bring healing agents to the area. The result is more blood and therefore heat
  2. Redness – is due to the increase in blood to the area
  3. Pain – is caused by the chemicals released from the injured tissues as well as the increased tissue pressure from the fluid acting on nearby nerve endings
  4.  Swelling – is the result of this accumulation of extra fluid.
This inflammatory reaction is necessary as it is part of the natural healing process. However the body tends to overreact to sudden traumatic injury and as a result more inflammatory fluid accumulates than is necessary for healing. This fluid contains a protein that turns into replacement ‘scar’ tissue. If too much can form it may prevent the structure returning to normal function with reduced flexibility and increased risk of re-injury.

THE ART OF THE BREATH

11.05.20

THE ART OF THE BREATH Breathing correctly promotes a sense of calm, helps us to de-stress and also promotes physical healing. We are all breathing all day everyday but most of us are not breathing correctly! Some common mistakes are: -breathing too quickly -breathing too shallow using our neck muscles rather than our diaphragm -breathing unevenly with lots of sighs and yawns -breathing through our mouth Start learning to breath properly again by focusing on the following: 1. Be sure to breathe through your nose - in and out all the time, even when exercising.  Your nose is designed to filter air and make it the perfect temperature and humidity. 2. Focus on each breath becoming smoother and slower.  We should aim to breathe 12 times per minute (many of us are breathing 16+ times per minute) 3. Your breathe should be even and silent - avoid noisy sighs and yawns 4. use your diaphragm and belly muscles to breathe.  Your shoulders should not move up and down to breathe. Learning to improve your breathing will help improve so many physical and psychological ailments.

Exercise and Mental Health

08.05.20

Exercise and Mental Health

  Staying active is not only critical for maintaining physical fitness during the COVID-19 restrictions, but also for providing important mental health benefits during the current period of social isolation. Physical activity is a key factor for the prevention and management of mental health issues such as anxiety, depression, Post-traumatic stress disorder (PTSD), Bipolar affective disorder (BPAD) and eating disorders. Physical activity, even in low doses, could lower the risk of mental illness in the community. The current Australian guidelines for exercise are 150 minutes of moderate-intensity aerobic activity and two sessions of resistance-based exercises per week, but for mental health a little bit of activity is better than doing nothing at all. Even one session per week has been shown to have great improvements. Mental disorders are already among the leading causes of disease and disability globally. There is mounting evidence that suggests that exercise is an effective component of treatment for people living with acute and chronic mental illness. With exercise making a big difference in mood and promoting a positive mental health, whilst also helping to reduce the symptoms of mental illness, there is a significant need for exercise to be a fundamental part of mental health treatment, particularly whilst we are in isolation. While gyms and fitness classes are now shut down, exercise is still considered an essential activity. Here are some tips for maintaining or building movement into your day:
  • Keep motivated by scheduling exercise into your diary as you would for a gym class
  • Put on your favourite music and do some simple body weight exercises such as squats, lunges, and push ups
  • Make use of online exercise classes to guide your home exercise. You can find some great online Pilates classes here
  • Get outside into the fresh air if you can, take a walk along the beach or kick the football in the backyard
  • Book in for an online consultation or alternatively a one-on-one session with our Accredited Exercise Physiologist for clinical exercise advice and treatment here
It is important to remember that it’s not about what type of exercise is the best kind, but rather to find something you enjoy doing as you are more likely to stick with it and achieve the mental health benefits. The most important thing is to find time every day to move your body – even if it is a couple of laps around the block. Regular exercise will help boost your state of mind and protect your mental well-being. If you or someone you love needs help, there is always someone to talk to at Lifeline on 13 11 14

The low down on Hip Replacement

25.02.20

The low down on Hip Replacement

The current state of affairs

Hip replacements are becoming increasingly common. Currently 1.3 people in every 1,000 will undergo a hip replacement operation, and more than 1.2 million are carried out each year worldwide. The biggest risk factors for needing a hip replacement are age and arthritis, with 85% of people having a hip replacement, also having osteoarthritis. In terms of gender, women have a higher risk of needing a hip replacement (58%) compared with men (42%). Hip replacement surgery in patients aged 45-54 has also doubled in the past 10 years.

What can we do, to reduce the risk of needing a hip replacement?

Physical activity helps. Running decreases your risk of developing osteoarthritis by 18% and as osteoarthritis is present in 85% of people who undergo a hip replacement, this has a knock-on effect in reducing your risk of needing a hip replacement by 35-50%. And if you’re not up for running that’s OK, walking can also reduce the risk of needing hip surgery, although by a smaller percentage (23%). Almost half of the protective effective of being physically active comes from weight control. The higher your BMI, the greater your risk of needing a hip replacement.  

And what can you do if you’re already experiencing hip pain?

If you need a hip replacement then the sooner you have it, the better the outcome is likely to be and the quicker you will recover from your operation. This is because the more pain you suffer prior to having surgery, the more compensations and adaptations the muscles and soft tissues will have made around the joint, in an effort to try and protect it and you from that pain, and the harder that will be to re-train once you’ve had the operation. That’s not to say it can’t be done, it will just take a bit longer and need a bit more of an investment in your time and energy. The good news is that outcomes from hip replacements are very good. Developments in materials and surgical techniques, mean that the artificial hips are lasting longer, and success rates are very good, with more than 80% of people experiencing pain relief and functional improvement, meaning their daily lives become easier and they’re able to do more.  

We hope you find this information helpful and if you have any questions or queries, please feel free to get in contact with us 6676 4000 or 6676 4577.

We are running the GLA:D program as a preventative for surgery for hips and knees with osteoarthritis.

Follow this link to read more - GLA:D program Pottsville and Cabarita Physiotherapy.

 

Remedial Massage Therapist Rosie

04.02.20

Rosie is our Remedial Muscle Therapist, and Swedish Relaxation Therapist.

Rosie has completed an advanced diploma in Soft Tissue Therapy at Kingscliff Tafe. These studies have laid down a solid foundation of awareness in the anatomy and functionality of the body. Rosie works with assessment and tactile massage tools to support the body. With these tools she can support you on getting out of pain, relieving tension, correcting compensation imbalances, and overall maintenance for physical and mental health.

Over the last year Rosie has also undertaken another bodywork course in Zenthai Shiatsu to help further deepen her understanding of the body and how it works/heals. This bodywork therapy looks through the lens of Ancient Traditional Chinese Medicine and Temple Thai massage, and works a lot more on the facial connective tissue (meridians) throughout the body. This modality has enabled Rosie to support others in healing that is not only physical but also psycho-emotional, nervous system balancing and stress relieving. Rosie also has studied 200hour multi-style yoga teacher training, which adds layers again onto her ability to understand the body and it’s movements, posture and alignment. Feel free to ask Rosie for some simple take-home yoga stretches/postures that will specifically support you and your body on your healing/health journey. Rosie is also happy to work hand-in-hand with your physio to obtain best results. For many cases the combination of physiotherapy and remedial massage therapy together, can accelerate your healing journey, and/or bring ease to maintaining and healthy functioning body (and mind). Call 6676 4000 to find out her availability!

 

What is an exercise physiologist?

20.01.20

What is an exercise physiologist?

An Accredited Exercise Physiologist (AEP) is a university qualified allied health professional who specialises in the delivery of exercise and lifestyle programs for healthy individuals and those with chronic medical conditions, injuries or disabilities.   AEPs possess extensive knowledge, skills and experience in clinical exercise delivery. They provide health modification counselling for people with chronic disease and injury with a strong focus on behavioural change.   Working across a variety of areas in health, exercise and sport, services delivered by an AEP are also claimable under compensable schemes such as Medicare and covered by most private health insurers. When it comes to the prescription of exercise, they are the most qualified professionals in Australia.   What makes AEPs different to other exercise professionals?
  • They are university qualified
  • They undertake strict accreditation requirements with Exercise and Sports Science Australia (ESSA)
  • They are eligible to register with Medicare Australia, the Department of Veteran’s Affairs and WorkCover, and are recognised by most private health insurers
  • They can treat and work with all people. From those who want to improve their health and well-being, to those with, or at risk of developing a chronic illness
Why should you see an AEP? AEPs are the experts in prescribing the right exercise to help you prevent/manage your chronic disease, help you recover faster from surgery or an injury, or help you to maintain a healthy lifestyle.   AEPs can help treat and/or manage:
  • Diabetes and pre-diabetes
  • Cardiovascular disease
  • Arthritis and osteoporosis
  • Chronic respiratory disease and asthma
  • Depression and mental health conditions
  • Different forms of cancer
  • Musculoskeletal injuries
  • Neuromuscular disease
  • Obesity
  • And much more!
    What makes AEPs even more special is they know how to set goals and maintain motivation, these are two aspects that will most commonly see people fail at exercise. What to expect when seeing an AEP?   During an initial consultation with your AEP, you will undertake a comprehensive assessment in order to develop an exercise plan based on your unique requirements. This session will likely be a fair few questions about your health and history. A lot of people are concerned about what to wear to this appointment. We always say wear comfortable clothing as you may be asked to do a range of movements and bring some comfortable walking shoes as you may need to complete an aerobic assessment. After this session, you will be provided with a plan of action. Working with an AEP can be a truly rewarding process and they can make a hugely positive impact to your life. Our AEP, Sammy, has special interests in the areas of Cancer and Exercise, Osteoporosis and Clinical Pilates. To make a booking with Sammy our AEP  please call 6676 4000 or 6676 4577.  

Headache 

06.01.20

Headache    If you’re one of the 47% of the global population who experiences regular headaches, you’ll know they’re no laughing matter. For some people, they’re just a minor inconvenience, for others they can be utterly debilitating, condemning you to a dark, quiet room for hours, and sometimes even days.   The trouble is that successfully diagnosing a headache gets complicated, because more than 130 distinct disorders have been identified along with over 300 triggers, which makes a headache almost as unique as an individual. Luckily at Pottsville and Cabarita Physio we specialise in treating headache and can confidently determine if Physiotherapy will help you within the first session. Headache is a unique condition in that you can also simultaneously suffer one, two or more types of headache or a migraine at the same time, where one may cause another, or overlap with each other. These are known as mixed or multi-source headaches and can take longer to resolve as your therapist works through treating the different causes. For example, a dysfunctional painful neck can cause an increase in surrounding muscle spasm, which will increase your blood pressure. In this scenario, you could have a cervicogenic (neck) headache, with a tension headache and a resultant migraine! The most commonly diagnosed headaches are:

  • Migraines (12%)
  • Tension headache (75%)
  • Cervicogenic headache (originating from the neck) (18%)
  • Sinus headaches
If you only suffer from the occasional headache, this is often caused by lifestyle factors such as:  
  • Dehydration
  • Stress
  • Alcohol
  • Caffeine
  • Some foods
  • Skipped meals
  • Lack of sleep
  • Posture
  • Muscular tension
  • Medications
  • High blood pressure
  • Infection
  • Hormonal influences
  However, if you suffer from headaches more regularly, there is some good news, because two of the most common headaches, tension-type headaches and cervicogenic headaches (which originate from musculoskeletal issues in and around the neck) can be significantly improved, and even cured by physiotherapy, both in the short term, as well as the long term.   There is a robust body of research, as well as clinical evidence, showing that physiotherapy is an extremely effective treatment for certain types of headache.   Manual, hands-on therapy manipulating or mobilising your neck can be hugely beneficial in eliminating your headache; or at least reducing the intensity and duration of the headache. Soft tissue work including trigger point therapy and massage, can be effective in relieving spasm in the head and neck muscles which may contribute to your headache. Massage has also been shown to help people cope better during headache episodes, reducing associated stress and anxiety. In addition, poor posture and repetitive movements in your daily life, have also been shown to increase the risk of experiencing headaches as they can cause muscle imbalances, muscle weakness and strain the ligaments and soft tissues in the joints of your neck. In these cases corrective exercises to strengthen weak muscles and stretch tight muscles can be extremely effective.  Our Physios specialise in these corrective exercises. We have some more downloadable resources and advice sheets on each specific headache type at the following link. If you would like to understand more about how we can help in the treatment and prevention of headaches, please don’t hesitate to contact us directly on 02 6676 4000 / 02 6676 4577. https://www.facebook.com/pottsvillephysiotherapy

Don’t Get into Deep Water with Swimming Injuries

10.12.19

Don’t Get into Deep Water with Swimming Injuries

Swimming is one of the most popular sports in the world. We swim in the sea, pools, lakes, streams, rivers and even ponds. And given 70% of the Earth’s surface is water, we’re not short of opportunities. And while swimming is considered a ‘low-impact’ sport due to the fact that the water supports a large percentage of, more than 84% of regular swimmers suffer from some type of overuse type injury caused by swimming. Why? The main reason is the high repetition number and forceful nature of the shoulder revolutions which takes our shoulder joint through its full range of motion (which is one of the greatest of all our joints), against resistance, over and over again. And as 50-90% of the power generated to propel you forward comes from the shoulders, you can see why they are the most frequently injured joint. However, swimming also puts stress on your back, to hold you level in the water; on the neck when raising your head out of the water to breathe and if you favour breaststroke as a stroke, there’s added pressure from the unnatural twisting motion on the knees. So, despite it seeming to be a low-impact sport, swimming actually carries a surprisingly high risk of injury. Let’s take a look at those injuries, why they happen and what you can do about them. Swimming injuries generally stem from two sources, and often these sources will combine:
  1. Muscle imbalances
  2. Stroke technique issues
Muscle Imbalances Our everyday posture, particularly if you spend a lot of time sitting at desk or in a car, or generally not moving around, creates all sorts of muscle imbalances from short hamstrings, tight muscles around the neck, back and shoulders. We unconsciously adopt a curved forward upper back, round shoulders and chin poke, which not only add to shoulder problems in swimmers but neck pain too. Poor posture is the biggest culprit of short tight trapezius and pectoral muscles and weak anterior (front) neck and upper back muscles. These muscles can be painful and develop trigger points which are hyperactive spots in the muscle, commonly referring pain and causing headaches. Tight muscles may also limit your neck movements. Good posture ensures good alignment of the joints and ligaments which allows for optimal contraction of your muscles and off-loads underlying structures. Stroke Technique This a big topic to cover because it depends what stroke you’re swimming mostly with and what kind of injury you may have but issues include: a wide, swinging arm recovery which requires excessive internal rotation, causing impingement on the joint; thumb in first with hand entry, which again causes excessive internal rotation in the shoulder and a dropped elbow or straight arm pull through which creates a long lever and overloads the shoulder. What does all of this mean to you? You shouldn’t swim? You should reduce your training or change your sport? The bottom line is that the benefits of swimming - whether it’s for general fitness and physical activity, the desire to win competitions, or just to find your quiet place for stress relief - far outweigh the risk of injury.

   

Exercise and Different Types of Cancer

09.12.19

Exercise and Different Types of Cancer

Every four minutes an Australian is diagnosed with cancer. Cancer can have a devastating effect on people’s lives – not just their physical and mental health, but also their family, work and social life. Exercise is commonly accepted as important in maintaining good health and reducing the risk of chronic disease. A growing body of research has shown exercise to be a very effective medicine for people with cancer to take in addition with their anti-cancer treatments. Depending on the cancer, the stage of disease, and time since diagnosis, will help to determine which exercise would be best suited to you. Listed below are some benefits and information on exercise effect in common cancer sites.   Breast Cancer Breast cancer is the most common form of cancer among females. Treatment typically involves surgery, radiation, chemotherapy, hormonal therapy or a combination of the above. These treatments can be successful at removing cancer cells and tumours, often they lead to physical side effects that may affect your function and require some modifications to exercise.
  • After breast surgery, pushing exercises may be difficult, along with reaching with arms over the head. It is recommended to include upper limb flexibility and range of motion exercises before strengthening to reduce the risk of injury, improve upper body functioning, and have greater long-term benefits.
  • Radiation and surgery can cause damage to lymph nodes, which can result in lymphedema. It was thought that exercise exacerbates lymphedema symptoms, but recent evidence suggests that exercise is safe for those with lymphedema and may even improve symptoms. The process of muscle contraction can return fluid flow back through the nodes and reduce swelling.
  • Another common side effect of treatment is a decrease in bone mineral density and loss of muscle mass, leading to an increase in risk of falls and fractures. Resistance training is recommended to increase bone mineral density, muscle mass and overall strength.
  Bowel Cancer Bowel cancer is the third most commonly diagnosed cancer in Australia. Lifestyle choices can affect risk of bower cancer, and there is convincing evidence to suggest that being physically active can reduce the risk of bowel cancer. Treatment depends of whether the disease has spread or is likely to spread. Treatment for bowel cancer can include surgery, chemotherapy and/or radiation depending on the severity of the tumour.
  • Exercise during and after treatment improves overall strength and function, reduces frequency and severity of treatment related side effects, and helps to maintain a healthy body composition.
  • Exercising with a colostomy bag is no reason not to exercise. A clearance from your GP is recommended for those with stomas prior to participation in certain types of exercise. Contact sports are not recommended due to risk of injury. Resistance exercise should be started at a low resistance and gradually built up over time to reduce the risk of a hernia at the stoma site.
  Lung Cancer Lung Cancer is the leading cause of cancer related death among men and women. There is a strong relationship between smoking and lung cancer, with smoking accounting for almost 90% of cases. Treatment of the disease is dependent on the severity and progression of the disease and can include surgery, chemotherapy, radiation, immunotherapy, or a combination of treatment.
  • Exercise is safe for people with lung cancer and can help to manage side effects of lung cancer treatments. Exercise in the weeks before lung cancer surgery can improve outcomes and reduce complications. Exercise post-surgery can improve recovery time and reduce time to return to ADL’s
  • Recommendations for exercise for those with advanced lung cancer are to remain as active as possible and avoid long periods of inactivity – a little bit is better than none
  • Exercising after lung cancer can help to reduce shortness of breath and reduce risk of return of cancer or chronic disease
  Prostate Cancer Prostate cancer is one of the most common cancers among males. Some of the treatments have debilitating side effects affecting both physical and mental capability. Exercise is both safe and effective for those who have survived prostate cancer. A combination of resistance training and aerobic training can reduce and almost reverse the treatment-related side effects.
  • One of the most common treatments for prostate survivors is androgen deprivation therapy (ADT). The side effects of this can be a reduction in testosterone levels, decreased bone mineral density, muscle atrophy, fatigue and insulin resistance. Prostate survivors undergoing ADT who complete regular resistance and aerobic based exercise regularly can expect to see improvements in muscular strength, physical function, and quality of life.
  • Prostate cancer survivors can also experience losses in bone mineral density and muscle mass, usually as a result of ADT coupled with physical inactivity. This leads to an increase in fall and fracture risk. Progressive resistance training is recommended to restore bone mineral density, improve muscle mass and overall function.
For more exercise recommendations or for an assessment with an Accredited Exercise Physiologist you can contact Pottsville and Cabarita Physiotherapy on (02) 6676 4000 or (02) 6676 4577.

Festive Follies Survival Strategies

26.11.19

Festive Follies Survival Strategies

Forget boot camp, with shopping mayhem and rampaging relatives, financial stress, late nights, too much TV and over-indulging – the festive season can be the most grueling event on the calendar. It’s no wonder that nearly every one of us emerges from it with a New Year’s resolution of detoxing, getting fit and losing weight! Surviving is all about preparation. The festive season is usually particularly problematic for those of us who take their nutrition and exercise seriously or even for those who just want to come out of the other side, with any luck, not worse off than when they started. Whether it’s the big high calorie meals, the parties, alcohol or general lack of structure in your week, it’s very easy to lose your way
in December which is why we put together some resources to help you minimise the festive ‘damage’ and help you maintain your physique and health, while still enjoying the party season. Our newsletter looks at three things:  
  1. What you can do to keep your eating on track
  2. What you can do to keep your fitness on track
  3. What you can do to keep your alcohol intake on track
  We have then produced three cheat sheets on:  
  1. Booze Busters explores the impact of alcohol on your body and how you can reduce the toll it takes on you physically
  2. Hangover Food Super-Heroes looks at how to replenish lost nourishment the day after a heavy night
  3. Hangover-Smashing Smoothies – three specially concocted smoothies to help get you back on your feet, the morning after the night before.
  In our Booze Busters bulletin we review what we know about alcohol including why it’s fattening, how our body burns alcohol calories and which drinks we should choose to reduce the toll on our liver.   Big night the night before? In our Hangover Food Super-Heroes, we discuss 10 of the best foods that are scientifically proven to help your body recover. It may surprise you to hear that stuffing your face with last night’s take-away, is not the best choice to ensure a speedy recovery from a hangover. Nor is it the healthiest option, as it’s likely to be carbohydrate and fat-loaded which just adds more toxins and stress to your already struggling liver that’s working overtime to try and get you back on track.   We explain why each food on our list is important and how it can benefit your body in the aftermath of a big night.   And lastly, we’ve concocted three recipes that will help you get back on your feet as quickly as possible the ‘morning after’!   To download any, or all, of these free resources click here