Skeletal muscles make up nearly half of our total bodyweight, so it should be no surprise that muscle injuries are amongst the most common occurring in sports. Some of the Northern Beaches’ most popular pastimes are muscle injury magnets, with rugby league, AFL, volleyball and surfing making up the bulk of culprits.
Muscle injuries are either ‘indirect’ or ‘direct’
A direct muscle injury is caused by an external blow or force, commonly during a collision with another person (think a tackle in rugby league) or by being struck with an object like a cricket ball. Direct injuries can cause dislocations and bone fractures and usually leave clues like haematomas and bruises to gauge how serious they are.
An indirect injury does not result from physical contact with an object or person, but from internal forces commonly caused by over-stretching, poor technique, fatigue and lack of fitness.
What do I do if I suffer a muscle injury?
The immediate management of muscular injuries during the acute inflammatory phase is very important for successful rehab.
First aid for muscle injuries follows the RICER principle. The objective of RICER is to stop the injury-induced bleeding into the muscle tissue and thereby minimise the extent of the injury.
- R for Rest
- I for Ice
- C for Compression
- E for Elevation
- R for Referral
If you follow the RICER method, you’ll go a long way to:
- preventing further tissue damage
- minimising swelling
- easing pain
- reducing the formation of scar tissue
- reducing the time needed for rehabilitation.
What shouldn’t I do if I have a muscle injury?
During the first 48–72 hours after an injury there are certain things that must be avoided.
- Applying heat to the injury – No hot rubs, saunas and or baths
- drinking alcohol
- partaking in more physical activity or
- a massage.
All of these actions will increase blood flow, and therefore bleeding and swelling. 
Don’t immobilise the affected area for too long
A few days of immobilisation to limit haemorrhage and oedema formation can provide time for your muscles to heal and regain strength for your rehab.
Prolonged immobilisation, while it might feel ‘comfortable’ at the time, could alter the biomechanical properties of the muscle-tendon unit, shrink healthy muscle fibres and substantially delay recovery of the injured skeletal muscle By restricting the length of immobilisation to a period of less than a week, the adverse effects of immobility per se can be minimised.
If you still feel like you can’t move properly after a few days, it’s time to bring in your local physio.
How do muscles heal?
Injured skeletal muscle heals by a repair process as opposed to fractured bone heals by a regenerative process. This means that when muscle tissues are being repaired, they will heal with a scar, which replaces the original tissue, whereas when a bone regenerates, the healing tissue is identical to the tissue that existed there before.
The healing of an injured skeletal muscle follows a fairly constant pattern irrespective of the underlying cause and musculoskeletal physiotherapists are the experts in rehab after a muscle tear.
Avoiding re-ruptures is one of the most important concepts of rehab and it has been shown that re-ruptures are actually the most severe skeletal muscle injuries causing the greatest amount of time lost from sporting activity.
If you have a muscle injury or pain, don’t walk it off; give us a call on give us a call on (02) 8964 4086 or book an appointment at info@ﬁxio.com.au
 Jarvinen M & Lehto MUK. The effect of early mobilization and immobilization on the healing process
following muscle injuries. Sports Medicine 1993; 15: 78–89.
 Järvinen TAH, Järvinen TLN, Kääriäinen M, Äärimaa V, Vaittinen S, Kalimo H, Järvinen M. Muscle injuries: optimising recovery. Best Pract Res Clin Rheumatol. 2007;21(2):317–31.
 Jarvinen TAH, Jarvinen TLN, Kaariainen M et al. Biology of muscle trauma. American Journal of Sports
Medicine 2005; 33: 745–766.
Everything we do revolves around the use of our hands. Whether we’re cooking, playing sport, eating, driving or texting our mates; we would be very limited without the amount of functions our hands can perform.
Your hand and wrist contain a total of 27 bones, 34 muscles and over 100 ligaments and tendons.
All that hardware means there’s a whole laundry list of things that can cause pain.
Conditions like De Quervain’s tenosynovitis restrict thumb movements, cause pain along the thumb side of the wrist, decrease grip strength and can hang around and recur without the right treatment.
This means that hand and wrist injuries require special guidance and knowledge from a Northern Beaches physio to treat and leave them in the past.
Why do I have hand and wrist pain?
Using a computer all day is the most common cause, believe it or not.
At first glance, boring old computer use might seem low stress on the body but it easily contributes to a large portion of the neck pain, back pain, headache, wrist fatigue, shoulder fatigue and carpal tunnel syndrome we see here at Fixio.
All those hours spent leaning over your desk is very taxing on your hands and wrists due to typing, writing and poor body posture. Some people keep typing until they get pins and needles or numbness in their fingers, or pain and swelling in their wrist or fingers. You need to be taking a break long before that point.
Other common causes of hand and wrist pain include:
- Carpal tunnel syndrome
- Wrist tendinitis
- Getting older
- Wrist & Hand Osteoarthritis
- Inflammatory arthritis
- Trigger finger
- Dupuytren’s contracture
How do physiotherapists treat hand and wrist injuries?
With there being so many possibilities when it comes to hand and wrist injuries, there are a range of treatments used by physios.
The bespoke treatment plan for your hand and wrist injury depends on the type and extent of your injury and is guided by a thorough assessment by your Fixio physio. Injuries like fractures and ligament injuries may require immobilisation, while overuse injuries may require specific stretching exercises or modification to your work equipment or technique.
When you meet with your physio, we will be looking for clues to help with our evidence based diagnosis.
- Inspectingthe palm and dorsal surfaces of the hands for any obvious joint swelling, deformity, skin discoloration and the presence of cysts or nodules is one of the first steps we will take to diagnose your pain.
- We’ll measure your Range of motion by opening and closing your hand to help determine the number of affected joints, and assess the severity of your condition. An inability to flex or extend may suggest an underlying tendon disruption, displacement, or dislocation.
- You’ll have Strength testingthat can include resisted motion in both flexion and extension across each joint in your hand.
- This might include Grip strength testing for a measurement of the integrity and strength of the muscles of your hand and forearm. Reduced grip strength is a symptom of nearly every hand and wrist complaint though, so it’s only a small piece of the puzzle.
For specific advice regarding your wrist pain, get in touch with your expert local Northern Beaches physio ASAP.
Meet Joe – Joe is a middle-aged accountant from the Northern Beaches who recently attended the Fixio physiotherapy clinic with left shin pain.
Joe started running 6 months ago to “lose weight” and one of his New Year resolutions for 2021 is to run his first half marathon. During the last 6 months Joe has been running sporadically from Dee Why to Curl Curl, a distance of about 6km. Since the start of 2021 though, Joe decided to run from Dee Why to Manly 3 times a week, a 17km round trip. Joe found the increase in k’s difficult, but pushed through some minor hip and ankle pain because he wants to run that half marathon.
Examining, evaluating and diagnosing an injured runner
Musculoskeletal physiotherapists use a comprehensive assessment of the entire mid-lower body to accurately diagnose shin splints and stress fractures in runners.
- Activity history
- range of motion
- foot type
- functional movement patterns
- walking and running gait
Are examined and measured to give your physio a holistic view of the zones causing you pain.
What are stress fractures?
In normal healthy bone, increased stress and physical loading can cause some deformation and microdamage. Stress fractures have 3 stages:
Stage 1 – Fracture initiation, which occurs at the site where the load stress is concentrated in a specific spot
Stage 2 – Fracture propagation occurs when physical loading is pushed past the level at which bone can be repaired or new bone can be laid down in the area.
Stage 3 – The final stage is a complete fracture with symptomatic presentation to our Fixio physio.
What are the symptoms of stress fractures for a runner?
People with stress fractures of the lower leg will commonly have:
- pain in the lower leg that comes on during exercise
- an ache in the front part of the lower leg that may continue after exercise
- pain on both sides of the shin bone
- tenderness or pain along the inner part of the lower leg
- mild swelling in the lower leg as it progresses
How are stress fractures treated by physiotherapy?
Because risk factors for stress fractures include faulty biomechanics, abnormal bony alignments, incorrect footwear and other physical factors, it’s important that stress fracture treatment is broad ranging.
Usually, a 3-phase (acute, subacute, and chronic) treatment approach is beneficial for runners with a stress fracture. 
At our Fixio clinic, Joe underwent treatment to increase joint mobility, flexibility, dynamic control and we went through a video running gait analysis and participated in gait retraining to address his hip and ankle impairments.
The acute phase focuses on rest and interventions to relieve symptoms, whereas the subacute phase focuses on progressing weight bearing tolerance.
How can I avoid stress fractures and shin splints?
You can’t completely eradicate any chance of suffering stress fractures, but there are steps you can take to minimise your risk:
- wear comfortable running shoes that fit well and offer good support
- avoid exercising on hard, slanted or uneven surfaces
- increase exercise intensity and length gradually
- warm up and stretch before exercising
- don’t just push through the pain, listen to your body.
Shin splints and stress fracture are not injuries to leave unattended. Physiotherapists see too many patients who have caused themselves ongoing pain and discomfort simply due to not having the issue seen to earlier. If you are suffering from increasing pain or stiffness in your legs and shins it is prudent to make an appointment with your local Fixio physio to have a full evaluation of the injury.
 Kaeding CC, Miller . the comprehensive description of stress fractures: a new classification system.
J Bone Joint Surg Am. 2013;95:1214-1220.
 Liem BC, ruswell HJ, Harrast MA. Rehabilitation and return to running after lower limb stress ractures.
Curr Sports Med Rep. 2013;12:200-207.
With the Australian Open just around the corner, we’ve been hearing a lot about tennis players lately. Today we’re going to be looking at overuse injuries in tennis players, but not the kind of Instagram or Twitter overuse we’ve become accustomed to.
Why are tennis players susceptible to overuse injuries?
Tennis play is a mix of overhead motions, quick starts and stops with short explosive bursts of motion, and a dynamic exchange of intricate strokes and serves. Athletes are susceptible to a variety of injuries because of these repetitive stresses.
Tennis is a demanding sport on both the lower and upper body, with overuse injuries of the shoulder, elbow and knee making up around two-thirds of all tennis injuries.
Muscle activation during the serve and forehand is focused on the subscapularis, the pectoralis major, and the serratus anterior. A common overuse injury in tennis players is rotator cuff tendonitis.
The backhand involves largely the middle deltoid, supraspinatus, and infraspinatus. This repetitive loading of the rotator cuff, particularly the supraspinatus and infraspinatus, leads to overuse injury due to the repetitive eccentric muscular activation. Wrist extensor activity is heavy in all strokes, which could help explain this joint’s predisposition to injury.
Common tennis injuries:
- Tennis elbow
- AC Joint injury
- High ankle sprain
- Rotator cuff
- De Quervain’s Tenosynovitis
- Patellofemoral pain syndrome
It is important for your physio to understand the chronology of your symptoms, prior injuries, biomechanics, training schedule and roundabout time spent practicing types of strokes.
Your Fixio physio will ask you a number of questions on your first visit to help work out the root cause of your injury and any other exacerbating factors. This allows us to help build a profile of the injury and lets us get stuck into creating your personalised recovery program.
Please try and think of these things:
- When your symptoms began
- If any motion or activity makes the pain better or worse
- Any recent direct injuries
Depending on what your physio deems is necessary for your recovery, you will receive any combination of the following treatments:
- Hands on treatment
- Dry needling / acupuncture
- Joint mobilisations
- Trigger point release
- Myofascial release
- Scar tissue management
- Active rehabilitation
- Strength training
- Posture retraining
- Muscle re-education
- Goal setting sessions
Top tips for avoiding tennis injuries
- Use the right equipment
- Take breaks
- Warm-up and warm-down
- Get a biomechanical assessment from your physio
Whether you’re a beginner or an advanced player, tennis is a very physically demanding sport. At Fixio, we understand tennis players and the intricacies of overuse injuries and can help you get back on court feeling strong and pain free ASAP.
Make a booking to speak with us on (02) 8964 4086 or send an email to info@ﬁxio.com.au.
 Kovacs MS. Applied physiology of tennis performance. Br J Sports Med. 2006;40:381–5 discussion 386.
 Kovacs M, Ellenbecker . An 8-stage model for evaluating the tennis serve: implications for performance
enhancement and injury prevention. Sports Health. 2011;3:504-513.
 Ryu RK, McCormick J, Jobe FW, et al: An electromyographic analysis of shoulder function in tennis players. Am J Sports Med 16:481-485, 1988
 Chow JW, Carlton LG, Lim YT, et al Muscle activation during the tennis volley. Med Sci Sports Exerc 31:846-854, 1999
 Manske R, Ellenbecker . Current concepts in shoulder examination of the overhead athlete. Int J
Sports Phys Ther. 2013;8:554-578.
Do you suffer from:
- a sore knee when running
- Increased pain after squatting movements and walking up and down stairs
- Pain after sitting for a long time with your knees bent
- The feeling of grinding or clicking sound in the kneecap when you bend and straighten your knee
- Kneecap region that is tender to the touch?
You may have Runner’s Knee, AKA – Patellofemoral pain syndrome.
What is Patellofemoral pain syndrome?
Patellofemoral pain syndrome, commonly known as Runner’s Knee is one of the most common knee complaints seen by Fixio physios. Patellofemoral pain syndrome can be found in both the young active sportsperson and the elderly and if not treated properly, can hang around for years.
Patellofemoral pain syndrome is pain felt behind and around your kneecap, where your patella (kneecap) meets your thigh bone (femur). This joint is known as your patellofemoral joint.
What causes Patellofemoral pain and what are the symptoms?
In musculoskeletal physiotherapy, the most common reasons for runner’s knee are overuse, muscle performance deficits, and trauma. Patellofemoral pain is what’s known as a heterogenous condition, meaning that not everybody that suffers it will have the same symptoms.
The symptoms of runner’s knee are notorious for looking like other conditions and over the past few years there has been an influx of new treatment guidelines that has changed the way physiotherapists treat Patellofemoral pain. It is important to see a musculoskeletal physio who has plenty of clinical experience with the injury and is constantly updating their skills. These experts are best placed to make an accurate diagnosis so you can move onto the recovery phase.
If you have:
- Sudden or severe pain in the knee
- Heard a loud pop or snap during sport or exercise
- Swelling in the knee after feeling pain
- A feeling of looseness in the joint
- An inability to put weight on the joint without pain, or any weight at all
These could all be symptoms of Patellofemoral pain syndrome.
Figure 1 Schematic overview of potential pathways to elevated patellofemoral joint (PFJ) stress, a proposed contributor to patellofemoral pain.
Do I need surgery?
Most likely no. People with patellofemoral pain syndrome alone do not need surgery. Be patient, and keep exercising to get better. Runner’s knee can be hard to treat. Some people get better quickly, but for others it might take six weeks or even longer for your knee to feel better.
How do musculoskeletal physiotherapists treat Runner’s Knee?
Thankfully, non-operative treatment provided by an expert physio is effective for most patients. Each treatment program is designed specifically to combat the root cause of your patellofemoral pain.
Once we have identified the cause of your pain and any underlying functional improvements we can work on, your physio will be able to guide you through your bespoke program. Physiotherapy may include exercises to make your hip, core, and knee muscles stronger and more flexible. Squats, quadriceps exercises, leg raises, climbing, and leg presses can be good since they target these specific areas.
Common treatments for patellofemoral pain include:
- Exercise therapy with hip and knee exercises
- Short-term tailored patellar taping
- Patient specific education in relation to biomechanics and exercise therapy
- Advice on loading programs
Will the pain come back?
Patellofemoral pain syndrome can come back.
The simplest advice for keeping runner’s knee at bay includes trying not to overstress your knees and listening as closely as you can to your body. You can do this by:
- Losing weight if needed
- Warming up before running
- Increasing your activities gradually
- Wearing good running shoes
If your knees are painful, take a break from activities that cause a lot of pounding on your legs, like running, volleyball, or basketball.
Instead, try swimming or another low-impact activity. As your knees feel better, you can slowly go back to your normal sports.
Make an appointment to see us at Fixio Physio for more information of Patellofemoral pain syndrome and what can be done to overcome it.
 Powers CM, et al. Br J Sports Med 2017;0:1–11. doi:10.1136/bjsports-2017-098717
 Kannus P, Natri A, Paakkala T, et al: An outcome study of chronic patellofemoral pain syndrome. Seven-year follow-up of patients in a randomized, controlled trial. J Bone Joint Surg 81A: 355–363, 1999
Let’s face it, the Christmas and New Year period is one where Australians overindulge in lots of the things that aren’t necessarily great for our bodies. Alcohol, cigarettes and endless plates of delicious leftovers are more likely to find themselves on the menu and on top of leaving you with a crook guts, these things can also hamper your rehab efforts.
What are the effects of alcohol on rehabilitation?
According to recent research from the Australian National University, during COVID-19, 1 in 5 Aussies increased their alcohol intake over the lockdown months. Going by ABS data, this means that in 2020 Australians have spent an average of $1891 on alcohol – up $270 on 2019.
That’s the equivalent of at least 2 gym memberships on alcohol.
Alcohol can have many effects on physical and mental performance;
- Decreasing reaction time and
- Hand-eye coordination
- Speeds up dehydration
- Increases blood pressure (Do not consume alcohol before a workout)
- Slows down muscle recovery
- Blood glucose levels can be affected, leading to hypoglycaemia
Imagine you’ve just come off the backyard cricket pitch injured with a side strain, there is some swelling and your shoulder is feeling very sore.
You notice there are drinks in the esky and you decide to have a few. Maybe a few more.
It is known that alcohol – no matter how much you indulge in – increases the bleeding and swelling around injured soft tissue. The alcohol is thinning your blood which makes the blood run faster to the injured area, increasing the swelling and the amount of toxins that will stay around the injured site which in turn will significantly delay healing.
This small injury that could have been looked after in a week or two with the R.I.C.E method and some physio, could now take four to five weeks due to alcohol and poor injury management.
The alcohol will also likely mask the pain you are feeling at the moment, increasing the chances of you standing or dancing on the injured area which again will increase the bleeding and swelling around the site.
If you are not sure whether or not your injury is “that bad” then it is best to be on the safe side and seek the advice of a musculoskeletal physio any way.
What are the effects of dehydration on injuries and rehab?
Alcohol consumption and the hot Aussie summer is a recipe for dehydration. Dehydration can contribute to several issues which have a negative effect on sports injuries, including:
- Slower rate of nutrient absorption
- a build-up of waste products such as lactic acid
- thickening of the blood
- impaired ability to regulate your body temperature
These dehydration effects mean that the body will not be able to get rid of toxins effectively and will not be able to get the body’s healing nutrients to the injured area fast, delaying the healing phase of your injury and causing you to spend more time out of action.
We’re not telling you not to drink, just remember that your injury is being affected by the alcohol you are consuming along with dehydration. It may add extra rehab to that healing time-frame your Physio gave you originally though…
If you have an injury that is not healing at the rate you would expect don’t hesitate to book in to see one of our Fixio physios.
Your acromioclavicular joint (or AC Joint) is located at the top of your shoulder between your clavicle (collarbone) and your scapula (shoulder blade) and is essential in allowing overhead and across your body shoulder movements.
What are the types of AC joint injury?
AC joint disorders can be classified into acute injuries, repetitive strain injuries and degenerative conditions. The diagnosis of an acute AC joint injury (sometimes referred to as a sprain or “separated” shoulder) is often straightforward due to the presence of tenderness, swelling, and deformity.
AC joint disorders from overuse, inflammation, or chronic degeneration can be more difficult to diagnose, particularly if other shoulder problems exist.
Overuse injuries — The AC joint is subject to inflammation from repetitive motion and stress, particularly activities involving an outstretched arm moving across the body.
Acute injuries – Acute AC joint injuries are most common in people younger than 35, with males sustaining more traumatic AC joint injuries than females.
Because younger athletes are more likely to participate in high-risk and collision activities, such as rugby league, biking, and snow sports traumatic AC joint injuries occur most often in this population.
AC joint injuries can be caused by:
- Falling directly on the outside of the shoulder
- Colliding with another player in a contact sport
- Falling onto an outstretched hand
- Lifting heavy weights overhead
A traumatic impact can push the top of the shoulder blade underneath the end of the collarbone, damaging the capsule surrounding the AC joint and the ligaments which support the joint.
What are the symptoms of an AC joint injury?
AC joint ligament damage can vary from a mild strain of one or more of the surrounding ligaments to complete ligament tears and deformity. The first sensation felt when the AC joint is injured is pain on the top of the shoulder. After this, you may also have a mix of:
- A visible bump above the shoulder
- Swelling and tenderness over the AC joint
- Loss of shoulder strength
- Loss of shoulder motion
- A popping sound or catching sensation with movement of the shoulder
- Discomfort with daily activities that stress the AC joint, like lifting objects overhead, reaching across your body, or carrying heavy objects at your side
AC joint injuries can be identified and effectively treated by a physiotherapist.
It is advised that all AC joint injuries are fully assessed by a physio in order to prevent ongoing shoulder pain and an increased risk of re-injury when you return to normal activities.
Your Fixio physio will examine your shoulder and assess your sensation, motion, strength, flexibility, tenderness, and swelling. They will then perform several tests and may also ask you to briefly demonstrate the activities or positions that cause your pain.
Your neck and upper back will also be examined to determine whether they, too, might be contributing to your shoulder condition through referred pain processes.
How can physiotherapy help treat an AC joint injury?
Physiotherapy for an AC joint injury is very important. Once an injury to the AC joint is diagnosed, your physio will work with you to develop a bespoke plan tailored to your specific shoulder condition and your goals. There are many physio treatments that have been shown to be effective in rehabilitating AC joint injuries, including:
- Range of Motion – An injury to the AC joint often causes swelling and stiffness, causing loss of normal motion.
- Strength Training – After an AC joint injury, your physiotherapist will design a bespoke exercise program to strengthen the muscles around the shoulder, so that each muscle is able to properly do its job.
- Manual Therapy – Physiotherapists are trained in hands-on therapy and will gently move and mobilise your shoulder joint and surrounding muscles as needed to improve their motion, flexibility, and strength.
If you have any questions regarding your AC joint injury (or any other condition), please contact your Fixio physio to discuss and organise an appointment to get your recovery on track.
De Quervain’s tendinopathy is a mouthful of a condition that causes pain along the thumb side of the wrist, swelling, decreased grip strength, and restricted thumb movements.
It inflames the sheath (the synovium) that surrounds the two tendons that are involved in moving your thumb and can be very painful if left untreated.
What causes Tenosynovitis?
In 1892, the 13th edition of Gray’s Anatomy first described this tenosynovitis as “wrist sprain of washerwomen”. A Swiss surgeon, Fritz de Quervain went further in 1895 and published a report on five cases of first dorsal compartment tenosynovitis and the condition has taken his name ever since.
While the exact causes are long and debated, repetitive activities requiring sideways movement of the wrist while gripping the thumb and modern handheld electronics have been shown to cause De Quervain’s tenosynovitis.
Who is most at risk?
De Quervain’s tenosynovitis occurs most often in individuals between 30 and 50 years of age and is at least 5 times more common in women. It commonly occurs in mothers with young infants due to a combination of overuse and hormone-related tendon swelling, and those in sports and jobs with repetitive movements.
What are the signs and symptoms?
Symptoms are typically of gradual onset, but may develop suddenly and pain located over the thumb side of the wrist, radiating up to the forearm and swelling is common. It is worse with use of the hand and thumb, especially forceful grasping, pinching and twisting. There may be swelling at the site of pain and “snapping” when the thumb is moved. Due to pain and swelling, thumb movement may be reduced.
How is De Quervain’s tenosynovitis diagnosed?
The Finkelstein test is a simple way physiotherapists diagnose De Quervain’s. It is performed by placing your thumb down into the palm of the same hand, making a fist around it and then bending the wrist towards your little finger. If this exacerbates the pain at the base of your thumb, this is considered a positive test and likely that you have De Quervain’s. X-rays are not usually required for diagnosis.
What is the treatment for De Quervain’s?
Injuries of the hand and thumb can be challenging, since we use them in our daily lives, healing time can take a little longer. Typical physical therapy management of de Quervain’s disease and other wrist disorders consists of:
Rest – As best as possible, try and limit the movements that aggravate symptoms and give it some time to settle down
Splinting – An off the shelf or custom made splint can help your thumb to rest by limiting its movement
Physiotherapy for De Quervain’s
First of all, your Fixio physio is going to check the way you do your work or sports tasks to try to reduce or eliminate the irritation on the thumb tendons. Your physiotherapist may suggest alternative techniques or ways of doing things to ensure healthy body alignment and wrist positions. Part of your bespoke rehab plan for De Quervain’s tenosynovitis supports helpful exercises, and tips on how to prevent future flare-ups.
As you progress, you’ll begin doing active movements and range-of-motion exercises as your physio gives you at-home exercises to help strengthen and stabilise the muscles and joints in the hand and thumb.
For specific advice regarding your wrist pain, please consult your Fixio Physiotherapist. We can create your personalised recovery plan straight away and get you back to doing the things you love, pain free.
The year is 1815 and French surgeon, Jacques Lisfranc de St. Martin is looking for the best place to make an amputation on his patient’s foot. This joint is at the junction between the midfoot and forefoot. The tarsometatarsal joint he chose now bears his name, and refers to an injury involving a break and possible dislocation of your metatarsal and tarsal bones in your foot.
Lisfranc injuries can be difficult to diagnose and treat, but if not detected and appropriately managed by a musculoskeletal physio they can cause long-term problems.
What causes a Lisfranc injury?
Lisfranc injuries can be caused by either direct or indirect trauma.
Extreme force applied to the midfoot, usually following a car accident or a fall from height and crush injuries such as dropping heavy objects onto your foot or your foot being run over are the most common ways of sustaining a Lisfranc injury.
In terms of indirect trauma, injury can occur from plantarward bending associated with rotational stress along with mechanisms where the forefoot is suddenly adducted relative to a fixed hindfoot. This type of injury occurs in equestrians during a fall from a horse when their foot remains in the stirrup.
Sports where your foot is held in position, for example; horse riders, cyclists, snowboarders, kitesurfers and windsurfers are more at risk of a Lisfranc injury. If a fall happens, the foot often is not removed from its placings, resulting in extreme force being applied to the midfoot region causing a dislocation or fracture.
What does a Lisfranc injury feel and look like?
A Lisfranc injury will usually present with:
- Swelling of the foot and/or ankle
- Bruising of the foot and/or ankle
- Pain usually in the middle part of the foot
- Widening of the midfoot area
- Large bump on the top midfoot area
- Not being able to put any weight on the injured foot
What Lisfranc injury symptoms can physiotherapy help with?
Physiotherapy improves the healing process allowing you to return to normal life as quickly as possible following a Lisfranc injury. After a Lisfranc fracture, your foot and ankle will likely be immobilised in a cast or walking boot.
Fixio Physiotherapy treatment provides many benefits following a Lisfranc fracture. These include:
- Decreased pain
- Decreased swelling
- Gait (walking) education without the use of aids
- Increase in muscle strength
- Increase in range of movement
- Increase in function
What does physiotherapy treatment for Lisfranc involve?
There are various treatment techniques that our physiotherapists will utilise depending on your presenting symptoms. Physiotherapy treatment should begin shortly after immobilisation and may include:
- Soft tissue massages to decrease swelling
- Calf stretches to regain the flexibility in the calves
- Range of motion exercises: Plantarflexion, dorsiflexion, inversion and eversion
- Toe and midfoot arch flexibility stretches:
- Ankle and foot strengthening exercises
- Balance exercises
- Plyometrics and jumping exercises: Jumping and landing, single leg hops
- Strengthening to address post immobilisation weakness
- Gait training
A bespoke rehab program will be designed when weight bearing has been commenced. This is to further develop strength, range of movement and flexibility.
You may benefit from the services of a musculoskeletal physio if you have suffered a Lisfranc injury. Your Fixio physio can assess your condition and offer treatments to help decrease your pain and improve your range of motion (ROM), strength, and overall functional mobility.
 Haapamaki V, Kiuru M, Koskinen S. Lisfranc fracture-dislocation in patients with multiple trauma: diagnosis with multidetector computed tomography. Foot Ankle Int. 2004 Sep;25(9):614–9.
 Wiley JJ. The mechanism of tarso-metatarsal joint injuries. J Bone Joint Surg Br. 1971 Aug;53(3):474–82.
Studies have shown that about 1 in 10 men and 1 in 5 women will suffer from upper back pain at some point in their lives. Thoracic spine and upper back pain is a complex issue with many biological, muscular, joint and lifestyle factors contributing to the overall problem.
In between the neck and lower back lies the thoracic spine region, containing 12 vertebral segments and 12 pairs of ribs that attach to the spine at the back and front, forming the rib cage that protects your heart and lungs and provides the mechanics that are essential for breathing.
So you could say it’s a pretty important area.
What causes upper back pain?
Unfortunately for our thoracic spine, our modern lifestyles include long periods of time sitting, slouching, and looking at our mobile phones and computers. This leads to stiffness and reduced movement, increasing the natural kyphosis (rounding curve) of your thoracic spine which can lead to injury and long term pain.
Pain in the thoracic spine is the ugly cousin of lower back pain. Upper back pain can range from a dull ache to borderline debilitating pain that can spread to the shoulders, neck and down to the lower back.
The root cause of your upper back pain may be quite complicated, it is essential that a thorough body assessment is undertaken by your physiotherapist to ensure any underlying issues are identified.
The most common causes of upper back pain include:
- Poor posture while using technology for long periods of time
- Myofascial pain
- Injury or overuse of muscles and ligaments
- A herniated disc (rare) or degenerative joint disease (DJD)
- Repetitive strain injury (RSI)
How can I prevent upper back pain?
Preventing every single cause of upper back pain may not be possible, but there are some basic steps you can take that may avoid some of the more common causes.
- Spending less time on your mobile phone looking down
- Taking regular breaks from sitting
- Stretching any stiff or sore areas
- Warming up the body before any strenuous activities or sports
- Avoiding excessive unaccustomed twisting or lifting with your back
- Have regular massage or physio to help work out the tension and reduce spasms
- Work with a musculoskeletal physio to strengthen weak muscles
- Being conscious of your posture at all times including walking upright and sitting correctly
By undertaking an in depth physical assessment, utilising techniques such as mobilisation, deep tissue massage, dry needling and patient education we aim to restore normal function and improve your quality of life and mobility.
At Fixio, we are experts in assessing all vertebral movements and analysing postural conditions. Your physio will undertake an assessment that will involve thoracic spine movements such as extensions, rotations, side bending and rib expansion.
Other areas of assessment may include shoulder movements such as serving for volleyballers and stroke analysis for swimmers, neck movements and lumbar spine movements as well. Sitting and standing posture will also be assessed by your musculoskeletal physio to watch for kyphosis.
Always remember prevention is much better than a cure.
If you live on the Northern Beaches and would like to know more about our Personal Training or Thoracic Mobility programs
 N. Fouquet, J. Bodin, A. Descatha, A. Petit, A. Ramond, C. Ha, Y. Roquelaure, Prevalence of thoracic spine pain in a surveillance network, Occupational Medicine, Volume 65, Issue 2, March 2015, Pages 122–125, https://doi.org/10.1093/occmed/kqu151
 Theisen, Christina & Wagensveld, Ad & Timmesfeld, Nina & Efe, Turgay & J Heyse, Thomas & fuchs-winkelmann, Susanne & D Schofer, Markus. (2010). Co-occurence of outlet impimgement syndrome of the shoulder and restricted range of motion in the thoracic spine – a prospective study with ultrasound-based motion analysis. BMC musculoskeletal disorders. 11. 135. 10.1186/1471-2474-11-135.
 Heneghan NR, Baker G, Thomas K, et al What is the effect of prolonged sitting and physical activity on thoracic spine mobility? An observational study of young adults in a UK university setting BMJ Open 2018;8:e019371. doi: 10.1136/bmjopen-2017-019371