The Chiropractors Association of Australia (NSW) have reported an increase in the number of drivers seeking treatment for leg cramps and pains in the ankles, hip and lower back. They attribute this new phenomenon to worsening traffic in Australian cities. Challenges of driving in peak-hour traffic at speeds of about 30-40km/h every day has been attributed to the cause of physical discomfort and injury due to constant braking and changing gears. The latest Roads and Maritime Services annual report showed the overall average speed on Sydney's seven major routes during peak hour dropped from 31km/h in 2009-2010 to 29km/h in 2010-2011. Manual car drivers suffered most due to repeated use of both legs for the clutch, brake and accelerator; but automatic car drivers also suffered from the pedal pressure due to constantly being under tension with all the stop-starting. Experts believe constant and repetitive strain on the ankles, knees and joints from "clutch foot" could lead to permanent wear and tear on the body.