Category: Musculoskeletal Injury

How to address and manage your knee pain

Knee pain can generally be categorized into two types:

  1. 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.

  2. 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.

  1. 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.

     

  2. 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. 

  1. 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.

Hamstring strains

Hamstring Strains

Hamstring muscle strains are among the most common lower limb injuries in sports, accounting for 22% of injuries in AFL and ranking within the top three for lower limb injuries in the NRL. In professional soccer, hamstring injuries are a leading cause of missed games, with 20% of players sidelined from matches or training due to these injuries.

Of particular concern is the high recurrence rate of hamstring injuries, with increased severity of each subsequent hamstring strain, resulting in longer rehab periods and delayed return to sport.

So, what is the typical recovery time for a hamstring strain? And more importantly, what strategies can be employed to mitigate the risk of these injuries?

Risk factors for hamstring injury

  1. Lack of strength

    One of the major risk factors for hamstring strains is a lack of strength and power needed to meet the demands of your sport.

Your hamstring strength should be equal to the strength of your quads. This strength is crucial in performing the rapid accelerations, decelerations, and change of direction movements required in field sports. Additionally, it is essential for executing actions such as kicking a soccer ball to a teammate across the field, picking up an AFL ball while in motion, or performing a sweep hit in hockey.

Strength preparation is best completed in the off season when the physical demands of training are reduced, and a strength program needs to be completed for a minimum of 8 weeks to yield results.

Exercises that put the hamstrings under strain while they are at their maximum length will adequately prepare them for sport.

Some examples of these are;
– Nordic curls
– Deadlifts
– Prone hamstring curls

2. Fatigue

Another significant risk factor for injury is fatigue.
One method to mitigate this is through participating in a preseason program focusing on fitness and skill training to ensure you are going into the season at optimal fitness levels. However, managing fatigue during a game is also crucial. Strategies include scheduling regular subs, rotating player positions to lower overall intensity, or reducing game minutes if fatigue levels are increased before a match. 

Effective management of fatigue requires a good awareness of fatigue signs in your body, along with open communication with coaches and teammates.

3. History of injury

Unfortunately, if you have experienced hamstring strains in the past, this will increase your chances of repeat strains. If you suspect a hamstring strain, getting early assessment and commencement of a rehab program is vital.
Hamstring rehab typically progresses through structured phases aimed at facilitating muscle repair, enhancing muscle strength, and preparing the hamstring for specific sporting demands.
This final phase is particularly critical but often overlooked in rehabilitation plans, focusing on reintegrating activities like running, explosive strength exercises, game-specific skills, and contact training.

How long will it take me to return to sport after a hamstring strain?

This will depend on the level of injury, your history of injury, and the level of activity you wish to return to, but an average return to sport timeframe will be between 2 – 8 weeks.


Phase 1: pain management and supporting healing
Phase 2: Strength
Phase 3: Power
Phase 4: running
Phase 5: change of direction and light skills
Phase 6: Increase running speed, agility and intro of light contact
Phase 7: Integration back in to training

You will be guided through these phases by your physio and return to sport will be determined on a number of return to sport tests.

How to Manage Niggles

How to Manage Niggles

Persistent niggles that linger throughout a sports season are common. There are strategies for managing that can help you through the remainder of a season, as well as addressing them during the offseason to prevent their recurrence the following year.

Minor injuries, or “niggles,” might not be severe enough to stop you from playing, but they often become more noticeable as the season progresses. You may start to feel them earlier in games, notice them longer after games, or find yourself avoiding certain activities during training or daily life. When is the right time to start taking these signs seriously?

Niggles should be addressed as soon as you start to notice them. When you start to feel pain or discomfort, it’s your body’s way of telling you there is an imbalance between training load and your body’s tolerance. If this is addressed early on, there are some simple strategies you can employ to allow the body to recover, and avoid too much disruption to your training.
Some ways you can modify load when feeling a niggle are;

  • Reduce playing minutes in a game
  • Rotate positions throughout a game to allow recovery within a game
  • Change the surfaces you’re training on
    Eg. Run on grass instead of concrete, or vary the shoes you train in
  • Increase the amount of recovery your are completing
    Eg. prioritise sleep and nutrition, increase mobility, prioritise rehab exercises, strategies such as ice, compression, resting throughout the day
  • Modify training sessions by replacing more intense drills/game scenarios with rehab exercises or skill practise

There are plenty of ways to still be involved in training and to focus on performance, whilst allowing the body to recover from overload.

How do we avoid niggles?


If you participate in sport, niggles are inevitable. The unpredictability of intensity and load in games makes it difficult to completely prepare. However as mentioned above, niggles can be managed so that they don’t result in missed games. And more importantly, adequate preparation leading into a season will significantly reduce the incidence and severity of these niggles.

How do we prepare?


1. Strength
2. Fitness
3. Skill and game practise

  1. Strength happens in the offseason, when training loads are lower and there is more time for your body to recover.
    To allow maximal strength gain, exercises need to be heavy and challenging. There should be a large focus on technique, and movements should replicate those that are apparent in your sport.
    For example, running requires high levels of calf strength, therefore an off season running strength program should involve a number of variations of heavy calf raises.
    A swimming or water polo off season program will involve lots of overhead shoulder strengthening exercises.
    And contact sports such as rugby or AFL will involve lots of core strength, and explosive power-based exercises to reduce the incidence of concussions and to prepare the body for contact.

2. Fitness
Will often occur in a pre-season block. This helps the body prepare for the amount of running volume that occurs within a season, and ensures the body can withstand the length of the season. Pre-season fitness programs will often replicate plays in a game, eg. 50m sprints for rugby winger, or short sharp 15m sprints for a netball wing attack. Or they will target the energy systems needed to complete an event eg. anaerobic fitness for a 200m track sprint, or aerobic fitness for a triathlon.

3. Skill and game practise will occur as the season approaches, to ensure the body is prepared for the specific movements and demands of the sport.

 

There a plenty of ways to manage niggles and still be involved in training and play.

Deciphering your hip pain…

Do you find yourself asking, “why is my hip sore?” … You’re not alone! 

Approximately 10% of the population grapple with hip pain, a figure that tends to rise as we age. 

Pain in this region can originate from multiple structures and so gaining an accurate diagnosis from your physiotherapist can narrow down the cause of your pain… is it muscle, tendon, ligament, cartilage or bone?

It’s all in the assessment: 

Determining the source of your hip pain begins with a comprehensive assessment.

When you first present to your physiotherapist with hip pain, they will take a thorough history to try and narrow down the potential sources of your hip pain. 

From there, they will run through a series of tests and movements to stress different structures in your hip and try to elicit your pain. 

They may need to send you for more scans or tests on the hip or they may have enough information to start you on a treatment and rehabilitation plan! 

Let’s delve into some of the questions your physiotherapist might pose (and why!):

Locating the Pain: Can you precisely pinpoint the area of your hip that’s causing discomfort? Identifying the specific location aids in narrowing down potential culprits, whether it’s anterior (at the front), lateral (on the side), or posterior (in the back) hip pain.

Age Matters: How old are you? Different age groups are predisposed to distinct hip pain diagnoses. For instance, certain injuries are more prevalent in children and adolescents, such as Legg-Calve-Perthes and Slipped Capital Femoral Epiphysis, respectively. Labral tears are more common in adolescents to older adults and osteoarthritis is more common in older athletes.

Onset of Pain: Did your pain start suddenly or gradually over time? E.g. when it comes to a muscle or tendon injury, acute mechanisms hint at muscle or tendon tear, whilst a gradual onset suggests overuse tendinopathy. The ability to differentiate between a tear and tendinopathy will not only guide your diagnosis but also your management and timeframes for your return to activity!

Associated Symptoms: Are there accompanying symptoms like clicking, catching, snapping, or limping? Whilst some hip pain and associated symptoms point more towards a hip joint injury, hip pain can also be caused by lower back and pelvic injury and so your physiotherapist will also need to assess these areas as well as your hip!

If you’re grappling with hip pain, reach out and let one of our hip pain physiotherapists establish a diagnosis and your plan of management!

Physiotherapy Sutherland Shire