ACL Injury

One of the most common yet debilitating injuries to the knee.

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One of the most common yet debilitating injuries to the knee.

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What you might be feeling

At the moment of injuring an anterior cruciate ligament (ACL), people commonly feel or hear a ‘pop’ in their knee – like a thick elastic band giving way. This is typically followed by rapid knee swelling within two hours of the incident. After these initial symptoms, ACL injuries can cause broad knee tenderness, reduced knee movement and a feeling of knee instability or ‘giving way’. Depending on damage to other structures, there may also be pain medially and laterally and/or a feeling of ‘locking’ with knee movement.  

What's really going on inside

A torn ACL is a significant injury, especially for sports players. The ACL is a band of fibrous tissue connecting the thigh bone (femur) to the shin bone (tibia). The ACL’s primary functions are to limit twisting (rotational) forces through the leg and to prevent forward movement of the tibia on the femur. ACL injuries occur frequently in sports involving pivoting and sudden deceleration such as, football, basketball, netball, soccer, gymnastics and downhill skiing. The majority of ACL tears occur in non-contact situations when a person lands from a jump, pivots or decelerates suddenly. ACL tears can also occur in contact sports when the knee is forced to rotate, the shin is forced backwards or incorrect binding release while skiing.  

Acute management advice

The priority immediately after an ACL injury should be to control knee swelling and seek advice from a Physiotherapist or Sports Doctor. This can be achieved by following these principles in the first 72 hours:
  • Rest: restrict occasions of walking and standing to essential tasks
  • Ice: apply to the knee, focusing on areas of pain
  • Compression: using an elastic bandage or compression garment
  • Elevation: using cushion or pillow for support and comfort
  • Referral: to a Physiotherapist or Sports Doctor for ongoing care
 

How a physio can help

If your physiotherapist is the first person to see you after an ACL injury they will take a thorough history of what happened and then assess your knee. Manual assessment of the knee is often hindered by the large amount of swelling that occurs after an ACL injury. As such, the most accurate assessments are conducted immediately after a suspected ACL injury (prior swelling accumulation) or once swelling has subsided. Based on your injury history and the best possible assessment of the ACL and other structures, your physiotherapist should be able to diagnose what damage has been done.   If your physiotherapist suspects an ACL rupture they may refer you for further assessment and investigation by your General Practitioner, a Sports Doctor or to an Orthopaedic Surgeon. A referral for an MRI will often be done to look inside the knee and determine the extent of the damage. Whether surgery is undertaken or not, there is excellent evidence to show that physiotherapist-guided rehabilitation is vital to maximizing recovery. The optimal management of an ACL rupture is debated; consequently, a decision on whether to follow surgical or non-surgical management is usually made based on a number of factors:
  • The age of the patient
  • Instability: at rest and during movement
  • A concurrent meniscus tear
  • Associated injuries (commonly medial cruciate ligament sprain)
  • The patient’s desire to return to sports involving jumping and pivoting
  • The patient’s occupation (e.g. fireman, policeman)
  • Adherence with a comprehensive rehabilitation program after surgery. A decision is made between the Orthopaedic Surgeon and the patient and reflects what will be best for the patient’s needs.
  The time taken to return to sport and daily activities varies.  For the general population, it usually takes around 9–12 months to return to sports that require changes of direction. In some cases, the prognosis is more optimistic, with recovery being much shorter (6–9 months). Most patients start to feel a lot better after 10–14 days; often reporting that they get better and better with each day, once pain starts to subside. However, feelings of knee instability are likely to persist if rehabilitation is not undertaken. The necessary rehabilitation is extensive and essential to restore the knee to full function post injury/surgery. Your physiotherapist will guide you throughout your rehabilitation, providing appropriate treatment/exercise progression and understanding of the healing process and treatment options. [post_title] => ACL Injuries [post_excerpt] => [post_status] => publish [comment_status] => closed [ping_status] => open [post_password] => [post_name] => acl-injuries [to_ping] => [pinged] => [post_modified] => 2016-11-17 00:24:10 [post_modified_gmt] => 2016-11-16 13:24:10 [post_content_filtered] => [post_parent] => 0 [guid] => http://www.sportscarephysio.com.au/?p=7085 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) )

Meniscal Injuries of the Knee

The meniscus (cartilage) in the knee can be damaged through wear and tear and also by an acute injury. We're here to help.

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    [name] => Meniscal Injuries of the Knee
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The meniscus (cartilage) in the knee can be damaged through wear and tear and also by an acute injury. We're here to help.

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What you might be feeling

A severe meniscal injury e.g. long radial tear called a “bucket handle” tear, can be severely painful and restrict range of motion. Intermittent locking may occur as a result of a torn flap impinging between the articular surfaces. This may unlock spontaneously with a clicking sensation.However other meniscal tears may have more subtle symptoms with more intermittent pain and almost no restriction. Pain is normally present with squatting. Meniscal injuries often occur with ACL (anterior cruciate ligament) tears. The most common sign is tenderness along the knee joint line, presence of a joint effusion (swelling within the joint capsule). There is usually a restriction of range of motion in the knee joint, this can be due to the torn meniscal flap or the effusion. Your physiotherapist will be able to perform a few tests to determine whether there is a meniscal injury. However not all meniscus injuries are positive on testing and an MRI scan may be necessary to diagnose the injury.

What's really going on inside

In the knee there are two menisci (Cartilage pads) the medial (sitting on the inside of the knee) and the lateral meniscus (on the outer side of the knee joint). The medial meniscus is more commonly injured than the lateral meniscus. The most common mechanism of injury is a twisting injury with the foot anchored on the ground, often by another player’s body. The twisting component may be a relatively slow speed. It is commonly seen in footballers, basketballers and netballers. The degree of pain associated with this injury varies, some people report a tearing sensation at the time of the injury, a small tear may cause no immediate symptoms but typically pain and swelling increases over time (24hrs). Small tears may also occur in the older population with only very minimal twisting or trauma as a result of degenerative changes to the Meniscus.

How a physi0 can help

The treatment of meniscal injuries varies considerably depending on the severity of the injury. Normally small tears or degenerative tears can be treated conservatively with physiotherapy this includes:
  • Reducing the effusion using electrotherapeutic modalities, soft tissue techniques and compression.
  • Restoring range of motion through manual techniques, gentle movement and stretching.
  • Improve weight bearing ability/ gait.
  • Guidance for strengthening surrounding muscles.
  • Graduated return to running and agility work.
  • Progressive return to sport.
If the meniscal injury is large and causing a locked knee it may require an arthroscope to preserve as much of the meniscus as possible; this can mean either suturing the tear or removing the torn flap depending of the location and severity of the tear. Following surgery physiotherapy can assist in the following ways:
  • Reduce pain and swelling.
  • Restore range of motion in the joint.
  • Graduated weight bearing exercises.
  • Progressive strengthening
  • Maintain strength and fitness of other parts of the body
  • Return to function activities
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Patello Femoral Pain

Pain at the front of the knee playing sport or just with sitting. Patello-femoral pain is the most common knee problem physios see.

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Pain at the front of the knee playing sport or just with sitting. Patello-femoral pain is the most common knee problem physios see.

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What You May Be Feeling

Patello-femoral pain (PFP) comprises of pain under, around or below the knee cap. It is a common source of anterior knee pain in both males and females of all activity levels. Pain can present in daily activities such as walking, running, prolonged sitting, squatting and walking up and down stairs.

What’s Really Going On Inside

PFP is considered to be caused by excessive friction on the back of the knee cap and can result from several causes. Excessive training load or sharp increases in physical activity beyond that of which, the loading capacity of the knee can cope. Poor movement patterns at the hip, knee and/or ankle, which may promote what is thought to be movement of the knee cap toward the outside of the knee. This impedes correct tracking of the knee cap within the groove of which it sits on the end of the thigh bone. A number of factors can contribute to this poor tracking of the knee cap including the natural structure of the knee and/or biomechanics of the lower limb such as weakness of the muscles around your hip and front of the thigh. These thigh muscles control the straightening movement of the knee and are known as the quadriceps.  
  • Poor muscle control and weakness around the hip muscles can cause the pelvis on the opposite side to drop and increase tension on the outside of leg
  • These deficits can also cause the hip to rotate the thigh inward.
  • Weak thigh muscles (quadriceps) provide inadequate support for the knee especially when loaded through propulsion and landing-type activities.
  • Foot can excessively roll inward, promoting the knee to roll inward also, and increase pressure on the knee cap.

How a physio can help

If you think have PFP, you should seek help and advice as soon as possible from a qualified health care professional to guide your treatment and optimise your chances of a successful recovery. As there are many causes of this condition, there are also many treatment options available. Avoid sitting with your knee bent for prolonged periods of time as this can agitate your knee. Try to sit with knees relaxed or extended. Avoid kneeling or squatting positions and minimise sitting with your legs crossed. When going down hills or stairs, try to do it slowly to minimise impact. Decrease high impact activities such as those involving running, jumping and stair climbing. With weight training, it is generally best to avoid full squats and lunges with the knee is loaded in a highly flexed or bent position. Leg extension machines can also be irritable and leg press is generally tolerated if the knees are not bent more than 90 degrees. Knee sleeves can be worn during weight training to support the knee cap in keeping it tracking more centrally. Once the quadriceps muscles are strong enough however, you should not need to keep using them. Icing the knee especially after aggravating activity can help reduce the pain and prevent symptoms from worsening. Exercise Most successful recoveries are those, which involve active participation. Appropriate activity modification is a good initial strategy towards a successful recovery. Ongoing research is further recognising tissue-overload to be a significant contributing factor to PFP. This can come from returning to exercise too much too fast after a period of rest or drastically increasing the amount of exercise you are already doing. If there is a particular activity that is aggravating your knee pain, you should look to reduce the amount that you are doing. In some instances, if your pain is particularly irritable, you may need to cease, modify or switch your physical activity completely. Your therapist may direct you to rest or switch exercise options before commencing exercise again. Exercise in sitting or lying are good ways to start off improving muscle function without provoking pain. These exercises should progress into more functional positions, which are reflective of your everyday activity such as standing. Supervision by your therapist should be provided when introducing new exercises into your rehab to ensure your technique is correct. This can be helped with use of mirrors, pictures or video recordings.  Exercises should be performed with correct technique and be performed regularly as prescribed by your therapist. Weakness and poor function of the hip and thigh muscles are common. You are likely to need exercises to improve these areas. Starting you on a progressive rehab program focusing on strengthening your quadriceps and hip muscles can help distribute load more evenly through your knee and reduce pressure and pain at the knee cap. Other areas which may need to be addressed include exercise for the foot and stretches for your quadriceps, calves and hamstrings. Exercises should be progressed to activities that were problematic previously such as squatting, running and stair use, while ensuring good movement patterns are reproduced and maintained. Taping Taping or strapping around the knee can be an effective method for temporary pain relief with facilitating corrective patella alignment. Foot Orthotics Foot orthotics may be helpful in improving lower limb movement and limiting knee cap stress for people with too much foot roll (pronation) or otherwise known as “flat feet”. Your physiotherapist can help determine if this is a reasonable option for you. Footwear You may be advised to alter your current footwear, such as avoid wearing high heels, shoes with a soft sole to reduce impact, or shoes which provide more support particularly around the “arch” of your foot.

How else can a physio help

Approximately 2.5 million runners are affected each year and 74% of sufferers result in decreasing the level of physical activity for at least 5 years. Between 70-90% of people with experience more than 1 episode of pain. Your physiotherapist will evaluate your movement patterns during functional activities such as running, squatting and moving up and down stairs. They will help identify areas of weakness and inflexibility through assessing Strength of the thigh and hip muscles. The foot and ankle will be examined for any restricted or excessive movement, in addition to any abnormal wear of your shoes, which may be contributing to your knee pain. Your physiotherapist will help decide which options will work best for you. They can help guide which exercises will be most beneficial to your recovery. They can answer questions related to your knee pain and help understand why you have developed knee pain and what factors have most likely caused it to occur. Your physio can help you manage your current training load, assess and modify your technique and provide alternative exercise options to maintain your strength and conditioning where appropriate. Finally, your physio can provide various forms of manual therapy to help improve pain and facilitate other aspects of your rehab. Adapted from:
  1. Barton, C.J. and Rathleff, M.S., 2015. Managing My Patellofemoral Pain. InForsknings-og udviklingssymposium i Nordjylland.
  2. J Orthop Sports Phys Ther 2012;42(6):573.
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Osgood-Schlatter's Disease

A common cause of anterior knee pain in children and early teenagers.

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A common cause of anterior knee pain in children and early teenagers.

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What is Osgood-Schlatter Disease

Osgood-Schlatter Disease in the most common cause of anterior knee pain in children and early teenagers. It is more common in boys than girls and can affect one or both knees. The disease most commonly occurs in children who are involved in sports that required lots of running and jumping.

What are the risk factors?

Risk factors include:
  • boys aged 11-18
  • a recent growth spurt
  • activities involving repetitive running and jumping
  • poor footwear, mechanics and insufficient strength

Signs and symptoms

  • Anterior knee pain where knee cap tendon attaches to shin (can develop lump)
  • Strong ache during and/or after impact exercise
  • Sometimes warm and swollen

Diagnosis and treatment

Osgood-Schlatter Disease can be diagnosed through clinical examination by a doctor or one of SportsCare and Physiotherapy's qualified physios. Treatment includes:
  • relieving discomfort through education and exercises (strengthening and stretching).
  • ice, anti-inflammatories and addressing biomechanical impairments
  • advice on strategies to modify training and games to reduce symptoms, as sport can make symptoms worse.
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Specialist Staff

Cervical Whiplash

Been in a car accident lately? Have neck pain? Here you can read more about the cause of whiplash and our advanced treatment techniques.

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Been in a car accident lately? Have neck pain? Here you can read more about the cause of whiplash and our advanced treatment techniques.

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What you might be feeling

Pain in the neck, shoulders, back, head or arms following a high speed incident most commonly in a motor vehicle accident. The pain doesn't necessarily come on immediately but is often associated with other symptoms such as pins and needles.

What's really going on inside

This is most common in motor vehicle accidents when the head is suddenly jerked back and forth beyond its normal limits, the muscles and ligaments supporting the spine can be over-stretched or torn. As the vehicle accelerates forward, it pushes the body forward too, but the head remains behind momentarily, rocking up and back, until some of the muscles and ligaments are stretched or torn. It can also occur in sports when the cervical spine is suddenly extended in contact with the ground or by a direct blow from an opponent. Symptoms Symptoms include:
    • Neck pain and/or stiffness
    • Blurred vision
    • Difficulty swallowing
    • Irritability, Fatigue, Dizziness
    • Pain between the shoulder blades
    • Pain in the arms or legs, feet and hands
    • Headache
    • Low back pain and/or stiffness
    • Shoulder pain
    • Nausea
    • Ringing in the ears
    • Vertigo
    • Numbness and tingling
    • Pain in the jaw or face
Complications The pain generally arises from damage to the cervical discs. It also affects muscles, ligaments, capsular tissue and the dura (covering of the nerves) . This can be a difficult condition to treat as the damaged discs may undergo progressive degeneration. Over time this can lead to altered biomechanics of the joints and thus further joint damage.

How a physio can help

Initial treatment: Sometimes a cervical collar in the first few days after injury can help to control the inflammation, but should be weaned off after 4-6 days to get some gentle movement occurring. Local pain relieving modalities or an anti-inflammatory may also help in the initial period. Secondary treatment Manual therapy, especially mobilisation, and manipulation will gently assist range of motion. The best results often occur when there is a combination of active range of motion exercises such as gentle mobilisation, massage therapy and gentle stretching. As the condition improves Massage and mobilisation will become deeper and more specific to regions of dysfunction. Once the pain has started to settle and movement has returned to normal some strengthening exercises should be performed to improve neck stability. This treatment can take up to 6-12 weeks and occasionally pain and dysfunction may persist in the years to come depending on the extent of the injury. [post_title] => Cervical Whiplash [post_excerpt] => [post_status] => publish [comment_status] => closed [ping_status] => open [post_password] => [post_name] => cervical-whiplash [to_ping] => [pinged] => [post_modified] => 2016-12-12 08:53:58 [post_modified_gmt] => 2016-12-11 21:53:58 [post_content_filtered] => [post_parent] => 0 [guid] => http://www.sportscarephysio.com.au/?p=7199 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) )

Acute Wry Neck

Randomly woken to a stiff, sore neck? Moving like a robot? It could be wry neck.

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Randomly woken to a stiff, sore neck? Moving like a robot? It could be wry neck.

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What you might be feeling

Wry neck is best described as neck pain and stiffness, which is often accompanied by spasm of the supporting neck muscles.  This causes neck pain and an inability to turn your neck through its full range of movement.   The onset of symptoms can often be sudden (ie; wake with a stiff and sore neck) and therefore can be often called ‘acute wry neck’.  Wry neck is a very common condition, which can be quite disabling as the sufferer can experience constant severe pain with simple neck movements.   However, treatment is normally very successful and can work relatively quickly to resolve symptoms.  Wry neck is most common is younger population.  Older wry neck sufferers tend to have a more gradual onset.  

What’s really going on inside

Wry neck is thought to have many causes.  However, it is believed that the pain and reduction in range of movement is due to either;
  1. Facet Wry Neck – caused by locked facet joint. This is the most common cause of wry neck.
  2. Discogenic Wry Neck – caused by cervical disc injury
Facet joints are located at the back of your spinal column and allow, guide and limit the movements of the neck.  They are intended to allow smooth gliding movements between the adjacent vertebra.   Wry neck pain is due to the numerous nerve endings that are located in the facet joint itself and the surrounding tissue.

How a physio can help

A physiotherapist can utilise a range of low risk joint mobilisation techniques and soft tissue massage to normalise your facet joint function.  You may experience some residual muscle spasm and swelling after treatment due to the trauma.  Similar to how a sprained ankle swells, neck joints will also become inflamed but it won’t be as visible.   Most patients get some immediate relief from treatment however the residual effects can last up to a week or two.   It is also important to normalise your neck muscle and joint function to prevent recurrence, which unfortunately commonly occurs without correct treatment. [post_title] => Acute Wry Neck [post_excerpt] => [post_status] => publish [comment_status] => closed [ping_status] => open [post_password] => [post_name] => acute-wry-neck [to_ping] => [pinged] => [post_modified] => 2016-12-13 22:30:45 [post_modified_gmt] => 2016-12-13 11:30:45 [post_content_filtered] => [post_parent] => 0 [guid] => http://www.sportscarephysio.com.au/?p=7237 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) )

Specialist Staff

AC Joint Injury

Fallen onto your arm and you've had shoulder pain since? Hit by a big tackle in footy? Learn more about the AC joint here.

Find out more
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Fallen onto your arm and you've had shoulder pain since? Hit by a big tackle in footy? Learn more about the AC joint here.

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What you might be feeling

Usually with this injury you will be feeling pain on the top of the shoulder. It may be difficult to move your shoulder and there could be swelling or a bump on top of the shoulder.

What is really going on inside

The acromio-clavicular (AC) joint is the joint formed between the clavicle (collarbone) and the acromion (the tip of the shoulder blade). You can feel it, if you put your hand on top of your shoulder, it is the bony bump about 4cms from the edge of the shoulder. The AC joint is a link between the arm and the trunk and is the only bony joint between the shoulder blade and the rest of the body. It helps transmit load from the arm to the trunk in pushing, pulling punching and resting on the arm. The AC joint is a quite common sporting injury especially in contact sports. It is usually injured by a fall directly onto the shoulder or a fall onto the arm or a tackle. The ligaments that bind the clavicle to the acromion are firstly stretched, then torn. Depending on the severity of the injury the clavicle can tear away from the acromion causing a noticeable lump to appear on top of the shoulder. The injury results in considerable pain, swelling and loss of shoulder movement. The injury does heal, depending on the severity of the injury by itself or if complicated with surgical intervention. However many years later degeneration can cause the AC joint to become painful again. Grading of an AC joint injury: The most commonly used classification system recognises 6 severities of AC joint injury. Grade I A slight displacement of the joint. The acromioclavicular ligament may be stretched or partially torn. This is the most common type of injury to the AC Joint. Grade 2 A partial dislocation of the joint in which there may be dome displacement that may not be obvious during a physical examination. The acromioclavicular ligament is completely torn, while the coracoclavicular ligaments remain intact. Grade 3 A complete separation of the joint. The acromioclavicular ligament, the coracoclavicular ligaments and the capsule surrounding the joint are torn. Usually, the displacement is obvious on clinical exam. Without any ligament support, the shoulder falls under the weight of the arm and the clavicle is pushed up, causing a bump on the shoulder Grades I-III are the most common. Grades IV-VI are uncommon and are usually a result of a very high-energy injury such as one s that might occur in a motor vehicle accident.

How A Physio Can Help

Treatment for an AC joint injury Initial treatment may consist of:
  • Rest
  • Ice
  • Compression
  • Support (a sling may be worn)
  • Your doctor may prescribe anti-inflammatory medications or pain relief medication.
  • Movement within the pain free range will help in maintaining mobility of the surrounding structures.
  • Taping may be beneficial to support the position of the joint.
As pain settles:
  • Load bearing exercises can be added to restore the normal function of the joint and surrounding muscles.
  • Massage and mobility exercises may be incorporated to ensure normal function is achieved.
In severe cases where the clavicle is completely torn away from the acromion the joint may remain painful and unstable and require surgical fixation. Returning to sport following an AC joint injury: Return to sport is possible when you have no localized tenderness, and full range of pain free movement has been achieved. On initial return to sport you may feel more comfortable to use taping or to have some padding over the AC joint. Your physiotherapist will guide you on your return to sport and any precautions that need to be taken. Examples of tasks you should be able to perform pain free are:
  • Landing against a wall sideways with your shoulder.
  • Landing against a wall onto an outstretched hand.
  • Throwing and catching a ball in awkward positions.
  • Completing one or more full contact training sessions.
Remember
  • Seek treatment at an early stage
  • Ensure you physiotherapist provides you with methods of self treatment and management.
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Labral Tear

Clicking or locking in your shoulder?

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    [name] => Labral Tear
    [location] => shoulder
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Clicking or locking in your shoulder?

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What you might be feeling

The pain caused by such injuries is not well defined, but commonly activities like lifting, overhead activities and twisting motions are painful. There may also be a clicking and popping catching and grinding with movement. Labral tears are best diagnosed with a combination of clinical tests and MRI scan.

What's really going on inside

What is the shoulder labrum? The shoulder or glenoid is a rim of thick cartilage tissue around the edge of the shoulder socket (the shoulder is a ball and socket joint). The labrum helps to make the shoulder socket deeper and in this way helps to make the shoulder more stable. The labrum is the site of attachment to one of the tendons of the bicep muscle (it attaches to the top part of the labrum) as well as the shoulder joint ligaments and the shoulder joint capsule. How is the labrum injured? The most common injury to the labrum is the SLAP lesion. SLAP stands for Superior Labrum Anterior to Posterior and refers to injuries involving the biceps tendon and the labrum. Other labral injuries are referred to as non-SLAP lesions. SLAP lesions occur when excessive force is placed through the biceps tendon/labrum combination and can occur in a single incident or as the result of repetitive loads. Activities that can result in a tear include catching a heavy load, holding a load overhead, falling onto an outstretched arm. Overhead sports such as baseball and tennis can cause injury via repetition. Non-SLAP lesions can occur in association with shoulder dislocation and subluxation (partial dislocation) as well as from the end result or repetitive loads.

How a physio can help

Labral tears are usually treated with arthroscopic surgery to the shoulder to either cut away the torn and irritated tissue or to re-attach the labrum to the socket of the shoulder. Following surgery it is important to restore the strength and proprioception (or balance) to the shoulder joint. This will usually involve a graduated exercise programme to allow enough time for post surgical healing and progressing through more and more challenging exercises until pre-injury levels of performance are achieved. Returning to Sport As labral tears are often associated with repetitive actions in sport, it is important that sporting technique is carefully assessed before return to sport. Returning to your sport or activity is determined by how long it takes for your shoulder to recover, not by how may days or weeks it has been since your injury occurred. You may safely return to your sport/activity when:
  • Your injured shoulder has full range of motion without pain.
  • Your injured shoulder has regained normal strength compared to the injured shoulder.
Faults should be corrected and you must have the load on the shoulder increased to a level comparable to the loads you will experience in playing sport again. Physiotherapy Treatment Following surgery, physiotherapy treatment involves a gradual strengthening and balancing of the shoulder using stretching and strengthening exercises and massage. You will do strengthening exercises to improve the strength and control of the rotator cuff and shoulder blade muscles. Your therapist will help you retrain these muscles to keep the ball of the humerus (upper arm) in the glenoid (the socket). This will improve the stability of your shoulder and help it move smoothly during all your activities. It is important to remember that everyone recovers from injuries at a different rate and the majority of patients are able to get back to their activities with full use of their arm. [post_title] => Labral tears of the shoulder [post_excerpt] => [post_status] => publish [comment_status] => closed [ping_status] => open [post_password] => [post_name] => labral-tears-of-the-shoulder [to_ping] => [pinged] => [post_modified] => 2016-12-12 09:31:56 [post_modified_gmt] => 2016-12-11 22:31:56 [post_content_filtered] => [post_parent] => 0 [guid] => http://www.sportscarephysio.com.au/?p=7209 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) )

Shoulder impingement

Is your shoulder bothering you? Read about shoulder impingement below

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Is your shoulder bothering you? Read about shoulder impingement below

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What you might be feeling

Pain in the shoulder or upper arm on overhead movements, with lifting and activities involving twisting the shoulder like doing up a bra or throwing. The pain can be sharp and catching with movement with an underlying deeper ache.

What's really going on inside

Shoulder impingement is often caused by altered scapular (shoulder blade) position, often described as ‘winging’. The scapular is noted to be more anteriorly (forward) and laterally (to the side) rotated. This causes a decrease in the space for shoulder tendons, bursae and nerves to run through and work in, which can lead to an decrease in the space in this area and compression of the structures which may result in possible tissue and / or nerve damage. The overhead action of throwing or taking the arm up over the head can generate a lot of force through the shoulder. This repetitive action can lead to some of the muscles around the shoulder to become tight and weaker while other muscles around the shoulder become stronger. This may result in shortening of the shoulder joint capsule and the supporting muscles around it. Unfortunately this can result in a “SICK” shoulder (Scapular mal-position, Inferior medial border prominence, Coracoid pain and mal-position, and dyskinesis of scapular). In other words: a shoulder that isn’t sitting as it normally would, with pain and movement dysfunction. The resulting muscle imbalance causes a shift in the position and movement of the scapula on the shoulder. An altered movement pattern results causing more stress and load on the surrounding structures resulting in further trauma, which may lead to tissue and/or nerve damage. Tenderness may be found on the bony parts of the shoulder joint where the muscles insert due, to the altered scapula position and increased tension on these soft tissue structures.

How a physio can help

To start to reduce the pain your  physio may ask you to follow the steps below: -Rest. - Ice. - Your doctor may prescribe anti-inflammatory medications or pain relief medication. - Movement within the pain free range will help in maintaining mobility of the surrounding structures. - No throwing or over arm technique until the pain settles. Avoiding things that are painful. - Your physiotherapist can use different treatment techniques, for pain and inflammation. As Pain settles: - You will begin a rehabilitation program that includes strengthening and stretching exercises to help re-establish your shoulder stability and restore normal shoulder motion. - Massage and mobility exercises may be incorporated to ensure normal function and movement is achieved. - A throwing program can now commence under the guidance of your physiotherapist. It is important to not do too much at this stage as symptoms may return if you try to push yourself too quickly. Swimmers and tennis players will return to stroke work and hitting. Returning to Sport: - Return to sport is possible when you have no localised tenderness, full range of pain free movement has been achieved and your strength is back to normal. - Your physiotherapist will guide you from a throwing program back to competitive throwing and inform you of any precautions that need to be taken. - Your coach or physiotherapist should check your over arm / throwing/ stroke/hitting technique to prevent reoccurrence. The smallest adjustments can make a huge difference. - You should continue strengthening lower limb, core and your up-per body to prevent reoccurrence. [post_title] => Shoulder Impingement [post_excerpt] => [post_status] => publish [comment_status] => closed [ping_status] => open [post_password] => [post_name] => shoulder-impingement [to_ping] => [pinged] => [post_modified] => 2016-12-13 13:46:15 [post_modified_gmt] => 2016-12-13 02:46:15 [post_content_filtered] => [post_parent] => 0 [guid] => http://www.sportscarephysio.com.au/?p=7233 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) )

Specialist Staff

Mastitis

Breastfeeding and feeling unwell and painful?

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Breastfeeding and feeling unwell and painful?

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What you might be feeling

The breast may demonstrate one or any of the following:
  • Red
  • Hot
  • Swollen
  • Painful
Systemic symptoms are usually only seen in infective mastitis and required medical input:
  • Fever (usually over 38.5°C
  • Lethargy
  • Headache
  • Nausea
  • Anxiety
  • Flu like symptoms e.g. aching joints

What is really going on inside

Mastitis is a condition that occurs in breastfeeding women when a milk duct becomes blocked. If not cleared, the blockage can cause inflammation of the surrounding breast tissue. Mastitis can be non-infective or infective.

Risk factors for mastitis

  • Poor attachment to the breast
  • Previous history of mastitis
  • Nipple damage
  • Breasts that are too full
  • Blocked milk ducts
  • Missing feeds and/or abrupt weaning
  • Overly tight or underwire bra
  • Poor hygiene prior to breastfeeding or use of nipple creams
  • Rough handling of breasts
  • Stress/lack of sleep
  • Anemia/poor diet
   

Acute management advice

  • Attempt to breastfeed/express from the affected breast first. Your milk is still safe for your baby.
  • Gently massage from your nipple up towards your arm pit with a flat open palm when feeding or expressing.
  • Place a warm pack prior to feeding and an icepack post feeding on the painful area.
  • Breastfeed your baby on demand (usually 8-12x/hour every 24hrs for a newborn). If your baby is not hungry, express a small amount of milk to make your breast more comfortable.
  • Drink plenty of fluids throughout the day.
  • Rest as much as possible and ask for help with chores.
  • Wear comfortable, loose fitting clothing and an appropriately sized maternity bra.
  • Take paracetamol or ibuprofen. They are safe to take while breastfeeding.

How a physio can help

Physiotherapy intervention is most beneficial when commenced early. If you start to develop the above symptoms, book an appointment with a Women’s Health physiotherapist. Your treatment may include:
  • Ultrasound – to assist in breaking down the milk duct blockage
  • Massage – to support lymphatic drainage
  • Taping – to help reduce pain and promote lymphatic drainage
  • Education – to encourage self management and prevent future episodes
  If you have systemic symptoms or the above measures do not help, please contact your General Practitioner for ongoing input. If you would like breastfeeding support, contact your maternal health nurse, a lactation consultant or the Australian Breastfeeding Association on 1800 686 268. This information provided is for general information and does not substitute for the advice and information your physiotherapist will provide about your particular condition. While every effort has been made to ensure the information provided is correct and accurate, SportsCare and Physiotherapy accepts no responsibility for inappropriate use, self diagnosis and rehabilitation of any health related condition.     [post_title] => Mastitis [post_excerpt] => [post_status] => publish [comment_status] => closed [ping_status] => open [post_password] => [post_name] => mastitis [to_ping] => [pinged] => [post_modified] => 2016-11-28 22:13:54 [post_modified_gmt] => 2016-11-28 11:13:54 [post_content_filtered] => [post_parent] => 0 [guid] => http://www.sportscarephysio.com.au/?p=7160 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) )

Specialist Staff

Specialist Staff

Extensor Tendinopathy (Tennis elbow)

Elbow pain when gripping? You don't have to be a tennis player to get tennis elbow.

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Elbow pain when gripping? You don't have to be a tennis player to get tennis elbow.

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What you might be feeling

Extensor tendinopathy or as it is most commonly know “tennis elbow” is pain in the outside of the elbow that comes from inflammation and degeneration of the tendons on the outside of the elbow. The tendons are part of the muscles that control movements of the wrist, hand and fingers. Pain is often felt with gripping, lifting, shaking hands and using a keyboard or mouse.  Extensor Tendinopathy is classified as an overuse injury occurring at the common extensor origin (CEO) on the outside of the elbow. The wrist extensor muscles are attached to the CEO via a common tendon. This overuse condition occurs due to repetitive forces at the CEO.

What's really going on inside

Extensor tendinopathy is usually caused by activities that require repetitive use of the muscles that control the wrist, hand and fingers. The problem is felt in the tendons or CEO of these muscles, on the outside of the arm. The overuse of these muscles can cause tiny tearing and degeneration or breakdown of the tendon. This series of events then leads to an increased blood vessel growth, that relates to an increase pain rather then healing. This is further complicated by an increase of nerve fibers. These new fibers pick up painful stimuli and this coincides with an increased in pain producing chemicals to the area. It can become a very painful and debilitating condition. Extensor tendinopathy starts as pain in the outside of the elbow and forearm. The pain usually develops gradually. Initially it may only be painful with activity and may disappear as you warm up and then return once you have
stopped activity. You may notice initially that the elbow and forearm feel a bit stiff and that this discomfort will disappear with some gentle stretching and heat (e.g. a hot shower). As the condition progresses it becomes painful with most arm, wrist and hand movements and as the tendinopathy worsens it may become painful all the time.

How a physio can help

Extensor tendinopathy generally doesn’t get better on its own. It will feel a little bit better with rest but once you start doing the aggravating exercise or activity again it will become painful again. Continuing to do aggravating activities may advance the process and may significantly prolong the recovery time. The goals of treatment are to identify any predisposing factors, reduce pain and inflammation and promote healing to restore the muscle and tendon. Early treatment may include:

    • Rest from provocative activities.
    • Ice or heat (as directed by your physiotherapist).
    • Physiotherapy electrotherapy modalities.
    • A gentle stretching and strengthening program.
    • Massage and soft tissue therapy.
    • Posture education-posture of the wrist and general upright posture (especially for people who have a sedentary job and who use the computer a lot)
    • Bracing or taping may be used to unload the muscle and tendon. Acupuncture and dry needling.
Once your pain has settled it is vital that physiotherapy is progressed to ensure complete healing of the area. Treatment may include:
    • Harder and more specific exercises. Once you have mastered basic muscle contractions your physiotherapist will progress you on to eccentric exercises which will help to restore the integrity of the tendon.
    • Correction of any predisposing or unusual biomechanics. This may relate to sport; for example using the wrist to hit a backhand in tennis rather then hit- ting with a stable wrist/forearm. Poor lifting/working technique within the workplace can also be a major predisposing factor. Your physiotherapist will guide you to help change/correct these.
Other things that may be used if the condition doesn’t settle are:
    • Corticosteroid injection.
    • Nitric Oxide therapy.
    • Surgery.
Your physiotherapist will guide you through your rehabilitation and refer you on to the appropriate specialist if the condition does not improve. When can you return to sport or activity? It is important that you return to sport or aggravating activities slowly. De- pending on the severity of the initial condition and the length of rehabilitation a graduated return may take 3 weeks or 3 months. What is the prognosis? Extensor tendinopathy, if treated properly and managed correctly will not have any long term effects. If not it can lead to prolonged pain on the outside of the elbow and forearm, a prolonged period away from sport/work/aggravating activities and may cause degeneration of the tendons which will cause lingering pain.   [post_title] => Extensor Tendinopathy [post_excerpt] => [post_status] => publish [comment_status] => closed [ping_status] => open [post_password] => [post_name] => extensor-tendinopathy [to_ping] => [pinged] => [post_modified] => 2016-12-12 09:18:58 [post_modified_gmt] => 2016-12-11 22:18:58 [post_content_filtered] => [post_parent] => 0 [guid] => http://www.sportscarephysio.com.au/?p=7205 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) )

Flexor Tendinopathy (Golfer's Elbow)

Find out more about this common condition

Find out more
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Find out more about this common condition

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What you might be feeling

Flexor tendinopathy starts as pain in the inside of the elbow and underside of the forearm. The pain usually develops gradually. Initially it may only be painful with activity and may disappear as you warm up, then return once you have stopped activity. You may notice initially that the elbow and forearm feel a bit stiff and that this discomfort will disappear with some gentle stretching and heat (e.g. a hot shower). As the condition progresses it becomes painful with most arm, wrist and hand movements and as the tendinopathy worsens it may become painful all the time.

What's going on inside

Flexor tendinopathy or as its most commonly know “golfers elbow” is pain on the inside of the elbow that comes from inflammation and degeneration of some of the tendons on the inside of the elbow. The tendons are part of the muscles that control movements of the wrist, hand and fingers. Flexor tendinopathy is usually caused by activities that require repetitive use of the muscles that control the wrist, hand and fingers. The problem/pain is felt in the tendons of these muscles, on the inside of the arm. The overuse of these muscles can cause tiny tearing and degeneration or breakdown of the tendon.

How a physio can help

Flexor tendinopathy generally doesn’t get better on its own. It will feel a little bit better with rest but once you start doing the aggravating exercise or activity again it will become painful again. Continuing to do aggravating activities may advance the process and may significantly pro-long the recovery time. The goals of treatment are to identify any predisposing factors, reduce pain and inflammation and promote healing to restore the muscle and tendon. Early treatment may include: - Rest from provocative activities. - Ice or heat (as directed by your physiotherapist). - Physiotherapy electrotherapy modalities. - A gentle stretching and strengthening program. - Massage and soft tissue therapy. - Posture education- posture and position of the wrist and general up-right posture (especially for people who have a sedentary job and who use the computer a lot). - Bracing or taping may be used to unload the muscle and tendon. - Acupuncture and dry needling. Once your pain has settled it is vital that physiotherapy is progressed to ensure complete healing of the area. Treatment may include: - Harder and more specific exercises. Once you have mastered basic muscle contractions your physiotherapist will progress you on to eccentric exercises which will help to restore the integrity of the tendon. - Correction of any predisposing or unusual biomechanics. Other things that may be used if the condition doesn’t settle are: - Corticosteroid injection. - Nitric Oxide therapy. - Surgery. Your physiotherapist will guide you through your rehabilitation and refer you on to the appropriate specialist if the condition does not improve. When can you return to sport or activity? It is important that you return to sport or aggravating activities slowly. Depending on the severity of the initial condition and the length of rehabilitation, a graduated return may take 3 weeks or 3 months, your physiotherapist will guide you through this. [post_title] => Flexor Tendinopathy (golfers elbow) [post_excerpt] => [post_status] => publish [comment_status] => closed [ping_status] => open [post_password] => [post_name] => flexor-tendinopathy-golfers-elbow [to_ping] => [pinged] => [post_modified] => 2016-12-12 22:32:05 [post_modified_gmt] => 2016-12-12 11:32:05 [post_content_filtered] => [post_parent] => 0 [guid] => http://www.sportscarephysio.com.au/?p=7230 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) )

Specialist Staff

Carpal Tunnel Syndrome

Have wrist pain without an 'injury'? Read more about carpal tunnel here.

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Have wrist pain without an 'injury'? Read more about carpal tunnel here.

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What you might be feeling

Classically CTS presents as pins and needles, numbness, burning or pain in the thumb, index finger, middle finger and half of the ring finger. The symptoms can be associated with swelling, difficulties distinguishing between hot and cold temperatures and reduced coordination of the hand. Commonly, people affected by this condition wake at night with symptoms and have to shake their hand to obtain relief.

What's going on inside

The carpal tunnel is a canal formed by ligaments and the small bones of the wrist on the palm side of your hand. Several tendons, blood vessels and a nerve pass through the carpal tunnel as they travel from the forearm to the hand. The nerve that passes through this narrow tunnel is called the Median nerve. If the median nerve is being compressed, it may result in carpal tunnel syndrome CTS is thought to occur as a result of increased pressure in the carpal tunnel. In some instances, there is an obvious reason for the increase in pressure such as: - A fracture of the small bones in the hand or the bones of the forearm. - Swelling of the tendons that pass through the carpal tunnel. Other causes can be related to occupational practices such as: - Exposure to vibration. - Maintaining the wrist in a bent position for prolonged periods e.g. sewing, painting, writing and computer work. Other contributing factors/causes are: - Pregnancy -  Age -  Diabetes -  Rheumatoid arthritis

How a physio can help

Determining the cause and contributing factors is important in the management of CTS. Reducing inflammation associated with a fracture or an injured tendon will help reduce pressure in the carpal tunnel. If symptoms are related to vibration then modifying work practices to avoid prolonged exposure is important. Similarly avoiding prolonged positioning of the wrist in a flexed or extended position is important. Splints, different equipment, different grips may all be useful to change and support the wrist mechanics. Wear a splint: A specific carpal tunnel splint that helps to keep the wrist in a neutral position helps minimise the pressure in the carpal tunnel. Initially, the splint may need to be worn for long periods to allow symptoms to settle. As symptoms settle the splint is worn for shorter periods. Rest: Rest from aggravating activities is important, it helps settle inflammation and alleviates symptoms. Exercise Program: Your physiotherapist will give you stretches and exercises that help to mobilise the median nerve, help strengthen the muscles around the wrist and stretches to stretch the structures around the wrist to help settle and alleviate symptoms and to prevent recurrences. Surgery? In cases that are left untreated, serious cases, or cases that don’t respond to treatment, surgery is sometimes needed. Surgery involves the decompression of the nerve. Most people do well after such surgery. [post_title] => Carpal Tunnel Syndrome (CTS) [post_excerpt] => [post_status] => publish [comment_status] => closed [ping_status] => open [post_password] => [post_name] => carpal-tunnel-syndrome-cts [to_ping] => [pinged] => [post_modified] => 2019-11-14 09:25:04 [post_modified_gmt] => 2019-11-13 22:25:04 [post_content_filtered] => [post_parent] => 0 [guid] => http://www.sportscarephysio.com.au/?p=7227 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) )

Distal Radius Fracture

A distal radius fracture is a common bone fracture.

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A distal radius fracture is a common bone fracture.

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Specialist Staff

Hands and Arthritis

Any joint in your fingers, thumbs, knuckles and wrists can be affected by arthritis.

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Any joint in your fingers, thumbs, knuckles and wrists can be affected by arthritis.

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[injury_page] => )

Hand Infections

Hands and the structures within are especially prone to infections.

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    [name] => Hand Infections
    [location] => hand
    [excerpt] => 

Hands and the structures within are especially prone to infections.

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[injury_page] => )

Nail Bed Injuries

Result of direct trauma to the fingertips.

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    [name] => Nail Bed Injuries
    [location] => hand
    [excerpt] => 

Result of direct trauma to the fingertips.

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[injury_page] => )

Digital Ligament Injuries

Digital (finger) ligament injuries involve damage to the collateral ligaments that stabilise the finger joints along the sides.

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    [name] => Digital Ligament Injuries
    [location] => hand
    [excerpt] => 

Digital (finger) ligament injuries involve damage to the collateral ligaments that stabilise the finger joints along the sides.

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[injury_page] => )

Dupuytren’s Disease

Dupuytren’s Disease (or Dupuytren’s Contracture) causes a contracture of the hand that typically progresses slowly, over several years.

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Dupuytren’s Disease (or Dupuytren’s Contracture) causes a contracture of the hand that typically progresses slowly, over several years.

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[injury_page] => )

Specialist Staff

Lower Back Pain

There are many causes of lower back pain in the human body. Here you can find out about some of the more common injuries and what can be done to help.

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There are many causes of lower back pain in the human body. Here you can find out about some of the more common injuries and what can be done to help.

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What is good posture?

Postural alignment is the composite of the positions of all the joints and limbs of the body at any given moment. Optimal postural alignment is a prerequisite for optimal movement function. It allows postural stability – the ability to maintain the position of the body, and specifically the centre of body mass within specific boundaries of space. What is Optimal Posture alignment?
  • Places minimum stress and strain on the supporting structures of the body while maximizing body efficiency.
  • Is a state of muscular and skeletal balance which protects the body against injury or progressive deformity
  • Is one that allows optimal movement
An Optimal Standing Posture may look like:
  • Tongue on the roof of the mouth, neutral bite, no clenched teeth
  • Plumb line from earlobe bisects neck and drops just behind collar bone
  • Slight convex curve of the neck with no tilt & rotation to one side, chin poke or retraction
  • No Shoulder blade drooping, elevation, movement forward or winging
  • Level collar bones
  • Slight concave curve of the middle back, no big ‘hunch’
  • Slight convex curve of the lower back, no big hollow
  • Minimal muscular effort
  • Even heights of the pelvic crests
  • No big forward or backward tilt of the pelvis
  • Plumb line slightly behind hip joint and in front of the knee joint
  • Front of the hips relaxed
  • Knees slightly bent, not hyper extended
  • Even weight on both feet with weight going down through the arches
  • Relaxed toes, well maintained arches and feet slightly turned
The Causes of Postural Alteration Postural alignment is the end result of the way the body has been used over a prolonged period of time. Abnormal muscle tension and alignment stress alter the compressive loads through bone, discs, ligaments and joints. Serious causes
  • Injury, intense pain, fracture
General Causes
  • Poor Eye sight – use of bifocals
  • Compensation for an injury
  • Muscular imbalance – weakness and tightness
  • Boney deformity – leg length difference
Emotional and physical tension Emotional and physical tension can often manifest as muscles being held tightly, teeth clenching, raised shoulders General Health
  • Obesity
  • Pregnancy
  • Post surgical, de-conditioning
Work
  • Prolonged periods of sitting in front of a computer, in a car and standing
Sleeping
  • Poor support from a pillow and/or bed
Recreational Activities
  • Do you do a lot of a particular sport e.g. sailing, chess
“A body is said to be in a position of equilibrium when there is a balanced distribution of weight and a stable position at each joint. Here the body can suspend ‘easily and freely’- with the best alignment and muscle calibration – therefore minimal effort” (Tobias). What Typical Poor Postures may look like Using “classical” postural types as indicators of postural alignment faults can help illustrate the stresses that are applied to the body as a result of changes in muscle strength and length. The following pictures describe the different “classical” static postural positions or types.

How a physio can help

  • Awareness of poor postural habits
  • Inhibit poor postural habits
  • Develop conscious control to replace old habits
  • Ensure integration into daily activities and movements
A Physiotherapy Assessment of Postural Alignment may include:
  • Static Plumb line alignment in sitting and standing
  • Muscle length and strength
  • Joint stiffness
  • Posture in recreational and work situations eg. on a bike or at a desk
A Physiotherapist may Facilitate Optimal Alignment with:
  • Verbal Instruction & Education
  • Optimal postures in lying, sitting, standing, work situations
  • Tactile Input and Handling
  • Correction and Connection
  • The Position of the head and neck influences the control of posture. By focusing ahead instead of down, will give the body an extra lift
  • Ergonomic Assessment & Correction: Advice on the best office furniture and set up, bed and pillow for you
  • Advice about when and how to change postures during your day
  • An individual exercise program that addresses your weak and tight muscles that support your trunk, and exercises to mobilize stiff joints.
  • Visualization & Relaxation Training will help you understand the factors that precipitate poor posture, the response your body has to this stressor, and to then enable you to take action.
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The Importance of Posture

"Sit up straight"... it's a common saying, but why does it matter and what is 'straight' anyway?

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"Sit up straight"... it's a common saying, but why does it matter and what is 'straight' anyway?

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What is good posture?

Postural alignment is the composite of the positions of all the joints and limbs of the body at any given moment. Optimal postural alignment is a prerequisite for optimal movement function. It allows postural stability – the ability to maintain the position of the body, and specifically the centre of body mass within specific boundaries of space. What is Optimal Posture alignment?
  • Places minimum stress and strain on the supporting structures of the body while maximizing body efficiency.
  • Is a state of muscular and skeletal balance which protects the body against injury or progressive deformity
  • Is one that allows optimal movement
An Optimal Standing Posture may look like:
  • Tongue on the roof of the mouth, neutral bite, no clenched teeth
  • Plumb line from earlobe bisects neck and drops just behind collar bone
  • Slight convex curve of the neck with no tilt & rotation to one side, chin poke or retraction
  • No Shoulder blade drooping, elevation, movement forward or winging
  • Level collar bones
  • Slight concave curve of the middle back, no big ‘hunch’
  • Slight convex curve of the lower back, no big hollow
  • Minimal muscular effort
  • Even heights of the pelvic crests
  • No big forward or backward tilt of the pelvis
  • Plumb line slightly behind hip joint and in front of the knee joint
  • Front of the hips relaxed
  • Knees slightly bent, not hyper extended
  • Even weight on both feet with weight going down through the arches
  • Relaxed toes, well maintained arches and feet slightly turned
The Causes of Postural Alteration Postural alignment is the end result of the way the body has been used over a prolonged period of time. Abnormal muscle tension and alignment stress alter the compressive loads through bone, discs, ligaments and joints. Serious causes
  • Injury, intense pain, fracture
General Causes
  • Poor Eye sight – use of bifocals
  • Compensation for an injury
  • Muscular imbalance – weakness and tightness
  • Boney deformity – leg length difference
Emotional and physical tension Emotional and physical tension can often manifest as muscles being held tightly, teeth clenching, raised shoulders General Health
  • Obesity
  • Pregnancy
  • Post surgical, de-conditioning
Work
  • Prolonged periods of sitting in front of a computer, in a car and standing
Sleeping
  • Poor support from a pillow and/or bed
Recreational Activities
  • Do you do a lot of a particular sport e.g. sailing, chess
“A body is said to be in a position of equilibrium when there is a balanced distribution of weight and a stable position at each joint. Here the body can suspend ‘easily and freely’- with the best alignment and muscle calibration – therefore minimal effort” (Tobias). What Typical Poor Postures may look like Using “classical” postural types as indicators of postural alignment faults can help illustrate the stresses that are applied to the body as a result of changes in muscle strength and length. The following pictures describe the different “classical” static postural positions or types.

How a physio can help

  • Awareness of poor postural habits
  • Inhibit poor postural habits
  • Develop conscious control to replace old habits
  • Ensure integration into daily activities and movements
A Physiotherapy Assessment of Postural Alignment may include:
  • Static Plumb line alignment in sitting and standing
  • Muscle length and strength
  • Joint stiffness
  • Posture in recreational and work situations eg. on a bike or at a desk
A Physiotherapist may Facilitate Optimal Alignment with:
  • Verbal Instruction & Education
  • Optimal postures in lying, sitting, standing, work situations
  • Tactile Input and Handling
  • Correction and Connection
  • The Position of the head and neck influences the control of posture. By focusing ahead instead of down, will give the body an extra lift
  • Ergonomic Assessment & Correction: Advice on the best office furniture and set up, bed and pillow for you
  • Advice about when and how to change postures during your day
  • An individual exercise program that addresses your weak and tight muscles that support your trunk, and exercises to mobilize stiff joints.
  • Visualization & Relaxation Training will help you understand the factors that precipitate poor posture, the response your body has to this stressor, and to then enable you to take action.
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Specialist Staff

Adductor Muscle Strains

Playing sport and felt a pain in the groin?

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Playing sport and felt a pain in the groin?

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What you might be feeling

You will have pain or tenderness either along the inner side of your thigh or in the groin area. You will have pain when you bring your legs together, and you may also have pain when lifting your knee. It may be painful to walk or run and there may be bruising in the groin area.
  • Pain in the groin area is not always associated with a strain of the adductor muscles.
  • Other sources of pain in the groin area include lumbar spine, sacroiliac joint, hip joint and nerve pathology.
  • It is important that any pain in the groin area is thoroughly investigated to establish the cause.

What's really going on inside

A groin injury is a layman’s term for a muscle strain of the adductor muscles. A strain is a stretch or tear of a muscle or tendon. The muscles in your groin help bring your legs together. There are two muscles that may commonly get injured in a groin strain: the adductor magnus (the muscle running down the inner side of the thigh), and the sartorius (a thinner muscle that starts on the outside of your hip, crosses your thigh, and attaches near the inside of the knee). What are the adductor Muscles? They are a group of muscles located on the inside of the thigh. These muscles are commonly injured in sports that involve sudden changes in direction (i.e. soccer and rugby). As with all muscle injuries the adductor muscle injuries can be classified as a Grade 1, a Grade 2 or a Grade 3 injury. Grade 1 adductor muscle strain involves damage to a small number of fibres, causing localised pain but no loss of strength. Grade 2 injury is a tear of a significant number of muscle fibres causing pain, swelling, and loss of movement and strength. Grade 3 injury is a complete rupture of the muscles.

How a physio can help

In the first 48 to 72 hours following a muscle injury it is important to follow the first aid principles of Rest, Ice, Compression and Elevation (R.I.C.E.). Following these principles is crucial to limiting the bleeding and swelling associated with muscle injuries. Physiotherapy management following an adductor muscle strain aims to promote tissue healing, restore movement, maintain or improve pelvic stability, restore muscle balance, prevent further injury, and aid in the return to sport. Electrotherapy is used to promote tissue healing and help with pain relief. Massage is used to promote effective scar formation and reduce muscles spasm associated with pain. Exercises to stretch and strengthen the adductor muscles are an important element of rehabilitation. Without sufficient strength and flexibility the muscles will be prone to re-injury.
  • The adductor muscles tend to overwork in the presence of poor pelvic stability. As a result your physiotherapist may prescribe pelvic stability exercises to reduce the stresses placed of the adductor muscles.
  • Your physiotherapist will advise you on exercises that you can perform to maintain your cardiovascular fitness while you are injured.
Bracing – Groin straps are an effective way of altering the stresses through the adductor muscles to reduce the risk of recurrent injury. Return to sport The goal of rehabilitation is to return you to your sport or activity as soon as is safely possible. If you return too soon you may worsen your injury, which could lead to permanent damage. Everyone recovers from injury at a different rate. Return to your activity will be determined by how soon your groin area recovers, not by how many days or weeks it has been since your injury occurred. In general, the longer that you have symptoms before you start treatment, the longer it will take you to get better. A staged return to sports and sports specific drills are effective ways of gradually increasing the stresses placed on the adductor muscles. [post_title] => Adductor Strains [post_excerpt] => [post_status] => publish [comment_status] => closed [ping_status] => open [post_password] => [post_name] => adductor-strains [to_ping] => [pinged] => [post_modified] => 2016-12-12 10:00:54 [post_modified_gmt] => 2016-12-11 23:00:54 [post_content_filtered] => [post_parent] => 0 [guid] => http://www.sportscarephysio.com.au/?p=7215 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) )

Specialist Staff

Specialist Staff

Muscle Contusions

Bumped hard at sport and now having difficulty moving?
You could have a muscle contusion.

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Bumped hard at sport and now having difficulty moving?
You could have a muscle contusion.

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What you may be feeling

Although there is potential for the muscle fibres to tear from the impact, contusions do not generally result in structural damage to the muscle tissue. This is generally why sporting participants can continue playing even after suffering a high-grade contusion. The injury commonly results in a diffuse, dull pain, with associated bruising, swelling and is sore to touch. Additionally, contusions affect the muscle function in both strength and flexibility. Range of motion of the affected area is therefore often restricted, such as a contusion to the front of the thigh resulting in reduced ability to bend the knee. Pain occurs in the muscle the harder it has to contract and harder it has to work. Pain can also me the case when the muscle is stretched. This is generally more noticeable after cessation of physical activity once the body has “cooled down” such as after a game or the next morning. Injury to the lower limb can also result in pain in weight bearing activities such as walking and running.

What’s Really Going On Inside?

Muscle contusions (otherwise known as a “cork”) are defined as an acute direct muscle injury caused by blunt trauma to the tissue with associated hematoma. Hematoma is the accumulation of blood due to the damaged integrity of the surrounding blood vessels, which in turn can cause the bruising one may see after the injury has occurred.  The hematoma can be localised or wide-spread throughout the muscle, the latter of which presenting with diffuse bruising.  Wide-spread bleeding/bruising is commonly due to tearing of the sheath surrounding the muscle bundle, which allows for the blood to spread throughout the muscle belly. Localised bruising is due to the muscle sheath remaining intact, however these forms of contusions can take longer to get better. Contusions are most commonly a result from a direct blow and common in the sporting community such as a from an opponent’s knee colliding into a thigh in a contact sport, or a player connecting with a ball or stick.  The severity can vary and injuries are generally graded as mild, moderate or severe depending on the amount of contact force and how contracted the muscle is at the point of impact.  The most common location for this to occur is in the quadriceps, the muscles on the front/side of the thigh.

Acute Management Advice

Management can be split into 3 phases. The acute phase (24-72 hours), the resolution phase and the sport-specific or functional phase. The Acute Phase The acute phase for management of a muscle contusion is basic acute injury management. This comprises of the first 24-72 hours and applying the “PRICE” Protocol, which stands for Protect, Rest, Ice, Compression, Elevation. Protect: The purpose of this first step is to protect the injured tissue from further damage. This may not be as crucial as compared with other injuries, however if severe enough, you may need crutches if having difficulty with walking (e.g. painful limp). Certain taping techniques may also feel supportive. Rest: A period of relative” rest is essential. This does not mean keeping the affected area immobilised for the next 2 days. Once able, it is important to get the limb moving, however this does not mean exerting under force. This may mean simply mean moving the limb from a rested position e.g. bending and straightening your knee after a contusion to the thigh. Weight-bearing should commence as tolerated but only do as much as what feels comfortable and do not push through the pain. Ice: The purpose of ice is to reduce pain and prevent secondary tissue damage. Ice can be applied with the purpose of helping to reduce blood flow, pain, muscle spasm and muscle inhibition. To get significant pain relief, it is important to reduce the body temperature enough to slow down the messages being sent between the injured tissue and the pain centres in the brain, which produce a pain response. Applying crushed ice will be most effective in reducing local tissue temperature than frozen vegetables or gel packs, however all can be helpful so use what is accessible to you at the time. Keep the ice on for 10-20 times and apply 2-3 times throughout the day. Aim to apply the ice with the muscle on pain-free stretch to further help limit blood flow. As temperature drops, the speed of these signals slows and with less signals, the can be less pain.  Cease icing immediately if there are any signs of adverse effects such as increased pain, swelling or skin irritation. Be wary of ice burns! Compression: Applying a compression bandage, tubigrip or even at least somewhere compression garments such as “skins” can helped reduce swelling, pain and aid circulation.  The area should feel compressed but not uncomfortable or painful. Glad-wrap can be an adequate temporary substitute. This can be worn throughout the day and if uncomfortable, removed at night for when sleeping as swelling can be better controlled when lying down. Elevation: The purpose of elevation is to reduce swelling and aid circulation. Try to elevate the injured area for 10-20 minutes at a time.

How A Physio Can Help

As you progress from the phase of acute injury management, you will enter the resolution stage where you want to promote movement and begin to improve muscle function. Initially, the area may be stiff, inflexible and painful. This is where heat packs and/or hot showers can come in handy as the can temporarily improve muscle extensibility and increase pain-free range of motion to facilitate movement. Applying a heat pack for 5-10 minutes of having a hot shower before commencing range of motion and muscle strengthening exercises can be helpful for this. Movement will help promote circulation, clear cellular debris in the area and prevent uneven distribution of scar tissue build up. It will also help facilitate muscle tissue remodelling and increase range of motion. This can be achieved by active range of motion where the muscles are simply engaged to provide movement. Static muscle contractions can also be commenced to begin building the strength of the injured muscle. The physiotherapist can provide you with the right exercises to start work on your strength and range of motion. Additionally, they can provide the right soft tissue therapy and taping techniques to further facilitate your rehabilitation. Ongoing rehabilitation will see you progress into the Sports-Specific/Functional-Specific Phase where you want to begin progressive resistance exercise to build the strength of the injured muscle and eventually move into more functional and sport specific exercise and drills.  This includes progressing from static muscle contractions to dynamic exercises, which the physio can instruct on. Additional stretching may be integrated into your rehab progress to improve your flexibility quicker. Progression into this phase will depend on a variety of factors including the severity of the contusion and the quality of the management in the lead up to this point. Muscles have good blood delivery and therefore receive good nutrients, which facilitate timely and reliable healing. Contusions generally take 2-3 weeks depending on the graded severity of the injury. Approximately: Mild – 13 days, Moderate – 19 days, Severe – 21 days. Contusions can also lead to complications such as active bleeding, acute compartment syndrome or large hematomas (Big bruises).  A relatively common complication which occurs in roughly 10% of cases within the sporting population is a condition called “Myositis Ossificans”. This occurs with recurrent contusions or excessive prolonged bleeding, which causes the tissue to calcify and harden. This can lead to significant tenderness, hardening on palpation and significant range of motion loss. This needs to be management with sufficient rest and gentle rehabilitation.       [post_title] => Muscle Contusions [post_excerpt] => [post_status] => publish [comment_status] => closed [ping_status] => open [post_password] => [post_name] => muscle-contusions [to_ping] => [pinged] => [post_modified] => 2016-12-11 21:50:25 [post_modified_gmt] => 2016-12-11 10:50:25 [post_content_filtered] => [post_parent] => 0 [guid] => http://www.sportscarephysio.com.au/?p=7188 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) )

Specialist Staff

Calf Tear

Sudden onset of calf pain when exercising? Here's a few things worth knowing.

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Sudden onset of calf pain when exercising? Here's a few things worth knowing.

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Calf Strain

What’s really going on inside

A calf strain is an injury characterised by tearing of one or more of the calf muscles and typically causes pain in the back of the lower leg. Anatomy The calf comprises of 2 major muscles one of which originates from above the knee joint (gastrocnemius) the other from below the knee joint (soleus).  Both insert into the heel bone via the Achilles tendon.  The muscle’s main roles are plantar flexion (pointing your toes) and to assist in bending the knee. Calf strains range from grade 1 to grade 3, majority are grade 2 Grade 1 (mild) – a small number of muscle fibres are torn resulting in some pain, but allowing full function Grade 2 (moderate) – a significant number of muscle fibres are torn with moderate loss of function Grade 3 (severe)– all muscle fibres are ruptured resulting in major loss of function Risk Calf strains commonly occur due to a sudden contraction of the calf muscle. This frequently occurs when a patient attempts to accelerate from a stationary position, when jumping or when lunging forward. Calf strains are also commonly seen in running sports such as football and athletics. Occasionally they occur due to gradual wear and tear associated with overuse. This may be due to activities such as repetitive jumping, distance running or walking excessively (especially up hills or on uneven surfaces).  The most common place to incur this injury is at the muscular tendinous junction (MTJ) of the Gastrocnemius; roughly halfway between the knee and the heel.  

What you might be feeling

  A sudden sharp pain or pulling sensation in the calf muscle can be felt at the time of injury. In minor strains, pain may be minimal allowing for continued activity. In more severe cases, patients may experience severe pain, muscle spasm, weakness, and the inability to continue activity.  A severe calf strain may result in the inability to walk without a limp or weight bear correctly on the affected leg.  Swelling, tenderness and bruising may also be present. In cases of a grade 3 tear a visible deformity in the muscle may be evident. Prevention
  • Keeping calf muscles strong so they can absorb the energy of sudden physical stress
  • Dynamic stretching of calf muscles before physical activity, i.e. calf rises.
  • Practicing proper technique for exercise and sporting activities
  • Undertaking fitness programs to develop strength, balance, coordination and flexibility
  • Gradually increasing the intensity and duration of training
  • Allowing adequate recovery time between workouts and or training sessions.
  • Wearing correctly fitted footwear.
  • Always checking the sporting environment for hazards.
  • Drinking plenty of water before, during and after physical activity
  Acute Management Advice The immediate treatment of any soft tissue injury is the RICER protocol – rest, ice, compression, elevation and referral to a medical professional. RICE should be followed for the initial 48–72 hours post injury. The aim is to reduce the bleeding and damage to the muscle tissue. The leg should be rested in an elevated position with an ice pack applied for 20 minutes every two hours (never apply ice directly to the skin to avoid ice burn). A correctly sized compression bandage can also be applied to help limit bleeding and swelling in the injured area. The No HARM protocol should also be applied which includes no heat, alcohol, running or activity, and no massage. This will help ensure decreased bleeding and swelling in the injured area.

How a physio can help

As pain decreases, gentle exercise and stretching can usually begin in addition to treatment recommended by a medical professional. Rehabilitation should be conducted under the supervision of a professional due to the risk of injury recurrence. Recovery can often be a slow process. [post_title] => Calf Strain [post_excerpt] => [post_status] => publish [comment_status] => closed [ping_status] => open [post_password] => [post_name] => calf-strain [to_ping] => [pinged] => [post_modified] => 2016-11-29 11:23:24 [post_modified_gmt] => 2016-11-29 00:23:24 [post_content_filtered] => [post_parent] => 0 [guid] => http://www.sportscarephysio.com.au/?p=7167 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) )

Fractures

Learn about breaks in bones and how physio can help.

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Learn about breaks in bones and how physio can help.

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Fractures:

  Fractures are broken bones. The severity of a fracture usually depends on the force required to break the bone: the larger the force, the worse the fracture.   Fractures may be caused by a traumatic incident, repetitive stress, or pathological.   Falls, motor vehicle accidents, or tackles during a rugby match are traumatic events that can all result in fractures.   A stress fracture usually occurs when muscles become fatigued and are unable to absorb shock. Eventually, the fatigued muscle transfers the excess stress to the bone, causing a tiny fracture called a stress fracture.   Some medical conditions, such as osteoporosis, cause our bones to weaken and increase your risk of fracture. An osteoporotic fracture is an example of a pathological fracture.  

Fracture Classification:

 
  • Open Vs Closed: An open fracture is a type of fracture that pierces the skin. Alternatively, if the overlying skin remains intact, the fracture is classified as a closed fracture.
 
  • Stable Vs Unstable: If the fractured bones are aligned the fracture is usually classified as “stable”. Most open fractures and unstable fractures require surgery to re-align the displaced bones.
 
  • Complete Vs Incomplete: A complete fracture involves the whole width of the bone, whereas an incomplete fracture does not cross the whole width of the bone.
 
  • Type: Bones can break by being twisted (spiral fracture), bent (transverse fracture), compressed, pulled (avulsion fracture), or a combination of the above.
   

Physiotherapy Management of Fractures

  Physiotherapists are involved in fracture detection, management decisions, and rehabilitation. Upon detection, your physiotherapist may refer you for imaging (x-rays, MRI, CT scans), or to an orthopaedic surgeon to better guide management.   If you have sustained a fracture, it is critical you contact a physiotherapist early to optimise healing and facilitate return to normal function.   Physiotherapy can assist your fracture healing by:  
  • Muscle Assessment: Following injury, muscles surrounding the fracture site weaken. It is critical that a safe exercise program is prescribed and progressed under the supervision of a physiotherapist to restore strength and prevent secondary complications.
 
  • Joint Mobilisation: Joint stiffness often occurs when a limb is not allowed to move for several weeks. Physiotherapists are trained in techniques that can improve and restore range of movement of the affected joints once the fracture has healed.
 
  • Heat and Electrotherapy: It is very common for stiffness within soft tissues to occur following immobilisation. Heat and Electrotherapy have been shown as useful adjuncts to manual treatment and exercise therapy in relieving pain and restoring muscle length.
 
  • Gait Education: If your fracture requires the use of gait aids, such as crutches, your physiotherapist can prescribe you with the most appropriate equipment and way of walking that promotes optimal healing and safety.
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Achilles Tendinopathy

Soreness at the back of the ankle when running? It could be Achilles tendinopathy

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Soreness at the back of the ankle when running? It could be Achilles tendinopathy

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What you might be feeling

Patients typically report a gradual onset of pain and stiffness localised to the back of the heel where the calf muscles attach to the bone. This pain and stiffness is worse in the morning and at the start of exercise, and may disappear as you warm up. Patients may also notice the area is swollen and tender to touch. The pain ranges from a minor inconvenience, to very severe pain, even with walking.

What's really going on inside

Achilles tendinopathy describes an overuse condition in the Achilles region. In the early stages, minor cell changes occur including increased cell number and size. The later stages are characterised by cell disruption and disorganisation, and increased blood vessels and nerves in the tendon. The changes that are present in early stages are reversible, however once the injury progresses permanent changes may be present. Acute management advice:
  • Rest from aggravating activities
  • Ice or heat (as directed by your physiotherapist)
  • Physiotherapy electrotherapy modalities to manage pain and swelling
  • A targeted stretching and strengthening program
  • Massage
  • Acupuncture and dry needling
  • Bracing or taping to unload the muscle and tendon
Other things that may be used if the condition does not settle are:
  • Corticosteroid injection
  • Nitric oxide therapy
  • Surgery
  • Blood injection

How a physio can help?

Achilles tendinopathy generally does not get better on its own. It will feel a little bit better with rest, but once you start doing the aggravating exercise or activity again it will become painful. Continuing to do aggravating activities may advance the process and prolong recovery time. The goals of physiotherapy treatment are to address any predisposing factors, reduce pain and inflammation, and promote healing to restore the muscle and tendon. Your physiotherapist will provide you with a targeted tendon strengthening program to make it stronger and more accustomed to load. This starts with gentle sustained contractions, and progresses to heavy fast contractions. Furthermore, your physiotherapist will address the factors that caused this injury in the first place, to help reduce the risk of the injury returning in the future. Some things your physiotherapist might address include:
  • Abnormal lower limb mechanics (foot, knee and hip)
  • Calf weakness
  • Poor muscle flexibility
  • Stiff ankle joints
  • Training errors, including inappropriate training load and inadequate recovery time between training sessions
  • Poor footwear, footwear wearing out
Finally, they will provide you with advice regarding when and how you can return to sport and/or activity. It is important to follow this advice to prevent recurrence, or worsening, of the tendon injury. The rehabilitation can be frustratingly slow but persevere, it will get better!   [post_title] => Achilles Tendinopathy [post_excerpt] => [post_status] => publish [comment_status] => closed [ping_status] => open [post_password] => [post_name] => achilles-tendinopathy [to_ping] => [pinged] => [post_modified] => 2016-12-12 09:03:25 [post_modified_gmt] => 2016-12-11 22:03:25 [post_content_filtered] => [post_parent] => 0 [guid] => http://www.sportscarephysio.com.au/?p=7202 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) )

Specialist Staff

Ankle Sprain

Rolled your ankle? Sore and swollen? Here's some helpful information that's worth reading.

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Rolled your ankle? Sore and swollen? Here's some helpful information that's worth reading.

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What you might be feeling

An ankle sprain is a common injury that can happen during sport or day to day living. It is caused by a rapid stretch of the ligaments around the ankle joint and this can result in a tear or rupture.  This can happen with an awkward land from a jump, a direct force to the ankle or even walking on uneven ground. At the time of injury it is common to hear a “pop” and experience immediate pain. Along with this you may also notice immediate swelling and some bruising may appear. The ankle will be tender to touch and it may feel warm due to the swelling around the area. Depending on the severity of the injury you may find it difficult to weight bear on the injured side and may not be able to walk at all due to pain. If you can walk it is likely you will be walking with a limp in order to keep off the sore area. It is also likely that your ankle will feel unstable during movement.  

What's really going on inside

There are many different types of tissue in the body, such as bone and muscle. Ligaments, similar to muscle, are considered as soft tissue. When soft tissue is damaged an inflammatory response is triggered. With this, lots of blood rushes to the area causing it to swell.  This swelling process is the beginning of soft tissue repair. There may be some bleeding from the damaged tissue and this is what causes the bruising to occur. You might find the bruising extends down to your heel and this wear the blood can pool due to gravity. This will settle over time and with appropriate management. Acute management of an ankle sprain After injury the first 72hrs are crucial. What you do to manage your injury during this time could mean the difference between a quick or slow recovery. To promote a good recovery these are some things that you can do:  
  • Discontinue play immediately if you are playing sport
  • Rest, Ice, Compression, Elevation
  • No Heat, Alcohol, Exercise or Massage
  • Avoid anti-inflammatories during this period, paracetamol is a good alternative for pain relief
  • Make an appointment with your physio to begin your rehab sooner rather than later

How a physio can help

It is important to remember that after an ankle sprain your risk of re-injury is quite high, especially if it goes untreated. Physiotherapy and rehabilitation have been shown to significantly reduce this risk. Your physiotherapist can help you return to normal function by doing a few things:
  • Strength and conditioning program to strengthen muscles around the joint
  • Balance and proprioception training to help improve overall function of the joint
  • Graded and safe return to sport/work to minimize your time out of action and prevent re-injury.
  • Taping and bracing techniques for ongoing management when returning to sport/work
Once you have completed your rehab, and you are cleared to return to activity, you should feel confident in your ability to move again and do what you love.     [post_title] => Ankle Sprains [post_excerpt] => [post_status] => publish [comment_status] => closed [ping_status] => open [post_password] => [post_name] => ankle-sprains [to_ping] => [pinged] => [post_modified] => 2016-12-12 18:01:54 [post_modified_gmt] => 2016-12-12 07:01:54 [post_content_filtered] => [post_parent] => 0 [guid] => http://www.sportscarephysio.com.au/?p=7221 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) )

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