Patellofemoral Pain Syndrome

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. 

Five Reasons To See a Physiotherapist After Injury

 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 article is a replacement for proper medical advice. Always see a medical professional for advice on your individual injury.  

Focus on Calf Tears

 What are they?

The calf muscles refer to a group of muscles at the back of the lower leg that act to point the foot away from the body and play an important role in walking and running. A tear or strain of these muscles occurs when some or all of the muscle fibres are torn or stretched. This is a common injury that can affect anyone from athletes to those with a more relaxed lifestyle.

How do they happen?

Calf tears are often caused by sudden, forceful movements or overuse of the calf muscles, leading to the rupture or strain of muscle fibres. Common mechanisms of injury are a quick take off during a sports match or simply going for a long walk when not accustomed. Factors that may increase the risk of a calf tear are previous calf tears that have not been fully rehabilitated, tight and weak calf muscles, poor balance and ill fitting footwear. 

What are the symptoms?

Typical symptoms of a calf tear are sharp pain over the site of the tear, especially with movement, swelling, bruising, and difficulty walking or standing. The severity of the injury can range from mild muscle strain to a complete tear, which will determine the appropriate treatment approach.

How can physiotherapy help?

The first step in managing calf tears is accurate diagnosis by a medical professional, who is able to rule out other conditions that might mimic a calf tear. They can determine the extent of the damage and create personalised treatment plans based on the patient’s specific needs. This ensures that the rehabilitation process addresses the root cause of the injury, leading to better outcomes.

Reducing pain and inflammation is important in the first one to two days following the injury. The muscle may need support during this time, depending on the severity. Over time as the swelling and inflammation subsides, your physiotherapist will help to address any factors that contributed to the injury such as muscle weakness or imbalance. Calf tears often lead to stiffness and limited range of motion in the affected leg.

Physiotherapists implement targeted stretching and range of motion exercises to restore flexibility and prevent the formation of scar tissue that may impede recovery. Gradually, the patient can regain the ability to move the calf muscle without pain or discomfort.

Rehabilitation past this point will progressively challenge the calf muscles without causing further damage. Strengthening these muscles not only aids in the healing process but also reduces the risk of future calf tears.

Proprioception, the body’s ability to sense its position in space, is crucial for balance and coordination. Physiotherapy includes specialised exercises that enhance proprioception and balance, reducing the likelihood of re-injury. This aspect of rehabilitation is especially important for athletes and active individuals who need to return to high-intensity activities safely.

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

Frozen Shoulder

 What is frozen shoulder?

Frozen Shoulder (also known as Adhesive Capsulitis) is a condition that affects the shoulder joint with no apparent (idiopathic) cause. It is characterised by severe pain and stiffness of the shoulder. The shoulder capsule thickens due to lack of synovial fluid, which leads to tightness and stiffness. Frozen shoulder occurs most frequently between the ages of 40-60 years old and affects more women than men. 

How does it happen?

The cause of Frozen Shoulder is still unknown, however some risk factors have been identified that increase your chances of developing the condition including diabetes mellitus, stroke, shoulder injuries and immobilisation.

The hallmark sign of Frozen Shoulder is being unable to move your shoulder even with the help of other people. This is particularly noticeable when moving the arm away from the body. Physicians may ask you to undergo investigations such as X-ray and MRI, however frozen shoulder doesn’t tend to show up on imaging. 

What are the symptoms?

Frozen Shoulder has three stages:

1. Freezing (Painful stage) – lasts from six weeks to nine months; patient has a slow onset of pain (usually pain at rest), and the shoulder starts to experience limitation of motion

2. Frozen (Adhesive stage) – lasts from four to six months; pain begins to diminish (the shoulder is still usually painful with movement), of the shoulder getting stiffer, and activities of daily living are affected).

3. Thawing (Recovery stage) – last six months to two years; shoulder’s normal range of motion is slowly returning to normal

How can physiotherapy help?

Though Frozen Shoulder is a self-limiting condition, an important part of physiotherapy management is the prevention of related neck and shoulder issues secondary to the original problem. As you can imagine, frozen shoulder can be extremely debilitating and many adaptations occur in the surrounding musculature. Physiotherapy also acts to reduce pain throughout phases one and two, while restoring joint movement as the joint moves through the painful phase. This is done through a variety of treatments, including heat, stretching, joint mobilisation, range of motion exercises to improve shoulder’s motion and resistance exercise to strengthen, you will also be given a home exercise program. Recovery time varies with every patient. If you’re working hard to regain your normal shoulder function, you’ll be rewarded with a faster recovery.

Medical management includes medications and corticosteroids, joint manipulation while under anaesthetic and/or surgery, however at this point nothing has come close to providing a consistent and simple cure.

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

Tips for Exercising when You have Pain

 One of the most challenging aspects of living with an injury or chronic pain is how it can quickly impact your exercise routine. If you have been working towards a fitness or weight goal, this can be extremely demoralising. Here are a few tips that can help to keep you on track while you recover. Staying as active as possible during this time can mean you’re in the best position to reach your goals again once your injury has healed. 

1. Try a new activity. 

When injury strikes, it can be tempting to stop exercising altogether and rest while you recover. An injury can be frustrating, but it can also be an opportunity to try out a different sport. If you’re a runner with an ankle injury, you can keep up your fitness by swimming instead. Cycling can be an excellent option for people for dealing with knee pain, and if you’re a swimmer with shoulder pain, maybe switch to running for a while. Check with your physiotherapist for some ideas to keep you moving. 

2. Exercise within your limits. 

If you’re getting pain at 5km, this doesn’t always mean you should give up running altogether. Your physiotherapist can help you monitor your symptoms carefully and plan an exercise routine that keeps your fitness up while reducing symptom flare-ups. Staying as active as possible throughout your recovery can also mean that you a better placed to get back to your best performance once symptoms reside

3. Take the opportunity to improve your footwear and equipment. 

Injury and pain can be a great prompt to look at your equipment and technique . For example, with hip and knee pain, the type of shoes you wear can have a significant difference. Often pain has more than once cause, with technique and equipment more often than not having a substantial impact on the stress placed on your body. Your physiotherapist is an excellent source of advice in this area, don’t hesitate to ask for an assessment. 

4. Take to the water

Hydrotherapy has long been used to help patients with joint pain or muscle weakness exercise. The water helps reduce joint stress and provide extra sensory input that can reduce pain. Exercising in water can be especially helpful for sufferers of chronic pain or those who have pain with weight-bearing. Speak to your physio for a hydrotherapy program if you’re not sure how to approach exercise in water. 

Our physiotherapists are happy to discuss your condition with you and share their tips to help you stay pain-free. None of the information in this article is a replacement for proper medical advice. Always see a medical professional for advice on your condition.

Tips for Optimal Stretching Results

 How do you stretch properly?

CUMBERLAND PHYSIOTHERAPY PARRAMATTA: While there are many benefits to be gained from effective stretching, employing an improper technique can actually result in injury. Here are some tips and guidelines for you to follow when stretching: 

·Warm up first with an activity such as walking (at least 5 -10 minutes).

·Stretches should be pain-free. You should only feel tension or a tight feeling when stretching. If you feel a sharp pain, this means you’re stretching too far and should relax a little. 

·Don’t hold your breath while stretching; keep breathing to ensure the muscle tissues remain oxygenated during the stretch.

·Stretch both sides. But, if one muscle is tighter than the other, focus on it more until they’re both in the same range.

·Avoid bouncing at the end of the stretch because it may lead to injury.

·Hold stretches for 20-30 seconds, if not longer. A 10 second stretch is not always enough to achieve a lasting effect.

·Repeat the stretch 3-5 times with intermittent rest periods in between.

·Make sure your body is aligned properly and observe good posture.

When to Stretch?

Traditionally, stretching has been encouraged before and after any kind of physical activity. However, recent studies show that there is no discerning difference between whether you stretch before exercise/sports or not, both-in terms of performance and injury prevention. In some cases, researchers say that it’s okay to omit the pre-event stretch since the post-event stretch is much more beneficial. 

Some of our everyday postures and activities can lead to certain muscles becoming tight while the others sit in a lengthened position. These habitual postures that lead to muscle imbalances then become more and more difficult to correct over time. Many therapists will suggest that stretching all muscles generically isn’t as beneficial as identifying which of your muscles are abnormally tight and developing a targeted stretching regime. 

Talk to your physiotherapist for advice regarding the best stretching program for your body type, posture and activity levels. 

Focus on Metatarsalgia

What is Metatarsalgia?

CUMBERLAND PHYSIOTHERAPY PARRAMATTA: Metatarsalgia is a medical term used to describe pain that occurs in the ball of the foot. This occurs due to rubbing of the long bones of the foot, called metatarsals, causing inflammation. Build-up of inflammation in the ball of the foot compresses the small nerves that run between the toes and along the foot. Inflammation and compression of these small nerves is painful. 

The pain can involve one or more joints of the foot including the big toe, second toe and third toe. It is unlikely to include the fourth or fifth joints. On occasion, the pain may involve the entire foot, or larger parts of the foot. The pain or symptoms may be made worse when bearing weight through the foot, such as walking or running. In severe cases, just standing or even wearing tight footwear can affect the foot.

How does it happen?

Metatarsalgia can be caused by a number of things. An abrupt change in the posturing of the lower back or pelvis may alter the way the foot is loaded, and cause rubbing of the long bones. Altered loading of the foot may also be caused by arthritic conditions that affect the knees, hips or pelvis.

Unavoidable factors, which may lead to the development of metatarsalgia, include increased age, and the physical shape of the foot and toe. As your body ages, the ligaments of the foot may loosen or weaken. Therefore, the bones of the foot move differently leading to altered positioning and loading of the foot.

Avoidable factors, which may lead to the development of metatarsalgia, include wearing inappropriately fitting footwear, and the type of exercise performed. Metatarsalgia is more highly associated with high-impact-type exercise such as running or gymnastics.

How can Physio help?

Your physio will determine the cause of the metatarsalgia pain and assist you with adapting your posture or improving the loading pattern of your foot. You may be advised to unload the foot by reducing or stopping exercise, changing the shoe you wear, or strengthening certain muscles in your legs.

Electrotherapeutic modalities such as icing, ultrasound or interferential therapy may be of assistance to reduce pain and inflammation in the beginning stages of treatment as well.

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

What Does a Physiotherapist Do?

CUMBERLAND PHYSIOTHERAPY PARRAMATTA: Many people know the value that physiotherapy brings to their life and some have even been visiting their physiotherapist since childhood. However, for those who have never been to see a physiotherapist before, there can be a question mark over exactly what it is that physiotherapists do. In fact, this is one of the most common questions physiotherapists are asked. 

What is the main job of a physiotherapist?

The answer is tricky, because physiotherapists do so much. Primarily, we might be described as pain management experts, as we work to reduce the pain of our patients, from those who have suffered a new injury, to those who have had pain for several years. We first identify the cause of the pain and then provide manual therapy techniques, education and management strategies to help our patient understand, manage and reduce their pain. 

While pain is usually the first thing that brings patients to see a physiotherapist, this pain has often caused patients to give up activities that they love and can even be getting in the way of everyday tasks. Many of us reduce our activity levels to reduce pain without even realizing it. Physiotherapists are able to identify which areas you are struggling in and why this is occurring.

 By identifying the cause of your symptoms, we can help to get you back to full function. Physiotherapists are able to do this for everyone including elite athletes and those dealing with serious disabilities. In fact, physiotherapists have a role to play at practically every stage of life. 

We can assess infants to monitor their motor skills development and as they grow we help them deal with the pains and vulnerabilities of a growing body. Among other things, we can help improve the function of athletes, assist in preventing injuries, help those with pelvic floor dysfunction and work to prevent falls in the elderly. 

Not just exercises and massage.

Physiotherapists offer a range of treatments, from targeted stretches, manual therapies, dry needling, exercises and massage. Physiotherapists are also committed educators and take our role as such seriously. 

A huge part of recovering from pain and injury comes from understanding what is happening and how to best manage these issues. Rather than create a dependency on their therapist, we aim to empower our patients to improve their health independently as much as possible. 

Physiotherapists aim, to improve your quality of life and remove any barriers to full participation, whether these barriers are due to pain, weakness or stiffness.

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