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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 admin@getactivephysio.com.au...

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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, http://instagram.com/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 Get Active Physiotherapy on 1300 8 9 10 11 or email us at...

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Block/Board Bench Press

Posted on 12:43 pm in Uncategorized |

The bench press is one the best lifts to add upper body strength and mass, however many lifters struggle to do this exercise without experiencing any discomfort. If you experience pain when doing bench presses, try adding a block or a board to the chest next time you lift.     Most bench pressers who get discomfort do so at the bottom of the lift whether it be due to shoulder instability, lack of mobility or stability of the shoulder blades at end of range. By adding the board you limit the range of motion which will enable you to keep training the motor pattern whilst avoiding the aggravating portion of movement.     Of course it is imperative to address the underlying causes of your pain, however if you are keen to bench whilst following your rehab protocol, try this as a pain free and strength building move. If you don’t have access to the traditional board used by powerlifters you can use yoga blocks or half foam rollers (have your training partner stabilise this on your chest if they need to).   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 admin@getactivephysio.com.au                  ...

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Long Term Knee Pain

Posted on 11:10 am in Uncategorized |

Have you had a sore/weak knee ever since you can remember? Does it swell up occasionally when you go for a long walk or decide to up the antics with your level of exercise? Have you previously had a knee reconstruction years ago? Maybe your knee will never quite be as symmetrical or have the capability of allowing you to do a half marathon, but with treatment at Get Active Physiotherapy, we can help you achieve your fitness goals without chronic, ongoing knee pain and swelling.   The knee is a rather complex joint, consisting of both the tibiofemoral and patellofemoral joints. What is unique about the knee joint is that it provides the ability for the lower leg to move, relative to the thigh whilst supporting the body’s weight. This means that large joint compression and shear forces are at work whenever we walk, climb, swat, run or jump.     In the absence of ligament damage, which usually can occur after a specific trauma to the knee, there can be a global loss of strength and flexibility in the knee, which can progress with time. Depending on your exercise capacity, your knee may be stopping you from reaching your fitness/sporting/walking goals. When there is loss of knee function over many years, your brain will also start to favour your other leg, thus increasing the strength and flexibility discrepancy between each leg, causing more pain and discomfort. Arthritis is a bit of a throw-around term when it comes to the knee. Many people with ongoing knee discomfort into their 40’s and 50’s will generally have moderate arthritic changes appearing on a scan, but their pain levels and functional insufficiency will often not be a match for their degree of arthritic degeneration. In other words, while we cannot reverse the ageing degenerative process, optimising knee function through a graded and specific rehabilitation program can have tremendous results which may not have been thought possible.   What can Get Active Physiotherapy offer you?   Significant reduction in pain and swelling through massage, joint mobilisations, taping and other specific passive treatments. A tailored and graded exercise program that will incorporate strength, endurance and proprioception (the brain/knee connection which is vital for balance). Access to the fitness first gym during physiotherapy sessions which offers a huge range of exercise machines space to exercise and rehabilitate. Advice and education on how to maintain your stronger pain-free knee, and thus reducing rate of degeneration for years to come.   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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PEP Programme

Posted on 2:46 pm in Uncategorized |

Are you a football, rugby, AFL, or netball player? Or are you an avid spectator? If so, you have no doubt heard about Anterior Cruciate Ligament (ACL) injuries, and the impact it can have on players, coaches and fans of the beautiful game(s).   What is the PEP Programme?   The PEP programme stands for Prevent Injury and Enhance Performance Program. It consists of a warm up, stretching, strengthening, plyometrics, and sports specific agilities to address potential deficits in the strength and coordination of the stabilizing muscles around the knee joint. ACL injuries can be reduced by up to 70%, by the introduction of the PEP. The PEP programme not only decreases both first time ACL injuries, it also prevents the incidence of re-injury after ACL reconstruction surgery. It was developed at the Santa Monica Orthopaedic and Sports Medicine Research Foundation – and is now used worldwide (including here at Get Active Physiotherapy) to help prevent and/or rehabilitate injuries.     How does it work?   The program is designed to assist athletes with their strength and stability of the knee, stamina and balance, which in turn improves their overall performance as well. Technique is everything with the PEP and if performed correctly, guided by a physiotherapist, athletes can reduce their risk of ACL injuries. Adding plyometric exercises, such as jumping, and balance drills helps improve neuromuscular conditioning and muscular reactions which decrease the risk of ACL injury.   When is the best time for introducing this programme?   Research has indicated that introducing this routine in early adolescence, (from 11 onwards) helps individuals develop optimum movement patterns and behaviours of the knee, hip, ankle and trunk, that they then take through into adulthood.  We also know that the incidence of ACL injuries is higher in young people who have their first injury before the age of 21 years, therefore it is key to start them young!   How often and when should the PEP be performed?   The PEP programme should be completed 3 times a week and takes 15-20 minutes to complete, although it may take slightly longer initially until you become well acquainted with each of the exercises. I would encourage this programme to be preformed during pre season or 8 weeks prior to commencing your chosen sport. After a thorough assessment and your current physical functioning level has been identified, we will guide you through the PEP programme, facilitating you to the stage of full function, self management and a return to normal sporting activities.   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 admin@getactivephysio.com.au  ...

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