Plantar Fasciitis.

What is plantar fasciitis?

Plantar fascia pain is associated with pain at the inside aspect of the heel. The plantar fascia is a thick fibrous band attaching our heel to our toes. They do a tonne of work for us in help us stabilise our feet, propel our bodies forward and support our body weight in standing. When we ask to much of this guy it can become very painful, weakened and very cranky. Due to the plantar fascia having a poor blood supply and simply being the back bone of all our daily movement, it is no surprise heeling time frames for this condition extend well beyond peoples expectations.

What causes Plantar fasciitis?

• Sudden increase or changes to training load.
• Poor footwear choice coupled with increasing walking or standing loads.
• Foot and ankle weakness** Read this again** Foot and Ankle Weakness!
• Restricted movement of ankle. 
• Restricted movement of the big toe or toes.
• Changes in body composition or weight gain.
• Diabetics.
• Age: 40-60 year olds cop this one the most.
• Foot shape and congenital issues.

What does it feel like? 

• Sharp pain around the heel: Generally worse in the morning or after periods of activity/standing.
• Feels more sensitive walking on hard floors bare-feet.
• Tight feeling under the arch of the foot when walking or stretching.
• Dull achey pain at the end of the day once pressure is off the foot.

 How do you fix plantar fasciitis?

• FIND OUT THE CAUSE: Foot mechanics, foot weakness, footwear, aggravating activities etc
  
• START WITH OFFLOADING THE PLANTAR FASCIA: Our preference is a period of low dye taping for up to 2 weeks.
  
• START STRENGTHENING  THE PLANTAR FASCIA ASAP: Our preference is using a fasciitis fighter or a rolled towel.
  
• INTEGRATE THIS WITH A FULL BODY CONDITIONING PROGRAM.
• TRAINING AND LOAD MODIFICATIONS.
• FOOTWEAR SUGGESTIONS AND CONSIDERATIONS.
• CROSS TRAINING PROGRAM FOR PEOPLE THAT LOVE TO RUN OR WALK.
• MASSAGE AND RELEASE WORK OF CALF AND FOOT.
• INTRINSIC FOOT MUSCLE STRENGTHENING.

There are no magic exercises for this condition.

Do the basics well and be consistent for a several months and you will be rewarded with pain free heels 🙂

Any questions about an  injury shoot us an email or give us a call on (02) 4751 9127

Need an appointment –> BOOK HERE! 

Written by Pat Lincoln

(Physiotherapist)

Swimmers shoulder

What is swimmers shoulder?

“Swimmer’s shoulder” is an umbrella term for shoulder pain / injuries that relate to the swimming population. Due to the complexity of the shoulder anatomy, many factors relating to the swimming stroke can contribute to the presence of pain.

Most grumpy shoulders among swimmers start from irritation of the shoulder bursa or the rotator cuff tendons, however think of this as only the symptom, we need to find the reason WHY these structures have become overloaded, and fix that!

What causes shoulder pain? 

Swimming involves a high amount of repetitive and powerful overhead movements (particularly freestyle, backstroke and butterfly), and with around 4,000 strokes roughly for most practice sessions, it makes sense that our shoulders might be the first thing niggle.

The most common culprits:

• Sudden increase or changes to training load
• Poor swimming technique or motor patterns 
• Poor shoulder blade control (this is a big one) —> If the arm is moving / rotating the shoulder blade must move well to allow the ball and socket of the joint to work together
• Poor shoulder strength and stability (rotator cuff and pulling muscles)
• Decreased shoulder rotation or overhead movement 

How long does it take to go away?

• Get niggles assessed quickly! The longer a grumpy shoulder is pushed through, the longer it will take to fix, and the more compensations will change your technique.
• Clinically it can take up to 4-6 weeks for an initial improvement of inflammatory symptoms.
• Full recovery will take up to 12-16 weeks

 How do you fix swimmer’s shoulder?

–> FIND OUT WHAT IS CAUSING SHOULDER OVERLOAD
–> MODIFY TRAINING TO CONTINUE PAIN-FREE
–>RE-TRAIN HOW THE SHOULDER WORKS
–> INTEGRATE THIS WITH SWIMMING TECHNIQUE

1. Initially you need to settle down the initial inflammation using a variety of methods.

• Training modification and cross-training: During this phase it’s still important we keep you swimming, we can do this by swapping painful strokes for variations such as breastroke or kick-board  work initially as we build things back up.
• Massage & release work
• Taping to assist with pain, awareness and shoulder mechanics during swimming 

2. Exercise is key to a long term solution! 

There are no magic exercises for all swimmers, and every swimmers shoulder will be treated differently depending on those contributing factors and unique training demands. 

• Organising shoulder blade mechanics during stroke patterns
• Mobility exercises targeting shoulder rotation and overhead positions
• Gradual overload of the pulling muscle system and shoulder stability 
• Designing a shoulder friendly gym or home program to follow to keep things happy and improve swimming performance!

Any questions about an  injury shoot us an email or give us a call on (02) 4751 9127

Need an appointment –> BOOK HERE! 

Written by Kieran Fercher

(Physiotherapist)

Sever’s Disease

What is Severs?

What causes Sever’s Disease:

• Rapid growth spurt or puberty.
• Change of footwear: Eg. Starting soccer season wearing new boots.
• Calf muscle weakness.
• Calf muscle tightness: As bones grow slightly slower than muscle we will see periods of excessive muscle tightness during a growth spurt.
• Frequency and intensity of physical exercise and activity.

Common signs and symptoms:

• Pain following or during physical activity especially running or jumping sports.
• Stiffness first thing in the morning or after activity.
• Limping after sport.
• Point tenderness on heel/calcaneal bone.
• Tendency to tip toe.
• Heel feels better in footwear with a little heel.

Got a question about an injury, shoot us a message or book a session online here.

Written by Patrick Lincoln

(Physiotherapist)

Osteoarthritic Knee Pain

What is knee Osteoarthritis

Common clinical symptoms include:

• Pain on the inside of the knee joint (but can effect the outer or front of the knee).
• Pain with weight bearing exercises: Walking, running, jumping or hiking.
• Night pain after exercise or activity.
• Tenderness on palpation.
• Crepitus or cracking within the joint.
• Knee swelling or effusion post/during activity.
• Restricted knee joint movement: Difficulty straightening or bending the knee.

Got a question about an injury, shoot us a message or book a session online here.

Written by Patrick Lincoln

(Physiotherapist)

What is tennis elbow? (It’s not just for tennis players)

The aim of physiotherapy is to get you back to doing the things you love so your treatment we make sure your treatment is specific to your goals.

Got a question about an injury, shoot us a message or book a session online here.

Written by Brianna Downward

(Physiotherapist)

Running related calf injuries!

Dreaded calf (or baby cow) muscle strains are a common running injury, and often leave you going crazy with the next running event getting closer and closer! Greater than 50% of running power is generated from the calf muscles, so it’s understandable that the calf can be a potential site of muscular injury for a runner.

Types of calf injuries: 

The calf is made up of 2 main muscles – the Gastrocnemius and Soleus. It’s important to understand which part of the calf is injured when designing a rehab plan and preventing recurrences.

1. Soleus strain – In most cases, runners don‘t feel a sudden twinge – but feel a tightening sensation in the calf that develops slowly during a run. This type of strain often involves injury to the soleus muscle and may occur with fatigue, overtraining or a change in running surface / hills. The Soleus muscle works harder during distance running and where the knee is in a bent position.
   
   
2. Gastrocnemius strain – These trigger sudden onset of pain in the region of the calf, often caused by faster intervals, sprinting, or high-speed tempo runs. The gastroc muscle crosses over the knee joint and works harder where the knee is in a straight position, and explosive sprinting/jumping activities.

What causes calf strains when running?

• Getting too keen! We’ve all been there, and we know how exciting training for your next event can be. Quickly Increasing training loads, speed or hill work most often overloads the calf.
• Poor strength and endurance of the calf!
  Clinically I like to see all runners be able to complete 25 single leg calf raises repetitions with good form, and arbitrarily use the following assessment criteria:
  < 15 reps (poor)
  15-30reps (satisfactory)
  > 30reps (good)
• Change in footwear – A change in heel to toe drop/angle with your shoes will change the amount of stretch and load on the calf muscle.
  
• Hip/knee weakness: Your glutes and quads work with your calf to push you forward. If muscle groups higher up the kinetic chain aren’t doing they’re job it’s going to increase load on the calf. 
  
• Running technique – A conscious change in running technique to mid-forefoot running

Can I still run with a calf strain?

Continuing to train in some form is important for a speedy recovery, whether it is a light running/walking program or cross-training program to keep you moving!

Severity of muscle strain can be assesed by your physio and will determine recovery timelines and structure of rehab. 

• Grade 1: 1-2 weeks to return to some running
• Grade 2: 2 weeks+ to return to some running
• Grade 3: 3-6 weeks to return to some running
• Grade 4: 3 months+ to return to some running

How do you treat a calf strain?

Accurate diagnosis of the type of calf injury, and early appropriate treatment can significantly affect duration of your recovery. 

Phase 1: Acute treatment is aimed at limiting pain and limiting further muscle damage.

• No stretching
• Ice and compression to limit muscle bleeding 
• Normal walking pattern: Heel wedges or a crutch are often helpful in the first couple of days
• Early calf loading exercises

Phase 2: Aimed at re-building calf load tolerance 

• Progress calf strengthening exercises targeting both muscles!
• Hip strength exercises

Phase 3: Building a resilient calf and a safe return to running 🙂

• Plyometric and calf endurance exercises 
• Return to running program!
  

If you have any questions shoot us a message or book an appointment online!

Any questions about an  injury shoot us a message, give us a call on (02) 4751 9127

or book a session online here.

Written by Kieran Fercher 

(Physiotherapist)

The Physio Depot’s 5 Top tips for managing shoulder pain!

Let’s face it shoulder pain is the worst. Not being able to get dressed without making loud grunting noises, difficulty reaching the top cupboard to get the wine glasses and spending weeks doing painful bench press in the gym hoping it will get better.

Shoulder pain affects EVERYONE – No matter gender, age, activity levels, sporty people or sedentary people.

Typically there is a trigger for that painful shoulder it could vary from an accident or fall, a change in activity load, a big day in the garden or lots smaller repetitive stress on the shoulder.

The Depot’s top tips for managing a painful shoulder!

2. Rest does not help shoulders get better!

If you have any questions shoot us a message or book an appointment online!

Any questions about an  injury shoot us a message, give us a call on (02) 4751 9127

or book a session online here.

Written by Patrick Lincoln

(Physiotherapist)

Ankle Syndesmosis Injuries 

The ‘high ankle sprain’ AKA ‘Syndesmosis injuries’ 

Everyone has known someone to ‘roll’ their ankle. Generally this is a twisting motion of the foot and damages the structures to the outer ankle, known as the lateral ligament complex. Ankle injuries involving excessive external rotation and/or dorsiflexion (toes up to shin and ankle twisting inwards) can disrupt the syndesmosis complex (pictured below). The syndesmosis is a fibrous tissue joining the shin bone with the fibular its primary role is to aid stability around the distal part of the ankle, as well as providing shock absorption when we run and jump. The syndesmosis is made up of 4 ligaments and is fundamental for good ankle function.

Tell tale signs you have a syndesmosis injury not a ‘lateral ligament’ injury!

It’s important you do not miss or confuse a syndesmosis injury with a normal ankle sprain. Early rehabilitation differs greatly and can lead to chronic issues if not managed appropriately.

The key things to remember if questioning a syndesmosis:

1. The mechanism of injury: Hyper-dorsiflexion or forceful external rotation.
2. The swelling pattern is above the ankle joint not laterally and below.
3. Pain increases with walking or weight-bearing that can be reduced by squeezing the lower leg bones together.
4. Pain increases with dorsiflexion, but can be eased with compression of the tibia and fibular junction

How long does syndesmosis take to heal?

Syndesmosis injuries generally involve a period of immobilisation for 4-6 weeks depending on severity. (Yes that means a moon boot!)
Following this we allow a further 6-12 weeks for a full recovery.
These injuries are much slower than your normal ankle sprain.
Higher grade sprains involving large seperation will need a surgical review and prolonged immobilisation this can increase the recovery to 3-6 months.

What causes syndesmosis?

1. The foot is forcefully pushed up and then twisted out
2. The is plantar flexed and rotatedBoth these positions pose a threat and create a force which widens the joint and can disrupt the ligament complex.

 

Do I need imaging?

Imaging can be an important part of creating an overall management plan. Either a weight bearing plain x-ray or an MRI can be used to diagnose a high ankle sprain.

 

What does my recovery of a syndesmosis look like?

 

Grade I

• Minimal swelling pattern.
• Patient can walk pain free.
• Pain with palpation and testing.
• Mild sprain= Boot till pain free 1-2 weeks and wean to brace for 2 weeks.
  = No early stretching into dorsiflexion.
  = Maintain calf and ankle strength.
  = return to sport 3-5 weeks.

Grade II

• Large disruption of ligament complex.
• Patient cannot weight bear and walking is diffcult.
• Large bruising over high ankle.
• Positive ligament testing,= Boot 6 weeks
  = Maintain calf complex strength from 2 weeks
  = 6-12 weeks Functional rehab and wean off boot. May need brace in interim.

Grade III

• Full rupture of syndesmosis. Normally associated with fracture or dislocation.
• MRI completed.
• CAM BOOT – Non weight bearing on crutches.
• Orthopaedic review.
• Surgery to stabilise the joint= Recovery time = 3-6 months,

TAKE HOME MESSAGE = DON’T CONFUSE A ‘HIGH ANKLE SPRAIN’ FOR A ‘NORMAL ANKLE SPRAIN’

Got a question about an injury, shoot us a message or book a session online here.

Written by Patrick Lincoln

(Physiotherapist)

Shoulder Dislocations Made Simple .

What is a shoulder dislocation?

A shoulder dislocation is when the top of our arm bone slips out of the cup like socket that contains our shoulder joint. Unfortunately, our shoulders are built for mobility not stability making it a very common injury.

How does a shoulder dislocate happen?

Shoulders can dislocate in a number of positions. Most commonly the shoulder pops out in a forward direction due to a force on the shoulder with our shoulder out to the side and above shoulder height or a blunt force to the back of the shoulder. Occasionally shoulders will dislocate backwards, this can happen due to a fall on an elbow or onto your hands in front of the body causing the arm bone to move backwards through the joint.

How painful is a dislocated shoulder and what should I do immediately afterwards?

Dislocated shoulders are generally very painful at the time. You will feel an immense pain, muscular spasm and inability to move the arm. The good news, once your shoulder is relocated the initial pain calms down instantaneously. The following 1-2 weeks your shoulder will be quite tender and may need the use of a sling.

How long does it take to recover?

General timeframes very depending on the type of dislocation and the mechanism of injury.

A rough time period of 6-12 weeks for return of normal function is a good starting point. More traumatic dislocations which cause extensive damage to the structural integrity of the shoulder can take upwards of 3 months for full recovery.

Is my shoulder going to permanently damaged after a dislocation?

Following a dislocation your rehabilitation is extremely important. Once the shoulder is dislocated you damage the structures that hold your shoulder in place on a day to day basis. In order for you to return to sport, overhead activity or gym training it’s imperative you follow a strict rehabilitation plan. Unfortunately the re-occurrence rate is quite high, especially in the adolescent patient group. In summary, your shoulder is not permanently damaged but you have to work hard strengthening and stabilising the muscles surrounding the shoulder.

How can Physio help?

• Restore shoulder range of motion.
• Immobilisation strategies to settle the shoulder down in first 10 days.
• Guided rehabilitation program to strengthen shoulder stabilisers.
• Return to sport/activity guidelines and testing.

Do I need surgery?

A first time dislocation does not generally need surgery unless you have a traumatic/unstable fracture. After your first dislocation you will generally start a rehabilitation program with your Physio over a 12 week period.

If you make dislocating your shoulder a habit despite your best efforts of Physio and exercise. Then you may be on your way to the surgeon to get your shoulder stabilised with an operation.

What does the first 6 weeks of Physio look like after a dislocation?

• IMMOBILISE 
  10-14 days of using a sling to support the injured arm. This is useful for pain, but also stops the shoulder popping out again in the first 5-7 days.
• PAIN RELIEF 
• ACTIVATE SHOULDER BLADE STABILISERS 
  Start muscle activation in supporting muscles at the back of the shoulder.
• LIGHT RESISTANCE 
  Begin light resistance training focusing on shoulder stabilisers, trunk muscles and rotator cuff.
• CLOSED CHAIN EXERCISES 
  With your shoulders supported start weight bearing shoulder exercises.
• ADD COMPLEXITY, LOAD AND OVERHEAD STRENGTH
  Build strength in zones above head and focus on stability exercises.
• RETURN TO SPORT TRAINING
  -Build functional exercise program targeting demands of your sport.

Got a question about an injury, shoot us a message or book a session online here.

Written by Patrick Lincoln

(Physiotherapist)