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
If I had a dollar for every time I saw a new patient who had been self treating a “quad strain” for months when the pain is actually from something completely different, I could be retired right now.
Your thigh and quadriceps might seem like a straightforward area to self diagnose when you’re feeling pain, but it’s actually a rather complicated musculoskeletal zone.
Without treatment from a sports physio or musculoskeletal specialist, thigh pain can linger and deteriorate into a more serious ailment. Thankfully, with the right diagnosis and treatment, your thigh pain is unlikely to become chronic.
Are my thighs and quadriceps the same thing?
No. Your thigh includes the quadriceps femoris, but the quads alone are not the entire thigh. Your thigh is actually a region made up of 3 main groups of muscles:
- The quadriceps (located at the front of your leg)
- The adductors (on the inside area of your leg)
- The hamstrings (at the rear of your leg towards your glutes)
The quadriceps is comprised of four muscles that connect just above your knee:
- The Vastus Lateralis (located to the outside of your thigh)
- The Vastus Intermedius (located in the centre of your thigh)
- The Rectus Femoris (smaller and located at the front of the thigh covering the Vastus Intermedius)
- The Vastus Medialis (to the inside of your thigh)
What are the signs of a quadriceps strain and how is it treated?
As with most muscular and tendon tears, thigh strains are divided into three grades:
- Grade one – the symptoms of a grade 1 tear may not be present until after the activity is over. It can commonly feel like a thigh cramp with associated tightness and mild pain when the muscles are stretched or contracted.
- Grade two – you will feel immediate pain during stretch and muscle contraction worse than a grade 1 injury and is usually sore to touch.
- Grade three – is a serious injury where the muscle is completely torn. You will feel an immediate burning or stabbing pain in your thigh that will stop you being able to walk without pain and there may even be a large lump of muscle tissue above a depression accompanied by bruising.
Your thigh is a prime area for referred pain
What is referred pain? Pain is a continually evolving science that we don’t know everything about yet. Referred pain is any pain felt at a location in your body that is not the direct source of the pain.
Have you ever visited a physio for a sore shoulder and the first place they started looking at was your neck? That’s referred pain.
Due to your thigh’s proximity to the groin, pelvis and role in ITB function, it is a prime candidate to feel referred pain from any number of local regions.
Thigh pain can also be the manifestation of:
- Sciatica type symptoms – your femoral nerve can refer pain to the front of your thigh
- Hip joint conditions such as arthritis
- Meralgia Paresthetica – when the lateral femoral cutaneous nerve becomes impinged
- Lower back pain
- Vascular problems such as a deep venous thrombosis
- And rarely; a fracture to the femur bone
As a musculoskeletal physio we have years of clinical experience diagnosing and treating thigh injuries of all kinds along with diagnosing causes of referred pain to the thigh. After a detailed clinical assessment of your injury, biomechanics, sporting technique and muscle coordination, we will devise a rehabilitation program tailored to your needs.
Give us a call on (02) 8964 4086 or book an appointment and firstname.lastname@example.org
Summer is nearly here and that means Northern Beaches cricketers will be dusting off the whites and getting ready for a spit free Summer of cricket. It also means your local Dee Why physio is getting prepared for the annual increase in throwing injuries and other shoulder, elbow and wrist injuries.
While throwing injuries usually occur in throwing sports such as cricket, softball, javelin and water polo, they can also pop up in sports that simply use a lot of overhead rotation and movement like serving in volleyball and tennis.
The biomechanics of throwing
Throwing is the co-ordinated effort of a number of muscle groups and is one of the fastest actions human beings can perform. Major league pitchers’ maximum humeral internal rotation velocity has been measured at over 7500°/second.
An overhead throw has 6 phases:
- wind up,
- deceleration and
- follow through
Escamilla RF, Andrews JR. Shoulder muscle recruitment patterns and related biomechanics during upper extremity sports
Throwing injuries tend to occur due to overuse, poor throwing technique and can come on gradually, sneaking up on you before you realise you’ve done yourself a painful injury.
Throwing injuries most commonly occur in the shoulder of the throwing arm, but can also appear as elbow and wrist complaints too.
The shoulder is the most common location for injuries from throwing and overhead movements and different phases of throwing gives us the possibility of all kinds of different injuries.
- Windup – No injuries are common
- Cocking – Anterior subluxation, internal impingement, glenoid labrum lesions, subacromial impingement.
- Acceleration – Shoulder instability, labral tears, overuse tendinitis, tendon ruptures.
- Deceleration – Labral tears at the attachment of long head of biceps, subluxation of long head of biceps by tearing of transverse ligament, lesions of rotator cuff
- Follow Through – Tear of superior aspect of glenoid labrum at the origin of biceps tendon, subacromial impingement.
During the throwing motion, your arm is acting like a whip just before it cracks. This leaves your elbow under a lot of stress and at risk of injury as well.
That repetitive sideways force to the elbow combined with a poor throwing technique is the recipe for a Medial Collateral Ligament Sprain and swelling and pain.
How do physiotherapists treat throwing injuries?
A number of factors contribute to the development of throwing injuries and your physio will do an in-depth biomechanical and injury assessment before getting stuck into your new program.
A bespoke program designed by a musculoskeletal physio will aim to:
- Improve shoulder flexion, abduction, external and internal rotation
- Utilise manual and massage therapy techniques on muscle tightness in your latissimus dorsi, pectorals, rotator cuff, abdominals & hip flexors
- Improve thoracic spine flexibility when performing extension and rotation of throwing
Help prevent throwing injuries with help from your physio
Whether you’re a weekend warrior or an elite athlete, a musculoskeletal physio is a goldmine for injury prevention techniques to ensure you can maintain optimal performance while taking care of your body.
A visit to a physio can help decrease your chances of injury in the future.
- Help to correct your throwing technique
Ensure your throwing technique is safe and efficient, minimising the risk of injury to the shoulder and elbow. Make sure you use the whole body, including the legs and hips rather than confining the throwing motion to the upper body.
- Improving flexibility
Upper back flexibility is extremely important for athletes that throw or use overhead motions regularly. Not only does upper back flexibility help with injury prevention to the shoulder, but it also acts as a performance enhancer. Having adequate flexibility in your upper and lower body is important to improving your throwing technique, reducing the risk of injury and performing to your full potential Key joints which require adequate range of motion for throwing include:
- Upper Back
- Lower Back
For more information on throwing injuries, injury prevention techniques and managing sports injuries, give us a call on (02) 8964 4086 and send an email to info@ﬁxio.com.au.
 Seroyer ST, Nho SJ, Bach BR, Bush-Joseph CA, Nicholson GP, Romeo AA. The kinetic chain in overhand pitching: its potential role for performance enhancement and injury prevention. Sports Health. 2010 Mar;2(2):135-46. doi: 10.1177/1941738110362656. PMID: 23015931; PMCID: PMC3445080.
 Escamilla RF, Andrews JR. Shoulder muscle recruitment patterns and related biomechanics during upper extremity sports. Sports Med. 2009;39(7):569-90. doi: 10.2165/00007256-200939070-00004. PMID: 19530752.
 Houglum PA, Bertoti DB. Brunnstrom’s clinical kinesiology. FA Davis; 2012
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.
The Achilles tendon is the longest tendon in the body, connecting the heel bone to the calf muscles.
Characterised by pain and inflammation of the Achilles tendon or its covering, Achilles Tendinopathy is an overuse injury that is most common in joggers, jumpers and other activities that require repetitive actions. This pain and stiffness is sometimes worse in the morning and at the start of exercise, and may disappear as you warm up. You may also notice the area is swollen and tender to touch.
The suffix ‘itis’ implies inflammation. Previously called ‘tendinitis’ or ‘tendinosis’, physios have moved on from these terms as modern science has proven that inflammation is not the driving force in tendon overuse injuries. So taking anti-inflammatories for your tendinopathy may not have great long term relief.
A more appropriate term is tendinopathy which means dysfunctional tendon health.
Common causes of Achilles tendinopathy 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
Achilles tendon rupture
The dreaded ‘snapped’ Achilles tendon. The mere thought of it brings a tear to the eye.
68% of all acute Achilles tendon ruptures occur during some form of athletic activity. Eccentric movements put an enormous amount of stress on the tendon and stop-and-go sports like volleyball, basketball, soccer and squash are commonly involved.
If you have ruptured your Achilles tendon you will probably experience:
- A loud crack or popping sound at the moment of injury
- A sharp pain at the moment of rupture
- An inability to raise or flex your heel
- The back of your heel may swell
How can a physio help?
Achilles injuries do not usually get better on their own. They may feel a little bit better with rest, but once you start doing an aggravating activity again it will become painful. Continuing to do aggravating activities despite pain or dysfunction is a great way to prolong your recovery time.
The goals of physiotherapy are to treat any acute issues associated with your Achilles injury:
- Rest from aggravating activities
- Ice or heat (as directed)
- A targeted stretching and strengthening program
- Dry needling
They will also look to identify predisposing factors, reduce pain and inflammation, and promote healing to restore the muscle and tendon.
Your physio will look to address the factors that caused the injury in the first place, to help reduce the risk of re-injury, commonly including:
- Abnormal lower limb mechanics (foot, knee and hip)
- Calf weakness
- Poor muscle flexibility
- Stiff ankle joints
- Training: inappropriate training load and recovery time between training sessions
- Poor footwear, footwear wearing out
Fixio will also provide you with a targeted tendon rehabilitation program to make your Achilles stronger and more flexible. Finally, we will provide you with advice regarding when and how you can return to sport and/or activity. It is important to follow this advice to prevent recurrence, or worsening, of the tendon injury. Rehabilitation can be frustratingly slow but with perseverance it will get better!
 Raikin SM, Garras DN, Krapchev PV. Achilles tendon injuries in a United States Population. Foot Ankle Int. 2013;34:475–480.
Ankle injuries, particularly ankle sprains are among the most common injuries seen by sports physiotherapists. Especially on the Northern Beaches where people are out and about playing sports, running and generally doing things that put them at more risk of doing themselves a mischief.
So, you’ve just rolled your ankle down at the beach playing volleyball and it hurts like heck! What do you do?
Hundreds of thousands of people attend emergency rooms around the world with ankle injuries, usually sustained recreationally or in a simple fall. Most of the time, these people end up having a simple soft tissue injury or a small fracture of no clinical significance. With most people just going straight for the emergency room, they’re exposing themselves not just to the germs of the emergency ward, but also to x-ray radiation for possibly no benefit.
Ankle injuries make up around 5% of all patients who visit emergency rooms. Fewer than 15% of them will have a clinically significant fracture. Some will have more serious fractures, requiring immobilisation or internal fixation, but there are more ways than one to determine whether you have a more serious injury of the ankle.
Are x-rays needed? Turn to the Ottawa rules
Ankle sprains cause pain, oedema, ecchymosis, and often make it impossible to bear weight without pain. Even though uncomplicated sprains usually heal with physio treatment, other ankle injuries may require a more surgical approach.
Differentiating between a simple and complicated injury is not always easy, particularly for relatively inexperienced physiotherapists. This is why a series of tests and rules have been developed to serve as guidelines for sports physios to diagnose ankle injuries and to determine the indications for radiography.
The Ottawa foot and ankle rules are an evidence-based guide that helps determine the use of initial x-rays after acute ankle injury. The rules state:
An ankle X-Ray series is required if there is any pain in the malleolar zone and:
- Bone tenderness at the posterior edge or tip of the lateral malleolus
- Bone tenderness at the posterior edge or tip of the medial malleolus
- An inability to bear weight both immediately and in the emergency department for four steps
A foot X-Ray series is required if there is any pain the midfoot zone and:
- Bone tenderness at the base of the fifth metatarsal
- Bone tenderness at the navicular
- An inability to bear weight both immediately and in the emergency department for four steps
In a recent review of 27 studies evaluating the implementation of the Ottawa ankle rules, a hit rate of almost 100% was found for the rules, with a possibility of reducing the number of unneeded x-rays by between 30–40%. With a reliability of nearly 100%, the rules have also shown to diagnose and exclude ankle and foot fractures in children and young adults.
Of course, the value of a normal x ray in providing reassurance and diagnosis of more serious injuries is still relevant. However, the Ottawa ankle rules provide a high level of diagnostic confidence in the absence of x-rays when considering treatment options and recommendations for return to activity.
If you have hurt your ankle, don’t waste any time in getting to your local sports or musculoskeletal physio ASAP. They will be able to take you through an in-depth physical assessment and likely determine the severity of your injury without clogging up emergency rooms and exposing yourself to radiation in the process.
 Heyworth, J. (2003). Ottawa ankle rules for the injured ankle. British Journal of Sports Medicine, 37(>3), 194–194.
 Stiell IG, Greenberg GH, McKnight RD, et al. Decision rules for the use of radiography in acute ankle injuries: refinement and prospective validation. JAMA 1993;269:1127–32.
 Bachmann LM, Kolb E, Koller MT, et al. Accuracy of Ottawa ankle rules to exclude fractures of the ankle and mid-foot: systematic review. BMJ 2003:326:417–9.
 Plint AC, Bulloch B, Osmond MH, et al. Validation of the Ottawa ankle rules in children with ankle injuries. Acad Emerg Med 1999;6:1005–9.