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Thornleigh Performance Physiotherapy
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Conservative Management of Meniscal Tear
History: A 47 year old male presents with an acute left knee injury from rotational standing up movement from a seated position at lunch. He felt immediate pain in the medial side of his knee and reports a locking sensation when attempting to straighten his knee. What can physiotherapy do to help?



Clinical examinations

The patient was unable to weight bear on his left leg as he could not straighten his left knee due to pain and catching sensation. During passive range of motion movements, his knee could be flexed to full range, however was painful at end of range and when moving leg back into extension. Passive patella movement did not reproduce his symptoms, though symptoms reproduced upon palpation of medial border of knee cap and medial knee joint. No swelling was evident at time of review, however this is expected in the acuteness of his injury.

His mechanism of injury and clinical presentation indicate an acute torn flap of his medical meniscus.



Management

Small meniscal tears can be managed conservatively if a person’s range of motion is not greatly affected, have minimal swelling and are able weight bear. The first phase of conservative management of an acute meniscal tear includes maintaining knee extension range of motion and providing stability to the knee to reduce any risk of further injury. Small amplitudes of passive accessory movements were undertaken in attempt to normalise joint range of motion. He was provided with education regarding the importance in maintaining knee extension and encouraged to undertake light knee extension stretching techniques to aid in this. Kinesiology tape was used to strap his knee to promote healing, support, reduce swelling and assist in pain reduction. The patient responded well with dry needling to his hamstrings and calf muscles which assisted in off-loading the knee joint from muscle tightness. Following the initial treatment, the patient had a reduction in pain symptoms and ability to weight bear as tolerated through left leg.

Over the next two to three weeks, the focus was to eliminate swelling and achieve full range of motion and focus on hamstring and quadriceps strength. Through the completing all home strengthening and stretching exercise program, this patient improved well and could obtain full range of knee extension with a reduction of pain and an increase of muscle strength. He was provided with full range squats and lunges as a progression to his hamstring and quadriceps strengthening exercises with added endurance training program for his hip external rotators. After another few weeks, he could return to his home-based fitness program and work schedule without any issues.



If you have any questions regarding your knees or are interested in seeing if we can help you, please give us a call at (02) 8411 2050. Here at Thornleigh Performance Physiotherapy, we can give you an accurate diagnosis and treatment, to help you get back in action as soon as possible. We are conveniently located near Beecroft, Cherrybrook, Hornsby, Normanhurst, Pennant Hills, Waitara, Wahroonga, Westleigh, West Pennant Hills, and West Pymble.
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Ankle Sprain from Basketball

History: A 15 year old boy presents with a recent right lateral ankle sprain from landing on someone’s foot and rolled inwards during basketball. What should he do to facilitate return to sports?



Clinical examinations

In observation, the patient has mild lateral ankle swelling but no bruises. He is able to walk without pain. Symptoms are provoked during eversion and lunging. His anterior talofibular ligament (ATFL) is tender on palpation. Ligament stability tests (anterior and posterior drawer tests) are negative.

The examination findings suggest that he has a low grade right ATFL sprain.



Management

A combination of education, RICE (rest, ice, compression and elevation) approach will be appropriate to manage his acute symptoms. In this scenario, his symptoms are able to further reduce with joint mobilisation and strapping.

Over the next two weeks, he is able to gradually progress his exercises from range of movement exercises to proprioception and strengthening exercises, specifically single leg balance and single leg heel raise. He was able to perform thirty repetitions in single leg heel raise which is clinically indicative for exercise progression and trial return to modified sports.

It is indicated from research that the reinjuring rate after the first ankle sprain within the first year is remarkably high, up to eighty per cent. It is also suggested that proprioceptive (balance) and ankle strengthening exercises will significantly reduce the risk of recurrence, and the exercises program should at least last up to two months. It is important to be aware that free of symptoms and ‘feeling good’ do not always mean the ankle function is fully recovered.



If you have any questions regarding ankle sprain and ankle braces, and need an assessment, please give us a call at (02) 8411 2050. Here at Thornleigh Performance Physiotherapy, we can give you an accurate diagnosis and treatment, to help you get back in action as soon as possible. We are conveniently located near Beecroft, Cherrybrook, Hornsby, Normanhurst, Pennant Hills, Waitara, Wahroonga, Westleigh, West Pennant Hills, and West Pymble.
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ACL Tear

History: A 15 years old female Miss K who is a netballer presents with a right ACL reconstruction surgery one week ago. Her surgeon has referred her to do physiotherapy. What does she need to do in rehab?



Clinical examinations

The patient is walking with two crutches. Her knee is moderately swollen. Her wound is covered by wound dressings. Her knee extension range is -5 degrees (meaning it’s in a slightly bended position) and her flexion range is about 20 degrees, both motions are limited by pain and stiffness.



Management

It is expected that ACL reconstruction rehabilitation to be a lengthy process. It generally takes at least six months to twelve months to return to sports. Most surgeons would provide the patient and the physiotherapist a rehabilitation protocol, but it is common to have variations which depend on the graft choice and individual factors.

Initial stage of ACL-recon for Miss K focuses on swelling control and restoring her loss of knee extension range. This is critical as it allows her to walk with normal gait as soon as possible and avoid the development of compensation strategies. Her treatment includes manual therapy, compression therapy, and inner range closed chain quadriceps exercises.

In six weeks times, Miss K has recovered full knee extension and ninety per cent flexion range of motion.

Depends on the sports type, most patients can return to sports after six to twelve months. In between this six to twelve months, there is a variety of exercises need to be covered to allow successful return to sports. That includes improvement on proprioception, strength, balance, flexibility, agility, functional strength, plyometric ability and sports-specific skills.

As Miss K is very compliance to her rehabilitation program and keen to return to sports. She performs her exercises well and on schedule. She is able to return to low level netball in nine months.



If you have any questions regarding your post operative rehabilitation or are interested in seeing if we can help you, please give us a call at (02) 8411 2050. Here at Thornleigh Performance Physiotherapy, we can give you an accurate diagnosis and treatment, to help you get back in action as soon as possible. We are conveniently located near Beecroft, Cherrybrook, Hornsby, Normanhurst, Pennant Hills, Waitara, Wahroonga, Westleigh, West Pennant Hills, and West Pymble.
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Knee Pain whilst Running



History: A 43 year old female presents with recurrent knee pain after training at the gym or running on and off for a few years. The location of her knee pain is in the front of her knee near the inside. She does not have a history of knee injury. What can physiotherapy do to help?



Clinical examinations

The patient does not have any symptoms walking and climbing stairs. Her knee pain is predominantly from squatting and worse in a single leg squat. While squatting, excessive knee adduction is observed. No flat feet are seen. Her knee joints are hypermobile but her right patella-femoral joint is not painful on palpation. Meniscus and ligament orthopaedic tests are negative. During quadriceps activation test, her vastus medialis oblique (VMO) was under-active and her patella was moving laterally. Her calves and hip external rotators are weak as well.



Her clinical presentation indicates a lateral tracking patella disorder.



Management

The cause of patella lateral tracking disorder is often multi-factorial. In terms of initial symptoms management, this patient responded well with McConnell Taping (medial glide of the patella with rigid tape), where she could squat without pain afterwards.

After a week, her knee pain settled. She then started a specific muscle training program focusing on activation, strength and endurance of the VMO, calves and hip external rotators. In her next review after another two weeks, there was noticeable improvement in her lower limb biomechanics since she started the exercises and she was happy with the results.



Clinically being able to have at least satisfactory closed chain lower limb biomechanics is very important to rehabilitation and injury prevention. For specific groups of people, such as runners and sports players, further dynamic, agility and plyometric assessment and training will be a key to their performance and sports specific injury prevention.



If you have any questions regarding your knees or are interested in seeing if we can help you, please give us a call at (02) 8411 2050. Here at Thornleigh Performance Physiotherapy, we can give you an accurate diagnosis and treatment, to help you get back in action as soon as possible. We are conveniently located near Beecroft, Cherrybrook, Hornsby, Normanhurst, Pennant Hills, Waitara, Wahroonga, Westleigh, West Pennant Hills, and West Pymble.
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Question: A 35 year old office worker presents with a recent episode of lower back pain and left buttock pain from prolonged sitting at work. Is there anything physiotherapy can help with?



Clinical examinations

In sitting, the patient finds it sore, stiff and tiring to sit upright. It is more comfortable to slouch at the beginning after it starts to hurt after a few minutes. In standing, the patient finds it painful to bend all the way forward and it is very stiff and painful bending backward.



Management

A combination of education, sitting posture adjustment and exercises help to address the cause of the problem and manage appropriately. Manual therapy helped to reduce the time it took become pain free.

As this is a sustained posture related issue, understand and be able to recognise ‘’prolonged sitting’’ is the most important part of the management. "Get up and move" will be a good first step.

After adding a lumbar support in sitting, the patient feels sitting is a lot more tolerable and less symptomatic.

The patient also responded well with repeated extension exercises, where his buttock symptom is centralizing (shifting towards the back) during exercises and the entire symptoms are abolished after the exercises. This particular symptom change often means a good prognosis for lower back pain.



Although extension exercise is commonly beneficial for lower back pain patients, this is not a one size fits all remedy. Please do not try it on your own without having an assessment done by medical professionals.



If you have any questions regarding your back pain or are interested in seeing if we can help you, please give us a call at (02) 8411 2050. At Thornleigh Performance Physiotherapy, we can give you an accurate diagnosis and treatment, to help you get back in action as soon as possible. We are conveniently located near Beecroft, Cherrybrook, Hornsby, Normanhurst, Pennant Hills, Waitara, Wahroonga, Westleigh, West Pennant Hills, and West Pymble.
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Shoulder Pain after a Fall





History: A 21 year old male presents with an acute fall of his shoulder on grass during running. He felt immediate pain and he could not move his arm. What can physiotherapy do to help?



Clinical examinations

The patient could not move his arm by himself due to pain. In the passive movement examination, his arm was able to be lifted forward and sideway to shoulder height before being stopped by pain. His arm across his body was the most painful and restricted movement. His shoulder internal and external rotation range is good, only mild pain is reported at end of range. His left acromioclavicular (AC) joint was the most painful on palpation. No step deformity was seen, which is a good sign for a lower grade injury.



His mechanism of injury and clinical presentation indicate an AC joint sprain (mild to moderate).



Management

Acute AC joint injury management includes supported immobilisation to allow the sprained joint capsule and ligaments to have time to heal. He was given a sling to wear during the day and his shoulder was strapped. He had trigger point muscular pain in the surrounding area such as upper trapezius and deltoid muscles, which is a common problem because these muscles are trying to compensate for the injured AC joint. This patient responded well with dry needling which helped him to alleviate resting pain and muscular ache.

Over the next two to three weeks, this patient improved well and was able to gradually reduce the usage of sling without symptoms. His horizontal adduction movement range was still restricted compared to the other movement which is common after AC joint injury because this is a stressful position to the AC joint. This would gradually improve with treatment and exercises.

He was given rotator cuff strengthening exercises and scapular stability exercises as a progression at a later stage of his rehabilitation.

In six week post injury, he was able to return to gym and perform his normal workout routine without issues.



If you have any questions regarding your specific problem or are interested in seeing if we can help you, please give us a call at (02) 8411 2050. Here at Thornleigh Performance Physiotherapy, we can give you an accurate diagnosis and treatment, to help you get back in action as soon as possible. We are conveniently located near Beecroft, Cherrybrook, Hornsby, Normanhurst, Pennant Hills, Waitara, Wahroonga, Westleigh, West Pennant Hills, and West Pymble.
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Good news! Thornleigh Performance Physiotherapy is now an NDIS approved provider. If you or someone you know needs to access services via the NDIS you can send them our way or give us their contact details and we can do the rest. If you are wondering what I am talking about, here is a link below to more information on them.

If you have read the link and ready to take the next step towards a better you, give us a call. Here at Thornleigh Performance Physiotherapy, we can give you an accurate diagnosis and treatment, as well as advice on the best course of action for your condition to get you back in action sooner than you could’ve imagined. We have an expertise in musculoskeletal physiotherapy and are conveniently located near Beecroft, Cherrybrook, Hornsby, Hornsby Heights, Normanhurst, Pennant Hills, Wahroonga, Waitara, Westleigh, West Pennant Hills, and West Pymble. So give one of our physiotherapists a call on (02) 8411 2050 to get started on a journey to a better you.
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Pain in your jaw? Trouble with chewing ? Jaw clicking? Let’s take a look at the TMJ....
So what’s the TMJ?

The temporomandibular joint (TMJ) is the small joint of the jaw located between the temporal bone of the skull and the lower jaw bone called the mandible [1]. These two bones are separated by a disc which acts as a cushion between these bones as the jaw opens and closes and moves side to side [2]. The TMJ plays an important role to functions we do on a daily basis – chewing and speaking, yawning and swallowing.

Temporomandibular disorder (TMD) occurs when the TMJ and its associated structures and musculature stop functioning correctly and can result in pain, clicking, popping and locking within the joint [3]. However sometimes jaw pain is not so straight forward. For example, pain may be felt in the jaw but may actually originate from other areas of your body such as the neck [2].

How common is it?



TMD is a very common problem affecting up to 33% of individuals within their lifetime[4]. More women than men experience TMD which may be related to hormonal factors, and it is more common in people between the ages of 20 and 40[2]. Approximately one third of the population have at least one TMD symptom [4].

Common causes and contributing factors to TMD:

§ Injury to the jaw, temporomandibular joint, or muscles of the head and neck – such as from a heavy blow or whiplash [5]
§ Grinding or clenching the teeth, which puts added pressure on the TMJ. Grinding and clenching particularly at night is called bruxism [2].

§ Disc dysfunction where the disc is displaced forward and causes a click as the mouth opens and closes [6].

§ Presence of osteoarthritis or rheumatoid arthritis in the joint [1]
§ Habitual overuse of facial muscles – for example biting fingernails [2]
§ Missing teeth and/or having an underbite or overbite [5]
§ Poor posture [7]


Common symptoms of TMD include:

§ Pain or tenderness in the face, jaw joint area, neck and shoulders, and in or around the ear when you chew, speak, or open your mouth wide (pain may occur on one or both sides of the face) [8]
§ Limited ability to open the mouth very wide [1]
§ Jaw may get get stuck or lock in an open or closed mouth position [9]
§ Clicking, popping, or grating sounds in the jaw joint when opening or closing the mouth (which may or may not be accompanied by pain) or chewing [6]


Other symptoms of TMD include toothaches, headaches, neck aches, dizziness, earaches, hearing problems, upper shoulder pain and ringing in the ears (tinnitus) [10].

How can physio help?

Physiotherapy is recommended before expensive dental splints or surgery are considered because it has been shown to reduce pain and disability associated with TMD [3, 11]. In fact, studies have shown that physiotherapy may be more effective when compared to dental splints [12-13].

What can I expect from my physiotherapy consultation?

- We will take a thorough history to understand your current condition and relevant past history

- This is followed by a physical examination to examine the TMJ and its associated structures. You will be asked to perform certain movements which will allow us to assess any impairments. A gloved finger may be used to assess the jaw and its muscles [1].

- Postural assessment and movement of the upper neck, middle back and muscle tension will be included [7].

- An explanation of the findings from our examination and education on your condition

- A treatment plan tailored specifically to you and your symptoms which may include manual therapy, soft tissue release and a tailored home exercise program [4].

- Referral to other health practitioners or for imaging if needed [1].

If you are worried by pain and clicking in your jaw and/or have headaches give us a call. Here at Thornleigh Performance Physiotherapy, we can give you an accurate diagnosis and treatment, as well as advice on the best course of action for your condition to get you back in action sooner than you could’ve imagined. All our physiotherapists an expertise in musculoskeletal physiotherapy and are conveniently located near Beecroft, Cherrybrook, Hornsby, Normanhurst, Pennant Hills, Wahroonga, Westleigh, West Pennant Hills, and West Pymble. So give one of our physiotherapists a call on (02) 8411 2050 to get started on a journey to a better you.



1. Magee, D.J., Orthopaedic Physical Assessment. 2008, St. Louis, Mo: Saunders Elsevier.

2. Dym, H. and H. Israel, Diagnosis and treatment of temporomandibular disorders. Dent Clin North Am., 2012. 56(1): p. 149-61, ix. doi 10.1016/j.cden.2011.08.002.

3. Murphy, M.K., et al., Temporomandibular Joint Disorders: A Review of Etiology, Clinical Management, and Tissue Engineering Strategies. The International journal of oral & maxillofacial implants, 2013. 28(6): p. e393-e414.

4. Wright, E.F. and S.L. North, Management and Treatment of Temporomandibular Disorders: A Clinical Perspective. The Journal of Manual & Manipulative Therapy, 2009. 17(4): p. 247-254.

5. Sharma, S., et al., Etiological factors of temporomandibular joint disorders. National Journal of Maxillofacial Surgery, 2011. 2(2): p. 116-119.

6. Naeije, M., et al., Disc displacement within the human temporomandibular joint: a systematic review of a 'noisy annoyance'. J Oral Rehabil, 2013. 40(2): p. 139-58.

7. Ries, L.G.K. and F. Bérzin, Analysis of the postural stability in individuals with or without signs and symptoms of temporomandibular disorder. Brazilian oral research, 2008. 22(4): p. 378-383.

8. Svensson, P., et al., Relationships between craniofacial pain and bruxism. J Oral Rehabil, 2008. 35.

9. Lobbezoo, F., et al., Principles for the management of bruxism. J Oral Rehabil, 2008. 35.

10. Manfredini, D. and F. Lobbezoo, Relationship between bruxism and temporomandibular disorders: a systematic review of literature from 1998 to 2008. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 2010. 109.

11. Haketa, T., et al., Randomized clinical trial of treatment for TMJ disc displacement. J Dent Res, 2010. 89(11): p. 1259-63.

12. van Grootel, R.J., et al., Towards an optimal therapy strategy for myogenous TMD, physiotherapy compared with occlusal splint therapy in an RCT with therapy-and-patient-specific treatment durations. BMC Musculoskelet Disord, 2017. 18(1): p. 76.

13. Amorim, C.S.M., et al., Effectiveness of two physical therapy interventions, relative to dental treatment in individuals with bruxism: study protocol of a randomized clinical trial. Trials, 2014. 15(1): p. 8.





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Kinesio tape (kinesiology tape) is a type of elastic tape made of cotton strip and acrylic adhesive. It is latex-free and water proof and usually wearable for multiple days. It can expand to 60% of its original length. It is designed to promote healing and recovery. It can provide support to joints, muscles, tendons and ligaments without limiting the range of movement. Kinesio tape also assists in pain reduction and lymphatic drainage. This is due to the lifting ability from the tape which stimulates the somatosensory systems and increases interstitial space.



Taping Method

There are many different application techniques and methods depending on the examination findings and the aim of the application. Here are some simplified examples.

Shape:

Fan cut – For swelling control e.g. lymphedema.

I cut (vertical) – For relaxing muscles or facilitating muscle contraction.

I cut (horizontal) – For unloading target tissues such as muscle fibres, ligaments or tendons

Y cut – For fascia release.



Tension (stretch percentage of the tape):

10-15% - to relax a muscle

15-30% - to activate a muscle

30-50% - to release fascia

50-80% - for supporting high tensile structure such as tendon or ligament

100% - for mechanical correction



Other kinesio taping properties and uses

Kinesio tape could be worn 24 hours a day for a few days continuously (even weeks we’ve seen on some patients) and it is water proof. This means that the tape can be used throughout the process of whole recovery, from the inflammatory phase to repair and eventually the remodelling phase. Moreover, patient or athlete who found rigid tape helpful often can use kinesio tape as a progression to weaning off tape completely while they perform their rehabilitation exercises.



Verdict of using Kinesio Tape

Clinical usage is based on assessment findings, subjective opinion, objective improvement, and patient preference, and it works better in skilled hands

The biggest criticism of using kinesio tape as treatment for some people was the lack of evidence in its benefit. However, besides the clinical benefits we see from patients, there has been growing evidence to show the advantage of using kinesio tape, and most likely there will be more in future.

If you are wondering if kinesio tape can improve your performance or help you heal, give us a call. Here at Thornleigh Performance Physiotherapy, we can give you an accurate diagnosis and treatment, as well as advice on the best course of action for your condition to get you back in action sooner than you could’ve imagined. We have an expertise in musculoskeletal physiotherapy and are conveniently located near Beecroft, Cherrybrook, Hornsby, Hornsby Heights, Normanhurst, Pennant Hills, Wahroonga, Westleigh, West Pennant Hills, and West Pymble. So give one of our physiotherapists a call on (02) 8411 2050 to get started on a journey to a better you.



https://kinesiotaping.com/research/published-research/
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What is mastitis?

It is an inflammation of the breast, commonly due to a blockage. In the breast, there are lobes which are made up of many smaller lobules, the glands that produces milk. Ducts serve to connect the lobes and lobules and carry the milk to the nipple.



A blockage of these ducts prevents the breast milk from flowing easily, causing the milk to spread into the surrounding tissue, producing inflammation. A bacterial infection may or may not be also present.



What does it look like?

A blocked duct presents as a painful, hot, swollen, firm mass in the breast, with or without symptoms of a fever. If you have symptoms of a fever, it is good to visit your GP to check whether you need antibiotics or not.

 

Who can get it?

Mastitis is a condition that affects mainly breastfeeding women, but can affect women who are not even breastfeeding or pregnant. In Western women, the incidence of postpartum mastitis is 20%.



Risk factors can include:

-        Cracked nipples

-        Poor attachment to the breast

-        Previous history of mastitis

-        Wearing a bra that is too tight

-        Stress/overly tired

-        Nipple pain during feeding



How do I prevent it from happening?

-        Ensure your baby is latched on properly and is feeding well

-        Breastfeed as often as your baby wants to

-        Avoid missing or putting off feeds

-        Rest

-        Alternate which breast you start to feed with

-        Consider waking your baby when your breasts become too full. If your baby doesn’t want to feed, you may need to express a small amount of milk

-        Avoid pressure on your breasts when feeding





What can I do if I have it?

-        Keep breastfeeding regularly, from the affected breast first – it is safe for your baby

-        Make sure your baby is latched on well and that you are relaxed and comfortable to help the let-down reflex work (the triggering of the milk by the baby’s sucking)

-        Use a warm pack before feeding (to assist milk flow) and an ice pack afterwards (to reduce inflammation)

-        Use a breast pump to drain the breast

-        Rest, and ensure you have good nutrition and fluids

-        Wear comfortable clothing and an appropriately-sized bra

-        Take panadol or nurofen – they are safe whilst breastfeeding

-        Position the baby appropriately in order to drain the breast better (ask your GP or a Women’s Health Physiotherapist)



How can Physiotherapy help?

When Physiotherapy treatment is sought, often the symptoms can be resolved more quickly. There are a variety of natural, non medicated treatments that Physiotherapists can use to help women suffering from mastitis. These include:

1)     Therapeutic ultrasound – to help open up the ducts and assist in removing the blockage

2)     Gentle massage – to assist in draining any fluid that is associated with inflammation

3)     Education – to encourage self-management and to prevent it happening again in the future

4)     Kinesiotaping to enhance drainage



If you have any questions regarding your breast health or are interested in seeing if we can help you, please give us a call at (02) 8411 2050. Here at Thornleigh Performance Physiotherapy, we can give you an accurate diagnosis and treatment, to help you get back in action as soon as possible. We are conveniently located near Beecroft, Cherrybrook, Hornsby, Normanhurst, Pennant Hills, Wahroonga, Westleigh, West Pennant Hills, and West Pymble.





Cooper, B. 2005, Physical therapy intervention for treatment of blocked milk ducts in lactating women, Quinnipiac University.



http://www.kellymom.com/store/handouts/concerns/mastitis-tips.pdf



https://www.breastfeeding.asn.au/bf-info/common-concerns%E2%80%93mum/mastitis



https://www.thewomens.org.au/health-information/breastfeeding/breastfeeding-problems/mastitis/
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