Author: Cumberland Physiotherapy

What is it? 

Our knees are complex hinge joints, designed to provide stability from side to side and smooth movement forwards and back as you walk, kick and run. The patella, or kneecap, is a small bone embedded in the tendon of the quadriceps muscle that protects the knee and also provides extra leverage to the quadriceps, amplifying their strength. The patella moves up and down in a groove at the front of the knee as the knee bends and straightens. Usually this movement is smooth, with little friction, however, if something causes the patella to move in a dysfunctional way, the soft tissue between the kneecap and the knee can become irritated, causing pain in a typical pattern. This condition is often referred to as ‘runner’s knee’, PFJ Syndrome or patellofemoral pain syndrome (PFPS).

What causes it?

The patella usually sits in a balanced position in the shallow groove at the front of the knee and moves easily without friction. The patella is attached to the quadriceps muscle at the top and connected to the lower leg via the patella tendon at the bottom. When the quadriceps contracts, this pulls on the patella and acts 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. 

There can be many factors that cause a muscle imbalance or weakness on one side of the quadriceps. In most people, the outer aspect of the quadriceps tends to be stronger and tighter than the inner muscle. 

Certain postures and leg positions require the outer muscles to work harder and the inside muscles to become less active. Lack of arch support in your feet or simply a physical abnormality of the knee can also place stress on the movement of the patella.

What are the symptoms?

This condition is characterized by pain felt on the inside or behind of the patella with activities that require repetitive bending of the knee. There may be a sensation of crepitus, clicking or grinding and some people report that their knee suddenly gives way. The pain is commonly felt when running, going up and down stairs or when doing squats and is relieved with rest. The pain may start as a small niggle and gradually become worse over time.

How can physiotherapy help?

The first step in effective treatment is to exclude any other conditions and have a physiotherapist confirm the diagnosis. Your physiotherapist is able to determine which factors are contributing to this condition, which could include poor posture, a lack of arch support in your feet or poor running technique.

Once these factors have been identified, you will be provided with 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. None of the information in this blog is a replacement for proper medical advice. Always see a medical professional for advice on your individual injury.

 

Most tissues in the body have healed completely in six to 12 weeks following an injury, however, many people have severe pain that lasts much longer than this. We know that the intensity of the pain you feel is not always associated with a similar amount of damage. In some cases, there can be a severe amount of pain with almost no detectable damage. With this in mind, we explore some reasons why your pain might not be getting better, long after the tissues have healed. 

You’re afraid of the pain. 

Pain can mean many different things, for some of us pain can affect our ability to work or can be a symptom of a serious disease. What you believe about your pain can either amplify or reduce the symptoms you experience. If you feel that every time you experience pain you are causing more damage, you will naturally pay more attention to this and your nervous system will amplify the signals in an attempt to keep you safe. 

If you understand the cause of your pain and know that while there is discomfort, you are not in danger of causing more damage, often the pain will feel less severe. This is one of the benefits of seeing a physiotherapist after your injury as they can help you to understand your pain, giving you more control over your recovery.

You started moving differently after the injury.  

Immediately after an injury, it’s natural to change the way you move to avoid painful movements. After a while, these changed movement patterns can become maladaptive and actually begin to cause pain and discomfort on their own due to the altered stress patterns placed on your body. 

Correcting these adaptive movement patterns can often go a long way in reducing pain after an injury. You might not have noticed these changes and might need a physiotherapist to identify and help you to return to your usual movement pattern.

You have lost muscle strength since the injury. 

While a certain amount of rest following an injury is always helpful, if we stop moving altogether, our muscles can lose strength. This can mean that our posture changes, we fatigue easier during our usual activities and that we are more susceptible to further injury. Less movement also means we actually focus on the pain more when it does happen. Physiotherapists are able to advise you on the right types and amounts of excercise for you in the period following your injury.

The pain has affected your lifestyle.When pain affects your ability to sleep, work and even concentrate, it’s not surprising that this can have a negative affect on your overall wellbeing and mental health. This can create a negative cycle of anxitey and depression that perpetuates and increases the experience of pain. If your pain is really getting you down, speaking to a mental health professional can actually be a valuable part of your physical recovery. 

There is no doubt that the human body can be very resilient. Short of regenerating new limbs, our bodies are capable of recovering from large amounts of damage, including broken bones. With this in mind, many people are happy to let nature take it’s course following an injury, thinking that seeing a physiotherapist will only act to speed up already healing tissues.

The speed of recovery, however, is only one measure of healing and despite our bodies’ incredible capacity for repair; injury repair can be less than straightforward. 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 excessive scarring from forming 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 re-injury. If you’ve ever heard someone say “my knee/ankle/shoulder still doesn’t feel 100%” then this could be why. The good news is that with a specific exercise program, proprioception can be improved and recovered.

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

Following an injury, ligaments may be lax, joints may be stiffer and muscles are almost always weaker. While the pain may be gone, there might still be factors that need to be addressed to prevent more complicated issues in the future.

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, this can lead to the development of poor movement patterns and muscle imbalances. Even though the pain has gone, these new patterns can remain and create further problems down the road.

5. Injuries don’t always heal completely.

 On rare occasions, injuries may not be able to heal completely on their own. The most serious example of this is 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. None of the information in this articleis a replacement for proper medical advice. Always see a medical professional for advice on your individual injury.

Stretching has long played an important role in the world of sport and fitness, with many athletes stretching religiously before and after exercise in hopes of preventing injuries.

Lately, this practice has been called into question with many people wondering if stretching really makes a difference to athletic performance. The answer, like most things, is not black and white, as we explore a little in this article.

A brief introduction to stretching

Stretching is a type of movement that increases flexibility by lengthening muscle fibres to the end of their range. Stretching before and after exercise has been thought to reduce the risk of injury, improve athletic performance and reduce muscle soreness after exercise.

The two most common types of stretching are static and dynamic stretching. Static stretching is when you lengthen your muscle and then hold that position for a period of time.

Dynamic stretching uses movement and momentum of the body to stretch muscles to their end range, without holding the stretch at the end.

 

What does the research say?

Some research has suggested that static stretching before an activity can actually reducepower, strength and performance. However, these reductions were shown to be minimal and not noticed at all if the stretches were held for less than 45 seconds.  It has also been found that stretching does improve flexibility but only for a short period of time. A few minutes after stretching, your joints move further, and with less resistance, so you may have improved flexibility immediately after stretching.

 

Why stretch at all?

One thing that is undeniable is that stretching feels great, with many people feeling more relaxed and reporting a rush of endorphins after a good stretching session. It is also difficult to test the long-term effects of stretching specific muscles showing abnormal tightness. A long-term static stretching routine will improve your overall flexibility, and this is thought to help prevent injuries, although the evidence is inconclusive.

If you’re an athlete, the decision to stretch or not can be a personal one. A warm-up prior to intense exercise that includes some form of dynamic stretching is generally recommended for reducing injury risk, but of course is no guarantee. Strength and balance training may have a far greater impact on reducing injuries in the long term.

Your physiotherapist is able to guide you on the best stretching advice for your individual activity and they may be able to identify some areas where improving your flexibility will help to reduce injuries and improve performance.

 

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.

Being active is one the most important aspects of a healthy lifestyle and there are many different ways to get your heart rate up. No matter what your choice of activity is, there is always some risk of injury. In this article, we have listed some tips from physiotherapists to help you prevent accidents and injuries.

1. Choose the right footwear

The correct footwear can go a long way in protecting your feet and ankles from injury and can even prevent serious accidents such as falls. Every activity places different demands on your body and tailoring your footwear to suit these stressors is a great strategy for preventing injuries.  For example, basketball players often wear shoes with support that extends above the ankles to help protect against ankle sprains, while hikers require thick and supportive soles to cushion and protect their feet. Wearing shoes that are too large or have poor grip can lead to slips and falls, particularly when exercising in the outdoors. Your physiotherapist can guide you with the correct choice of footwear for your chosen activity.

2. Pace yourself

When you start to see improvements in your fitness and strength, it can be tempting to push your limits to see just how far you can go. The danger in this is that often your tissues are still adapting to the increased demands of your new exercise regime. Increasing your weights, training time or running distances by too much too soon can lead to major setbacks. Give your body time to adjust and progress in a slow and steady manner.

3. Check your form and posture

Checking your posture in the middle of a workout is probably the last thing on your mind, however poor form is a leading cause of injury in athletes. Lifting heavy weights when your spine is not in its optimal position causes many low back injuries. Taking a second to check your posture before starting a lift is highly recommended.

4. Seek professional advice

Coaches and trainers are able to help you spot vulnerabilities and share their knowledge, helping you get the most out of your chosen activity.  Often it is easier to prevent bad habits from forming than it is to break them once they are already in place. Invest in the advice of an expert, they can help you to avoid injuries as well as reach your peak performance.

Your physiotherapist is able to identify weakness in your training technique, biomechanical vulnerabilities, tight and/or weak muscles and can help guide you through your recovery if an injury does occur. However, prevention of injuries is always preferable to treatment, whenever possible.

 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. 

Low back pain is one of the most common conditions treated by physiotherapists and if you are unlucky enough to have been a sufferer, you know that severe back pain can take over your life. With improved understanding, health professionals have come to identify some common myths about back pain that are inaccurate, misleading or even counterproductive.

Myth #1 – Discs can ‘slip’ out of place

Sitting between the vertebrae of the spine are soft discs that provide flexibility and shock absorption to the spine. In the past, many health professionals including doctors and physiotherapists told patients that these discs had ‘slipped’ as a way of explaining their pain to them. While this was helpful to some extent, it is not entirely accurate, as these discs are actually very secure and rarely, if ever ‘slip’ out of place. Discs may bulge slightly or in some cases tear, however more often than not these injuries will heal without any permanent damage and exist in many people without causing any pain at all.  Thinking that a part of your spine has permanently ‘slipped’ out of place can cause you to move differently, which can create more pain and dysfunction in itself.

Myth #2 – If you have low back pain, you should stay in bed

When back pain strikes, our natural instinct is to rest, avoid movement and wait for the pain to pass. However, studies have shown that being active and performing targeted and gentle exercises can help improve low back pain. In fact, our impulse to stop moving and protect our spines can actually cause abnormal movement patterns and stress, leading to ongoing pain after the original injury has healed. If you are unsure of what kind of exercises you should be doing, your physiotherapist can help guide you with a targeted exercise program.

Myth #3 – Severe pain means severe damage

Pain that is severe, strikes suddenly and without warning can be a very scary experience. If this happens to you, you could be forgiven for assuming you must have sustained a very serious injury. The fact is, however, that the spine, being surrounded by nerves is a particularly sensitive area of the body and pain in this area can be very strong without significant damage. A small ligament sprain or muscle tear can actually cause a large amount of pain and it is common for intense symptoms to settle down quickly, even disappearing within a few days. In many cases, symptoms that last for longer than 2-3 weeks are caused by changes to your movement patterns in response to this pain and not the original injury itself.

If you are suffering from back pain, the best person to see is your physiotherapist. They can help you to recover without any complications or side effects and help you safely return to your usual activities while also ruling out any serious damage that might need further investigation.

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 it?

 

Patella tendinopathy, also known as jumper’s knee, is an overuse disorder characterised by pain at the base of the patella (kneecap) with activities such as squatting, sitting or going up and down stairs. The condition is known as jumper’s knee because it commonly affects athletes involved in sports that require jumping and repetitive loading of the patella tendon, such as basketball, volleyball, football and tennis.

 

Landing and jumping activities put a great amount of stress on the patella tendon. This tendon is responsible for transmitting the full force of the quadriceps muscles to the lower leg and during activities such as jumping and landing, this force can actually be many times more than your body weight.

 

What are the symptoms?

 

The hallmark sign of patellar tendinopathy is sharp, localised pain in the patellar tendon just below the base of the patella. The pain is usually aggravated by activities that increase load through the quadriceps muscles such as squatting and jumping.  Pain associated with patellar tendinopathy usually occurs gradually, often when a person has been very active for a long period of time or if they have recently increased their training schedule. The pain will often start as a small niggle, gradually becoming more noticeable and there may also be a feeling of stiffness with movements of the knee or first thing in the morning.

 

How does it happen?

 

Patellar tendinopathy is not a traumatic condition rather, it usually develops gradually over time due to prolonged overloading of the tendon. Like other tissues in the body, tendons are dynamic and can adapt to be able to withstand more force with training. However, if a tendon is unable to adapt to increased load quickly enough, it can develop micro tears leading to pain and dysfunction, known as tendinopathy. The risk of developing this condition can be increased by external factors, such as the type of sports chosen, training volume and the hardness of the training surface.

Intrinsic factors such as bone structure, muscle length, diet, age, muscle strength and overall health can also affect the ability of a tendon to adapt to forces. Anything that impairs the tendon’s ability to absorb force can lead to the development of tendinopathy. In general, men are affected by this condition more often than women.

 

How can physiotherapy help?

As with all conditions, the first step to effective treatment is an accurate diagnosis. Your physiotherapist will be able to correctly identify this condition and any factors that have led to its development. Treatment for any tendinopathy will involve a degree of rest and re-evaluation of your training schedule. Treatment of the tendon itself has been shown to be most effective with a targeted exercise program involving isometricand eccentric muscle contractions. These types of movements have been shown to help stimulate healthy tendon tissue to increase strength and support the damaged tissue, ultimately reducing pain. Tendinopathies can be notoriously difficult to resolve without patience and commitment to a rehabilitation program guided by a physiotherapist.

 

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

Our muscles play an important role in the movement of our body. Without our muscles, we wouldn’t be able to bend our elbow or straighten our leg. As our muscles are soft and designed for flexibility, they are also prone to injury and if you have ever had a muscle tear, you know that they can be surprisingly painful.

In the period following a muscle tear, there are a few mistakes we see people make, that can actually make their injury worse and delay healing times. Here are a few of the most common mistakes we see.

1. Stretching

After a muscle tear, the damaged fibres slowly begin to heal and reattach to each other. This process can be quite fragile and during the early stages, aggressive stretching of recovering tissue can impair healing or even lead to more tearing. While gentle stretching a few days after the injury can have a positive effect, you should check with your physiotherapist to ensure you’re not stretching too far and causing further damage.

2. Applying H.A.R.M.

Most of us are aware of the acronym R.I.C.E (rest, apply ice, compress the area and elevate) as the recommended treatment in the early stages of an acute injury. The acronym H.A.R.M is less well known and is used to remember the things you shouldn’t do after an injury. This stands for applying heat, drinking alcohol, running or massage. All of these activities can increase swelling, pain and increase the damage of the injury in the first 48-72 hours.

3. Failing to see a physiotherapist

The diagnosis of a muscle tear might seem straightforward, however, there might be more going on than you realize. Many conditions can mimic a muscle tear, or you may have suffered a tear due to an underlying weakness or pathology. Having a physiotherapist confirm your muscle tear or identify another condition is vital to ensuring you recover fully.

Your physiotherapist is also able to identify any factors that could lead to further injury and is able to help restore your tissue to its previous level.

4. Returning to sport too early

One of the most confusing things about muscle tears is that often they become less painful while the tissues are still not completely healed. Many people suffer another tear simply because they return to sport too early. While you may feel as though your tissues are back to full strength, the muscle fibres can still be healing and vulnerable to a tear. It is important to test your injury gradually, starting with gentle exercise and building up to high-intensity activities.

 

Your physiotherapist is able to guide you with a full rehabilitation program. This can help to restore strength, flexibility and control to your damaged muscle, keeping you injury free for the future.

Low back pain (LBP) is thought to affect up to 60 to 80% of the Western population throughout the course of their life.  Many people do not have any preceding events to cause this back pain, although specific injuries can also initiate their symptoms. Lower back pain constitutes almost half of all chronic pain.  This has a huge effect on quality of life and people with LBP tend to have more time off work and higher of medical costs than those who do not have symptoms.

Sedentary lifestyles, increased body weight, reduced physical activity and poor postures are all contributing factors to LBP.   Obesity rates in the western world have never been higher, and this is known to cause greater rates of musculoskeletal pain than ever before. Back pain can strike suddenly or build up slowly over a period of time. Many people report sudden and severe onset of back pain from a seemingly innocent movement. Others find that their back aches towards the end of the workday and follows a regular pattern. Thankfully, more and more workplaces are advocating for better ergonomic set-ups in order to pre-emptively reduce the incidence of LBP amongst employees.

Dealing with back pain is complicated as there are many treatments to choose from.  Unfortunately, there is rarely a miracle cure that works for everyone. What research tells us is that effective and timely advice, thorough professional assessment and a tailored exercise program shows the best outcomes in the long term.

There are some cases where your physiotherapist or doctor will suggest that you have imaging such as an x-ray or MRI. While imaging can be helpful in ruling out serious injuries it is important to realise that if everyone was to have an MRI of their spine, it is reasonable to expect that most people would have changes in the appearance of their spines, even if they don’t have any pain or other symptoms. The take-home message is that scans do not always paint an accurate picture of what is happening within a person’s back.

The back is made up of a number of different structures that work together to achieve the required movements needed to perform daily activities. With such a complex combination of tissues and joints, aches and pains can be caused by any number of structures. Keeping the muscles and joints of the spine strong and healthy can have a remarkable impact on pain levels regardless of the specific structure causing symptoms.

If you are suffering from back pain, speak to your physiotherapist for advice on how to best manage your symptoms. While no one can prevent back pain with 100% certainty, keeping active, avoiding smoking and maintaining a healthy relationship with alcohol and heavy labour, can reduce your chances of having low back pain.

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

What is it?

The biceps brachii muscle, commonly known as the biceps, sits between the shoulder and elbow.   It has two parts: the long head and short heads.  These come together to form the main muscle bulk, which is the “Popeye” part of your upper arm.   The biceps brachii muscle runs from the top and front of the shoulder all the way down to the upper forearm.  The biceps tendon is the part that attaches the muscle to the bone, both at the shoulder and the elbow.

The biceps muscle functions to bend the elbow and turn the hand to face palm-up. The term “tendinopathy” is used to describe injury and pain of a tendon. This is most commonly due to overuse. Biceps tendinitis tends to affect the long head of the biceps more commonly. Both the tendon itself and the tendon sheath can be the source of pain.

How does it happen?

 

This condition occurs most commonly due to repeated use of the biceps over a long period of time.  People with this condition often present in the later stages of tendon damage, when they begin to experience pain.  This means that biceps tendinopathy is a slow-developing condition, without any symptoms until it reaches the point that the tissues become injured and painful. This is the body’s way of self-defence; it is telling you that it doesn’t like the activity you are asking it to do.

While specific tasks such as throwing sports, tennis or golf can increase the risk of developing a biceps tendinopathy, often it is simply caused by usual daily activities throughout the course of an adult’s life.  With aging comes a decrease in the collagen and elastin components of tendons.  This contributes to a reduced ability to sustain a high load, which can cause degeneration or inflammation over a longer period of time.

What are the symptoms?

 

Biceps tendinitis is painful; often aching at night and increasing in intensity when performing overhead tasks such as reaching and lifting.  The pain is usually at the front of the shoulder, and can radiate downwards along the front of the arm.

People with this condition often have developed adaptations to their usual movement patterns in order to avoid aggravating this pain.  This in itself can lead to other issues such as strained or overworked muscles.  An example of this is hitching up the shoulder to the ear when going to use the affected side, as this will help to offload the affected muscle, allowing the biceps to be under less stress.  Unfortunately, eventually this will increase the stress on the muscles of the upper neck and shoulder, leading to secondary aches and pains.

How can physiotherapy help?

 

Your physiotherapist will assess and diagnose this condition, which will in turn allow for a comprehensive management plan to be put in place.  A combination of strengthening, stretching and muscle release is often beneficial to assist in management of this condition.

If you have developed secondary complications with changes to your normal movement patterns, your physiotherapist can assist you in addressing these and training your body to avoid causing further damage.

If further imaging or onward referral is needed, your physiotherapist can help in guiding you through this process.

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