While it’s outside of the scope of my practice as a sports physio to prescribe medication, as rehabilitation and pain specialists, physiotherapists regularly prescribe exercise to maximise recovery for our patients.
But why do physiotherapists do that? Aren’t they supposed to take care of everything during the consultation at the clinic?
Compliance with home exercises throughout a patient’s rehab is one of the most important indicators of rehab success. Many patients find it hard to stay consistent with a home exercise program because of their work, family, and school commitments.
But now that we’re all at home, there’s plenty of time to make sure we’re all doing what we need to in order to recover from those injuries.
Why are home exercises so important?
Creating a bespoke home exercise program (HEP) to patients is one of the fundamental aspects of great physiotherapy. Research has shown that patients who follow their prescribed exercises are significantly better at achieving their goals and demonstrate a greater increase in physical function.1
Exercise at home is designed by your physio to continue the progress made at the clinic. By working on things like increasing your flexibility and stamina at home, home exercise programs allow you to increase function and improve muscle memory so that progress is actually gained instead of lost between visits.
To recover from an injury, developing an exercise routine is one of the most important things you can do.
Here are just a few reasons why sticking to your physio created HEP is important:
- Home exercises are specifically designed to improve muscle memory
- Research shows that patients who comply with their HEP are more likely to reach their rehab goals like pain reduction and physical movement
- Home exercises can be the beginning of a new active lifestyle
- Home exercise compliance helps prevent recurring injury and flare-ups
How often do you do your homework?
If you answered rarely, you’re like most Australians. Research shows that up to 65% of people don’t complete their home exercise programs! Instead of detention though, it could be long term pain or lack of movement you’re risking.
While our in-clinic treatment is designed to decrease pain and improve mobility, without strengthening or improving flexibility consistently, your condition won’t improve.
Your Fixio home exercise program is personalised for your needs
When our Fixio physiotherapists implement a home exercise program for you, the exercises are tailored to each individual. Even when two people have the same injury, the requirements of each person’s body is different and is influenced by their individual history.
For example, two people with the same rotator cuff injury may not have the same HEP due to a previous injury or muscular impairment. Individual history like this dictates the type of exercises– whether they are stretches, strength training or endurance training.
With a personalised approach, patients enjoy quicker recovery times and reduced chances of recurrence. As you gradually recover, your Fixio physio will assess your HEP and increase or change your program with your tolerance, so that your pain does not increase.
At Fixio Physiotherapy, your sports physio or musculoskeletal physio will work closely with you to provide a repeatable, realistic and trackable home exercise program. Whether you want to spend 10 minutes a day through to hours on end, your physiotherapist will develop a home exercise program that is not only beneficial but realistic to complete.
If you have any questions about your home exercise program and what it contributes to your recovery talk to your physio. Education and understanding are crucial to making sure your experience throughout recovery is positive and effective. Call us today or book online for a consultation to ensure you are doing the best exercises as part of your rehabilitation.
In previous blogs we’ve looked at some of the physical, psychological and social benefits that playing a team sport can have on children. Today we’re going to be looking specifically at Australian Rules Football (we’ll just call it AFL for ease of reading from here on in!) and some of the great effects it can have on kids’ physical and social development. As AFL continues to grow in NSW, so does physiotherapists’, Doctors’, psychologists’ and education expert’s knowledge of how AFL and other ball sports positively affect children and their development into young adults. Unfortunately my love of AFL can only be channelled through being able to support the physical needs of players and unashamedly cheering on the GWS Giants from the stands. Us sports physiotherapists aren’t much help to others when we’re injured, and I seem to be a target for big hits and big injuries (ask me any time about the number of surgeries I’ve been through).
This year I am going to be sponsoring the Balgowlah Suns Junior AFL Club and helping kids and parents to get a sports physiotherapists view of the biomechanics, preparation and recovery that go into every game. When prepared for properly, AFL is one of the safest sports children can play, with less physical contact than rugby league, more hand to eye co-ordination skills and more aerobic fitness. Getting kids into safe and fun sports is essential in combating childhood obesity and improving social development skills.
What are the physical benefits of AFL and programs like Auskick?
Children learn a variety of fundamental and advanced gross motor skills from kicking, handballing, catching, running, jumping and evading that will benefit them for future physical development and sports participation. Through regular training, children are also learning the basics of fitness conditioning and the basic principles and importance of health and nutrition.
- Improved physical fitness
- Increased hand-eye coordination
- Better aerobic capacity
- Strengthening muscles and bones
How does AFL improve psychological and social skills?
Children who play physically active team sports are more attentive, have a more efficient memory, enhanced creativity, better learning adaptability and problem solving and attitude regulations abilities. AFL Juniors have to make rapid and complex decisions during the game while remembering certain structures of play and achieving pre-defined goals. This allows children to adapt to a variety of situations off the field more efficiently with the neuroplasticity of the brain creating new neural pathways at an astonishing speed in young kid’s brains. Yes, you read that correctly, football gameplay learning makes kids more adaptable. There’s more good news though.
Children who participate in team sports develop important social skills, a sense of belonging and camaraderie much faster than kids who don’t. The President of the International Council for Sport Science and Physical Education, Professor Margaret Talbot once stated ‘Sports and other challenging physical activities are distinctively powerful ways of helping young people learn to ‘be themselves’. These benefits flow positively through children’s lives and the broader community is better for it too.
- Better communication skills
- Fosters a sense of self belief
- Improves concentration and cognitive function
- Increases teamwork skills
- Builds a sense of mateship/belonging
- Make a ton of new friends
Good preparation and recovery is vital
Preparation and recovery is much more than hitting the carbs the night before and a bottle of powerade in the morning (more on why you shouldn’t dose your kids with powerade in a following article). It is important to stay hydrated leading up to and on the day of the game and eating a balanced, nutritional diet is going to help keep kids fuelled up for the big game. Complete a warm up and cool down including stretching, slow jogging and running activities, with and without the football to minimise the risk of muscular and joint injuries.
Get a musculoskeletal screening test
Wouldn’t it be cool to be able to see into the future and prevent an injury before it happened? Musculoskeletal screening tests aren’t quite looking into a crystal ball, but they are becoming increasingly backed up by numbers and science. Do you think the pros step out onto the pitch and just hope that their body has it in it that day? They have an entire team of physiotherapists, sports scientists and strength and conditioning experts monitoring every step that they take. Musculoskeletal physiotherapists test a range of movements and take measurements to create a physical profile that will identify areas that may be more susceptible to an injury. Musculoskeletal screening tests have been shown to be an accurate and reliable indicator of specific injuries in AFL players. Finding a Dee Why sports physiotherapy expert is crucial to ensuring any musculoskeletal screening tests are comprehensive and accurate, otherwise you may actually be putting yourself or your child at risk of suffering an injury.
AFL is an all round awesome sport for children to help grow and adapt so many skills that are going to benefit them in later life, not to mention they get a real kick out of it! If you have any questions about all sports physiotherapy or musculoskeletal screening tests for AFL or other sports, get in touch with us.
 Erwin H, Fedewa A, Beighle A, Ahn S. A Quantitative Review of Physical Activity, Health, and Learning Outcomes Associated With Classroom-Based Physical Activity Interventions. Journal of Applied School Psychology. 2012;28(1):14–36.
 Reliability of common lower extremity musculoskeletal screening tests Belinda J. Gabbea, Bennellb, Wajswelnerc, Finch. Physical Therapy in Sport 5 (2004) 90–97
Photo: High five mum by Mike Hauser (2008) https://flickr.com/photos/35314767
What is frozen shoulder?
Frozen shoulder is a painful condition known by many names –
- Adhesive Capsulitis – even though it’s not associated with capsular adhesions
- Idiopathic frozen shoulder
- Periarthritis Scapulohumeralis
But no matter what label is put on it, shoulder guru Ernest Codman got it right way back in 1934 when he first described frozen shoulder as being “difficult to define, difficult to treat and difficult to explain from the point of view of pathology”.
If the body wasn’t already stiff and sore enough already as we get older, frozen shoulder most commonly affects people in their 50s and is a prime culprit for limiting daily activities and disturbing sleep. It is a rare diagnosis before the age of 35 years and is unusual in patients over 70 years, with women marginally more affected than men.
What does frozen shoulder feel like?
Frozen shoulder is characterised by a number of symptoms that can vary between each individual patient, but normally including a mix and match of:
- Shoulder stiffness
- Shoulder pain in the deltoid insertion area
- Pain during the night pain that may wake you from sleep
- An inability to lie on the affected side
- Restriction of active movement and external rotation of the shoulder
- Pain that radiates down the arm
The onset of frozen shoulder is usually gradual and can be brushed off as a general ache or pain before developing rapidly over a day or two.
How long does frozen shoulder last?
The pain from frozen shoulder has been observed as passing through three distinct phases.
- Phase 1 or Freezing: 2–9 months – The painful phase, with progressive stiffening and increasing pain during movement
- Phase 2 or Frozen: 4–12 months – The joint stiffening phase, where there can be a slight reduction in pain but increase in stiffness and restriction in range of motion
- Phase 3 or Thawing: 12–42 months – The regaining mobility phase, where with physiotherapy treatment there is improvement in range of motion and resolution of stiffness
Can physiotherapy fix frozen shoulder?
Physiotherapy has been shown to be an effective supporting treatment for frozen shoulder, speeding up recovery, improving mobility and decreasing pain levels. A Fixio sports physio can assess your shoulder and use several methods to increase movement and decrease pain.
The goals of your treatment will depend on what stage of frozen shoulder you are currently in. These could be a mix of:
- Relieving pain
- Increasing arm movement
- Reducing the duration of symptoms
- Returning to normal activities
Regardless of treatment, studies have shown that patient success is directly influenced by the amount of knowledge they have about their frozen shoulder condition. At Fixio, we believe that patient education is essential to managing your recovery.
What to remember about frozen shoulder:
- At first, the pain will be your main problem: worse in bed, especially if lying on that side
- The pain slowly eases, but stiffness then increases, becoming the main problem,
- The whole process could last from a few months to two to three years without treatment
- Using your arm will not do you any harm, but avoid doing too much
- The treatment options are most effective depend on your circumstances; discuss treatment with your sports physio or musculoskeletal physio based on your needs
If you’ve got questions, Sports and musculoskeletal physios are experts in injuries, movements and activities related to sport, work and the day to day activities that were aggravating your shoulder so that you can get back to what you were doing before the pain.
 Maund E et al. Management of frozen shoulder: a systematic review and cost-effectiveness analysis. Health Technol Assess 2012; 16: 1-264
 Codman EA. Arthritis, periarthritis, and bursitis of the shoulder joint. In: The shoulder. Boston: Thomas Todd Co; 1934. p. 216e24.
 Hand GC, Athanasou NA, Matthews T, Carr AJ. The pathology of frozen shoulder. J Bone Joint Surg Br 2007;89B:928–32.
 Dias R et al. Frozen shoulder. BMJ 2005; 331: 1453-6.
 Dias R, Cutts S, Massoud S. Frozen shoulder. BMJ 2005;331:1453–6.
 Jones S, Hanchard N, Hamilton S, Rangan A. A qualitative study of patients’ perceptions and priorities when living with primary frozen shoulder. BMJ Open 2013;3:e003452. doi: 10.1136/bmjopen-2013-003452. pmid:24078753.
With literally thousands of physiotherapists now at your fingertips and an infinite number of Google options to choose from, how do you know if the Dee Why physio you choose is appropriately qualified to treat your specific condition? Anyone who can legally call themselves a physiotherapist has studied for 4 years at university, covering multiple areas of practice including: Musculoskeletal injuries and conditions (joints, muscles, bones, tendons and ligaments,) Neurology (spinal cord and brain injuries) Cardio-respiratory conditions (heart and lungs) Paediatric issues (children). Fresh out of uni you could say a physio is a jack of all trades, but a master of none. It is after admission as a fully fledged physiotherapist that we can really delve into the more specific and advanced areas of practice and hone our skills to become experts in our field.
What is a Titled Physiotherapist?
If you think of a regular physiotherapist as a General Practitioner, a Titled Physiotherapist is the equivalent of a specialist. The Australian Physiotherapy Association (APA) defines a Titled Physio as “highly qualified physiotherapist with expert knowledge and skills”. That’s putting it pretty lightly. To be eligible to call yourself a “Titled Musculoskeletal Physiotherapist” you need to do your 4 years Bachelor of Applied Science (Physiotherapy), complete a 2 year Masters of Musculoskeletal Physiotherapy (making a substantial contribution to the field academically) followed by a minimum of 2 years full time clinical experience dealing primarily with musculoskeletal conditions. That’s nearly a decade of study right there.
What are the common areas of Titled Physiotherapy?
- Sports medicine
- Animal physiotherapy
- Musculoskeletal physiotherapy
- Neurological physiotherapy
- Gerontological physiotherapy
- Cardio respiratory physiotherapy
- Occupational Health and Safety
- Continence and Women’s Health
What does a musculoskeletal physio specialise in?
Musculoskeletal Physiotherapists have expertise in the treatment of muscular and joint conditions. These rockstars have a comprehensive knowledge of anatomy, physiology, pathology, injury assessment and utilise up to date evidence based approaches to treating spinal and joint injuries. Musculoskeletal Physiotherapists are the experts in assessing the structures, contributing factors and mechanics causing your pain. Think of them as the pain doctors.
How musculoskeletal physiotherapy can help you.
- Completely relieving or reducing your pain
- Helping you to avoid future injury recurrences
- Providing you with ongoing strategies and support to manage your injury or condition
- Improving your flexibility, muscle strength, quality of movement and co-ordination
- Enabling a quicker recovery and allowing you to your normal activities sooner
- Assisting you to achieve your exercise or functional goals
- Improving your fitness by structuring a personalised injury management training program
- Prescribing exercises to do at home or in the gym to enhance your recovery
How common are Titled Musculoskeletal Physiotherapists?
Not quite as rare as hen’s teeth, but not far off. Did you know that less than 5% of physiotherapists attain the level of Titled Musculoskeletal Physiotherapist? Your local Dee Why physiotherapist, Damien Glover combines an expert understanding of anatomy and human biomechanics, the latest scientific methods and years of practical experience in the field to provide a multi-pronged program designed to combat a number of common musculoskeletal issues.
The multifactorial approach of a musculoskeletal physiotherapist to your examination allows us to accurately diagnose your condition or injury and highlight further influencing factors of what is happening with you. This deep dive into your physical health allows your Northern Beaches physio to design a bespoke rehabilitation program with short, medium and long term outcomes to ensure success and a pain free future.
Are you suffering from a pain in the neck? I’m not talking about your latest electricity bill, or an annoying co-worker, I’m talking good old fashioned inescapable neck pain. Over the course of a lifetime there is a 50% chance you will suffer from neck pain at one point or another. This risk can be heightened by a number of factors: your age (another great part of getting older), your sex (women are more likely than men to experience neck pain) and the type of work you do (I’m looking at you, computer using people). For most Australians neck pain is something that usually lasts 6-8 weeks, but for around 30% of people, neck pain can become a chronic source of pain, limiting the activities you can take part in and disrupting sleep patterns which in turn can cause other problems. Neck pain is one of the most common complaints physiotherapists deal with and there are a number of scientifically proven exercises and treatments to ensure your neck pain doesn’t turn chronic.
What are common symptoms associated with neck pain?
To put it simply, the spine and neck are very complicated regions of the body and can cause a variety of symptoms and finding the right Northern Beaches physio is essential to pinpointing the cause. In all there are seven cervical vertebrae acting as building blocks of the spine in the neck and surrounding the spinal cord and canal. Within the neck, structures include the neck muscles, arteries, veins, lymph glands, thyroid gland, parathyroid glands, oesophagus, larynx, and trachea. This means that neck pain can present a wide array of related symptoms, requiring a skilled musculoskeletal physiotherapist to identify the source. Neck pain can culminate in the following symptoms:
- Numbness, weakness and tingling in the arms and fingers
- Surrounding muscle pain, commonly the shoulders
- Stiff neck
- Sore throat
- Even loss of bowel or bladder control
What are some of the causes of neck pain?
Neck pain just doesn’t come about for no reason, it is usually related to a specific issue with another part of the body, or begins as a direct result of an injury or overuse problem. When you first discuss neck pain with your physio they will conduct an analysis of your body in order to pinpoint the root cause in order to create the most effective program to treat it. Musculoskeletal physiotherapists and General practitioners have highlighted the following as the most common causes of neck pain:
- Degenerative disc disease
- Neck strain
- Cervical Spondylosis
- Poor posture
- Pinched nerve
Is your phone being a pain in the neck?
As more people spend their days scrolling mindlessly through Facebook, the average number of hours spent on our phones is increasing rapidly, with Australians clocking up 10 hours of mobile screen time PER DAY. Did you know that within 5 minutes of waking up over one third of Australians have already checked their mobile phone at least once, not even dinner time puts the brakes on mobile usage with around 70% checking their phones while eating with family and friends? They are some seriously crazy numbers. We’ve even had to give it a name, text neck. Staring down at your phone causes your neck extensors to stretch unnaturally causing them to weaken over time and can add nearly 30kg of pressure to the back of the neck. This unnatural forward head posture has also been shown to inhibit breathing capacity which can lead to migraines and cause brain fog throughout the day. If you also happen to have a job that requires you to stare at a computer screen or you spend a few hours a day watching television, your risk of suffering neck pain increases.
What are the best treatments for neck pain?
Your Dee Why physio will most likely recommend a multi-modal approach to tackling your neck pain, with studies showing that a combined process is the most effective at shortening the duration and intensity of the pain. A combination of strength and mobility exercises, postural and ergonomic changes, hands on treatment and dry needling have all been shown to be effective and are utilised by musculoskeletal physiotherapists around the world.
If you have been suffering from a sore neck, or any of the symptoms outlined above, you are only increasing your chances of your neck pain becoming chronic and affecting other areas of your body and daily life by not having it treated. It can be easy to shrug off neck, shoulder and back pain as a normal part of life, work and getting older, but nobody should have to put up with chronic pain. You might not be able to get rid of every pain in the neck in your life, but speaking with your Northern Beaches physio can certainly go a long way to getting rid of the actual pain.
 Hogg-Johnson S, Van der Velde S, Carroll L, Holm L, Cassidy D, Guzman J, Côté P, Haldeman S, Ammendolia C, Carragee,14,15 Eric Hurwitz E, Nordin, M, Peloso P. The Burden and Determinants of Neck Pain in the General Population: Results of the Bone and Joint Decade 2000–2010 Task Force on Neck Pain and Its Associated Disorders. Eur Spine J. 2008 April; 17(Suppl 1): 39–51.
 Ostergren PO, Hanson BS, Balogh I, Ektor-Andersen J, Isacsson A, Orbaek P, Winkel J, Isacsson SO; Incidence of shoulder and neck pain in a working population: effect modification between mechanical and psychosocial exposures at work? Results from a one year follow up of the Malmö shoulder and neck study cohort. Malmö Shoulder Neck Study Group. J Epidemiol Community Health. 2005 Sep; 59(9):721-8.
 Mehanical Neck Pain and Cervicogenic Headache. Neurosurgery 2007: 60:S1-21–S1-27
 Bot SD, Van der waal JM, Terwee CB, et al. Incidence and prevalence of complaints of the neck and upper extremity in general practice. Ann Rheum Dis 2005:64(1):118–23.
 Australian consumers spending more than 10 hours of every day on their digital devices’, 2016, Ernst & Young, www.ey.com
 Mobile Consumer Survey 2017: The Australian Cut, Deloitte, https://www2.deloitte.com/au/mobile-consumer-survey
 William J. Hanney WJ, Kolber MJ, Schack-Dugre J, Negrete R, Pabian P, The Influence of Education and Exercise on Neck Pain. Am J Lifestyle Med. 2010;4(2):166-175.
Hamstring strains (a.k.a. “doing a hammy!”) are one of the most common injuries seen by Northern Beaches physiotherapists. Hammy strains are most prevalent in sports that use a combination of dynamic movements like sprinting, Australian Rules football (AFL), soccer, dancing, surfing, rugby league and other activities where quick eccentric contractions, when the leg is being straightened and the hamstring is working hard, occur frequently such as slowing the leg down after kicking a ball. In AFL hamstring strains are the most common injury with a rate of 6 injuries per club per season combined with the highest rate of re-injury at over 30%. Musculoskeletal physiotherapists know that it is perfectly normal for two people to tear exactly the same muscle but recover at different speeds. Recovery time is dependent on the grade of the injury with a grade 1 injury possibly healing in only a few days, while a grade 3 injury could take months and, in extreme cases, even require surgery.
“My hamstring is ok but derogatory and sexist comments aren’t”
Most hamstrings will have torn well before this point so all can admire the incredible strength and flexibility of Tayla Harris during the AFLW 2019 season.
What are the hamstrings and what do they do?
The hamstrings are a group of muscles and their tendons at the back of your upper leg. They are made up of three different muscles: the biceps femoris, the semitendinosus and the semimembranosus. You use your hamstrings for all kinds of things: walking, running, dancing and jumping. They enable you to flex your knee and extend the hip at the beginning of each step you take. Your hamstrings play a large role in many movements of the legs and hips which is why physiotherapists have spent so long studying them and how to reduce the occurrence and length of injuries.
How do hamstring injuries occur?
Like most injuries, hamstring strains or injuries can be classified as being caused by either primary or secondary factors.
- Primary factors include:
- Poor timing coordination in the hamstring (the swing phase of the leg in sprinting)
- Lack of strength and stiffness in the hamstring
- Muscle imbalances
- Increased neural tension through the sciatic nerve
- Common secondary factors include:
- Overstriding or poor pelvic control when running
- Improper warm-up to prepare hamstring muscles
- Lower back problems
- Prior hamstring injuries
What are the symptoms of a hamstring strain?
The nature of hamstring strains means that symptoms can vary greatly between injuries. Mild hamstring strains could present as tightness or a mild ache in your hamstring. While a severe strain can be extremely painful, with some people describing it like being shot in the back of the leg even making it impossible to walk or even stand. If you have any of the following symptoms get in to see your Dee Why physio ASAP:
- Hamstring tenderness
- Pain or difficulty running, walking or standing
- Pain in the back of the thigh or lower buttock
- Bruising or swelling
- Sudden severe pain while exercising, with a popping sound or snapping feeling
How physiotherapy helps treat hamstring strains
If you have had a hamstring injury your best course of action is to consult with a physiotherapist that has an expert knowledge of sporting and musculoskeletal injuries. Due to the high rate of reinjuring your hamstring, there is no substitute for high quality initial care and rehabilitation. Physiotherapy helps patients with a hamstring injury to speed up the healing process and ensure the best outcome. They will be able to assess and treat your strain and help you to minimise their recurrence in the future.
- Acute or initial phase of a hamstring injury
Your physio will likely recommend the trusty RICE (Rest, Ice, Compression, Elevation) method for the first few days. This will help to reduce swelling and minimise pain. I like the saying ‘the early bird gets the worm’ and when it comes to intervention for hamstring injuries the early bird getting treatment always recovers quicker and more effectively. An expert sports physio will also get you loading your hamstrings in a variety of different ways, even in the early stages!
- Your physio will then comprehensively assess:
- Your range of motion
- The strength and mobility of your lower back
- Your gait
- Your flexibility
- If possible, your running, jumping and sporting techniques
How to prevent another Hamstring Strain
If you’ve ever had a hamstring strain I can pretty much guarantee you won’t want another one, they certainly don’t tickle. Dealing with a hamstring injury once it’s already happened is much harder than preventing it. Here are some tips:
- Stretch before and after physical activity
- Increase the intensity of your physical activity gradually
- If you feel pain, stop exercising (it’s not all ‘no pain, no gain’)
- Stretch and strengthen hamstrings as a preventative measure
Whether you have recently suffered a hamstring injury and are in need of immediate physical therapy or you have suffered a hamstring injury in the past, a physiotherapist is able to assess and recommend the best activities and stretches to help speed along your recovery and reduce the likelihood of experiencing further strains.
 Sutton G. Hamstrung by hamstring strains: a review of the literature*.J Orthop Sports Phys Ther. 1984; 5(4):184-95.
 Orchard J, Seward H. Epidemiology of injuries in the Australian Football League, season 1997–2000. Br J Sports Med2002;36:39–44.
 Schunke M., Schulte E., Schumacher. Anatomische atlas Prometheus: Algemene anatomie en bewegingsapparaat. Nederland: Bohn Stafleu Van Loghum, 2005.
We’re an active bunch on the Northern Beaches and you’ll find that injury prevention and recovery are 2 major aspects of sports physio clinics in Dee Why. Chances are at some point you’ve experienced an injury, whether you tore an ACL, strained a hammy or twinged your neck and if you’re one of the unfortunate many you’ve probably reinjured it at least a couple of times. Recurrent injuries aren’t confined to AFL players and other professional athletes. Computer programmers are more susceptible to a recurrence of tennis elbow than tennis players, remember? Unfortunately prevention can’t always prevent a hammy strain, but once an injury has occurred you have the power to start the prevention cycle all over again.
There are a number of factors that influence the statistical probability of suffering an injury recurrence; if you watch a sport regularly you can probably name 1 or 2 athletes that seem to suffer the same injury over and over again. NRL player Tautau Moga for instance is only 25 years old and has torn his left ACL 4 times, having a full reconstruction and rehabilitation after each occasion. Researchers are getting better at injury prevention and management every day and sports and musculoskeletal physiotherapists are experts in getting to the things that increase injury recurrence:
Insufficient rehabilitation from previous injury
Call it youthful exuberance in wanting to get back into it too quickly, call it being lazy and not completing your full rehabilitation but one of the most common reasons for suffering a recurrence of an injury is failing to rehab properly. Overloading is a great short term principle and is part of effective programming to allow for super-compensation and increase fitness and strength, but IT DOES NOT APPLY DURING INJURY RECOVERY. Any professional level athlete in any sport will tell you their recovery is just as important as their training when it comes to performance. Failing to follow your physiotherapist’s full rehabilitation program for your sore hammy is only going to end one way. Your guessed it – a pain in the butt!
Neglecting symptoms of pain
Speaking of pain, one of the next most popular reasons people reinjure themselves is failing to heed your body’s best warning signal; pain. “I’ll just run it off” doesn’t cut it as an effective treatment strategy for managing most musculoskeletal injuries but it’s still one of the most common things that people like to do for some reason. Most chronic back, neck, knee, hip, groin, ankle and hamstring injuries will usually give you some warning sign before they completely give up. Don’t treat that shooting pain in your leg like the check engine light in an old car and just put some tape on it either. Strapping and taping is good in some instances, but it can’t keep a hamstring in place for long.
Poor conditioning or fitness
Coming back from long term injury can be tough and it’s common to let fitness levels slip while injured which can often lead to poor performance or additional musculoskeletal injury upon returning to physical activity. Every bit of physical activity outside of your physically repetitive job is going to lower your chances of suffering a repetitive strain injury as well. While you are recovering from an injury, try and do all you can to keep moderately active, whether it be short walks, dumbbell curls or simple sit-ups.
Poor technique and movement control
Poor technique and movement control are probably the 2 most important factors that cause injuries in the first place and they continue to play a part in injury recurrences. I don’t know how many times I’ve seen someone load up weights to the max at the gym, lifting far too much and trading technique for weight. This principle can be applied to most physical activities. Most injuries occur when you go too hard, are fatigued and are using movements that you are not at the unconscious competence stage of performing yet.
Poor or no warm-up/warm-down
Be honest, do you spend 10 minutes warming up and down every time before and after sport and physical activity? A well performed warm-up before a workout is going to dilate your blood vessels, ensuring your muscles are supplied with enough oxygen while also raising your muscles’ temperature aiding in achieving optimal flexibility and efficiency. Cooling down after physical activity is every bit as important as warming up. Stretching while you’re cooling down is the way to go because your muscles, limbs and joints are still warm. Stretching is going to reduce the build-up of lactic acid, which is the leading cause of muscle cramp and stiffness.
If you have suffered an injury, don’t shirk your recovery. Speaking with an expert in sports and musculoskeletal physiotherapy and undertaking a custom made rehabilitation program is going to shorten the length of your recovery, minimise your risk of a recurrence of your injury and also help provide you with the knowledge you need to continue to prevent injury independently.
Your feet are full of bits and pieces that can cause plenty of pain. 26 bones, 33 joints and over 100 ligaments, nerves, muscles and tendons that are all capable of causing varying degrees of feeling from ooh that tickles to CALL THE AMBULANCE!!! Each foot is intricately designed to absorb the forces of walking, running and jumping, morphing to the shape of the ground and transmitting these forces through the ankle to the legs. When everything is going smoothly, this process is seamless and unnoticeable, when it’s not, it can affect your day to day life. According to the 2017 Healthy Feet Survey around half of Australians experience heel/arch pain and 6% of people surveyed wake up every morning with foot pain. The same study also showed that despite having expert knowledge, musculoskeletal physiotherapists are only consulted by 5% of people suffering foot pain, with 80% heading to the GP for advice. GP’s commonly refer clients to musculoskeletal physios for foot and ankle pain, physios are really just doctors to manage and prevent pain.
So, what are the most common types of foot pain, and what do they mean?
Ball of the foot pain or Metatarsalgia
Pain and inflammation in the ball of the foot is referred to by physiotherapists as Metatarsalgia . Good news for people who are more active, you’re more likely to experience ball of foot pain due to your activities that involve a lot of running and jumping. It is also common for people to suffer Metatarsalgia due to the over-usage of improper fitting shoes.
Musculoskeletal physiotherapists recommend a number of conservative treatment methods for ball of the foot pain such as rest and ice therapy. It is also important to take an in depth look at your shoes. Ideally you participate in sports with shock absorbing arch supports or insoles to minimise future complications or recurrences of metatarsalgia. Signs and symptoms of ball of foot pain include:
- Burning or aching pain in the ball of the foot
- Pain around the big toe only
- Worsening pain with weight bearing activities such as standing, running or walking
- Numbness or tingling in the toes of the foot
- The pain improves with rest
Plantar Fasciosis aka Plantar Fasciitis
“Plantar fasciitis” (a common misnomer as there is rarely any inflammation!) is one of the most common causes of heel pain characterised by pain in the plantar fascia, a thick fibrous band of connective tissue running from the bottom surface of the heel bone extending along the sole of the foot towards the toes. Have you ever jumped out of bed in the morning only to feel a stabbing pain in your heel with each step? That’s probably plantar fasciitis. Plantar fasciitis is most commonly found in impact and running sports but can sometimes feel like it just popped out randomly out of nowhere. People with poor foot biomechanics and those with flat feet or weak foot arch control muscles are more likely to suffer heel pain.
One of the most important aspects of treating and preventing a recurrence of plantar fasciitis is assessing and correcting any issues in your foot and leg biomechanics, sporting technique and your shoes. Not all Dee why physio clinics are experts in foot control assessment and its dynamic biomechanical correction. After an initial in depth physiological assessment, your physiotherapist will likely prescribe manual therapy techniques such as joint mobilisations, soft tissue massage or release, muscle stretches for flexibility, foot taping and lower limb strengthening exercises.
Characterised by pain in the Achilles tendon or its covering, Achilles Tendonitis is an overuse injury that is most common in joggers, jumpers and other activities that require repetitive actions. Tendons are tough fibres that connect your muscle to bone but they are susceptible to overuse and injuries are usually caused by a number of micro tears occurring over a period of time. Common causes of Achilles tendonitis include:
- Tight hamstrings and calf muscles
- Walking on your toes (or excessive high heel wearing)
- Overtraining and failing to warm up or down
- Poorly supportive footwear
Foot pain is a common issue for Australians to put off until recovery includes being totally laid off your feet. It can be easy to write off foot pain as simple pain but it can also be caused by fractures, nerve compressions, loss of blood supply to the bone and even problems stemming from the lower back. The best way to pinpoint and treat foot pain is to undergo a full body analysis with your local physio. The good news if you are suffering foot pain is that research has shown that physiotherapy is effective management and will get you back to playing the sports and doing the activities you enjoy, free from pain.
Going for my early bird swim at Dee Why pool this weekend it took a few minutes longer than usual for my muscles and joints to really get going. I couldn’t quite put my finger on it until I got out of the pool and a fresh gust of wind reminded me… Winter Is Coming. Checking the weather and in 2 days the minimum temperature has dropped 7 degrees. Did you know that May, June and July are the busiest months for sport and exercise related injuries in Australia? While you can attribute some of that rise to the winter contact ball sports, a contributor to the rise in muscle and tendon related injuries is the drop in temperature. The muscles and ligaments of the body function and perform better when they are warmer. It’s also easier to get out of bed and actually go on that early morning run too when it’s not 5 degrees. Let’s look at how the cold affects the performance and injury rate of the muscles and tendons and how you can lower your chances of a cold related injury.
Can cold weather make joints and muscles hurt more?
My Dad is one of those people who say that his joints can predict the weather, “a cold front is coming through” he’d say on a 30 degree day and it did seem like he picked it once or twice (little did I know at the time that he constantly consulted the Bureau of Meteorology as much as Gen-Y checks Facebook). But let’s just say science is far less convinced than he and a few other patients of mine who are convinced that their arthritic conditions can predict the weather. Over the years a number of studies have looked at the correlation between temperature, weather and barometric pressure with none being totally conclusive. That being said, some studies have shown a plausible link between barometric pressure and cold weather on some specific arthritic conditions or under less strict conditions. If you believe your joints hurt more in the cold, I’m not going to not believe you.
Increase your warm-up time and quality
This is probably the single most important piece of advice if you are undertaking any physical activity during the winter months. Cold muscles and ligaments mixed with physical activity are going to equal a lot of pain. Cold muscles, tendons and ligaments are more likely to lead to muscle sprains and joint strains due to decreased flexibility and elasticity. If you normally warm up for 5 minutes, extend it to 10 as it gets colder, if you normally don’t warm up, extending that to 10 minutes is fine too. A good warm-up:
- Prepares the body and mind for the activity
- Increases the body’s core temperature
- Increases the heart rate
- Increases breathing rate
- Stimulates flexibility and power
Don’t skimp on the cool-down either!
Many musculoskeletal physiotherapists will agree that failing to cool down adequately is a major contributor to muscular and tendon injuries. I don’t know why but it doesn’t seem like it’s cool to cool down. After physical exercise the body needs time to slow down and recover, so cool down immediately after your activity for at least 5 to10 minutes. Sports and exercise physiotherapists recommend your cool-down can be the same sort of exercise as the warm-up with low intensity body movement such as jogging or walking substituted for running.
Can stretching help to reduce injuries?
Stretching before and after physical activity helps to promote maximum flexibility, relax the muscles, return them to their resting length and promotes recovery by assisting in the body’s natural repair process. When stretching it is important to:
- Stretch all muscle groups that will be or were involved in the activity
- Stretch gently and slowly
- Don’t bounce or try and stretch too quickly
- Only ever stretch to the point of mild discomfort – PAIN DOES NOT EQUAL GAIN
- Don’t hold your breath – breathe slow and easy
Don’t forget to stay hydrated
While it may not be scorching hot outside your body is still going to need a healthy dose of water daily. Dehydration is one of the major causes of muscle cramps and the winter months are an easy time to lost sight of drinking a couple of litres of the good stuff every day. Please don’t think a couple of shots of something harder will warm you up either, alcohol will only impair your coordination and your body’s ability to regulate your temperature which could lead to an injury. Caffeine drinks also cause dehydration, so steer clear of excessive coffee and energy drinks too if you can.
 The influence of weather on the risk of pain exacerbation in patients with knee osteoarthritis – a case-crossover study. Ferreira, M.L. et al. Osteoarthritis and Cartilage , Volume 24 , Issue 12 , 2042 – 2047
 Deall C, Majeed H (2016) Effect of Cold Weather on the Symptoms of Arthritic Disease: A Review of the Literature. J Gen Pract (Los Angel) 4:275. doi: 10.4172/2329-9126.1000275
 Woods K, Bishop P, Jones E. Warm-up and stretching in the prevention of muscular injury. Sports Med 2007;37:1089-1099.
 Scott, E E F et al. “Increased risk of muscle tears below physiological temperature ranges.” Bone & joint research vol. 5,2 (2016): 61-5. doi:10.1302/2046-3758.52.2000484
Sever’s disease, aka calcaneal apophysitis to musculoskeletal physiotherapists is the most common cause of heel pain in growing athletes. Sever’s Disease isn’t really a true disease per se and was actually first identified by Patrick Haglund in 1907, but it was James Sever’s characterisation of the disease in 1912 that led to it being named after him. Maybe it just had more dramatic ring to it? Sever’s disease is the inflammation of the calcaneal apophysisa, located on the heel close to where it connects into the Achilles tendon. Sever’s Disease most commonly occurs before or during a child’s peak growth spurt and is often seen when they begin a new sport or footy season. It is most common in boys between the ages of 8 and 12 and quite frequently in girls between the ages of 8 and 10 years old who are also active in sports.
How is Sever’s Disease diagnosed?
For your physio to find the cause of your child’s heel pain and rule out more serious conditions, they will ask some thorough questions about their medical history and ask questions about recent activities or injuries. There is rarely the need for any blood tests or x-rays, your physiotherapist will perform what’s called a squeeze test and some other tests to confirm the diagnosis of Sever’s Disease. During the squeeze test (which is exactly what it sounds like) if the child’s medial and lateral sections of the heel are tender and there are no symptoms such as red skin or swelling, almost always indicates a diagnosis of Sever’s disease.
- Pain in the back or bottom of the heel
- Walking on toes
- Difficulty running, jumping or participating in usual activities or sports
- Pain when the sides of the heel are squeezed
What causes Sever’s Disease?
When children (especially boys) are going through a growth spurt, the bones will grow first and the muscles and tendons can take a while to catch up. In Sever’s disease, the area around the heel bone can become quite sore and swollen where the Achilles tendon attaches to it. Children who participate in running and jumping sports such as AFL, soccer, Basketball and athletics are more likely to end up with Sever’s disease. Research has also shown that wearing boots with studs or spikes increases the risk of developing Sever’s disease.
Factors contributing to Sever’s Disease in children include changes to:
- Height and weight – high BMI children have higher rates of the disease
- The frequency of physical activity – AFL carnivals over a few consecutive days
- The type of physical activity – Changing sports or starting new ones eg. Netball, gymnastics
- Shoes and equipment – Many football boots have a lower heel that can add pressure to the apophysis by stretching the Achilles tendon slightly. Lots of barefoot running and even walking in thongs on the soft sand at Dee Why can cause the same increased load.
How is Sever’s Disease treated?
As with most soft tissue injuries, in the first stages of recovery your physio will recommend the R.I.C.E method – Rest, Ice, Compression, and Elevation. Unfortunately, no one treatment method has been definitively proven to be better than others in the long-term management of Sever’s disease. During the early phase your child will probably be unable to walk pain-free, so the first aim is to prescribe your child with some active rest activities and keep away from pain-provoking activities for the time being. Your physio will use and teach your child a range of pain relieving techniques including joint mobilisations for stiff ankles and give the area a good massage in order to restore full Range of Motion, reduce pain and regain full foot biomechanics. A good musculoskeletal physiotherapist will also want to see your child’s biomechanics and technique in action and if they have injured themselves playing AFL or another sport, getting your physio to check it out will help reduce flare ups in the future.
How does Sever’s Disease affect my child’s sport?
Sever’s disease is a self-limiting condition and will fully heal with the right treatment. The first important step is to seek treatment when early signs of Sever’s become apparent. Sub-optimally treated Sever’s disease can cause a permanent bone deformity at the rear of the heel bone which can be painful and annoying. For the time being, seeing a physio will be be helpful to learn ways to stretch the Achilles tendon and keep pain under control. Limit your child’s sport load during the initial period and monitor their return to sport closely afterwards.
If your child is between the ages of 8 to 12 and is complaining of heel pain with no exterior causes, you should suspect Sever’s disease until proven otherwise. Sever’s Disease is a common issue seen by your local Dee Why physio due to the high number of active kids on the Northern Beaches (a positive and a negative there) and they are the best people to speak to if your child is complaining of a sore ankle.
 HAGLUND P: Ueber fractur des epiphysenkerns des calcaneus, nebst allgemeinen bemerkungen ueber einige
aehnliche juvenile knochenkernverletzungen. Archiv fur
klinische Chirurgie 82: 922, 1907
 SEVER JW: Apophysitis of the os calcis. N Y Med J 95:1025, 1912
 Sever’s Disease: What Does the Literature Really Tell Us? Rolf W. Scharfbillig, PhD* Sara Jones, PhD† Sheila D. Scutter, PhD May/June 2008 • Vol 98 • No 3 • Journal of the American Podiatric Medical Association