fitandflow, Author at Fit and Flow Physiotherapy

5 Common Mistakes People Make When Managing Tendinopathies

Tendinopathy is the clinical term for ‘tendon overload’. Tendons can be overloaded via various mechanisms but most commonly we see tendinopathies as result of a sudden increase in load that exceeds the tendons capacity and results in tendon pain.

Tendons are tricky to manage as they are very responsive to load – either too much or not enough can cause and increase in pain. Exercising into pain can result in an overloaded and painful tendon, and not exercising into pain or discomfort may result in an underloaded and weak tendon. This is what makes tendons so difficult to manage, and why seeing a Physio can help to determine at what stage of tendinopathy you’re at, where to start with loading and how long to wait before returning to activity.

The following are 5 common mistakes we see people make when trying to self manage their tendon pain.

1. Rest

Resting the tendon from the aggravating activity will improve your symptoms in the short term, however rest does not improve the tendon’s capacity to tolerate load. Therefore when you return to that activity, the tendon will have even less tolerance to load and your pain will come back straight away, if not worse than before.
Tendons respond to load. Too much load and the tendon will hurt, not enough load and the tendon will weaken. If you rest for too long from tendon pain, you will have a harder time trying to return to activity.

2. Stretching

Aggravated tendons do not like to be compressed or squashed. Stretching aggravated tendons can place tensile compression on the tendon and expose it to the potential of increased pain. Although it may feel like you need to stretch, often it is better to focus on mobility of the associated muscle through massage, foam rolling or trigger ball.

3. Massage

Following on from above, angry tendons also don’t respond well to compressive forces – which are direct pressure on the tendon.

Massaging, rolling or triggering your tendon will only cause more pain and delay your recovery. All tendons are attached to a muscle eg. the achilles tendon attaches the soleus to the heel bone, and the patella tendon attaches the quads to your tibia. If mobility is an issue then massaging your quads and soleus while avoiding the tendons may assist with pain management and recovery.

4. Not Enough Load

We spoke about rest not doing anything to help the tendon’s load capacity. The same goes with underloading the tendon. The idea with tendon rehab is to produce a tendon that is much stronger than it needs to be to complete daily activities or your sport of choice.

In the early stages of rehab we try to load the tendon enough to facilitate a strengthening stimulus, but not enough to overload and aggravate the tendon. We aim to load the tendon into a little bit of pain (a 3-4/10) and make sure there is no increase in pain for the 24-48 hours to follow.

When pain has decreased and the tendon is tolerating higher loads, you need to be putting it under even heavier loads.

Exercises need to be performed at over 80% intensity to be effective. As an example, for an achilles tendinopathy, you would aim to complete single leg calf raises for 8-10 repetitions at 8/10 intensity – meaning you would finish the set with 2 reps left in the tank.

When running, the achilles tendon absorbs up to 12 times your body weight at each step. If you think about how much load that is in kilograms, it’s clear that low or body weight exercises are not enough to produce a tendon that can tolerate thousands of repetitions of that load.

5. Returning To Sport Too Early

So if you’ve been able to reduce pain with the right amount of rest, and progressively overload the tendon by performing exercises at 80% or your maximum effort, the next step is to load the tendon specific to the type of activity you want to return to.

Tendons act like springs, they absorb and store force, then release it with movement helping to reduce the stress going through the muscles and the bones. Therefore we need to train them in this way to be able to tolerate the high demands of sport.
A plyometric tendon loading program should be completed alongside a strength program to help the tendon adapt to high impact forces. This involves a number hopping, jumping and running drills along with a gradual return to running and change of direction.
Once this has been completed, a gradual return to sport to allow the tendon to adjust to the volume (time and intensity) of sport needs to be considered.

Timeframes for tendon rehab will vary greatly depending on the nature of the overload. Acutely overloaded tendons that have been addressed early may only set you back 4-6 weeks. However more often than not, tendinopathies will be an acute flare up on a chronically overloaded tendon. Meaning that you’ve probably been feeling pain for some time, but not to the point that it has stopped you from playing or participating. In these cases tendons take longer to heal, and the above protocol can take from 3 – 6 months to complete.

There are other techniques Physio’s can use to help manage tendon pain such as isometric exercises to help reduce pain before activity, strapping techniques to help reduce tendon loads, or ways to modify daily tasks to reduce forces going through the aggravated tendon. Most importantly, we aim to keep you as active as possible while recovering from tendinopathy, therefore we will try to find ways you can still train or participate without making your injury worse.
Tendons are difficult to manage as they need just the right amount of load for recovery. Getting a detailed and specific program will help with a quicker recovery and return to sport and reduce the risk of your tendon pain becoming a long term issue.

If you feel you may be suffering from a tendinopathy, come and see us. We may be able to save you weeks of pain and get you back sooner.

Physio for your Jaw Pain

The temporo-mandibular joint (TMJ) refers to the two joints located on either side of your face that connect your jaw to your skull. Pain in this area can stem from muscle tension, joint inflammation, or structural damage to the cartilage and bones of the joint.

Treatment options may include soft tissue release, gentle joint manipulation, or strengthening exercises for the muscles surrounding your neck and face. Occasionally TMJ pain will require imaging and specialist referral for surgery or orthodontic braces to help support the joint.

Symptoms of TMJ pain and dysfunction

TMJ pain can manifest as an ache in the jaw or face and may also lead to headaches. Dysfunction of the TMJ can result in clicking or locking of the jaw, often occurring while eating or chewing, but it can also happen upon waking or at rest.

Stiffness or dysfunction in this joint may limit jaw movement, making it feel as though you can’t fully open your mouth. Additionally, you might experience the sensation that your teeth are misaligned or don’t come together properly when chewing.

Causes of pain

TMJ dysfunction can result from tension in the muscles surrounding the jaw, including those involved in chewing and moving the mouth, as well as neck and shoulder muscles that connect to the base of the skull. The alignment of your head and neck can influence the position of the jaw and the effectiveness of these muscles. Consequently, posture can play a significant role in TMJ-related issues.

Stress

Stress can lead to tension in the muscles around the neck and shoulders, negatively impacting posture and jaw function. Grinding your teeth or clenching your jaw is often a sign of stress, leading to overuse of the jaw muscles and resulting in pain.

Posture

i. Sleeping

Sleeping posture can contribute to jaw dysfunction. For instance, sleeping on your stomach can place your neck and jaw in an unfavorable position, causing stiffness and pain over time.

ii. Sitting

Sitting posture also plays a role; when your head is positioned forward on your neck—common in slumped postures—it can create tension in the muscles under the jaw, leading to discomfort.

ii. Exercising

Additionally, exercise posture can affect jaw health in several ways. Maintaining tension in your jaw or clenching your teeth during workouts can lead to muscle overuse and fatigue, resulting in jaw pain. Poor movement patterns can also increase strain on your shoulders and neck, which can further contribute to tension and discomfort in the jaw.

Structural causes

Damage to the cartilage ring within the joint can lead to clicking and locking. This damage may be degenerative, resulting from years of teeth grinding, poor posture, or genetic factors, or it could stem from an acute injury, such as a blow to the jaw or biting down on something hard.

Arthritis in the TMJ can also result in stiffness, pain, or clicking. While the incidence of arthritis is largely influenced by genetics, poor joint function over time can accelerate the degeneration process.

Physio treatment

Physiotherapists employ various techniques to alleviate TMJ pain. These may include soft tissue massage for the muscles around the neck and jaw, and occasionally the shoulders, if they contribute to jaw tension. Specific jaw releases can be applied if one side is tighter than the other. If motor control issues are contributing to jaw pain, physiotherapists will provide targeted exercises to improve strength and movement in the jaw.

Posture in the head, neck, and shoulders plays a significant role in jaw pain. For instance, rounded shoulders or a slumped posture can increase tension in the muscles that connect to the base of the skull and jaw. Physiotherapists can identify poor postures and prescribe exercises to strengthen the relevant muscles and correct these patterns. They are also skilled in assessing your workspace and recommending modifications to improve your posture. For desk-related jobs, reviewing your desk setup, chair, monitor, and devices can help alleviate posture-related tension. For physically demanding jobs, evaluating your working postures, tools, and movement patterns can ensure your body is positioned favorably to prevent muscle fatigue, tension, and jaw pain.

If sleep posture is identified as a contributing factor to TMJ pain, adjustments to your sleep position, along with the use of specialized pillows or mattresses, may help manage discomfort.

TMJ specialists, dentists, or orthodontists may recommend braces to improve jaw alignment, reducing undue stress on the jaw and alleviating the effects of teeth grinding. In some cases, Botox injections may be suggested to decrease muscle activity around the jaw that contributes to pain, while surgery might be necessary if the cartilage needs to be repaired, removed, or replaced.

Psychologists can assist with stress management, which may help reduce instances of teeth grinding and jaw clenching.

TMJ pain can arise from a variety of causes and therefore require specific assessment and a targeted treatment approach. If you feel you are experiencing TMJ pain, make an appointment with us today.

From Babies and Barbells: Emma’s Postpartum CrossFit Story

Leading up to her pregnancy, Emma enjoyed training Crossfit 4 x week as well as trail running on the weekends.
Emma’s twin girls are now 2 years old, she is back in the gym 3 times a week and training for a half marathon

We spoke to Emma about her Exercise and activity before and during pregnancy and how she approached her postpartum rehab after giving birth.

What were your activity levels in the lead up to pregnancy and what was your activity like during?

I’ve always been very active, I did gymnastics when I was younger and have trained in the gym for the last 15 years. In the lead up to pregnancy I’d been doing Crossfit for about 4 years. I trained 3-4 times a week in the gym and would run trails or with a run club 1-2 times a week. I also saw a PT every few weeks for technique advice and strength with some lifting.

When I found out I was pregnant I was already rehabbing a hip injury and needing to heavily modify crossfit workouts. I decided for this reason to stop crossfit and focus on my PT program in the gym. I know plenty of people who have done crossfit throughout their pregnancies, and there’s no contraindications of doing so while you’re pregnant, but I made the decision to stop so that I could focus on quality movement and training based on how my body felt.

It turns out that I was so sick during my first trimester that I didn’t train much at all anyway. I managed to get out to walk my dog around the block once a day and that was it.

During my second trimester I was able to get to the gym about twice a week. My PT had written me a pregnancy program to follow and I did what I was comfortable with, and what I felt like doing on the day. My training goals during this time were to move my body, so I didn’t place any great pressure on myself to train hard or get my programs done.

During my third trimester my training slowed down again. Carrying twins was taking its toll, and I needed to rest a lot during the day. Walking was causing pelvic pain, I tried some pregnancy yoga classes online but these did not feel comfortable though my pelvis or ribs and I was needing to modify so much in the gym that I felt it was no longer worth the energy of going. I felt during this time that swimming was the only type of exercise I could manage, and I really enjoyed this. I could get my heart rate up without fatiguing myself too much or causing pain, and I felt like the buoyancy of the water taking pressure off my joints felt really good. So I swam about once a week towards the end of my pregnancy.

For someone who is used to training high intensities most days of the week, this period of reduced activity was initially very challenging mentally. But over time I got good at listening to my body and it felt good being able to let go of the pressure I put on myself to train everyday, and to train intuitively based on how I felt.

How long after birth did you start exercising?

The girls were born via planned cesarean, so I took my postpartum recovery very slowly.
I did nothing for the first 4 weeks except think about feeding and looking after the girls.
My mum was in the house to do all the washing and cleaning and she would push the pram for me when we went out for walks – which consisted of walking 15 minutes to get coffee then walking back.

After 4 weeks I started to feel more mobile and the pain from the surgery had reduced, so at this stage I started to work on my pelvic floor activation lying on my back. This is all I did for 4 weeks – practising pelvic floor activation, endurance and relaxation. I slowly began to add some leg movements in, and as I got more mobile I started to add in some gentle thoracic stretches.

From about 8 weeks on I had a small home routine that I would try to complete 3-4 times a week while the girls napped. As anyone with babies knows this (mostly) didn’t go to plan, but I did what I could, when I could, and relied on the consistency of doing at lease one thing everyday to help with progress.

The program involved some body weight squats, low level core exercises and some banded rowing for my upper body. I started to add lunges in, slowly increased my walks and started to add in some small hills.

I didn’t put pressure on myself at this stage, I moved because it felt good to have some control back of my body. I was also starting to notice aches in my lower back from feeding, holding and rocking the babies, so I wanted to prioritise strength to avoid an injury or further pain.

At about 4 months postpartum I was starting to feel like I had a bit more freedom and energy to leave the house, and I felt I’d built enough basic strength to start some exercises in the gym.
At this stage I wrote myself a postpartum gym program involving some basic machine exercises and light compound movements such as squats and deadlifts, bench presses and rowing, and completed this in the gym 2 times a week. I had great support from my sister who would train with me on those two days, and a lovely, supportive environment to train in (Anytime Caringbah).

I planned the next 6 months of training out in 8 weeks blocks, with the goal of returning to crossfit 1 year after giving birth. I completed this program consistently 2-3 times a week.

Running wasn’t a priority for me but when I reached 1 year postpartum I felt like getting outdoors and going for a run once a week balanced my training out. I started with 1 min intervals and built over 3 months until I could run 30 minutes without discomfort or issues.

My twins are 2 years old now, and I am back doing crossfit 2-3 times a week and running once a week on the weekends.

What were some struggles you found when returning to exercise?

Because I planned my training well and took my time returning to exercise, I found that my physical capacity wasn’t an issue. I was able to return comfortably without injury or issues.
The challenge was more about finding the time during the week to train. Juggling babies with work schedules, either finding gyms with creches or training very early or very late in the day, and the lack of sleep affecting training quality and recovery was the biggest challenge.

I again had to let go of pressures I put on myself to get to the gym and had to accept that some sessions may not go to plan, if they happen at all!
I was still able to progress and reach my goals, I had to learn patience and trusting the process.

Would you do anything differently?

I was quite proud of how I managed my rehab, I felt like I was equally able to enjoy newborn life and watching my girls grow while simultaneously taking time to look after myself and build my body back again.

I had stages where I worried if my body would ever be able to do the things it used to do again, but knowing now that for the most part it will and that it just takes time, maybe next time I’d take even longer to get back.

It’s amazing how capable the body is of adapting to change, I have a new appreciation for it and these days enjoy training to nurture it rather than smash it.
I hope to pass on these healthy exercise and activity habits to my girls and hope to be active myself throughout their lifetime.

If you’re looking to get back to activity after childbirth, or interested in a postpartum gym or running program, our Physios specialise in women’s health conditions, pre and postpartum rehab and strength and conditioning programs.
Get in contact with the clinic today to make an appointment.

4 Strategies for Managing Frozen Shoulder

Frozen shoulder, also known as adhesive capsulitis, is a condition that affects the connective tissues around the shoulder joint causing it to become stiff and painful.

This condition is more common in women, it is more prevalent in individuals with type 2 diabetes, and some medications can also increase the risk. Most cases of frozen shoulder resolve on their own over time. Some people may continue to have mild symptoms even after the condition has run its course, but these are usually less severe.

What often surprises people is just how long frozen shoulder can persist – lasting anywhere from 2 to 3 years, with some cases lasting up to 5 years. The condition progresses through three distinct stages: first, a phase of pain and increasing stiffness; then, a stage where stiffness remains but pain lessens; and finally, a ‘thawing’ phase where range of motion gradually improves.

There’s no one treatment that fixes it quickly, over time the condition improves on its own. However a combination of interventions can help improve shoulder function as the condition progresses and outcomes as it resolves.

We’ve put together 4 techniques to help manage frozen shoulder and reduce the impact it has on your daily life.

1. Exercise

Although the long term benefits of exercise in the management of frozen shoulder is unclear, the short term benefits of exercise include a reduction in pain, increases in range of motion, strengthening of the rotator cuff and reduction in the stiffness associated with avoidance of using the shoulder.

Exercising with frozen shoulder can include gentle stretching, active assisted movements and strengthening the rotator cuff within the range of motion that is available.

Exercise also provides the individual with a level of control and ownership of their injury which can reduce depression and anxiety scores, helping to manage pain.

2. Manual Therapy

Manual therapy can include massage, joint mobilisations and dry needling. Although manual therapy is unlikely to change the range of motion of the shoulder joint and frozen shoulder itself, it can have an impact on the joints and muscles around the shoulder.
Due to a decrease in range, compensatory patterns of movement are usually developed in order to move around pain and stiffness. This can create further issues in areas such as the neck, thoracic spine or elbow and wrist.
Treatment here can help improve the quality of movement at these joints, and reduce pain and injury.

3. Education

Understanding frozen shoulder as a condition can help manage the extent at which the condition affects the individual’s mental health and therefore their pain and disability.

It can assist with setting realistic expectations, which boosts motivation and improves mood. This, in turn, supports adherence to a management plan and exercise, while also helping the individual feel more in control of both the condition and their body.
All of these will help with the management of pain and reduce disability associated with frozen shoulder.

4. Injections

Cortisone and/or saline and anaesthetic injections can be administered into the joint to help reduce the pain associated with frozen shoulder. However these have been shown to have short term effects (about 3 months) and don’t appear to affect long term recovery. These could be an option for short term management of pain, along with exercise and education as a holistic approach to management.

Although frozen shoulder is unfortunately a limiting and painful condition, there are still plenty of management options that can significantly reduce the pain and functional limitations associated with the condition. Not one intervention alone can significantly affect the progression of the condition, however it is clear that a holistic approach to managing frozen shoulder can help to decrease the pain and disability associated with the condition.

If you suspect you may be developing frozen shoulder, or know someone who may be experiencing it, please be encouraged to come and see us to create a plan for management.

Getting back to running after a baby

After having a baby, many mums are keen to get their fitness back—running is often a big goal. But, pregnancy and childbirth can take a serious toll on your body, so getting back to running takes time, patience, and a bit of preparation. While there’s plenty of advice and return-to-run programs available, how ready you are to run will depend on your individual recovery and meeting a few key milestones.

How Pregnancy and Birth Affect Your Body

Pregnancy puts a lot of pressure on your body. Your abdominal muscles stretch and separate, your pelvic floor gets stretched, and your joints become looser. As exercise intensity usually decreases during pregnancy, you may lose some strength and fitness, too.

After birth, estrogen levels drop, especially if you’re breastfeeding, which can weaken the pelvic floor further. This makes it harder for your pelvic floor to support organs like your bladder and uterus. Joint laxity can also stick around, making your hips, knees, and pelvis more vulnerable to strain or injury. That’s why it’s so important to focus on rebuilding strength and control in your muscles and joints before considering higher-impact activities like running.

Abdominal separation (where the muscles in your belly stretch apart) happens to all mums who carry to full term, and while it’s necessary for baby’s growth, it means less support in your abdominal wall after birth. Without this support, running or any impact activity can place extra stress on your pelvic floor and spine.

On top of all this, the general decrease in fitness during pregnancy and the demands of caring for a newborn (hello, sleep deprivation!) can make it even harder to get back on track.

What You Need to Consider Before Running Again

1. Rest and Recovery

Your body needs time to recover before jumping back into exercise. Pregnancy and childbirth cause a lot of changes, and it takes time for things to settle. For vaginal births, about a third of first-time mums experience perineal tearing, and there’s a risk of pelvic organ prolapse (when your pelvic organs drop down), especially if labour was long or complicated. While prolapse is common, most cases aren’t serious and often improve within a few months. That’s why it’s generally recommended to wait at least three months before returning to high-impact activities like running.

For C-sections, it’s important to remember that it’s major abdominal surgery. Recovery typically takes 6-8 weeks, during which time your body is healing. No lifting or strenuous activity during that time—wait until you’ve had enough healing before thinking about strength exercises or impact activities.

2. Abdominal Strength and Healing

The first few months postpartum are crucial for your abdominal recovery. Wearing compression garments can help your abdominal muscles heal by supporting them and reducing unnecessary pressure. Strengthening deep core muscles, like the transverse abdominis and pelvic floor, is key to rebuilding your abdominal wall. This will help prevent unnecessary strain during impact activities like running.

If you notice your belly “doming” (bulging in the middle) or experience bladder leakage during activities, it’s a sign your core isn’t ready for high-impact exercises yet. Focus on deep core strengthening before progressing to more intense exercises.

3. Pelvic Floor Strength

Your pelvic floor plays a huge role in supporting your bladder, bowel, uterus, and helps manage abdominal pressure during activities like running, jumping, or even coughing and sneezing. If your pelvic floor isn’t strong enough, you might experience incontinence, pelvic pain, or feelings of heaviness down below.

Before returning to running, your pelvic floor needs to be strong enough to cope with the impact. This means being able to perform pelvic floor contractions quickly and hold them for a reasonable amount of time. If you’re experiencing any pelvic floor symptoms, such as leaking, pain, or heaviness, it’s important to address those before considering running.

4. Lower Limb Strength and Control

To run without injury, your legs and joints need a baseline level of strength and control. There are a few basic tests to check if you’re ready for running, such as:

Walking for 30 minutes
Balancing on one leg for 10 seconds
10 single-leg squats
Jogging on the spot for 1 minute
10 forward bounds or
10 single-leg hops
10 Running mans

If you’re able to do these without issues, you’re on the right track. But don’t rush it—gradually build up strength and control before adding the impact of running.

5. Gradual Build-Up and Structured Program

When you’re ready to start running again, it’s important to ease into it with a structured program. Start with short, easy runs and gradually increase the distance and intensity. This helps your body adjust to the demands of running without risking injury. Patience is key here—don’t rush the process.

6. Supportive Gear

Wearing supportive underwear and a good sports bra can help protect your pelvic floor while you run. Research shows these can reduce strain on the pelvic floor and lower the risk of dysfunction. There are also compression garments designed specifically for postpartum recovery that can provide extra support, especially for the pelvic region.

The Risks of Rushing Back into Running

It’s important to follow a proper return-to-run program to avoid long-term issues like pelvic organ prolapse, incontinence, or musculoskeletal injuries (such as tendinitis or stress fractures). Working with a physio can help ensure your return to running is safe and effective, based on your individual recovery and fitness level.

The key is to take your time, rebuild strength and control, and only progress to running when your body is truly ready. You’ve got this—just make sure to listen to your body and move at your own pace!

How to ‘heel’ your plantar fasciitis

What is plantar fasciitis?

The plantar fascia is the connective tissue that runs along the bottom of the foot from the heel to the toe bones. This makes up the arch of your foot. Plantar fasciitis is the overload of this tissue, and causes pain primarily at the base of your heel, however can occasionally be felt along the line of the plantar fascia.The plantar fascia is an extension of the fascia that connects your calf muscle to your foot. So often an overload or tightness in your calves will contribute to plantar fasciitis.

Common signs and symptoms

Pain in the plantar fascia is typically felt underneath the heel, especially during activities that put stress on the calves, such as walking or running. The discomfort often worsens after periods of rest, feeling more intense in the morning but improving with movement. In some cases, there may be tenderness when touching the base of the heel, and while the pain can vary from day to day, it usually diminishes as you move and the muscles warm up.

How does it happen?

Overload of the plantar fascia can occur in a number of ways, but when daily loads exceed the capacity of the plantar fascia, it will respond in pain.
Overload can occur suddenly, for example a person may jump off a step and feel immediate pain at the base of the heel. Or it can happen gradually over time, such as increasing running kilometers to prepare for a marathon. The accumulative load of progressively running longer distances can eventually exceed the foot’s ability to cope, leading to pain.

Overload can also occur indirectly. For example, if you’re limping because of an injury, you may put extra strain on your uninjured leg. This increased reliance can lead to overuse and ultimately result in pain in the plantar fascia.

Switching footwear can lead to increased strain on the calves, which may, in turn, overload the heel. This is often seen with high heels, where the foot is positioned in plantar flexion, causing the calves to work harder and putting extra stress on the fascia. Additionally, changing to sneakers that promote a more forefoot-striking pattern can also raise the load on both the calves and the plantar fascia.

Hormonal fluctuations can weaken tendons and raise their risk of overuse injuries. For instance, a decrease in estrogen around menopause leads to tendon stiffness, reducing their flexibility and making them more susceptible to injury. As a result, there is an increase in tendinopathies, including plantar fasciitis, among women aged 40 to 60 during the perimenopausal phase.

Additionally, some medications can have a similar effect on tendons, causing degeneration over time without inflammation. This includes statins, which are often prescribed for cholesterol management, and long-term use of steroids to treat inflammation.

How to fix it

1. Pain management

Our initial goal in treating plantar fasciitis is to reduce the pain. There are a number of strategies Physio’s use to aid in pain management.
Firstly we recommend modifying the activities that cause pain. These will often be weight bearing activities such as walking or running, and although it may not be realistic or helpful to completely eliminate these activities from someone’s day, it may be as simple as opting for a lift to work instead of walking to and from the station, or reducing daily walks by half and taking a break from running temporarily.
Plantar fasciitis is typically worse after periods or rest and particularly with your feet resting in a plantar flexed (pointed) position. So a footrest at your desk chair, little exercises to perform at your desk or regularly getting up to move may help in controlling pain.

There are certain taping strategies we can use to better support the plantar fascia which may reduce loading and help with pain. The same goes for arch support in your shoes, or opting for more supportive shoes during the day.

Occasionally other interventions are used to more aggressively manage pain. These can include corticosteriod injections which allow a period of reduced pain, and when used in conjunction with activity modification, strength and mobility, can be a helpful contribution to the overall rehab journey.

2. Mobility

Mobility is an important factor in controlling plantar fasciitis, especially calf mobility. Massage, foam rolling and stretching are all strategies employed to help maintain calf length which can reduce pain, manage the injury and prevent its recurrence in the future.

3. Strength.

At the end of the day, the stronger your calves and feet are, and therefore your tendons and plantar fascia are, the more load they can tolerate and the less chance of them being overloaded. Strength is key in treating plantar fascia, however loading needs to be appropriate for the individual. Strengthening exercises shouldn’t cause pain, or overload the plantar fascia more than it already is. They should replicate and prepare the feet and calves for the type of activity the individual needs to get back to, and be maintained at a certain level to prevent overload occuring again in the future.

How to avoid it

Injuries like this can be challenging to avoid, especially if the triggering factor is something out of your control such as hormones fluctuations, rapid gain in weight similar to what happens in pregnancy, or an unaccounted increase in daily loads. But recognising the warning signs and addressing them immediately, sets you up better for a successful recovery.

Headaches – Can Physiotherapy Help?

Headaches can be challenging to manage due to their various causes and the different ways they manifest in individuals. Triggers can be physical such as an irritated joint or a tight muscle, psychological such as stress or anxiety, or related to lifestyle factors like dehydration, food intolerances, or lack of sleep. This variety is what often complicates effective management.

Identifying common factors associated with headaches can help you recognise their specific causes, allowing for more targeted management strategies.

Understanding the sources of headaches

Musculoskeletal headaches

Headaches can originate from musculoskeletal structures, such as joints or nerves in the spine. The upper three cervical joints (C1-3) refer to the head, so irritation at these levels can lead to headaches, nausea, or dizziness.

Muscle tension is another common trigger for headaches. Certain muscles in the neck, jaw, and shoulders connect to the base of the skull, and if these muscles become tense or overactive, they can produce pain that manifests as a headache.

Additionally, poor posture or physical overexertion can lead to muscle tension, contributing to this type of headache.

Preventing Tension-Related Headaches

Preventing these types of headaches often involves improving posture, especially in work-related settings where many people spend most of their day. An ergonomic assessment of your workplace can help identify poor habits that may be contributing to muscle tension and fatigue.

New mothers often experience neck and head pain from hours spent nursing or rocking their babies in awkward, repetitive positions. Various nursing pillows and chairs can provide support, along with changing feeding positions, incorporating muscle stretches and releases, and engaging in strength exercises to help manage discomfort.

For those who are active, reviewing your exercise routine may reveal movement patterns that place extra strain on the muscles at the base of your head. A physiotherapist can assist in identifying these issues and targeting specific muscles and movements to reduce the load on your head.

Migraines

Migraines are primarily a genetic neurological condition that can cause moderate to severe pain, often accompanied by nausea and sensitivity to light and sound. Typically, an aura precedes a migraine, which may result in visual disturbances like spots or stars, ringing in the ears, or escalating head pain. While migraines are usually one-sided, they can affect both sides of the head.

Because migraines stem from changes in blood flow and nerve sensitivity within the central nervous system, medication is often necessary for management. Keeping a headache diary can also help identify potential migraine triggers, such as hormonal fluctuations, specific foods, or exposure to light and sound.

Physiotherapy can assist in managing the musculoskeletal tension and pain associated with migraines, complimenting medication as part of treatment.

Lifestyle-related headaches

Dehydration can influence blood pressure, leading to headaches that are typically experienced as a diffuse pain across the whole head. To differentiate a blood pressure-related headache, it’s important to assess factors such as fluid intake, alcohol and caffeine consumption, medications, and exercise habits.

Mental health significantly contributes to the incidence of headaches. Increased cortisol levels during stressful periods can trigger headaches, while stress can also reduce pain tolerance and lead to muscle tension that radiates to the head. Similarly, lack of sleep decreases pain tolerance, often resulting in more intense headaches. Quality sleep is essential for the brain to rest and function properly; disruptions can lead to mood and hormonal imbalances that contribute to headaches.

In addition to stress management techniques, physiotherapy can help relieve tension in the neck and jaw, which may reduce the severity of stress-related headaches.

Certain medications and food intolerances can lead to headaches as a side effect. Your doctor may evaluate your medications to help manage these side effects, while a dietitian might suggest keeping a food and headache diary to pinpoint potential triggers. This approach can help you find suitable alternatives while still meeting your nutrition needs.

The most effective management of headaches involves a multidisciplinary team of healthcare professionals. Doctors play a crucial role in referring patients for scans, specialists, and prescribing medications to alleviate headache symptoms. Physiotherapists can address muscle tension related to headaches, assess posture and movement, and provide corrective exercises to reduce recurrence. Psychologists contribute by offering stress management strategies, which can help mitigate headache triggers. Meanwhile, dietitians can identify food-related triggers and recommend suitable alternatives to improve overall well-being.

All professionals involved have the expertise to identify headache triggers, manage symptoms within their area of expertise, and refer you to the appropriate healthcare provider for issues they cannot address. If you are experiencing recurrent headaches, please don’t hesitate to seek help.

How to address and manage your knee pain

Knee pain can generally be categorized into two types:

Acute Injuries: These occur as a result of a specific incident or trauma. Acute injuries typically require early evaluation to determine the extent of the damage. This then may involve imaging or a referral to a specialist, and a rehabilitation program will be initiated to help you return to your activities as quickly and safely as possible.
Chronic Injuries: These are conditions that develop gradually over time. While they may occasionally require imaging or consultation with a specialist, they usually benefit more from a tailored strength program and continuous management. With the right approach, you can manage these conditions effectively, minimizing pain and preserving your quality of life. Ongoing care is essential to ensure these issues don’t interfere significantly with your daily activities.

How can Physio help?

Physio’s are usually the first professionals people consult when experiencing knee pain. We have the expertise to evaluate your knee, identify the underlying injury or cause of pain, and determine the next steps. This may involve referring you for imaging or a specialist consultation, or initiating a rehabilitation program to address the issue.

Rehab will involve a period of relative rest and recovery.
Our aim is to keep you as active as possible while allowing your knee pain to settle. We will identify exercises you can do or make adjustments to your work, so you can continue working or participating in activities without exacerbating your knee pain.

Once pain has settled we then work on the strength, control and power to get you back to your former level of activity. We make your rehab specific to your goals. For example, getting back to a physical job might involve lifting and lunging type exercises, whereas returning to a sport like netball will involve running, change of direction, and powerful movements in the gym.

Delaying surgery

Discussions around surgery in both acute and chronic knee injuries are important to have.
Surgery increases an individual’s chances of developing osteoarthritis later in life, it also exposes you to risks such as infection, nerve damage and tissue scarring that could affect function. Whenever possible, it is recommended to explore rehabilitation options before considering surgery.

For acute injuries, most meniscus tears are typically managed with conservative treatment, and if addressed early, individuals can often return to their previous level of function. Additionally, recent research supports non-surgical rehabilitation for ACL injuries. New techniques are available to promote healing without surgery, and there is promising long-term data showing that effective function can be maintained over the years with non-operative approaches.

Physiotherapy plays a crucial role in non-surgical management, especially when structural knee stability has been compromised. It’s essential to ensure that functional stability is maintained through strengthening the muscles around the knee, improving neuromuscular control to avoid positions that could cause further damage, and enhancing muscle power if the individual’s goal is to return to sports.

In chronic conditions, surgery is usually only considered if function and quality of life are severely affected. This means that function is preserved for as long as possible before surgery becomes an option. To preserve function, strength and control are the main priorities.
There are several reputable resources backed by reliable research that offer exercises designed to help manage and slow the progression of knee arthritis. The primary goals are to enhance quality of life and reduce the need for surgery. Physiotherapists and exercise physiologists are specially trained in this field, making them valuable resources for managing and mitigating the impact of arthritis.

How rehab can fast track your recovery

The stronger your knee, the better it can handle various loads. Improved balance and control enables you to perform more complex movements without risking injury. Typically, an injury occurs when loads exceed the capacity of your muscles, joints, and tendons.

While the body can most of the time resolve inflammation and heal tissues on its own, there are strategies you can use to support and speed up this process. More importantly, there are strategies you can employ, to help strengthen your knee beyond the basic level needed for daily tasks, or the demands of sport, to enhance overall function and resilience.

Phase one:
Reduce pain, support healing
Physiotherapists employ techniques to help reduce pain and provide guidance on what to avoid to prevent aggravating the injury. They also offer recommendations on activities you can do to maintain strength and mobility, which can accelerate the rehabilitation process.

Phase two:
Physiotherapists can prescribe targeted exercises to strengthen the muscles and tendons around the knee, as well as improve neuromuscular control. This approach is crucial for preventing future injuries and reducing the risk of recurring pain.

Phase three:
Physiotherapists have the expertise to prescribe exercises tailored to the intensity and complexity of your chosen sport. This ensures a smooth and low-risk transition from rehabilitation back to athletic activities.

Lower Back Pain

Hurting your back can be scary, but most lower back injuries are treated similarly to other injuries, with the potential for a full recovery and a return to your usual activities.

Anatomy

Your spine is divided into four sections: the cervical spine, which forms your neck; the thoracic spine, which makes up your upper back; the lumbar spine, which is your lower back; and the sacrum, the lowest part of your spine, also known as your tailbone. When we talk about lower back pain, we generally mean injuries affecting the lumbar spine from the upper segment (L1) to the lowest segment (L5), and occasionally involving the upper segment of the sacrum (S1).

Your spine consists of bones called vertebrae, which are linked by joints and ligaments. Between each vertebra are intervertebral discs that help absorb shock and enable movement. In front of these discs is the spinal cord, through which nerves travel from each spinal level to different parts of the lower body, extending all the way down to the feet.

These nerves innervate the muscles and skin of the lower body, providing movement and sensation.

Injury

The structures of the spine are similar to structures elsewhere in the body (bones, joints, ligaments and nerves) therefore we manage them in much the same way.
However, with lower back pain, the proximity of the spinal cord and nerves which control movement and sensation, can lead to additional symptoms such as pins and needles, numbness, or weakness in the hips, legs, and feet.

Inflammation or nerve compression in this area may contribute to these symptoms. As physiotherapists, we use specialised assessments to identify the specific location and cause of your symptoms, enabling us to target and treat the root of your lower back pain effectively.

Will I need Surgery?

90% of back pain cases do not end up needing surgery, and in fact most cases of lower back pain don’t even require imaging (XRays or MRI’s).

Imaging is required if symptoms indicate a more serious pathology, which will be indicated when seeing your Physio or Dr.
For most cases though, a physical assessment will tend to reveal enough information to treat the cause of pain and resolve symptoms.

Imaging may pick up on some abnormalities within the spine, but these are not necessarily the cause of pain. Similar to scars on your skin, they are present, and an indication of use, but do not cause pain or affect the function of your skin.
For that reason, clinicians tend to steer away from imaging in the early stages and focus on improving function and movement quality.

Surgery is a last resort option if all other conservative forms of management fail, and if there is indication of a structural cause for the pain.

Recovery

If all red flags (serious conditions) have been ruled out after assessment, lower back pain is treated much like any other injury in your body

Phase 1: Rest and recover
Modification to daily tasks allows your back pain to settle, and supports healing. These changes will be dependent on the type of injury, and the tasks that are required of the individual. This is why assessment is so important in the early stages. The quicker we can identify the triggers for pain, the quicker we can assist in healing.

Although we encourage relative rest, it is still important to maintain as much movement as possible without aggravating the injury. There are usually some gentle stretches and movements that can assist in range of motion as well as support the healing process.

Phase 2: Load and strengthen
When the initial inflammation and pain starts to settle, we will start to load your spine to restore strength and to ensure you can not only return to your former activity, but do it in a way that will reduce your risk of re-injuring. It is within this phase that we identify range of motion, strength or movement pattern issues that may have contributed to your initial injury, and we focus on improving these and developing better ways to move to protect your back.

Phase 3: Integration back into previous activityYour rehab exercises will start to mimic movement patterns you require during the day, whether that be specific to your job, your sport or daily activity, we start to increase your daily loads and encourage returning to your former activities.
There will always be ongoing maintenance exercises necessary to remain injury-free.

Future prognosis

Like any other injury, the presence of previous injury, increases your likelihood or re-injury. Recurrence of lower back within the first year of injury can range from 15% – 85%. Often the cause for the higher incidence in re-injury is failing to identify the cause of the injury and addressing it correctly, or failing to complete or carry on with a rehabilitation program.

For this reason it’s important to get a thorough assessment and follow through with a rehab plan completely.

Tips for Running

Running

The biggest mistake we see in the clinic is when people take on too much training, too soon. Whether its to get fit, lose weight or to tick a marathon off the bucket list, it’s crucial to have a well-structured training plan and set realistic goals to prevent overtraining and reduce the risk of injury.

No matter how good your training program is, it takes time for your body to adapt to the loads of running. If you consistently push your training loads beyond what your body can handle, your joints, tendons, and bones may not cope, leading to overuse injuries over time.

Here are some simple tips to help manage your loads and to reduce your risk of overuse injuries.

80/20 rule

This number came from some research that demonstrated endurance runners only spending 20% of their training running at a higher intensity (eg interval training at 90% VO2max), with the bulk of their training involving lower intensity or ‘easy’ runs.

This rule won’t apply for everyone, however it is a good guide to base your training off.
Be mindful of how challenging each session is, give it a rating out of 10 (1= very easy and 10= very challenging) or think about your sessions as easy, moderate or hard.
Make sure most of your sessions sit under a 5/10 or are ‘easy’ runs.
10% overload

Again, this number was based on research calculating injury risk in athletes and demonstrated that a fluctuation in load (either an increase or decrease) increased an athletes risk of injury.
If you think about this number, a 10% fluctuation in a training week of 20k/week is only 2km’s. This doesn’t allow for a lot of room in training variation.
Again this rule can be taken with a grain of salt, as this research wont apply to everyone. But it is important to keep in mind that if you’re feeling good in a run and decide to add a few k’s, or your pace is quicker than normal, think about reducing your k’s or pace in a run later in the week to preserve your body.

This is also important to consider as a runner just starting out. If you’ve never run before, your 10% overload is going to look very different from if you’re a regular 15k/week runner looking to increase volume to run a marathon.

As a beginner your running minutes and pace should start very low, and increase very slowly. For example, run at a ‘comfortable’ pace (you should be able to hold a conversation) and start in intervals, eg. 1 min on 1 min off for 10 minutes.
Starting with just one run a week and increase to 2 and 3 days over the following months.
Realistically we would recommend at least a year’s worth of training for a strong, fit, injury free beginner runner to run a marathon.

Rest and recovery

Recovery is important in managing your body’s loads. Without adequate recovery you’re putting your body under stress before its had a chance to recover, contributing to cumulative overload and potential injuries.

Ideally you would want to be running every second day with alternative sessions on the in between days (eg. strength training, a mobility session like yoga or pilates, or an active recovery such as a swim or a walk)

Quality sleep also facilitates recovery. Individuals who get under 7 hours of sleep a night are 1.7 times more likely to sustain an injury.
Ideally you should be aiming for over 8 hours a night to allow adequate recovery from training.

4. Modifying loads (shoes, cadence, terrain, cross training)

Changing the loads going through your body will help to disperse load across the body and reduce the risk of overuse injuries in certain areas. There are a number of ways you can do this across the week, or within a training session.

Shoes

Switching up your shoes for each run can alter how your foot hits the ground, which in turn changes the ground reaction force through your body. This reduces the repetitiveness of load going through your body and reduce the risk of overuse injury.

Terrain

Changing the terrain you train on will help to control intensity and load. Eg.you could opt for a flat run to decrease intensity if your loads that week are high. Or opt for a run on grass rather than concrete to decrease ground reaction forces through the body if you’re feeling sore in your legs. The variation in terrain of a trail run can also be gentler on the joints vs a run on concrete which can be highly repetitive on joints.

5. Strength

Strength is so important in adequately preparing your joints for the loads associated with running. Strength increases your tissues capacity for load, meaning you can run longer and harder without overloading your body. 1-2 strength sessions a week can decrease your injury risk by up to 50%.

Strength sessions need to be heavy (so calf raises while you brush your teeth won’t do!). They need to incorporate a mixture of big compound lifts such as squats or deadlifts, calf raises and single leg exercises such as step ups or lunges. If you’re inexperienced in the gym it is highly recommended you see a personal trainer, Physio or exercise physiologist to write and supervise your program.

If you’re a beginner planning your first fun run, or a regular runner looking to challenge yourself further, we’d highly recommend coming in for an assessment so we can set you up with an individualised program that will reduce your risk of injury, produce the result you want, and most importantly that you will enjoy doing.