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Patella Tendinopathy

Posted on 3:03 pm in Uncategorized |

Do you have pain with running, jumping, lunges that you feel at the bottom of your kneecap? Patella tendinopathy, commonly referred to as ‘jumper’s knee’ due to the increased incidence in jumping sports i.e. basketball, netball, athletics, is a condition of deterioration and subsequent weakness and pain of your patella tendon. Tendons are thick elastic tissues that connect muscle to bone. Unlike muscles, tendons have very little blood supply, meaning that the nutrients and ‘healing’ mediators that are in our blood are not very evident in our tendons. Due to this property of tendons, they are not very good at healing. In this way, continuing to exercise through pain in the hope that it will sort itself out in time is often an unlikely occurrence. The body is an incredible system that is very good at self-healing and regeneration, but tendon tissue react and heal differently, thus needing a different approach.     Clinical Symptoms   localised pain at the base of the knee-cap (patella) pain initially with exercise (such as running, lunges), which then warms up and is less painful, only to become painful when exercise is finished, or notably the next morning after exercising that previous day Can appear puffy and swollen at the base of knee cap tender to touch, or to kneel on ground pain walking downhill, or down stairs more than uphill or up stairs   Causes   The biggest pre-disposing factor to developing tendon injuries is a relatively sudden increase in load, i.e. increased volume or frequency or exercise from a previously less intense regime/nil exercise. The other causes are often strength and flexibility imbalances in the rest of the leg or the non-symptomatic leg. The longer you have had your symptoms for generally means the longer it will take to completely heal. A person who has had persistent pain for the first time can take between 3-6 months to reach a full recovery. If you have had the pain intermittently for over 6 months, then it can take up to 12 months. This is probably the most frustrating element of patella tendinopathy, but the sooner you start, the sooner you will be on the road to recovery.   How Do We Fix It?   There is a considerable amount of quality evidence suggesting that a loaded and customised strength program, which we can take you through here at Get Active Physiotherapy, is an effective intervention to a full pain-free return to activity or sport. It is important to note the slower healing time for tendon injuries. Volume modification of exercise/sport is a huge component of management with this injury, and thus a thorough understanding of how much is too much will be explained to you by your physiotherapist. Leveling out any biomechanical abnormalities or asymmetries will be a key focus within your recovery plan, and this will reduce likelihood of developing other injuries in different areas in the future. Remember, the longer you have had this pain for, the longer it may take to heal, so book your initial appointment today and feel the difference tomorrow.   If you have any questions or would like to address any running issues or injuries you may have, book in to see one of our physiotherapists. Please do not hesitate to contact Get Active Physiotherapy on 1300...

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Running and Physiotherapy 

Posted on 1:09 pm in Uncategorized |

Running is one of the most common forms of recreational exercise currently performed by Australians. It is cheap, time-efficient with no specialist equipment required. You may run home from work, go to the local oval and do laps, or running could even be your way of “switching off” and relaxing. Whatever your reason for running and wherever you do it, it is important to understand some basic principles which could significantly reduce your risk of injury.     Capacity & Load Management   Everyone has a capacity that their body can deal with when it comes to any task. You wouldn’t try and lift a 100kg bench press if your previous best was 60kg. Similarly, it is not appropriate to attempt to run 20 km’s when last week you struggled with a slow 5 km run. If our bodies/body parts can’t deal with the load that we put on them, we are more likely to get injured and be in pain as we exceed the capacity we can deal with. A gradual increase in load is important to minimise the risk of injury.   Dispelling a Myth   Around 80% of runners land with a heel-strike pattern. You may have heard this is wrong and a forefoot strike is better for you and less likely to result in injury. Both forms of strike can be acceptable, depending on your running style and injury history. For some current or previous injuries forefoot strike can actually aggravate your symptoms. Either way, it’s really important to get assessed to find out which style is the most appropriate for you.   Reasons For Injury Due To Running   There are many factors that influence a running style. There are, therefore, many reasons why we might get injured with running. Common reasons include overstriding with each step, being too stiff during the strike phase, too much ankle dorsiflexion in a number of positions during the running cycle and poor proximal control and stability. These are but a few of the reasons we may get injured with running.   Physiotherapy & Running Retraining   Physiotherapists can be excellent clinicians at identifying the reasons you are getting injured with running. At Get Active Physiotherapy we perform a thorough assessment that will get to the bottom of your running injury. The assessment is split in to two parts. Firstly, a detailed assessment of the function of multiple body parts in isolation, combined with functional movements, identifies any weakness or restriction you may have. Secondly, a treadmill running assessment focusing on your running style, this is to identify any potential harmful mechanics. Cues are then given to retrain the body and running style. Specific exercises are also given to overcome any issues identified in the assessment and get you back on track (pun intended!).   If you have any questions or would like to address any running issues or injuries you may have, book in to see one of our physiotherapists. Please do not hesitate to contact Get Active Physiotherapy on 1300 8 9 10 11 or email us at

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Should You Go Under the Knife?

Posted on 12:45 pm in Uncategorized |

  So you’ve been dealing with extreme pain for quite a while now, maybe in your knees or in your lower back and medication is not providing the same sort of pain relief that they once did. You go to your doctor, desperate for a solution. “Let’s investigate further, get some scans” they may  suggest. You go for said scans and the results are not good, the outlook is terrible. The report reads something like a doomsday letter – “massive eruption of tendon”, or “extreme protrusion of sac on nerves” or “end stage degenerative joint disease”. Your doctor reads the report as your palms begin to sweat. “Ah this is why you are in so much pain” they exclaim. Straight to the orthopaedic surgeon! A few days later you walk through the doors of the lush clinical orthopaedic surgery ready for going under the knife.     Is It Necessary?   It has been long known that scans show a lot of things which may not be the cause of your pain, especially when your pain is chronic. Evidence shows that MRI results are a poor way to find the cause of chronic pain, furthermore they can actually lead to worse outcomes than if they had not been done at all. Why is this so? Studies show that almost no matter which area of the body goes under, there is a high percentage that you will find something wrong even in parts that don’t give you pain.   Recent evidence is now showing that many of the surgeries that have been used for a long time to correct the anatomical deficits found in scans to be useless. Take for example knee osteoarthritis. Knee osteoarthritis is very common and in even the worst cases does not always result in pain. One study was conducted where real knee surgery was performed versus sham surgery where the surgeons would just create an incision in the skin. The study was conducted over a few years where subjects would report their function and to no surprise, both groups reported equally better knee pain and function at all points in time. This strongly suggests that surgery may not be effective due to the structural changes made but by the change in psychology of the person who had the surgery. Subsequent research has also proved that surgeries for the knee for osteoarthritis are no more effective than interventions such as physiotherapy, exercise, weight loss and over the counter medicine.   Not all surgeries are useless but some are. Sometimes a well designed rehab solution is what is needed to keep you from being on that surgeons table.   If you have any questions or would like to book in to see one of our physiotherapists, please do not hesitate to contact Get Active Physiotherapy on 1300 8 9 10 11 or email us at...

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Achilles Tendinopathy

Posted on 2:06 pm in Uncategorized |

  Achilles tendinopathy is a common, yet potentially debilitating injury in which load can be both anabolic and catabolic (Cook and Purdam., 2008). There are multiple contributing factors to Achilles tendinopathy and rehabilitation can often be difficult and prolonged (Kountouris and Cook., 2007).       Diagnostic criteria for Achilles tendinopathy   When diagnosing Achilles tendinopathy, the main diagnostic criteria is patient history and pain on palpation over the tendon (Maffulli, Kenward, Testa, Capasso, Regine and King, 2003). Cook, Khan and Purdam (2002) suggest that Achilles tendinopathy results in local pain over the Achilles tendon and does not refer elsewhere. The other diagnostic criteria are direct relationship between worsening of symptoms and increase in training load and load related pain (Cook, Khan and Purdam., 2002). Gymnastics is an example of a sport which puts individuals in a high-risk category for Achilles tendinopathy with incidence as high at 17.5% due to the excessive plantarflexion and high recoil aspects of this sport (Emerson, Morrisey, Perry and Jalan., 2010). If a patient has an isolated location of pain over the mid-portion of the tendon, this decreases the likelihood of differential diagnoses such as sever’s disease, avulsion fracture of the calcaneus or insertional tendinopathy (Adirim & Cheng., 2003). Gradual onset of symptoms that warm up 5-10 minutes into training, stiffness during exercises and decreased function/muscular endurance of the calf are also characteristic of a tendinopathy (Joyce and Lewindon., 2016).   Causative factors of Achilles Tendinopathy   It is now widely documented that the causes of Achilles tendinopathy are not well-known and diagnosis may be complicated due to close proximity of numerous other soft tissue structures (Hutchison et al., 2012; Kader, Saxena, Movin & Maffulli, 2002). Causative factors include both extrinsic factors such as training load and potentially poor technique and intrinsic factors such as family history, collagen make-up, muscle/tendon strength, biomechanics and previous injury history (Abate et al., 2009).   Training load/repetitive stretch-shortening cycles   Increased training volume that coincides with onset of symptoms is one of the biggest predictive factors for developing a tendinopathy (Cook, Khan and Purdam., 2002; Clement, Taunton and Smart., 1984; Abate, Gravare-Silbernagel, Siljeholm, Di Iorio, De Amicis, Salini, Werner and Paganelli 2009; Joyce and Lewindon., 2016). For example, Gymnastics and trampoline require high levels of repetitive, explosive/plyometric loads with up to 6-8x body weight being absorbed in running, hopping and jumping (Malliaris and O’Neill., 2017). When the tendon is overloaded there is a breakdown of the quality of tissues within the tendon which causes inflammation and degeneration (Notarnicola, Maccagnano, Di Leo, Tafuri and Moretti., 2014). Repeated loading through an injured tendon results in micro-ruptures occurring due to the breakdown of cross-links by collagen fibres sliding past one another (Abate et al., 2009). This cumulative micro-trauma leads to a change in ground substance, collagen disarray and increased vascularity which therefore decreases tensile strength (Abate et al., 2009; Brukner and Kahn., 2007). Type 1 collagen fibres, which make up normal tendons, are often replaced with Type 3 collagen in injured tendons which makes the tendon weaker due to a decreased volume of cross-links between and within the tropo-collagen units (Kader, Saxena, Movin and Maffuli., 2002).   Biomechanics/Strength & Stability   Sports such as gymnastics require a large amount of controlled jumping and landing and therefore a high level of functional motor control for these...

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Common Causes & Treatments For Hand Injuries

Posted on 1:26 pm in Uncategorized |

The hand is one of many complex structures in our body. Given the importance of our hands and their role in facilitating our everyday tasks and activities, it is essential to have your injury or symptoms addressed at the onset of your symptoms.   This article will briefly outline some of the common presentations and give a brief description of how to manage them. It is important to seek the advice and assessment of a Hand Physiotherapist to ensure you are receiving the highest level of care. Firstly, if we take a look at the wrist, it contains many small bones neatly joined together by ligaments. This area is commonly referred to as the Carpus. The other end of the carpus is where our finger and thumb bones join, our metacarpals and the ends of our fingers called phalanges. Our thumb contains a proximal and distal phalanx, and the 2nd to 5th digits contain a proximal, middle and distal phalanx. Each joint of the hand shares ligaments that help maintain the stability of the joint by connecting two bones together. The joints between our metacarpals and phalanges are call metacarpal-phalangeal joints (MCPJs) and the joints between our phalanges are called proximal interphalangeal joints (PIPs) and distal inter-phalangeal joints (DIPs). We have a number of tendons and muscles that either traverse the top or bottom of the wrist and or digits and accompanying these are nerves and blood vessels. When we look at types of injury, we can very loosely divide them into two categories; a traumatic presentation and an overuse condition. Typically with traumatic injury, we generally feel symptoms immediately and generally, these symptoms immediately follow a particular movement or mechanism of injury. An overuse injury, refers to symptoms that have developed over a period of time, whether the symptoms stay the same or gradually change. One common mechanism of injury for the wrist is falling on an outstretched hand. This is a common occurrence out on the football field, tripping over when walking or coming off a bike. Structures that are commonly injured around the wrist include: a fracture of the distal radius / ulna scaphoid fracture scapho-lunate ligament tear / / scapho-lunate dissociation (separation) Triangulo-fibrocartilaginous complex tear (TFCC) Each of these structures will require a period of immobilisation in a particular position prior to commencing rehabilitation to restore movement and strength to the hand and wrist. Wrist pain can also occur after repeating a movement for a prolonged period of time, or vigorous repetitions with force. Some of the conditions that can occur include: Carpal Tunnel Syndrome De Quervain’s Tenosynovitis Intersection Syndrome Tenosynovitis or synovitis of the extensor or flexor tendons at the level of the wrist and forearm Management of these conditions would typically involve splinting into a specific position for a period of time with regular tendon gliding exercises, icing of the affected area. Once the symptoms have begun to subside, weaning from the splint is introduced and gradual strengthening and movement exercises are prescribed. When we look at common traumatic injuries to the thumb and digits, the following presentations come to mind: fractures of the metacarpals and phalanges dislocations of the PIP and DIP joints (most commonly) collateral ligament tears to the base of the thumb (MCP joint), PIP joints of the thumb and...

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Biceps Tendinopathy: What, How & What To Do Going Forward

Posted on 1:02 pm in Uncategorized |

So you’ve been training at the gym for a while now and the numbers on your lifts have been steadily increasing, however you’ve been noticing for last 4-6 weeks that the slight niggle at the front of your shoulder is starting to bother you more and more. Not just while you are training, but sometimes when you try to put your jacket on or when you roll over your shoulder in bed. Alternatively, you may not go to the gym at all. You did that one thing on the weekend – carrying groceries, lifting a heavy couch up the stairs – and that ache just isn’t going away. So what could it be?     Tendinopathies   Tendon pathologies are very common and are probably one the most frequent things we see in the clinic. Tendons are the fibrous tissues that connect muscle to the bone and function to transmit force that facilitates movement around a joint and also absorbs force to limit muscle damage or produce torque. They are composed primarily of water and collagen and their mechanical properties vary depending on the type of stress which is applied to them. Tendon pathologies are thought to occur on a continuum where tendons undergo three distinct phases: Reactive tendinopathy: an acute reversible process, brought about by an increase in mechanical loading Tendon Disrepair: if loading continues to exceed the tendon’s capacity to regenerate for a prolonged period of time, the tendon matrix begins to breakdown and growth of neural and vascular begin to pervade the tendon space Degenerative tendinopathy: further collagen breakdown, advanced matrix breakdown and increased fibre thickness. Once the tendon has reached this state there is very limited ability for the tendon to repair itself. This process is often brought on by increased volume of work on the tendon, be it one supra maximal load or continuous insults to the tendon which are below its threshold but accumulate over a short period of time leading to the reactive tendinopathy. The biceps tendon, particularly the long head of biceps (LHB) has been shown to function as a humeral head depressor/stabiliser of the shoulder joint and research shows that if the rotator cuff loses its integrity (via a tear or strain) the activity of the LHB increases, and superior migration of the humerus may concomitantly occur. This further stresses the soft tissue and the compressive force on the tendon increases. This can be particularly evident when we put the arm in extension (e.g. hand behind the back) or with the arm in abducted and externally rotated positions (high five position). Furthermore, biceps tendinopathy is rarely seen in isolation but commonly exists with other shoulder pathologies such as rotator cuff tears/strains, SLAP lesions and instability.   Biceps Tendinopathy Treatment   If you think you have a biceps tendinopathy, the most important factor in determining the course of treatment is finding the cause. The cause may be increased load, incorrect loading, faulty mechanics at the shoulder or all of the above Altering external stress to below provocative loads is an important first step. Correcting scapular kinematics which may be contributing to the faulty load is also important for preventing future recurrence of the tendon pathology. For example, if there is increased anterior tilt of the scapula there is a decrease in...

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Glute Activation Test

Posted on 11:02 am in Uncategorized |

Take a look at our Instagram post, where Jasper takes us through the Gluteal Activation Test with hip extension! Gluteal activation test with hip extension. . . This is a nice and simple test to see whether your gluteal muscles are firing and activating when they should be. Here, we can feel and compare the timing of contraction between your lower back muscles, gluteals and hamstrings. As the patient extends their hip without bending the knee, a desirable result is that the gluteal muscles activate first/no later than the hamstrings or lumbar muscles. The lumbar muscles for for spinal stabilisation (not heavy lifting or bending) and the hamstrings are predominately for flexing the knee, but the long head of biceps femoris does aid in hip extension. . . There can be multiple reasons why your gluteals may not be firing. Some reasons include having a ‘sway’ posture, can be from a history/time-frame of general inactivity and then sudden load, or could be muscle inhibition from lower back pain. Regardless of what the reason is, having glutes that activate immediately when we extend our hip is vital for knee, hip and ankle control, to protect our lower backs from excessive loads with training and bending, and to offload other smaller muscles (like the calf) down the leg so they don’t have to overwork and lead to injury. . . If you are experiencing back pain, or pain in your legs and you're not sure why, don't wait and come to Get Active Physiotherapy for an assessment today as it could be your underperforming bottom that is a primary driver of your condition! A post shared by Get Active Physiotherapy (@getactivephysiotherapy) on Jul 19, 2017 at 6:42pm PDT Don’t forget to follow us on Instagram, @getactivephysiotherapy and if you have any questions or would like to book in to see one of our physiotherapists, please do not hesitate to contact us on 1300 8 9 10 11 or email us at...

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Assessing The SIJ

Posted on 11:13 am in Uncategorized |

Take a look at our Instagram post where Tom takes us through the Stork Test, a tool to assess the SIJ, which can play a large role in contributing to lower back pain. 85% of the western population will suffer low back pain at some point in their life. 18-30% of cases of persistent low back pain have the SIJ as a pain generator. . . The Stork Test is one of a number of tests to assess the sacroiliac joint (SIJ), the articulation between the spine and the innominates bones. It has two phases; the hip flexion phase and the stance phase. The hip flexion phase assesses joint mobility, whereas the stance phase assesses the ability to maintain the closed-pack joint position in weight bearing. . . Let's say we are assessing the right Stork Test, the patient faces away and the therapist placing one thumb on the right PSIS and then placing the other thumb on the spine level with the PSIS, usually S2. . . The right hip flexion phase is performed by asking the patient to stand on the left leg and flex the right hip and knee. The right PSIS should move inferiority and the innominate rotates posteriorly. A positive test is if there is no relative motion between the PSIS and S2 or if superior motion. . . The right Stork Test support phase is performed by asking the patient to stand on the right leg and flex the left hip and knee. The therapist continues to palmate the relative motion between the right PSIS and S2. There should be no palpable movement or slight inferior motion of the right PSIS. A positive test is if the right PSIS rotates anteriorly. A post shared by Get Active Physiotherapy (@getactivephysiotherapy) on Jun 26, 2017 at 10:24pm PDT Don’t forget to follow us on Instagram, @getactivephysiotherapy and if you have any questions or would like to book in to see one of our physiotherapists, please do not hesitate to contact us on 1300 8 9 10 11 or email us at...

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Dry Needling: Benefits, Effects & When To Use

Posted on 12:08 pm in Uncategorized |

How does Dry Needling work?   Dry needling is a technique of inactivating trigger points through insertion of a needle into a tight band of muscle until a twitch response occurs. Trigger points are a common symptom of myofascial pain and are defined as a point within a taut/tight band of muscle that is tender/sore to touch. A trigger point can cause pain, weakness, range restriction and/or other symptoms at both its location and can refer pain to other regions within the body. Your physiotherapist can identify these trigger points for you in the clinic.   What are the benefits and effects of Dry Needling?   Decreased muscle spasm and improved range of motion of muscles/joints Reduce pain Resolvement of radicular symptoms (e.g. sciatica and referred pain down leg/arm) Better recruitment and activation of appropriate muscles Improved muscle activation patterns (Meaning you can lift more weight in the gym/increase speed/improve performance!) Central Nervous system response at the level of the dry needling Alteration in chemical balance within the muscle (this can decrease sensations of pain and reduces muscular dysfunction) Relief of both acute and chronic pain Promote healing at the area of the injury Better relaxation/switching off in tight muscles   What causes Trigger Points?   Trigger points are commonly present when you are in pain due to muscles being tight or joints not moving properly: – Caffeine – Muscle dysfunction – Muscle overload – Stress – Lack of sleep – Excessive exercise/over training     What is the difference between trigger point release with dry needling vs with a therapist’s thumbs?   Dry needling allows a therapist to be more specific with their treatment of trigger points and also allows easier access to trigger points which are located in deep muscles. However, some of the effects of dry needling can be achieved through hands-on therapy by the practitioner. Both of these treatments have beneficial effects on pain and joint range of motion   What disorders can have dry needling performed on them?   Any issue that a Physiotherapist is seeing you for can be treated with dry needling technique – ask your Physiotherapist about it today!   If you have any questions or would like to book in to see one of our physiotherapists, please do not hesitate to contact Get Active Physiotherapy on 1300 8 9 10 11 or email us at

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Pronation Taping Technique

Posted on 1:58 pm in Uncategorized |

Take a look at our Instagram post, where Brendan guides us through taping for pronation control. This taping technique may help reduce pronation by not only providing some structural support to the arch but also buy proprioceptively cuing the wearer to control their own foot posture. It can be useful in treating patients with a wide variety of lower limb conditions including plantar fasciopathy, shin splints, achilles tendinopathy, tibialis posterior tendinopathy, patello-femoral pain and list goes on. . . This technique can be used for short term pain relief but is not a substitute for strengthening of foot calf an hips, biomechanical retraining, appropriate footwear and if appropriate custom orthotics. . . Tip: using the white hypafix underneath increases adhesion and reduces skin irritation. . . #plantarfasciopathy #shinsplints #footpain #achillestendinopathy #tibposttendinopathy #runninginjuries #patellofemoralpain #runnersknee #getactivephysio #getactive #stleonards A post shared by Get Active Physiotherapy (@getactivephysiotherapy) on Jun 21, 2017 at 4:12pm PDT Don’t forget to follow us on Instagram, and if you have any questions or would like to book in to see one of our physiotherapists, please do not hesitate to contact Get Active Physiotherapy on 1300 8 9 10 11 or email us at...

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