Focus: Can Stress Affect My Pain? - Physio Direct NZ

Focus: Can Stress Affect My Pain?

A common fear for patients when discussing pain is the idea that their symptoms are ‘all in their head’ or that they won’t be believed either by friends, family, therapists or workplace. This fear can be worse when there appears to be no obvious cause for their pain or it has been present for a long time.

What is pain?

Many of the models used in the past to explain pain lead us to believe that the intensity of pain will always be proportional to the severity of an injury. The experience of pain is always real and usually distressing. However, pain is a warning system used by our nervous system to alert us to danger, not a direct indicator of damage done. This is a subtle, yet important distinction meaning that the experience of pain can be influenced by many different factors and not exclusively tissue damage.

How can stress impact pain?

Part of the role of your nervous system is to sort through a huge amount of sensory input and interpret it in a meaningful way. When pain is considered to be a serious threat to the body, the intensity of the pain will be worse.

This can happen in many situations, for example:

-The source of the pain is not well understood, leading to fear that the pain might be something very serious.

-The nervous system is in a state of hyper-arousal, such as when you are stressed or tired.

-The pain or injury could have a significant impact on your quality of life, career, relationships or hobbies.

-The injury occurred through a traumatic event such as a car accident.

What does this mean for my treatment?

Along with all our more traditional treatments, we also know that stress reduction strategies, mindfulness and addressing any emotional trauma associated with pain can all help to aid recovery and improve quality of life. Your physiotherapist is a great person to speak to about pain management strategies so you can get the most out of your life while dealing with long-term pain.

None of the information in this article is a replacement for proper medical advice. Always see a medical professional for advice on your individual injury.

Achilles Tendon Tears - Physio Direct NZ

Achilles Tendon Tears

What is it?

The Achilles tendon is a band of fibrous tissue located at the back of the ankle. Its main role is to connect the calf muscles to the heel of the foot. This tendon is the largest tendon in the body and when it tightens, as the calf muscles contract, it pulls the heel allowing you to stand on tiptoe or to point your foot.

Achilles tendon tears commonly occur in athletes, however, this injury can affect anyone and surprisingly, a complete tear is actually more common than a partial tear.

These tears are commonly located at the part of the tendon where there is poor blood flow approximately 6cm above its attachment to the heel. Since there is poor blood supply, this part of the tendon is both vulnerable to injury and slow to heal.

What are the Symptoms?

Primarily, an Achilles tendon tear will cause difficulty in activities such as walking, running and jumping. Other signs and symptoms of an Achilles tendon tear include:

  • A loud pop or snap is heard
  • Sudden and severe pain at the back of the calf or ankle
  • Feeling of having been kicked in the calf
  • There is a gap between the tendon and the heel (about 2 inches above the heel)
  • Swelling and stiffness followed by weakness and bruising
  • Difficulty walking particularly during push off
  • Standing on tiptoe may be impossible

What Causes It?

Anyone can tear their Achilles tendon if the tendon is subject to excessive force or overstretching, however there are some factors that can increase your risk of injury. The most common activities that cause this injury are running and jumping.

The Achilles tendon can thin and weaken both as we age and also if it is not used. As a result of this weakening, it becomes prone to injury like tear or rupture with less force or stretching required before an injury occurs. A tear of the Achilles is often observed in people with pre-existing Achilles tendinitis. Other factors such as certain medications including antibiotics and steroids and some illnesses like diabetes and arthritis can also result in weakness of the tendon, increasing injury risk. Being obese is also a risk factor as excess weight puts additional strain on the tendon.

How Can Physiotherapy Help?

Treatment for Achilles tendon tear will depend on the patient’s age, how severe the injury is and the patient’s activity level. For young people especially athletes, they opt to have surgery while older people choose conservative treatments including physiotherapy.

Physiotherapy treatment for an Achilles tendon tear will involve exercises to strengthen the calf muscles and the Achilles tendon and exercises for stability. Many people are able to return to their normal activities within 4 to 6 months. Functional rehabilitation is also part of the program as it focuses on how you coordinate your body and how to move it. The aim of functional rehabilitation is to help you return to your highest level of performance.

None of the information in this newsletter is a replacement for proper medical advice. Always see a medical professional for advice on your individual injury.

Tomato, Basil and Barley Soup - Physio Direct NZ

Tomato, Basil and Barley Soup

Ingredients:

2 tins diced Tomatoes

1 small Red Onion, diced

2 small carrots, diced

1 handful Fresh Basil

2 cloves of Garlic

2 cloves of Star Anise

2 cups Vegetable Stock

2 cups Water

1/2 cup Pearl Barley

100g Fresh Parmesan

2 Tbsp. Olive Oil

Salt and Pepper

  1. Heat olive oil in a large pot on medium heat. Add diced onion, carrots, basil and garlic and cook until onions begin to soften. Soak barley in a separate pot of cold water for 10 minutes and set aside.
  2. Add tomatoes, vegetable stock, water and star anise to the pot and bring to boil, stirring occasionally.
  3. Drain barley and add to the soup mix. Reduce heat and simmer for about 30-40 minutes, add salt and pepper to taste. Remove from heat and serve while hot.

Garnish with basil and Parmesan cheese

Tips for Finding Your Perfect Exercise Match - Physio Direct NZ

Tips for Finding Your Perfect Exercise Match

Exercise is such an essential part of mental and physical wellbeing, however many of us find it difficult to make time to stay active. 

Often, when we think of exercise we imagine jogging or the gym. Exercise can be anything that gets you moving, and the trick to reaping the long term benefits is to find an activity that you love and do often.

Exercise can offer more than just physical benefits, a new activity can be a way to join a new community, improve self-esteem and can even improve brain function. By learning new skills or movements, your brain is laying down new neural pathways, a process known as neuroplasticityPhysical exercise has also been shown to help to improve learning and memory, in some cases even having a slight protective effect against age-related dementia. Here are a few tips to help you find the right exercise for you. 

1. Do a quick personality assessment.

Are you a competitive person? Or do you prefer to focus on your personal improvement of technique? The type of activity that captures your attention and focus will be easier for you to commit to. Matching your activity to your personality will also mean that you meet people who have similar interests to you.

2. Work with your injuries.

Injuries that stop us from participating in an activity we love can be devastating. However, you can often find another activity that doesn’t aggravate your injury, either as a replacement or to maintain fitness while rehabilitating.

If you are struggling with hip or knee pain with impact sports such as running, switching to swimming or cycling are great options. If you like a little adrenaline, then mountain biking can be more of your style. Physiotherapists are able to advise you on which activities will be suitable for your particular condition.

Capitalise on your natural ability. 

Throwing and catching might not be your thing, but your balance might be exceptional. We all have natural abilities, finding a sport that challenges and develops areas that you find to be strengths is key to enjoying a hobby.

None of the information in this article is a replacement for proper medical advice. Always see a medical professional for advice on your individual condition.

Shoulder Labral Tears - Physio Direct NZ

Shoulder Labral Tears

(SLAP Tears)

What is it?

A ring of flexible, fibrous connective tissue, known as the glenohumeral labrum, surrounds the shoulder joint. This labrum increases the stability of the shoulder while allowing for the required flexibility of one of the bodies’ most sophisticated joints. One well-known muscle of the arm, the biceps, has an attachment directly into the labrum and is a common site of injury. A tear of the labrum can occur in many locations, however the most common is at the point where the biceps tendon attaches to the labrum. Usually, this tear follows a typical pattern and is referred to as a superior labrum tear, anterior to posterior (SLAP tear).

What causes it?

SLAP tears can be caused by trauma such as a fall onto an outstretched hand or a dislocated shoulder. Tears can also develop over time with repeated throwing actions or overhead activities as the labrum is weakened and eventually injured. Traumatic tears are more likely to be symptomatic than tears that develop slowly.

What are the symptoms?

As mentioned, SLAP tears can occur suddenly, through trauma or develop slowly through repeated stress. Often if the injury develops over time, patients can be unaware they have sustained a tear and the injury doesn’t have a significant impact on their pain or function. Preexisting SLAP tears can however, place more tension on the long head of biceps tendon, leading to overuse disorders as a secondary complication.

When the tear occurs through a sudden action or trauma, symptoms can be more marked. Sufferers often notice pain deep in the shoulder joint with overhead shoulder movements, a feeling of weakness, loss of power and/or accuracy with throwing activities. Some people may notice a popping or clicking sensation and occasionally the shoulder may give way. In severe tears, the shoulder might feel unstable and even be at increased risk of dislocation.

How can physiotherapy help?

Your physiotherapist is able to help diagnose a suspected SLAP tear and send you for further imaging if needed. SLAP tears are often graded by severity from I to IV as a way to guide treatment. Physiotherapy is usually recommended as a trial for all tears before considering surgical repair and in many cases can effectively help patients return to their previous activities, symptom-free. 

If physiotherapy is unsuccessful, surgical repair with a full rehabilitation program is recommended. Surgery will usually either repair the tear or reattach the biceps tendon to the humerus (tenodesis). Following surgery, a period of rest in a sling is required before rehabilitation can begin.

None of the information in this newsletter is a replacement for proper medical advice. Always see a medical professional for advice on your individual injury. 

Cucumber and Sesame Salad - Physio Direct NZ

Cucumber and Sesame Salad

Ingredients:

1 whole Cucumber

1 large Lemon

1 Tbsp. Sesame Oil

1 Tbsp. White Vinegar

1 tsp. Sugar

1 Tbsp. Soy Sauce

1/2 tsp. Salt

  1. Slice cucumber into thin slices and set aside.
  2. Cut lemon into slices and set juice aside.
  3. Combine sesame oil, vinegar, soy sauce, lemon juice, sugar and salt in a jar and shake until combined.
  4. Pour dressing over sliced cucumbers in a bowl, add sesame seeds and stir gently until mixed through.

Garnish with fresh basil and lemon zest for a delicious side salad.

Physio Tips for Better Running - Physio Direct NZ

Physio Tips for Better Running

Distance running can be a surprisingly complicated sport. In this article, we offer some words of wisdom from our physiotherapists to help you get the most out of your training and avoid injuries. 

Choose your shoes carefully:

Repeated stress from running long distances will show up any biomechanical flaws in your body relatively quickly. Choosing the wrong shoes can exacerbate an existing problem causing pain and injury. Your physiotherapist can guide you on what style of shoe will best suit you. 

Don’t neglect your upper body:

While running can appear to be a purely leg based activity, increasing the strength and mobility of your upper body can have a surprisingly large impact on your posture, running style, breathing and overall performance. 

Find time to train strength as well as endurance:

Your body is great at finding ways to compensate for weak muscles, however, over time this can lead to overuse injuries of tendons and muscles. Identifying any areas of weakness early and specifically strengthening these muscles can both improve your running and help keep you injury-free.

Pace your progress: 

Entering an event is a great way to set a specific goal and keep you motivated. While trying to increase distances and speed, it is easy to forget to include rest days as a part of your routine. Your body needs time to recover and restore itself, just as much as the active portions of your training program.

Increasing your speed and distances gradually also allows your body to adapt to new demands without breaking down. 

Enjoy your training and listen to your body:

Your body will guide you as to when you need to rest and when you can push a little further. Training will be more enjoyable when you are well-rested and pain-free. Most importantly, if you are able to enjoy your runs, this will help you maintain motivation over a longer period of time, so you can continue for many years to come.

Ask your physiotherapist for more tips on how to reach your running goals while staying injury-free. None of the information in this article is a replacement for proper medical advice. Always see a medical professional for assessment of your individual condition.

Focus on Shin Splints - Physio Direct NZ

Focus on Shin Splints

What is it?

Shin splints, are a painful condition of the lower leg, also known as Medial Tibial Stress Syndrome, it is an overuse injury that causes pain along the inside of the tibia or shin bone. It is a common condition in runners, hikers and soldiers who march long distances.

What are the symptoms?

Shin splints are typified by persistent leg pain, usually the inside of the shin, halfway down the lower leg. The pain might be felt during exercise or directly after. Some people experience a dull ache over their shin that lasts for quite a while after exercise stops, while for others the pain may be sharp and fade quickly. The pain is often progressive, becoming worse with shorter distances. Eventually, shin splints can severely impact activity levels as the pain becomes too severe to continue exercising.

Shin splints can be extremely painful and very disruptive to activity levels. As the pain usually starts gradually and progresses many people find themselves unable to continue

training, shin splints may also progress to stress fractures if not diagnosed early and managed effectively.

How does it happen?

Shin splints are predominantly seen in runners who increase their distances quickly, often while training for an event. Activities that require repetitive weight-bearing of any kind, such as marching or high impact sports have also been shown to cause shin splints. Although the pathology of shin splints is unclear, studies have been able to identify certain risk factors that may predispose someone to shin splints. These include;

·An abrupt increase in activity level

·Improper footwear and support

·Higher BMI

·Training on hard or uneven surfaces

·Tight calf muscles

·Flat feet

·Increased external rotation range of the hips

·Females are more likely to develop shin splints than males.

·Prior history of shin splints

·Wearing or having worn orthotics

How can physiotherapy help?

The first step for your physiotherapist will be to address any contributing factors and help to adapt your training program to a level that is optimum for you. A period of relative rest may be recommended along with a targeted strengthening and stretching program for any tight or weak muscles. Switching to low-impact activities such as swimming, cycling and yoga may also help to maintain fitness during recovery. Your running technique will be analyzed and any training errors may be corrected. When getting back into your training routine, it is usually recommended that distances are not increased by more than 10% per week as this allows the tissues of the body to react to the increased demands and adapt accordingly.

None of the information in this newsletter is a replacement for proper medical advice. Always see a medical professional for advice on your injury.

Sweet Potato & Carrot Cake - Physio Direct NZ

Sweet Potato & Carrot Cake

Ingredients: 

 2 cups Plain Flour

1 tsp. Baking Powder

1 cup Sugar

1 Egg

1 Sweet Potato, roasted and mashed

2 Carrots, grated

1 cup Milk

1 tsp. Ground Cinnamon

3 Tbsp. Butter

Icing

1/2 cup Icing Sugar

1 cup Plain Greek Yoghurt, strained 

1 tsp. Vanilla Essence

  1. Preheat oven to 180d ℃ and grease a medium-sized cake tin.
  2. Combine butter, cinnamon, carrots, sweet potato, eggs, milk, sugar and baking powder in a medium-sized mixing bowl and mix thoroughly.
  3. Add flour and stir into the mixture until a smooth batter forms.
  4. Add mixture to cake tin and bake for 35-40 minutes. Use a skewer to check when the centre of the cake is cooked.
  5. To make the icing, take strained yoghurt, vanilla essence, butter and sugar and mix with an electric hand mixer until the icing is thick and smooth with no lumps. Place in fridge to set while the cake is baking. 

Allow to cool, cover with icing and serve when ready.

Four Surprising Reasons Why Your Pain Is Not Improving - Physio Direct NZ

Four Surprising Reasons Why Your Pain Is Not Improving

Most tissues in the body have healed completely in six to 12 weeks following an injury, however, many people have severe pain that lasts much longer than this. We know that the intensity of the pain you feel is not always associated with a similar amount of damage. In some cases, there can be a severe amount of pain with almost no detectable damage. With this in mind, we explore some reasons why your pain might not be getting better, long after the tissues have healed.

You’re afraid of the pain.

Pain can mean many different things, for some of us pain can affect our ability to work or can be a symptom of a serious disease. What you believe about your pain can either amplify or reduce the symptoms you experience. If you feel that every time you experience pain you are causing more damage, you will naturally pay more attention to this and your nervous system will amplify the signals in an attempt to keep you safe.

If you understand the cause of your pain and know that while there is discomfort, you are not in danger of causing more damage, often the pain will feel less severe. This is one of the benefits of seeing a physiotherapist after your injury as they can help you to understand your pain, giving you more control over your recovery.

You started moving differently after the injury. 

Immediately after an injury, it’s natural to change the way you move to avoid painful movements. After a while, these changed movement patterns can become maladaptive and actually begin to cause pain and discomfort on their own due to the altered stress patterns placed on your body.

Correcting these adaptive movement patterns can often go a long way in reducing pain after an injury. You might not have noticed these changes and might need a physiotherapist to identify and help you to return to your usual movement pattern.

You have lost muscle strength since the injury.

While a certain amount of rest following an injury is always helpful, if we stop moving altogether, our muscles can lose strength. This can mean that our posture changes, we fatigue easier during our usual activities and that we are more susceptible to further injury. Less movement also means we actually focus on the pain more when it does happen. Physiotherapists are able to advise you on the right types and amounts of excercise for you in the period following your injury.

The pain has affected your lifestyle.

When pain affects your ability to sleep, work and even concentrate, it’s not surprising that this can have a negative affect on your overall wellbeing and mental health. This can create a negative cycle of anxiety and depression that perpetuates and increases the experience of pain. If your pain is really getting you down, speaking to a mental health professional can actually be a valuable part of your physical recovery. 

Focus: The Broken Collarbone - Physio Direct NZ

Focus: The Broken Collarbone

What is it?

A broken collarbone, also known as the clavicle, is one of the most commonly broken bones in the body.

The collarbone connects the front of the ribcage to the shoulder and is the only bony connection the arm has to the rest of the body. Many muscles attach to the collarbone, including the Deltoid and Pectoralis Major.

How does it happen?

The most common way for this injury to occur is through a fall onto the shoulder. This can happen from a simple fall or sports such as mountain biking or rugby. It is a very common childhood injury but can happen at any age.

What are the symptoms?

Usually, a broken collarbone will cause moderate to severe pain over the broken area. The patient may have heard or felt a popping or cracking at the time of the injury and there may be an ongoing grinding or creaking with movements of the upper arm. If the skin is not broken there may be bruising and swelling over the painful area.

What is the treatment?

While very severe cases can be surgically fixed, more often a broken collarbone will be allowed to heal naturally with rest and monitoring. By supporting the arm in a sling and providing pain relief the arm will mend on its own. As with most fractures, there are also often other injuries that may need to be dealt with at the same time. There are many important structures near the collarbone that can also be damaged

including muscles, nerves and blood vessels. In very severe cases, the lung tissue under the collarbone can be damaged causing the lung to collapse. 

Physiotherapy and recovery:

Once a treatment plan has been decided by your medical team, your physiotherapist can help you to return to your pre injury strength and mobility with a full rehabilitation program.

None of the information in this newsletter is a replacement for proper medical advice. Always see a medical professional for advice on your individual injury.

Mixed Seed Pumpkin Bread - Physio Direct NZ

Mixed Seed Pumpkin Bread

Ingredients:

½ cup of coconut oil

2 cups of plain flour

1 tsp. baking soda

½ tsp. baking powder

1½ tsp. ground cinnamon

¼ tsp. grated nutmeg

¼ tsp. ground cardamom

½ tsp. salt

1 cup brown sugar

2 large eggs

1 cup pumpkin puree

1/3 cup coconut cream

2 tsp. pure vanilla extract

¼ cup coarsely chopped walnuts

¼ cup roasted pumpkin seeds

2 Tbsp. salted sunflower seeds

1. Preheat an oven to 180 degrees Celsius or 350 degrees Fahrenheit. Prepare a medium sized cake tin by greasing with butter (or coconut oil) and a small amount of flour.

2. Mix the spices, flour, baking soda, baking powder and salt together in a medium sized bowl and set aside.

3. In a larger bowl, beat coconut oil and brown sugar until they are well mixed. Continue to beat mixture, slowly adding eggs one at a time, waiting a minute before adding the second egg. Once well combined, add the pumpkin puree, coconut cream and vanilla and continue mixing. Finally add flour mixture and beat on low speed until combined.

4. Spoon the mixture into the greased cake tin. Cover with walnuts, pecans, and seeds.

5. Bake mixture for 45-55 minutes until a golden brown colour. To test the inside, insert a wooden skewer, if it comes out clean it is ready. Set bread on a cooling rack and allow to cool for 15 minutes before serving.

10 Facts About Tendons - Physio Direct NZ

10 Facts About Tendons

Tendons are found all over the body and while you may know a little about them, you might be surprised to learn a few of these facts.

1. Tendons can be found at the ends of muscles. Tendons are simply connective tissues that attach muscles to bone and help them move our joints when they contract.

2. Tendons come in many shapes and sizes. While the most recognizable shape is the long thin kind (such as the Achilles tendon), they can also be flat and thin or very thick, depending on the shape of the muscle and attachment of the bone. A thin flat tendon is also known by the name aponeurosis.

 3. Tendons are able to act like elastic bands, they can stretch and bounce back into shape. Like elastic bands, if too much force is applied they can stretch or tear.

4. Unlike elastic bands, tendons are living tissue and their properties are affected by many different factors. Seemingly unrelated things such as hormonal changes, autoimmune disorders and nutrition can all affect a tendon’s ability to withstand load.

5. Tendons don’t only attach muscles to bone, they can attach to other structures as well such as the eyeball.

6. Tendons can tear however; more often they are injured through overuse. Healing of tendons can be quite slow as they have less blood supply than other tissues of the body, such as muscles.

7. Tendons are mostly made of organized collagen fibres. Areas of tendon degeneration have been shown to have collagen fibres that are disorganised, with this area having less strength and elasticity.

8.The Achilles tendon is the strongest tendon in the body. This connects the large calf muscles to the back of the heel to point the ankle away from the body. Most tendons are simply named for the muscle they attach to, however the Achilles has it’s own name, named for the mythical Greek character who’s heel was his only point of weakness.

9. The smallest tendon is located in the inner ear, attaching to the smallest muscle in the body.

10. Tendons and muscles work together to move your joints and are called a contractile unit.

Tibialis Posterior Tendinopathy - Physio Direct NZ

Tibialis Posterior Tendinopathy

The tibialis posterior muscle sits just inside the shin, halfway up the lower leg. The muscle travels downwards and runs along the inside of the heel, with the tendon attaching at the base of the arch of the foot.   

The role of the tibialis posterior muscle is to move the foot and ankle downwards and towards the midline of the body. The tibialis posterior also helps to support and maintain the arch of the foot. Tendinopathy is a broad term that refers to painful pathologies of the tissues in and around a tendon, usually related to overuse.

What are the symptoms?

Signs and symptoms of tibialis posterior tendinopathy can include pain and/or stiffness over the tendon, clicking or ‘crepitus’ sounds with movement and swelling. Pain can be felt both when you touch the tendon or with movements that involve contraction of the tibialis posterior muscle, such as when going up on to your toes, hopping or running. 

As the condition progresses, the tendon might be come weaker and elongated, providing less support to the arch of the foot. This might become more noticeable over time as the lack of support in the foot further aggravates the damaged tendon.  

Pain may become so severe that eventually running becomes too painful to continue and even walking may be sore. In some cases, the affected tendon may be weakened but painless. For some, a complete tear of a weakened tendon can be the first sign that anything is wrong.

What are the causes?

Like most tendinopathies, overuse and biomechanical errors are the main cause of tendon pathology. Prolonged or repetitive activities that place excessive strain on the tibialis posterior tendon can cause degeneration and disorganization of collagen fibres within the tendon.  

Excessive pronation or rolling in of the foot while walking can place the tendon under extra stress as it acts to support the arch. Unsupportive footwear can exacerbate this process as it allows the foot to roll inwards. Often, a person may not have any issues until they begin to increase their training. If tendons are subjected to too much load too quickly, they can begin to breakdown, developing into a tendinopathy.

Being overweight, muscle weakness or tightness, poor warm up and insufficient recovery periods can all contribute to the development of tendinopathy. As you might expect, runners are most affected by this condition, along with other athletes of sports that require lots of running. Non- athletes can also be affected with day-to-day activities causing tendinopathy. 

How can physiotherapy help?

Your physiotherapist can help by making an accurate diagnosis in clinic, which can be confirmed by MRI or ultrasound. Your physiotherapist can also identify which factors may be involved in the development of this condition, helping to address them and reduce pain as quickly as possible.

For most tendinopathies, a period of relative rest is required and a graded training program to help strengthen the tendon has been shown to have the best evidence for recovery. Other interventions such as ultrasound, ice or heat treatment, soft tissue massage, stretching and joint mobilization may be used. Arch support taping, biomechanical correction, bracing and footwear advice may also be added. None of the information in this article is a replacement for proper medical advice. Always see a medical professional for advice on your individual injury.

Kale & Brussel Sprout Salad - Physio Direct NZ

Kale & Brussel Sprout Salad

Ingredients: 

12 Brussel Sprouts

3 Tbsp. Sliced Baking Almonds

1 cup chopped Kale

¼ cup shaved Parmesan Cheese

2 cloves of Garlic, Crushed

Dressing: 

2 Tbsp. White Wine Vinegar

2 Tbsp. Olive Oil

Salt & Pepper

  1. Preheat your oven to 180º Celsius. Slice brussel sprouts in half and place on a baking tray lined with baking paper. Sprinkle sprouts with olive oil, salt and pepper, add garlic and cover with almonds. 
  2. Roast brussel sprouts in the oven for 20-30 minutes until slightly brown. Prepare kale by chopping into small pieces, washing and placing in a medium sized salad bowl. 
  3. Prepare salad dressing by whisking together olive oil, white wine vinegar, salt and pepper. Mix brussel sprouts, almonds, kale and dressing together gently in the salad bowl. 
  4. Sprinkle thin slices of Parmesan cheese over salad and serve. 

Serves Two.