Common Knee Injuries and How To Treat Them

Common Knee Injuries And How To Treat Them

In this post we will focus on knee injuries, and what treatment may be required to get back to living your barefoot lifestyle!

Common knee injuries can occur through daily movements and activities, whether it be a car ride, sport or landing differently on your knee. Three common knee injuries we will look at are ACL, PCL and Meniscus tear which cause discomfort and potential long term effects if not treated properly.

Common Injuries

Meniscus tear: Damage to the meniscus, can be caused by awkward pivoting on the knee, direct blow to the knee or in some cases repeated squatting with poor technique. Symptoms include pain in certain ranges of movement, a feeling of something ‘catching’ or ‘locking’ in the knee

Medial collateral or lateral collateral ligament tear: Damage to these ligaments typically occur from changing direction. This can be when the foot stays planted or a direct blow to the inside (LCL) or outside (MCL) of the knee. Symptoms include localised pain, swelling and feeling of instability.

ACL tear: Depending on the severity of the injury, the ACL could be strained, partially torn or completely ruptured. Damage to the ACL is often caused by pivoting/change of direction when the foot remains planted (most common). Damage can also be caused by hyperextension (eg knee being pushed past straight) which can occur when the foot remains planted, and the body pushed sideways (eg in a contact sport).

Symptoms include an audible popping noise at time of injury, significant pain and swelling immediately or a feeling of instability. Due to the mechanisms of injury, it is not uncommon for an ACL tear to occur with meniscus damage and medical collateral ligament damage (known as the “unhappy triad”).

PCL tear: PCL tears are much less common than ACL ruptures, as they are stronger and larger ligaments. A PCL tear can occur from direct force to the shin, while the knee is flexed (such as knee hitting the dashboard in a car accident). This is the most common cause of PCL injury. Another common PCL tear can occur from falling onto a bent a knee, with hyper extension causing damage to the PCL.

Symptoms are often similar but far  less severe than an ACL tear.

Treatment
If you have suffered an acute knee injury, or are feeling pain and discomfort in your knee/s then the following can help to reduce pain and inflamation,

Settle inflammation down:
Relative rest (don’t do anything painful, but don’t do nothing- aim to gently keep your knee moving); ice for 20 minutes every few hours; no alcohol; discuss anti-inflammatory medication options with your doctor or pharmacist

  • Consult your doctor or physio to determine if imaging is necessary. There are clinical tests that can help determine if any of these structures are damaged. Your physio or doctor should talk you through each test and your results. If there is any concern, an MRI (magnetic resonance image) will often be recommended for more certainty
  • If damage is detected on imaging, then your doctor will likely refer you to an orthopaedic surgeon (specialist doctor) to determine the best management for your injury (ie surgery or physio)
    Whether your injury requires surgery or not, we suggest popping in to see one of our physio’s to get you back to doing what you love, sooner!

This article was originally posted on barefootphysiotherapy.com.au. It has been re-published with the permission of the author.

Sore back playing golf?

Sore back playing golf?

Over one million people play golf in Australia, making it one of the highest participation sports nationally.
Golf related injuries are common for both amateur and professional golfers, with lower back pain contributing to approximately 25% of all golfing injuries, in those that play at least three times per week.

Research also reveals that on average a lower back pain episode will keep you off the golf course for up to six weeks. It therefore makes sense to practice not only your playing techniques but also your preparation habits – to reduce your risk of injury.

In amateur golfers lower back pain is caused by:

  • poor swing technique
  • overuse
  • failure to warm up
  • reduced flexibility – especially spine and hips
  • reduced trunk muscle strength
  • reduced general fitness
  • ill-fitting equipment

We know that the main force going through your lower back during the golf swing is compression and this has been measured at up to eight times your body weight. The majority of this force occurs at impact (when you hit the ball).

Low back pain is often caused by stresses to the discs, ligaments and muscles in these areas. Excessive flexion or ‘slouching’ of your spine in various positions such as when bending forward or sitting is a common cause of pain.

Preparing for your day on the green

Golfers are often giving their back a work out prior to hitting the first shot off the tee – where habits can cause stress to the back overtime.

What habits you have formed that may be contributing to lower back pain? Use the checklist below to consider the type of load on your back associated with playing golf:

  • lifting your clubs and buggy in and out of the car
  • driving your car to the golf course
  • assembling your buggy and searching through your golf bag
  • hitting and then picking up practice balls, including putting practice
  • teeing up the ball
  • pushing/pulling your buggy – especially up hill
  • repairing pitch marks and getting the ball out of the hole

So how does this help you to manage back pain with golf?

Gaining a better understanding of the contributing factors to back pain with golf is the first step. Now whether you’re looking to manage golf related back pain or prevent it, we’ve listed our most important tips – no matter your playing level.

  1. Warm up! This should incorporate specific stretching exercises; driving range and putting practice; and practice swings on the first tee. These warm up exercises should take no longer than 10 minutes each.
    See your physiotherapist for a massage, stretching routines, or to strengthen the trunk, low back and neck muscles using Pilates based techniques and methods.
  2. Have a 3D golf swing analysis and/or golf assessment to correct your swing technique. This is otherwise referred to as ‘the MRI of your golf swing.’ A 3D analysis can assess in detail exactly the way your body moves during the golf swing in real time. This will make the cause of your back pain during golf easy to identify and manage.
  3. See a golf professional for a lesson to ensure your technique is correct.
  4. Adopt correct lifting and bending techniques to maintain spinal curves and bent knees
  5. Pay attention to correct equipment and usage – lighten your bag and push rather than pull your buggy.

So next time you’re preparing to head out for a game of golf or even a practice session, take note of the above, prepare like a professional and continue to enjoy your time on the green.

Ben Corso – Director of The Physio Clinic recently presented a workshop on Golf Injury Management and Rehabilitation to the Italian Sports Physiotherapy Group in Milan, in May 2017 through Manualmente.
This article is a patient centred summary of the information presented and how this can assist your golfing patients. www.thephysioclinic.com.au

Not All Hamstring Strains Are Equal

Not All Hamstring Strains Are Equal

Hamstring Strains Are Most Frequently A Sprinting Injury

The winter sports season is upon us, meaning physiotherapists all around Melbourne will be dealing with athletes having suffered hamstring strains. AFL and soccer are sports with notoriously high numbers of hamstring strains the majority of which occur during high speed running.

70% of hamstring injuries in elite football players occur during high-speed running (sprinting) and the rest with stretching, sliding, twisting, turning, passing, jumping and overuse.

Predictors Of Poor Recovery With Hamstring Strains

Poor prognostic predictors regarding hamstring strains and athletes returning to play following hamstring injury (referring to hamstring injuries that are likely to take longer than average to recover) include:

  • Suffering a stretching type injury such as reaching for a ball with an outstretched leg or bending to pick up a ball whilst on the move are injuries that have on average 84% longer return to play times than contraction injuries (contraction injuries referring to hamstring strains occurring during regular sprinting motions).
  • The area where the peak point of pain is to touch on the back of the thigh. The closer to your sit bones (the ischial tuberosity) the peak pain point is felt the longer the recover times.
  • Location of swelling. Similar to the location of peak pain, the closer any swelling present is to the ischial tuberosity the poorer the prognosis.
  • Most weekend warriors will not require an MRI for an acute hamstring strain but another predictor of poor prognosis found was the length of swelling upon MRI. The longer the area of swelling visualized on imaging likely indicates a longer return to play time frame.
  • These findings although relating to the professional footballer (soccer player) can arguably be applied to the weekend warrior. Notably the professional athlete may have both more resources and motivation to aid their return to play but these can be considered useful guidelines for the armature sportsman to help with estimating a safe return to play.

Return To Play In 23 Days

45% of athletes return to play in 23 days following sustaining a hamstring strain. Individuals variations will always exist and many variables come in to play such as pre injury status, adherence to any physiotherapy guided protocols… But it is nice to have a bench mark to aim for and the realization that with the majority of hamstring strains the sportsperson is likely to miss 2-3 matches based on having weekly games.

It is easy to see improving recovery times by just a few days could be the difference between missing only two matches verses three or more. In a short season every game missed through injury is significant so adherence to physiotherapy advice and protocols can help you play more matches during the season which is what being a weekend warrior is all about, getting out there and having a run.

Loading Over Stretching With Hamstring Strains

With hamstring strains rehabilitation programs based on exercises primarily involving high loads at long muscle-tendon lengths were found by Askling CM, et al to be the most effective at reducing the time to return to play.

The idea is that rehabilitation in a controlled graduated fashion should attempt to mirror the particular situation that lead to the injury. Where rehabilitation of acute hamstring injuries should build on attaining eccentric loading at long muscle lengths (the phase of contraction that occurs as the muscle lengthens is considered an eccentric contraction).

Eccentric loading and loading muscles towards their end of range can put strain on healthy tissue let alone muscle tissue recovering from injury so guidance with such rehabilitation techniques is crucial for successful outcomes.

Professionally Guided Management Makes The Difference

If you have sustained a hamstring strain having a physiotherapist assess your injury to help gauge a working return to play time frame and set up a rehabilitation protocol. Can help you return to play quicker and reduce the likelihood of any recurrence.

Reference: 2013 Acute hamstring injuries in Swedish elite football: a prospective randomised controlled clinical trial comparing two rehabilitation protocols. Askling CM, et al Br J Sports Med 2013.

Written by Hayden Latimer. Hayden’s practice is based in Sydney, he is the owner of Sydney Physio Clinic. Prior to opening https://www.sydneyphysioclinic.com.au/ Hayden has worked as a physiotherapist around the world for over 15 years.

How Do I Avoid Injury? Prevention Is Always Better Than A Cure

How Do I Avoid Injury

The new year has turned over and everyone is having a fresh start.

It’s the time of year most team sports are into pre-season training, new year resolution fitness regimes are taking off and excitement is high for new opportunity.

Players may be returning from long injury lay-offs, runners hitting the track following their Christmas holidays and of course cricket and tennis are in full swing.

This is also means it’s the time of year that a lot injuries occur!

Whether it’s an athlete returning to their sport or someone in the middle of a long season, I regularly get asked as a physio, ‘how do I best avoid injury’?

The answer to this involves a lot of factors but a great place to start is to identify your injury risks and preparing well for your sport.

Although accidents happen and we can never guarantee an injury won’t occur, what we do know is that different sports are more susceptible to different injuries due to their differing physical demands. For example, we tend to see overload injuries such as Achilles and Patella tendinopathies in runners and teenagers, shoulder impingements in swimmers, ankle sprains in jumping sports like basketball and netball, hamstring and groin strains in AFL footballers and of course the dreaded ACL injury with our Basketballers, Netballers and Footballers.

The good news is we know that the risk of a lot of these injuries occurring can be reduced by implementing preventative strengthening and improved neuromuscular control programs.
As mentioned above, a lot of sports are prone to the devastating ACL injury and given it’s long rehab and unfortunately low rate of return to previous level of sport amongst athletes who have undergone an ACL reconstruction, it’s become the ‘poster injury’ in sports medicine.

As research shows that 50%-70% of non-contact ACL injuries are preventable, this makes it a great example of how identifying your injury risks and implementing an injury prevention program can help you stay on the park longer.

If you’ve been listening to the news over the past few months or are just a keen sports fan you’d be well aware of the media attention and hype around the upcoming AFL Women’s, and also recently the Women’s Big Bash cricket taking off. You may have also heard or read about the conversation regarding the concern of a potential increased injury rate as these sports grow, and in particular, again, ACL injuries!

The reason for this concern is due to several reasons, as research has shown us who is most at risk and why.
We know through research that most at risk are girls aged between 14-18 and men aged 19-25, teenagers with recent growth spurts, previous ACL injury, athletes who are increasing their training load and the athlete who has increased their level of competition.

You can quickly see why these young girls, who are going from semi-professional footballers to elite AFL stars, are regarded as high risk for injuries!

Now although this attention has centred around our soon to be AFL idols, the caution for increased injury rates filters right down to our grassroots where participation numbers are on a rapid rise, particularly with our adolescent female footballers.

Continuing with our example of ACL risks, our research shows young females are at more risk of ACL injury compared to young males and this is thought to be due to a smaller attachment site of the ACL, increased hip angle which biomechanically increases loading through the knees and a decreased ratio of quads to hamstring strength. What this often results in is a decrease in control through the knee when jumping, landing, twisting and turning. The mechanism for ACL injury!

Now the point I’m making here isn’t that it’s all doom and gloom for adolescent female athletes, it’s how important efficient biomechanics and strong neuromuscular control are to avoid injury. Not just for ACL injury, but all injuries.

So what can we take away from this?

Whether you’re an elite athlete, weekend warrior or returning to the running track, we’re all susceptible to injuries but they can be prevented!

By identifying what injuries you’re likely to be exposed to and understanding your biomechanics, implementing an injury preventative program to improve biomechanics and neuromuscular control, you can reduce your chance of becoming another injury stat and improve performance.

Remember, Prevention is always better than a cure!

This post was written by Tristan Dower and originally appeared on vivaphysio.com

RISE: Our New Balance Rehabilitation Program

RISE 3

At Fresh Start Physiotherapy, we see all too often clients that present with injuries from falls, trips, stumbles and overbalancing.

As humans, if we experience something that shakes us up a bit, we have a tendency to lose confidence in our abilities and avoid tackling the problem head on.

Herein lies a problem.  If we become less mobile and less adventurous with our walking and daily activities, our body decreases its ability to respond the same way in those particular circumstances. We become less conditioned to moving, bending, twisting, balancing and our body’s response to overbalancing or a trip is significantly impaired.

The real question is “how do we fix this?”

Fresh Start Physiotherapy has a solution.

By becoming a participant in our program RISE, you will be taken through a series of tests to determine which of your body’s mechanisms are not responding at the optimum capacity in a 1:1 consultation. We can discuss your goals in relation to where you would like your body’s capacity to be.

Our program runs over a six week period, one hour per week for six consecutive weeks. The session involves two parts. Part 1 is a series of warm ups, balance exercises and stretches that are tailored to your individual needs over a 30 minute period.

Part 2 involves 30 minutes of education from a health care professional in relation to managing your balance issues with medications, footwear, set up of your home and others.

After your six week participation, we will take you through your initial tests and measure your improvement. You will then have the option to continue a further six weeks of progressed balance exercises to further improve your confidence and function.

Our goal is to restore your confidence in your body’s capabilities, reduce the fear of falling and get you back on your feet with a smile.

For more information, please make an appointment online by visiting freshstartphysio.com.au/book-now or call the clinic on (03) 4201 5074.

Sciatica: What You Need to Know

Pilates

Sciatica is commonly described as pain experienced mostly on one side of the body and runs down the buttock, hamstring and sometimes extends to the lower leg. Sciatica pain is normally caused by compression of the nerve that originates from your lower back. It can be triggered by joint inflammation, tight buttock, arthritic growth or locked facet joints.

Symptoms that are generally experienced are:

  • Pain in the lower back, buttock and back of leg
  • Pins and needles down the leg
  • Weakness and numbness of the leg or foot
  • Sharp pain when standing up

However, just because you tick most of the boxes above, you still may not have sciatica. Leg pain can be from various causes and sciatica is often misdiagnosed. Therefore, you should always get yourself diagnosed by a therapist who will take into consideration the findings from the physical examination and the history of symptoms.

Treatment

Sciatica is firstly managed conservatively with a combination of pain relief medications and physical therapy. The majority of people who experience sciatica get better within a few weeks or months with the right Physiotherapy treatment. If the symptoms do not improve your therapist might suggest surgery (only as a last resort). However, research has shown that long term benefits from surgery appear to be equivalent to the conservative care.
Research conducted in 2011 showed that the best results are seen by restoring normal flexibility, posture and strength through a directional bias exercise plan. Here, at Fresh Start Physio we treat our patients using the concept of Clinical Pilates which is a rehabilitation modality developed by Craig Phillips, Director of DMA (Dance Medicine Australia). Clinical Pilates is used to restore dynamic postural stability deficits following the directional bias concept.

This article was originally published on Wisdom Physiotherapy. It has been modified and re-published with permission.

References

Valat, JP; Genevay, S; Marty, M; Rozenberg, S; Koes, B (April 2010). “Sciatica.”. Best practice & research. Clinical rheumatology. 24 (2): 241–52. 

Markova, Tsvetio (2007). “Treatment of Acute Sciatica”. Am Fam Physician. 75 (1): 99–100.

Angela Dunsford, Saravana Kumar and Sarah Clarke. (2011). “Integrating evidence into practice: use of McKenzie-based treatment for mechanical low back pain”. J Multidiscip Healthc. 4: 393–402.

The Benefits Of Clinical Pilates

Girl Doing Clinical Pilates

As Physiotherapists, we often get asked what the difference is between Clinical Pilates classes and gym run classes. Although both versions use machines called reformers, that is where the similarities end.

Firstly…what actually is Pilates?

Pilates is a form of exercise targeted at improving your core strength, balance and stability. It focuses on building strength in your deeper layer of abdominal muscles, your deep supportive spinal muscles and your hip/pelvic musculature. The idea being that building a strong core foundation will allow your body to function at a higher capacity, improve your posture and reduce the incidence of lower back pain.

Clinical vs Gym/studio Pilates

The first major difference is that Clinical Pilates reformer classes are run by fully qualified Physiotherapists, not Pilates Instructors. This means that not only does your Instructor have 4 years of university training in anatomy, physiology and injury management, they are also trained in what is known as “clinical reasoning”. This means that they are fully qualified and highly trained to assess you and establish which particular type of exercise is suitable for your injury or condition, whether that be lower back pain, shoulder pain, a medical illness or pregnancy. Your Physiotherapist will also be able to modify your exercise program to account for flare ups or changes in your injury on a particular day or week. Hence, your Clinical Pilates program is specifically tailored to meet your needs.

The second major difference is the class size. Clinical Pilates classes are usually kept to a maximum of 3 or 4 people per group, ensuring that you receive adequate supervision and attention, in order to monitor technique and prevent injury. Gym classes often have 10-12 people in a class, sometimes up to 20! It is impossible for the instructor to monitor technique and also modify exercises for the individual. When using any piece of exercise machinery whether it be a reformer or gym machine, correct technique is essential otherwise injuries can occur. It can be very difficult to monitor each person closely in bigger class sizes, which is why classes are kept small.

Why should I do Clinical Pilates if I don’t have an injury?

You don’t need to have an injury to attend Clinical Pilates classes, many people attend classes to keep fit and healthy, enjoying the personalised attention that a small class size allows. It gives them the peace of mind to know that they are performing the exercises correctly under qualified supervision. Clinical Pilates improves core strength, changes your body shape, assists with posture and alignment, and provides a safe way to tone the whole body.

There can be the misconception that Clinical Pilates won’t be as challenging as a gym based reformer class. However, this is not the case at all. Programs can be as challenging as the individual requires and are always modified and progressed over time as your body adapts. It all comes back to the small class sizes, and therefore having the ability to individualise programs.

Written by Sally Maple. (Modified by Sophie H-M)

Physiotherapist and Director of Port Melbourne Physiotherapy & Pilates

 

Arthritis And My Hands: Can A Hand Physiotherapist Help?

Hand Physiotherapy

Hands are very important tools in our daily lives. We use them to dress, do housework, put food in our mouths, work to earn a crust, use them as part of our body language to express our emotions. However, when we have pain, stiffness, swelling and an altered appearance, our lives can become very challenging.

Arthritis is a term to describe over 100 forms of a condition where a person may experience symptoms including:

– Stiffness
– Inflammation
– Damage to the joint cartilage (tissue that covers the ends of bones)
– Swelling

These symptoms can result in deformity of the joints, joint weakness, joint instability and weakness of the surrounding tissues such as ligaments and tendons. So, enough of the doom and gloom.

Hand Physiotherapy Can Help You

A Hand Physiotherapist will be able to assess your hand function, including the range, stability and quality of your joint movement, the strength and length of all of the muscles in your hand and has the ability to order and view your x-ray when they are appropriate.

From here, your Hand Physiotherapist will be able to determine your key problems and discuss a tailored management plan with you.

Moderate Your Activities

Quite often, joints of the hand and wrist are overused with repetitive movement and become highly inflamed and very painful. Your Hand Physiotherapist can advise you of how to moderate your activities, so you can use your hands without experiencing these flare ups.

A Resting Splint

Sometimes, a joint may need a rest. A resting splint may be custom made to enable the joint to be protected from excessive movements if it is unstable, or rested if it is very inflamed and painful. Splints are a great way of managing your symptoms and protecting your joints.

Exercise

You may also require exercises for strengthening weak muscles of the hand and wrist, or you may require hands on treatment and exercises to optimise the movement of your joints. All of these factors will be thoroughly addressed by your Hand Physiotherapist during your consultation.

Finally, the word “management” is the key, when addressing arthritis. We can’t reverse the arthritic changes that have already occurred, but a Hand Physiotherapist is able to help you to slow down and further prevent joint destruction, reduce your pain, improve your strength and joint movement by providing you with a tailored hands on treatment program, home management program and information during your journey.

If you are experiencing pain or issues with your hands, it might be time to visit a physiotherapist who specialises in hand therapy.

References:
www.arthritisaustralia.com.au