Author: Cumberland Physiotherapy

 What Is It?

The knees function as hinges, allowing your legs to swing forwards and backwards smoothly as you walk, kick and run. The kneecap, also known as the patella, sits at the front of the knee and has a variety of functions, including guiding the muscles that straighten the knee, protecting the knee joint and absorbing forces when the knee is bent. When something goes wrong and the kneecap doesn’t move up and down smoothly, the soft tissue between the kneecap and the knee can become irritated, causing pain in a predictable fashion. This is called patellofemoral pain syndrome (PFPS), sometimes also referred to as PFJ syndrome or runner’s knee.

Pain is usually felt on the inside of the kneecap when you put pressure on your knees by running, squatting, bending, using stairs, or hopping. Sitting for long periods of time or keeping your knees bent could also result in pain.

What Causes It?

The kneecap sits in a shallow groove at the front of the knee and usually moves up and down as the knee bends and straightens without too much trouble. The quadriceps muscles, located at the front of the thigh, contract and pull on the kneecap, which then attaches to the lower leg and act to straighten the knee. If one side of the quadriceps is stronger or tighter than the other, it can cause the kneecap to pull to one side and over time become irritated. 

The cause of muscle imbalance or weakness can be for many reasons. In general, the outer muscles of the thigh tend to be stronger and tighter than the inside muscles. If you have poor posture and hip position, this often causes the outer muscles to work harder and the inside muscles to become weaker. Lack of arch support in your feet or simply a physical abnormality of the knees can also cause this condition.

How Can Physiotherapy Help?

Diagnosing patella-femoral pain syndrome correctly is important because pain on the inside of the knee can also be caused by injury, dislocation, inflammation, arthritis and a variety of other less common diseases.

With that in mind, it is helpful to know that your physiotherapist can diagnosis PFPS and identify its likely causes.

Whether it is due to poor posture, a lack of arch support in your feet, or poor running technique, your physiotherapist will assess the problem and provide a specific treatment program to best approach your condition. PFP syndrome usually responds quite well to biomechanical analysis and correction of any muscular weakness and imbalance. Having the correct shoes and orthotics can also make a huge difference. There are some short-term treatments, such as patella taping, try needling, trigger point therapy and ultrasound, which may help alleviate symptoms quickly and keep you active while you address the other factors contributing to your pain.

In the rare case that your condition is not helped by physiotherapy, surgery is also considered as last resort. For more information, please feel free to ask your physiotherapist.

None of the information in this article is a replacement for proper medical advice. Always see a medical professional for advice on your individual injury.

 There is no doubt that the human body can be resilient. The body is capable of recovering from amazing amounts of damage, including broken bones. Perhaps because of this, many people feel that physiotherapy treatment can only speed up recovery and if they are not elite athletes then simply letting nature take its course is the best, and most cost-effective choice for them. 

Speed of recovery, however, is only one very small measure of physiotherapy success and fails to fully represent how important proper treatment is. Here are a few things about injury healing you may not have been aware of.

1. Scar Tissue is more likely to form without treatment. 

Scar tissue can cause ongoing pain and stiffness in skin, muscles and ligaments. Physiotherapy can prevent excess scarring through advice regarding movement, massage and other hands-on treatment. 

2. Your ability to sense the position of your body, known as proprioception, is often damaged after an injury and can be retrained. 

Impaired proprioception is a major factor in reinjury. If you’ve ever heard someone say “my knee/ankle/shoulder still doesn’t feel 100%” then this could be why. Physiotherapy treatment will aim to restore proprioception as a part of standard rehabilitation. 

3. Once healing has finished, your body may not be quite the same as before. 

Injured ligaments may be weaker, torn muscles and joints may be stiffer and tighter. While the original pain may resolve, there may still be some residual issues that need to be addressed to prevent reinjury. 

4. You may have picked up some bad habits while waiting for the injury to heal. 

While in pain, we often change the way we do things, which can lead to the development of poor movement patterns and muscle imbalances. Even though the pain has gone, these new patterns can persist and create further problems down the road. 

5. Injuries don’t always heal completely.

On rare occasions, circumstances may prevent an injury from healing fully. The most serious example of this would be a fracture that cannot heal if the bone is not kept still enough. Other factors that may prevent an injury from healing include poor circulation, diabetes, insufficient care of the injury and poor nutrition. 

Your physiotherapist can assess your injury and develop a treatment plan that will both restore you to the best possible function and prevent further injuries.

 Back pain is such a common experience that it is estimated up to 80% of adults will have at least one severe episode of back pain in their lifetime.  

For many people, the pain quickly resolves and things go back to normal. However the first time this happens to you it can be scary, particularly as very severe pain can occur suddenly and without warning. 

Statistics, however, are on your side. Most of the time, acute low back pain resolves without consequence and doesn’t recur. If you happen to be in the middle of an episode, here are a few tips to help you get through.

1. Avoid heavy lifting

While this may seem obvious, there are a few people who will always try to push through the pain. The expression “no pain, no gain” is in many cases outdated and if your work requires heavy lifting, it is more than reasonable to take a few days off. 

2. Avoid too much rest.

On the other hand, lying in bed all day is bad for you as well. If you have severe back pain, gentle movement under the advice of a physiotherapist is much better for you than complete rest. 

3. Avoid long car or plane trips

If possible, now is the time to avoid long distance travel. If you absolutely must travel, speak to your physiotherapist about how to manage your pain during the trip. 

4. Avoid listening to horror stories

There are always stories about pain that never went away, requiring surgery, which only made it worse. While worst case scenarios do happen, being fearful is a negative factor in a healthy recovery. That terrible story is probably not going to happen to you and hearing these stories is only going to impact your recovery negatively.

5. Avoid delaying treatment

While your pain may go away on its own, it is important to have a professional assess your condition to screen for any serious injuries and advise you on how to best manage your pain while you are getting better. They can also help you recover as quickly as possible.

6.   Don’t expect a miracle cure

Back pain is complicated, and a single treatment that works for everyone does not exist. It is important to follow the directions of your therapist and work with them to set reasonable and realistic goals for your recovery. 

None of the information in this article is a replacement for proper medical advice. Always see a medical professional for advice on your individual injury.

What is a stress fracture?

A stress fracture is a microscopic fracture of the bone that is so small that it often cannot be picked up on X-ray. If left untreated, a stress fracture can cause significant disability and develop into a full fracture, possibly even requiring surgery. 

The majority of stress fractures occur in the lower limb, being particularly common in the hip, shins and foot at points where the most force passes through when weight bearing. Most stress fractures are overuse injuries and are common in long distance runners.

What are the symptoms?

As with many overuse injuries, the pain of a stress fracture starts gradually, beginning with pain during or after activity or sometimes the morning after. If activity continues without modification, the pain will gradually increase. Eventually most people are unable to maintain their usual activity level. Stress fractures are common in runners and military personnel who are required to march for long periods. A stress fracture will be more likely to occur in a person who has weaker bone strength, such as someone with osteoporosis, which is itself affected by many factors such as adequate calcium intake, vitamin D deficiency and a history of inactivity.

How are stress fractures treated and how long will it take to get better? 

Stress fractures can easily be mistaken for other conditions such as shin splints. As the fracture is often too small to show up on X-ray, definitive diagnosis can be made using MRI or bone scan.

After diagnosis, the most important part of treatment will be resting the area to allow the bone to heal before resuming activity. Stress fractures usually need at least 6 weeks to recover fully. Some areas of the body have poor blood supply, which makes healing more complicated.  For example, stress fractures of the navicular bone of the foot may need to be kept still and placed in a boot or cast for a period of time to heal properly. 

Other aspects of treatment will involve correcting any factors that contributed to the original injury. There is some evidence that unsupportive footwear is a risk factor, along with poor biomechanics and weak muscles that provide inadequate support to the skeletal system during activity. Speak to your physiotherapist if you suspect you may have a stress fracture or simply want to know more.

None of the information in this article is a replacement for proper medical advice. Always see a medical professional for advice on your individual injury.

 Tendons, the soft connective tissues that join muscles to bone are known for being notoriously difficult to treat once injured. The reason for this is that often they are injured through stress or overuse, and compared to muscles have relatively small blood flow, which is essential for healing. 

Tendons and muscles work together to move your joints and are called a contractile unit. As muscles are exercised and gain strength, the attaching tendons are also placed under tension and adapt to this to become stronger. If the load placed on the tissues exceeds their capacity, the tendon fibres can begin to break down and become stiff and painful. 

Is my pain related to a tendon injury?

For an accurate diagnosis, you will need to be assessed by a physiotherapist. However, some signs that your pain might be coming from an in issue with your tendon are; 

· The pain is quite specific and can be felt over the tendon itself. 

· The pain is worse when under stress and improves when rested. 

· The pain improves after exercise has started, but it might be worse the day after. 

· The area around the tendon may feel stiff after periods of rest, particularly in the morning. 

How are tendon injuries treated?

When it comes to recovery, tendons are often treated differently to other injuries. While each tendon injury is unique and will require assessment and intervention by a physiotherapist, there are a few general approaches that usually help with all tendon injuries.  

Reducing your activity to a comfortable level is the first step to recovery. Complete rest can actually delay healing as the tendon simply becomes weaker and less able to cope with subsequent loads. Your physiotherapist can provide you with a targeted exercise program to aid your recovery. Eccentric exercises, which are exercises that work alongside gravity, have been shown to stimulate tendon healing and strength.

Stretching may aggravate your injury and should be used with caution. Assessment of any biomechanical faults or stresses that are placing undue load on the tendon is also a central component of treatment. Your physiotherapist is able to guide you with your recovery and return to sport to avoid aggravating any injury. 

The information in this article is not a replacement for proper medical advice. Always see a medical professional for an assessment of your condition.

 Your physiotherapist has a wide variety of skills and can help treat so much more than just pain and injury. Here are a few reasons to visit your physiotherapist that can keep you healthy and pain-free, before injury strikes.

Stiffness and Inflexibility

Almost all of us have experienced pain and stiffness after a day of increased or unaccustomed exercise. This kind of stiffness usually wears off quickly and is referred to as DOMS (delayed onset muscles soreness). However, if you find yourself feeling stiff for more extended periods, or even most the time – it might be time to see a physiotherapist. There are many different causes of stiffness and inflexibility; by far, the most common is lack of movement. Our joints and muscles both lose flexibility if not moved through their range regularly. Muscle stiffness can feel like a tightness with a bouncy feeling of restriction, and joint stiffness can create a hard ‘blocked’ feeling when you try to move. 

When it comes to stiffness the evolves from lack of movement, you may not even notice that you have lost range, as it can be very easy to adapt your movements to compensate. Your physiotherapist can help you to identify where you have areas of inflexibility and help you to exercise, stretch and mobilise your joints to get them back to a healthy range. Disease processes such as Osteoarthritis and Rheumatoid Arthritis can also cause prolonged stiffness, and your physiotherapist is well equipped to help you deal with these conditions. 

Reduced Strength or Weakness

There are many reasons for weakness in the body, from generalised disuse, weakness in one muscle group following an injury, neurological weakness or structural weakness of joint following a ligament tear. Musculoskeletal deficiency of any kind can predispose you to future injuries and can be surprisingly difficult to resolve without targeted exercises. Your physiotherapist can determine the cause of your weakness and determine the best treatment to restore your muscle strength. 

Reduced Balance

Keeping your balance is a very complicated process, and your body works hard to make sure you stay on your feet. Humans have a very small base of support for our height, and we use all our senses together to determine which movements we should make to stay upright, including our visual, vestibular, muscular and sensory systems. As balance is so essential for walking, if one system that supports our balance begins to weaken, the others will quickly compensate, so you may not notice that your balance has worsened until you fall or trip over more often. 

As a general rule, balance does deteriorate as we age, but this does not mean that falling should be an inevitable part of aging. Actively working to maintain or improve your balance can have a significant effect on your quality of life and confidence in getting around. Your physiotherapist is able to test all the aspects of your balance and provide effective rehabilitation to help keep you on your feet.

The information in this article is not a replacement for proper medical advice. Always see a medical professional for an assessment of your condition. 

 Have you ever woken up with an inexplicably stiff and painful neck that will only turn to one side? You might have been suffering from acute wry neck, a painful condition following a typical pattern of symptoms. In the clinic, wry neck is classified as one of two different types – Facet or Discogenic wry neck. 

Facet Wry Neck:

Facet joints are found on either side of the spine and allow controlled rotation and side bending of the neck. An awkward or sudden movement of the neck can cause a part of the joint capsule to tear or get caught in the joint, making it feel locked. The muscles around the area can also become tight and spasm, which amplifies the pain. The pain is usually sharp and can be pinpointed quite accurately to the part of the neck causing the problem, and the pain rarely travels down into the arm. It is usually possible to find a resting position where the pain goes away completely, only having pain when turning in specific directions. The good news about Facet Wry Neck is that your physiotherapist is usually able to help you ‘unlock’ the neck quite quickly with gentle mobilisations. Most of the time, a full recovery can be expected within a week. 

Discogenic Wry Neck: 

The vertebrae of the neck are separated from each other by fibrous discs, filled with a gelatinous centre. These discs provide support, flexibility and shock absorption. When placed under pressure, these discs may bulge or tear, and the resulting swelling can cause pain and muscle spasm in the surrounding area. It is important to note that in an area as sensitive as the neck, a small amount of damage can result in a large amount of pain. 

The development of discogenic wry neck is usually due to a combination of factors, including neck stiffness, poor posture and biomechanics than can contribute to the disc being vulnerable prior to the injury. In this case, it can be challenging to find a comfortable position, and it is more likely for the pain to travel into the arm and include pins and needles. 

Treatment of discogenic wry neck is focused on reducing pain and muscle spasm with massage, taping, heat and postural education. Further treatment aims to reduce any stress that is being placed on the disc, mobilise any stiff spinal segments and correct any muscle imbalances. While the initial symptoms may settle down quite quickly, it can take up to six weeks to fully recover from discogenic wry neck. In this condition, it is also essential to address all the factors that may cause a recurrence of the issue.

The information in this newsletter is not a replacement for proper medical advice. Always see a medical professional for an assessment of your condition. 

 Many of us spend more time at our desks than any other place. While the risk of injury while seated can seem very unlikely, spending hours in a poorly set up workspace can place vast amounts of pressure on your body and lead to overuse injuries. Below are a few tips that can help you set up your workstation correctly.

Your Chair

Starting with the height of your chair is the best place to begin. Ideally, your feet should be flat on the floor, and if you can adjust the height of the chair, your thighs should be parallel to the floor. If your chair has armrests, they should be low enough to allow your elbows to sit comfortably between 90-110 degrees and resting by the side of your body. A small cushion or rolled-up towel may be added to the back of the chair to add support to the lower back, and this can also help to prevent slouching. 

If you are unable to adjust your chair and it is too high, you can use a footrest to allow them to rest comfortably. 

Your Desk 

The height of your desk should be set so that your arms can rest comfortably at the keyboard and hands, wrists and forearms can sit in a neutral position and parallel to the floor. Where possible, put everything you need within easy reach and alternate days using your mouse and phone with different hands-on different days. 

Your Screen

The height of your computer should be raised so that the top of the screen is slightly below eye level. Allowing your neck to rest in a neutral position can help to prevent neck pain and headaches. Ideally, if you can set the screen to be 20-40 inches away from your face, this will reduce strain on your eyes while reading. 

Some other tips

Being comfortable is extremely important for productivity and focus if you are struggling with pain; your work will often suffer. Even joint stiffness and muscle tightness can disrupt your workflow, and taking the time to adjust your workstation can save you countless hours in the long run and prevent painful overuse injuries. 

Taking active breaks from sitting to move and stretch can help to maintain muscle and joint health, which can be compromised from being in the same posture too long. You can set a timer or make an active effort to take phone calls and meetings while standing. 

Speak to your physiotherapist for personalised advice on your workplace setup. 

The information in this article is not a replacement for proper medical advice. Always see a medical professional for an assessment of your condition.

 What is Trochanteric Bursitis?

The muscles that surround the hips have a complicated role to play. They work to keep the pelvis level and control one of the most flexible joints of the body. They are organized in layers, and the deeper muscles are separated from the outer muscles by sheets of connective tissue, to allow easy gliding, as they interact with each other. 

With all the layers of muscles working together, some points in the body are more prone to experiencing tension and friction during movement. Small sacs called bursa release a natural lubricant to allow gliding and sliding of different muscular layers and are scattered around the body at points of increased stress.

They are found all over the body and usually are quite inconspicuous, which is why most people have never heard of them. However, occasionally something goes wrong, and they become irritated and painful. This will usually happen in a few typical places in the body and one of them this over the greater trochanter, the bony part of the outer hip. 

What Are The Symptoms?

The most common symptoms of trochanteric bursitis are a sharp, superficial pain on the outside of your hip, which may radiate down to the knee. You can experience pain with a number of activities such as walking, jogging, climbing stairs and cycling or simply lying on the affected side.

How Does It Happen?

The most common cause for this is a combination poor biomechanics and overuse. When you have poor biomechanics, the structures around the bursa become tighter and can begin to irritate the bursa.

Some things that contribute to poor biomechanics around the hip are weak, uncontrolled muscles, tight muscles, flat feet with unsupportive footwear, a difference in leg length, incorrect equipment settings and scoliosis. These can all lead to irritation of the bursa around the hip.

How Can Physiotherapy Help?

As there are many other conditions that can cause pain at the outer hip, correct diagnosis is essential. Once diagnosis is confirmed, the first phase of treatment is to reduce pain and irritation.

This can be done with muscle release techniques, ice application, rest, fitting you with orthotics and advice for modification to your lifestyle. Your physiotherapist will also evaluate the causes of the irritation and prescribe a suitable rehabilitation program to change your biomechanics.

Serious cases can be treated with corticosteroid injection or even surgery, but with thorough physiotherapy treatment, you can usually get back into action within six weeks. 

None of the information in this article is a replacement for proper medical advice. Always see a medical professional for advice on your injury.

Staying active at home can be challenging especially when many of us don’t have access to our local gym. Physical health and wellbeing are  equally important both mental health and with this in mind, we’re offering a few suggestions for how to use everyday home objects to stay in shape. Even if you don’t have access to a single piece of gym equipment, there are many items in your home that can be used to keep you active.

Water bottles, soup cans or jug of laundry detergent – these things are substitutes for dumbbells. The size or weight of the bottles or cans will depend on how heavy you can lift. If you have empty water bottles just sitting around in your garage, fill them with sand or rocks for a heavier load.

Chair – choose the most stable chair in your house then you can start doing triceps dips and push-ups. When you do these exercises, you’re using your own body weight, thus, eliminating the need for other equipment.

Towels – these can be used to strengthen and stretch your muscles. For example, place each of your hands on the ends of the towel. Bring your arms over your head and then, pull the towel on both sides. Doing so can tone your arm muscles. For stretching, hold one end of the towel and position one arm as if you’re doing a triceps curl. Place your other arm behind your lower back and hold the towel. Pull the towel downwards until you feel a stretch on your triceps. Hold that position for 30 seconds and do that for five repetitions. Repeat this on your other arm.

Wall – if you’re having a hard time perfecting your squats, standing with your back against the wall can help as it promotes the proper posture and alignment of your body when doing squats.

Stairs – going up and down the stairs will boost your cardio level. To challenge yourself further, run up and down the stairs a couple of times a day. You can also strengthen your calves on the first step of the stairs by doing toe lifts.

Basketball, volleyball or soccer ball – use any of these balls as a medicine ball alternative. These would be great for thigh and leg squeezes. You can also use the balls if you want to improve your balance.

Backpack – get your backpack and fill it with anything you want. Just make sure you’ll be able to carry it. When you’re ready, do some squats, lunges and push-ups. The added weight on your backpack maximizes your workout by engaging your muscles better and getting your heart rate up faster.

Working out at home can require a little more creativity but can be done! Speak to one of our physiotherapists for more tips so you can keep active at home.

The information in this article is not a replacement for proper medical advice. Always see a medical professional for an assessment of your condition.