Category Archives: Conditions, Injuries & Advice

Anterior knee pain or Patellofemoral pain syndrome (PFPS) is characterised by knee pain behind the patella or kneecap.  It is of non-traumatic cause but may occur after an injury and can affect people’s daily lives quite significantly.  Some common complaints include pain going up and more likely down stairs, pain when sitting with a bent knee too long (such as in the car or movies) and pain with increased exercise especially running activities.  It can affect both men and women although is most common in young women.  It can be related to activities such as running due to a lack of pelvic stability and knee control and is made worse by overtraining. With PFPS there is normally a maltracking patella and there may be an increased patella height. There is normally a muscle imbalance with a weakness in the inside quadricep muscle called the VMO and poor pelvic stability and knee control with single leg squat.  VMO weakness can occur due to disuse such as after injury, pain inhibition and a poor patella position due to a lateral pull with tightness in the outside retinacular and ligamentous structures.  There is normally a weakness in the deep pelvic stabilisers which causes overactivity in the outer muscle group around the hip and pelvis.  This will lead to a tightness in the band on the outside of the leg (ITB) which has attachments to the patella and can pull the patella laterally or cause a lateral tilt, both affecting the alignment.  This population of people may also show some overpronation or increased rolling of the foot which will further disrupt the tracking of the patella.  An orthotic may be required to correct this biomechanical dysfunction. In physiotherapy it is important to address all of the underlying causative factors.  This requires a biomechanical assessment to look at patella tracking, muscle imbalance and weakness, foot posture and function, footwear, training regimes and exercise advice.  Without all of these factors assessed and then treated by soft tissue massage, mobilisation, stretches and strengthening work +/- prescription of orthotics it is common to find that the condition of PFPS can reoccur. By Melanie Roberts

For many, surfing is a way of life and if injury strikes the effects can be devastating.  Despite the obvious dangers, surfing has become increasingly more popular over the years. As we all get out there and brave those big waves during the summer months we need to keep in mind the safety aspects to prevent any obvious injuries.  Surfing is physically demanding, repetitious and often hazardous.  Advances in surfboard technology enables more speed and sharper turns pushing people to their limit more than ever before. Lacerations to the head, lower leg and foot are the most common injuries, usually caused by contact with the surfer’s own or another surfer’s board or fins; with the ocean floor, or with beach litter. Soft tissue injuries such as bruises and acute sprains to the back, neck, shoulder, knee and ankle comprise the second largest group of injuries.  Fractures of the skull, nose and ribs are common, while eyes and ears are also vulnerable. Chronic low back pain is another common problem surfer’s face due the constant extension when paddling.  To help avoid this take regular rests from paddling and sit up on your board for a while.  Shoulder pain may also be a problem when paddling, if the shoulder is tight or has muscle imbalance or incoordination of muscles.  A common problem is when the shoulder blade does not coordinate with the upper arm – there may be overactivity in the muscle between the neck and the shoulder (the upper trapezius) which may lead to impingement of the rotator cuff.  It is important to retrain these patterns of movement so that the problem will go away and stay away rather than reoccurring every surf. A surfer’s flexibility is very important to reduce the chance of injuries and to improve performance.  Make sure you warm up before you go for surfing, as most injuries occur when people are cold and have not warmed up, or are fatigued at the end of a big session.  Warming up properly including stretching before jumping in the water will make a difference in performance and injury prevention.  If you feel tired take a break or stop for the day.  That way you can get out there and have a great time the next day without those niggling aches or more severe injuries. If you have any aches and pains or want some warm up or stretching exercises before you get out there amongst those waves, get in touch with your physio to get the correct advice.  Have fun….SURF’S UP! By Melanie Roberts

Is your child’s school bag damaging their spine?  If it’s too heavy or incorrectly carried it might be. Do them a favour and encourage them to use their backpack correctly and take some simple steps to prevent back complaints. Many of us complain of a bad back at some stage in our lives and for some it becomes a debilitating condition. By teaching your kids to take care of their spines from an early age we can help prevent serious damage to their backs. Many children suffer from back and neck pain at some time during their school years.  This can be due to a number of factors, including poor posture, prolonged sitting and the use of computers, and every-day load carrying such as the heavy school bag. Children need to be reminded that a heavy bag, and carrying their bag incorrectly, can result in a back injury which can prevent them from participating in sport and other recreational activities, not least of all, causing them pain from spinal stress and dysfunction. A backpack that has wide straps and allows for even weight distribution across the shoulders and is adjustable to allow for proper fitting and growth is the best choice. Generally, a young person shouldn’t lift anything that is more than ten per cent of their bodyweight.  Remind your kids to lift their backpack safely by bending at the knees and keeping their back straight. Encourage them to develop good posture, sensible lifting and generally take care of their back. Promote physical activity, to strengthen their back but teach them to always be careful and warm up before any strenuous exercise. A back injury can negatively impact your child’s health for years to come so do them a big favour and make sure they have a backpack which fits properly, isn’t too heavy and is carried correctly.  By Melanie Roberts

Hasn’t the warm weather approached us quickly this year?  From baggy jumpers and jeans to the skimpy shorts and bikinis – it’s a scary thought!!  For most of us at this time of year we resolve to get fit and lose those extra kilos that we have put on over the winter months.  Subsequently, as physiotherapists we get an influx of people presenting with overuse injuries. As physiotherapists we encourage people to stay fit and healthy, but in a controlled and progressive manner.  We all have to remember as we jump on those treadmills and hit the pavement with increased motivation to begin slowly and not overdo it, whereby injuries may result.  During fatigue we are at the greatest risk to sustain an injury.  Furthermore, if we have underlying tightness and weakness in muscle groups, which remain undetected, this can be a major contributing factor to overuse injuries; for example, rotator cuff pathology, Achilles tendonitis and hamstring problems to name a few. By Melanie Roberts

For many our New Year’s Resolution was ‘get fit and exercise more’, however, in this day and age with our busy schedules, many of us neglect our health and physical fitness. There are some simple solutions: Vary exercise and modify it as we go.  Build exercise into your daily life; get a friend to commit with you, set goals and get moving!!  Do exercises at home – buy a Swiss ball –get a total body workout in the comfort of your own home.  Use weights such as a bag of rice or can of beans.  Incorporate cardio vascular fitness with strength training and stretching exercises.  As with any exercise program you should seek advice as to the best type of exercise and concentrate on technique to avoid injury. Ask us to advise you on the most appropriate exercises and show you correct technique for maximum benefit.  There are many screening tests that can be done before partaking in exercise to detect predisposition to injuries.  Get the right advice as to the appropriate equipment that should be used to prevent injuries.  It is a common time to see patients who have exercised too much, too quickly – increase gradually.  If you have any niggling aches or pains – don’t neglect them and assume they will go away by themselves – seek help sooner rather than later. By Melanie Roberts

Unfortunately for many of us high self esteem and a good amount of “self-love” comes from our perception of our image.  Despite the fact that self esteem should be related to a lot more than what we have and how we look, many people still cannot separate these things from the more important qualities in life.  The percentage of people in this day and age who have a high self-love is arguably quite low.  These days there is a lot of pressure to look good and have a good body, which for many takes a lot of motivation and hard work.  We worry about our family and their health, yet seem to neglect ourselves.  Here are some simple and fun ways to get active and healthy, which may as an added bonus improve your strength and overall body shape. Fitness and health involve a lot more than just sweating it out – it should be a fun and relaxing time.  Try yoga and meditation to add to your routine, which will not only give you a workout but help you to get in touch with yourself and your body.  Pilates is another form of exercise that is fun and challenging at the same time.  Need something else – why not buy a fitball that you can use at home and get a great all over body workout?  Get a friend to join a gym with you, set goals and a routine that you can manage.  Exercise to music; go to aerobics or buy a walkman to walk in the mornings or during your lunch break.  Continue to encourage yourself with positive “self talk” and don’t give up.  Get involved with a team sport like touch football or netball, it is a great way to meet people, get fit and have fun. We often put things off in order to please others, especially our friends and family, and forget about doing things for ourselves.  We get busy in our work and home lives and forget about the simple things like going for a walk on the beach or having a massage for relaxation.  If we have aches and pains, they are often neglected with the excuse that they will “go away”.  This is often not the case and in fact the opposite may occur, where adaptations and compensations develop to cope with the injury or dysfunction.  An example of this is with shoulder pain, which may be from a simple fall or lifting injury.  If left, compensations occur, as muscles or ligaments may be injured and prevent the muscle from contracting properly, due to pain inhibition.  This in turn means that other muscles must take over and work too hard, and therefore become tight.  The whole shoulder becomes dysfunctional and can then put extra strain on other parts of the body, for example, the neck.  This neck pain may in turn lead to headaches, and so on.  By leaving problems because you do not look after yourself as well as you would look after your loved ones may lead to a lot of long term unnecessary pain.  Think about it…if your child came home from school or footy and said that they hurt themselves, you would have them off to the doctor or physio the next day.  Take more time to love yourself, as you only have one body, so look after it!  By Melanie Roberts

Ankle sprains are one of the most common injuries. An ankle sprain occurs when the ankle is rolled or turned past its normal range of limits. This usually happens when the foot is planted awkwardly, twisted on an uneven surface or an unusually high force is applied to the ankle. Ankle sprains are common in sports such as soccer, netball and touch footy, but can also occur in daily activities such as walking or stepping off a curb. During an ankle sprain, the ligaments holding the bones together are ‘overstretched’ or sprained causing an inflammatory reaction and pain. As a result of the swelling and pain, movement at the ankle joint is restricted, muscles such as the calf become tight, and a limp is often noticeable. Ice should be applied to the area immediately after an ankle has been sprained. Rest from painful movements, elevation of the ankle and a compression bandage will also be helpful for the next 48 hours. If an ankle sprain does not heal properly then the joint may become unstable, stiff and may lead to further injury. After an ankle sprain, your physiotherapist can help reduce pain and swelling, restore full movement, strength and proprioception. Once you sprain your ankle and ligaments are damaged, your proprioception (balance) is affected. Proprioception is your body’s ability to sense where a joint is in space. If you have poor ankle proprioception then your body doesn’t know when your ankle is getting into an overstretched or bad position and then your muscles don’t have the ability to correct your position and prevent re-injury. Poor proprioception is one of the biggest risk factors for re-injuring your ankle. Treatment of an ankle sprain may include soft tissue massage to reduce swelling and tightness within the calf, joint mobilisations to regain full movement at the ankle. Your physio can also provide you with some exercises to strengthen the muscles around your ankle joint as well as some exercises to improve your proprioception. A couple of tips for preventing further re-injury include: Proprioceptive, strength and stretching exercises as shown by your physio Wear shoes with good support Avoid training on uneven surfaces Ensure adequate warm up   By Jessica Norton

“Snapping” or “clicking” hip is a condition often seen in a physiotherapy clinic.  “Snapping” hip is common in dancers, soccer players and any exercise that involves repeated movements of the hip.  “Snapping” hip refers to the snapping sensation experienced during hip movement, usually bending and straightening.  The snapping sensation may be accompanied by an audible noise and is usually painless.  “Snapping” hip can be caused by a couple of structures.  A ‘side’ snap is usually created by a small muscle around the hip called the tensor fascia latae.  When this muscle is tight, it ‘flicks’ over a prominence on your femur bone called the greater trochanter when the hip is moved.  If this occurs repeatedly, it may irritate a fluid-filled sack (called a bursa) near the greater trochanter and bursitis (inflammation of the bursa) may develop.  A ‘front’ snap is usually caused by a deep muscle at the front of the hip called the iliopsoas, which ‘flicks’ across a bony prominence on the pelvis. Both of these snapping sensations are caused by tightness in that muscle.  The least common cause of the ‘snapping’ sensation is injury to the cartilage deep in the hip joint which has caused a loose flap of cartilage to ‘catch’ when the hip is moved in certain positions.  Your physiotherapist will perform an assessment and determine the cause of your “snapping” hip.  Physiotherapy is useful for correcting this tightness with soft tissue massage as well as providing stretches for these muscles.  Your physiotherapist can also assess to see if there any underlying weaknesses in muscles around the hip and pelvis that also contributed to the tightness building up.  If weaknesses are found, your physio can show you some strengthening exercises to prevent snapping hip from recurring. By Jessica Norton

Does your sport involve running?  Then you need to read this to understand the importance of having strong gluteal or buttocks muscles. The three gluteal muscles in the buttocks the gluteus maximus, gluteus medius and gluteus minimus are crucial for strength and power in athletic movement and also key to the stability control of your trunk. The problem is we rather take these muscles for granted. We fail to appreciate the different roles for which we need to condition and balance the musculature. Our failure to do so frequently leads to a wide range of injuries in athletes – including many of the most common ailments: patellofemoral pain, anterior cruciate ligament injuries, iliotibial band syndrome, ankle injuries, iliotibial band friction syndrome and Achilles tendinopathy to name a few.  This weakness can also lead to a loading of the spine due to the lack of pelvic control.  The more load that is applied such as during running activities the more strength and endurance that is required.  Therefore, you need to strengthen the gluteals, especially the inner layer.  This work is very specific and cannot be done with gym exercises alone.  Furthermore, once these deep muscles become weak the outer muscles will take over and they may never correctly turn back on and function the way they are meant to.  These muscle adaptations allow us to continue to function but will cause an overloading of the “prime movers” rather than using the “stabilisers” as intented.  This overloading will lead to tightness and pain. Strength per se is not enough for peak, injury-free athletic performance. What’s often required in strength in specific positions and movements as well as endurance.  The recruitment of the muscle is the important part. So while athletes may have good gluteal strength when performing an exercise such as the squat or leg press, they may be unable to use their inner gluteus to stabilise the hip and  pelvis effectively in an extended position with the pelvis held in neutral. This position – which is referred to as the ‘inner range’ –is crucial for athletes involved in running sports, because the gluteals support the upright position of the trunk, and help maintain the pelvis and lumbar spine in neutral. If an athlete cannot maintain an upright trunk or has a lordotic position (pelvis tilted down at the front) while running, this is in effect the same as flexing the hip.  A lack of inner-range strength in the gluteals can place greater strain on the lower back, or affect the biomechanics of the lower limbs, increasing the risk of injury. As these exercises are so specific it is important to get a biomechanical assessment to see if they are functioning correctly and what exercises may be required. By Melanie Roberts.

Osteoporosis is a systemic skeletal disease characterized by low bone mass and micro-deterioration of bone tissue leading to bone fragility and increased risk of fracture.  It is estimated that there are over 1.5 million fractures per year in this high risk group.  The health care costs associated with fractures in this group of Caucasian women are estimated to be as high ad $45.2 billion over the next ten years. Some of the most common sites for fracture are the wrist, spine and hip with hip fractures being the most devastating.  The loss of independence, prolonged immobility and death due to multi-system failure are some of the complications of hip fractures.  Only one-quarter of hip fracture patients regain full independence. The biggest focus is looking at how to prevent osteoporosis and to decrease the incidence of fractures.  Preventative measures include lifestyle changes, such as altering nutrition and exercise. Bone mass density changes across the lifespan of females with a gradual loss throughout adult years and a steeper decline with menopause. Research suggests that athletes involved in activities requiring high impact loads have higher bone mass than those involved in endurance training. Those activities that involve muscular involvement without gravitational forces, for example, swimming, are associated with lower bone mass density than those with a weight bearing component. The impact of training should be at the bone site of interest since loading has a localized effect.  Overload means that the training stimulus must include forces much greater than that afforded by habitual activity and reversibility indicates that in the absence of the training stimulus, the positive effect will be lost. Studies show that there is improvement in spinal bone mass density in postmenopausal women with a program consisting of vigorous, progressive exercises including walking, jogging, stair climbing and rowing.  Discontinued participation showed reversal in bone mass, confirming that the benefits of training only persist as long as the stimulus is applied. Intervention which includes dynamic resistance training 2 days/week on pneumatic machines demonstrates improvements in muscle strength, muscle mass, bone mass and dynamic balance in oestrogen-deplete postmenopausal women. It takes about 9 – 12 months to detect significant change in bone mass.  The change may be a > 1% increase, since the average rate of loss is 0.5 – 1% per year. The program should include squats, lunges, chair raises and jumping which helps with strengthening the hip abductors and extensors.  It also helps with lateral stability and decreases the risk of falls.  Balance exercises are an important part of the exercise program, as a common reason for the fractures is due to falls.  Physical activity that involves twisting, bending or high impact should be avoided for those already diagnosed with a low bone mass density and sports like golf and tennis apply torsional stresses to weakened bones.  Therefore, patients at risk should be involved in swimming, water aerobics, dancing, low impact aerobics, walking, cycling and light resistance weight training. Get out there and stimulate those bones and have some fun! By Melanie Roberts