Patella tendinopathy typically causes localised pain at the patella tendon (below the kneecap).
Most general daily activities can still be performed in those with this problem however with reduced capacity. Symptoms are generally most noticeable during high impact activities such as running, jumping and hopping.
Patella tendinopathy is commonly associated with high impact jumping sports, such as volleyball, basketball and netball. It is also more likely to occur at certain stages of life, such as adolescence and through to the fourth decade of age. It has been found to be more prevalent in males compared to females.
Patella tendinopathy most commonly occurs as a result of a sudden increase or changes in a particular activity, so your physiotherapist will spend some time in your assessment discussing your physical activity and exercise habits.The will also ask about previous knee and other associated lower body injuries.
A thorough assessment will be undertaken to identify any other potential contributing factors that would need to be addressed during management. This will include things like your range of movement, how you run, jump and land.
In most people, a thorough assessment by your physiotherapist is usually enough to make a diagnosis and to determine the best treatment, so investigations like x-rays and scans are not needed to get you started on treatment.
Ultrasound and MRI imaging may be used in some cases to exclude other potential diagnoses, however imaging is not required to confirm diagnosis. Interestingly 22% of elite athletes without symptoms have been found to show some tendon pathology based on imaging, so it is important to note that the presence of tendon pathology seen on imaging may not correlate to a person’s reported symptoms. If you’ve had a scan your physiotherapist will be able to discuss the findings with you and determine the relevance of those findings to your presentation.
In the management of patella tendinopathy isometric-based exercises are usually performed in the initial stages with the aim to reduce pain and start safe tendon loading. Isometric exercises contract particular muscle groups without changing the length of the muscle. Some common exercises prescribed may include a single leg knee extension hold or squat variations such as Spanish squat.
Your Physiotherapist will also provide advice on how to modify your daily and/or sporting activities. This is important during the initial stages to settle your symptoms and to gain an understanding on what is an appropriate symptom response and how to gradually build your activity tolerance.
As you progress through treatment and rehabilitation, heavy and slow resisted exercises are later prescribed to build on the initial isometric loading period. Exercises in this phase could include single leg knee extension, leg press, hack or back squat, Bulgarian squat and single leg box squat.
Towards the end stage of your rehabilitation the Physiotherapist will introduce plyometric exercises (high energy movements) such as split squats, hopping, skipping etc. and functional training consisting of movements related to the activity or sport you plan to return to.
People presenting with Patellofemoral Pain Syndrome (PFPS) most commonly experience vague pain around the patella (kneecap) especially during knee flexion (bending) activities. These may include sitting for a long period of time, kneeling, squatting, walking up/down steps and running.
It is most commonly reported in people aged 12-17 years however it can occur in other age groups too, and has been found more prevalent among females.
There are a range of physical and biomechanical factors that may put you at risk of developing PFPS, which include:
There are also other factors, other than physical and biomechanical, that can influence a person’s presentation, therefore consideration of the whole person rather than just the injury is required during your assessment and management.
Your physiotherapist will perform a thorough assessment to identify which factors are most relevant to you and those that need to be addressed during management.
The assessment with a physiotherapist will involve a range of questions and tests to help confirm the diagnosis, and to also determine what factors led to it developing. Treatment is often needed to target these factors to ensure the problem doesn’t recur in the future.
Simple answer, no.
In most people, a thorough assessment by your physiotherapist is usually enough to make a diagnosis and to determine the best treatment, so investigations like x-rays and scans are not needed to get you started on treatment.
However, if your physiotherapy assessment determines that there may be other knee joint injuries, or if you don’t improve despite a thorough non-surgical treatment program, it is only then that x-rays or scans could be necessary.
This highlights that tissue damage does not always equal pain and other factors need to be considered in order to achieve the best outcome for management.
A broad management approach is recommended as a range of factors can contribute to a person’s presentation.
During the initial stages of recovery, the Physiotherapist will provide advice on how to modify your daily and/or sporting activities. For example, it has been found that increasing cadence (number of steps taken per minute) by 10% can reduce load over the kneecap by 14%, so this can be an effective way to reduce pain. They will also review the type and number of activities you perform during a typical day/week and monitor your symptom response to guide decisions when managing your total load and recovery.
Hands-on treatment may be performed to ease muscle tension around hips, buttock, thigh and lower leg areas. Specific joint mobilisations can be used to improve kneecap mobility if indicated by clinical assessment. In addition, taping may be used to reduce load over the kneecap area during the initial stages.
Most importantly your Physiotherapist will help guide you through an exercise program to best manage your condition in building your capacity to meet your training needs.
In people who present with increased pain related to PFPS good outcomes have been found from exercise programs targeting higher muscle groups areas such as the trunk, abdominal, hip and buttock areas to reduce pain and improve function. A person will also perform knee strengthening exercises in particular targeting the quadriceps muscles.
During the middle and late stage of management your Physiotherapist will incorporate more functional movements such as squats, lunges and steps with specific parameters to monitor your symptom response to these activities.
Bone stress injuries are commonly related to overuse among runners and up to two thirds of long distance and competitive cross-country runners will experience this problem. The most common areas affected are the shin, lower leg, heel and foot bones.
In a normal situation, the bone responds to the load from weight bearing exercise by making itself stronger which is why exercise like walking and running are recommended for good bone health. If there is enough recovery time between runs then the bone copes well with this process and adapts to get stronger.
The development of bone stress injuries occurs over a continuum when the repetitive strain put on the bone due to running, gradually exceeds the bone’s capacity to strengthen itself. If this process is repetitive and/or exceeds the bone’s capacity to a load and hasn’t had enough time to recover then this may lead to a stress reaction which is the beginning of a bone stress injury. This is typically when the bone starts to cause pain. If this cycle continues then a stress fracture may develop and in the later stage may lead to a complete bone fracture.
The main issues that need to be considered are things that change how much load is placed on the bone and the bone’s capacity to tolerate load.
When assessing a runner, we look at the following things to determine whether they are contributing to the problem (or putting you at risk of bone stress injury):
An understanding of load and a runner’s capacity is crucial for the management of bone stress injuries.
When load is greater than capacity there is an increased risk of the onset and progression of bone stress injury!
When capacity is greater than load the risk and severity of bone stress injury reduces!
Typically bone stress injuries present with a history of gradual worsening of symptoms over a period of time. It is also important to note that symptoms can occur very quickly in the area of bone stress.
Signs and symptoms can vary and depend on what stage along the continuum of injury. Initially pain may be described as vague and a mild ache that occurs during a specific period of running which settles after ceasing the activity. Bone stress injuries usually worsen as you continue to run, and the pain does not settle as you ‘warm up’ unlike tendon pain (another common running problem).
As the injury progresses the runner may experience more severe and localised pain which may persist after the completion of an activity and during lower bone loading activities such as walking. Towards the later stage runners may experience pain at rest and night, and potential redness, swelling and warmth over the affected area in the presence of an underlying inflammatory component. A runner’s participation in their normal activities may become quite restricted and/or discontinue.
During clinical assessment range of motion and strength testing may not be able to pick up bone stress injuries. Symptoms may be provoked by specific bone loading tests such as walking, running, jumping, hopping etc. Localised tenderness over bone may be noted during palpation. If a stress fracture is suspected clinically, MRI imaging is recommended to assess the severity of the injury and potential presence of a fracture line which can be further evaluated by CT scan.
A period of modified weight-bearing and rest will be required prior to a gradual return to running. This will be guided by your treating physiotherapist. During this period, it will be important to maintain your physical conditioning of other unaffected areas such as your upper body if your lower body is affected, and to maintain some cardiovascular fitness such as performing cross training in the form of stationary bike, rowing or swimming.
Your physiotherapist will help you plan a program to maintain your fitness and flexibility while you are modifying your running training. This could include seeing an Exercise Physiologist to ensure the training you do is as safe and effective as possible.
If issues have been identified with your footwear, previous/old orthotics or foot biomechanics, a podiatrist may be consulted to assess these and provide recommendations to assist your return to running safely.
Recovery timeframes can vary between each runner. Severity of bone stress injury, location of injury, nutritional and hormone status and the general bone mineral density have been shown to be key factors to influence return to running timeframes, in addition to the risk factors listed earlier in this blog.
Your physiotherapist will work with you to assist your return to walking or a graded return to running once the initial period of modified weight-bearing is completed. The training plan needs to be tailored to the individual and monitored closely to ensure that the problem is not recurring.
Some key suggestions for endurance-based runners include:
‘It’s just a niggle’. ’I’ll be alright, it’s nothing major’.
I was able to keep playing, I’ll be good for next week’…
Does this sound familiar?
Have you ever heard the phrase, ‘listen to your body’?
Well, here is some research to support that players, coaches, parents and health professionals should start paying more attention to these common niggles!
A study by Whalan et al. (2019) found that an injury that resulted in time loss for a player was 3 to 7 times more likely to occur 7 days after a niggle was reported.
In the study a niggle was referred to as a non-time loss injury, and was classified as either minor (when a player was able to continue and fully participate in training), or moderate (still able to continue training however at a modified capacity). A time loss injury was defined as an injury that resulted in a player not being able to participate in training due to the injury.
What does this mean? Well reporting of a niggle may actually help to identify those players who may be at an increased risk of injury. It is important to note that a niggle should not be solely used to predict whether a player may experience a time loss injury. Rather it could be used to flag a player who might be at risk.
Early recognition from a player, coach, parent and/or medical staff is recommended in order to minimise potential time loss due to injury, and to optimise sporting and athletic performance.
So very simply, listen to your body!
Whalan, M Lovell, R & Sampson, J 2019, ‘Do niggles matter? – increased injury risk following physical complaints in football (soccer), Science and Medicine in Football, vo. 4 , no. 3, pp 216-224.
We’re using our phones more than ever, for things like daily reminders, emails, navigation and as a ‘mobile wallet’ to make purchases. But what about using your phone to track and organise important health and fitness information?
There are thousands of health and fitness apps that you could download or that are already pre-installed on your phone to track and organise a range of health and fitness information.
It can bring together all health-related data from your phone, associated apps and Smartwatches to one convenient place.
The possibilities are endless! Your phone can track trends in a range of body measurements, activity levels, nutrition intake, heart rate, blood pressure, breathing patterns, sleep performance and much more. Some common health and fitness that you may have come across include:
This health & fitness information may be used to track long-term trends in health and fitness, monitor recovery, assist in goal setting and developing a training plan, and to identify any variations to trends that may prompt an assessment from a medical and health professional.
Careful interpretation of all this wonderful information needs to be considered, and it is recommended to consult a health professional with expertise and knowledge in the use of apps to gain a good understanding of the data to determine what is most important for you, and how this information could be used to improve your health and fitness.
It is important to understand that these apps don’t know enough about a person, and that one size does not fit all. The use and relevance of this information should be individual specific. These apps don’t replace any medical and health assessment, and mostly have not been tested for their accuracy to a level that is sufficient to make significant health decisions, nor are they regulated in Australia in a way that can guarantee their safe use without the input of a health professional.
Our Physiotherapists use a program called ‘Physitrack’ to help with managing the treatment of many conditions. This programme allows the physiotherapist to send information regarding your condition, questionnaires to measure your improvement and can be used for prescribing an exercise program based on your specific management needs.
Your Physitrack program can be accessed on your phone or other electronic device such as an iPad using the app called ‘PhysiApp’. It has built-in reminders and clear instructions using either videos or images to teach the exercise correctly. The app allows our Physiotherapists to measure your compliance, response to exercise in terms of symptoms such as pain experienced during its performance, and to track trends and progression to management.
‘Whoop’ is a tool app used by the team of Exercise Physiologists at iNform Health and Fitness Solutions. Whoop is comprised of an App, and a band, worn around your wrist which monitors your sleep, recovery levels, and activity levels. It then uses that information to help coach you on how much you should ideally sleep and exercise to improve your fitness and health!
What we love about the Whoop system is that it takes into consideration the overall ‘load’ – they call it ‘strain’ – that you are under. All our life commitments, activities and pressures result in a measurable physiological ‘stress’, or strain. So Whoop takes into consideration how tired, fatigued, stressed – or full of beans (!) – you may be, and recommends the right level of activity you can do that day. This makes sure you progress appropriately to ensure it is safe!
It then recommends how much one should sleep to recover from that strain. Based on how you actually slept, it rates your recovery and recommends the amount of strain you can get away with the following day. Very simple concept, supported by very smart technology! and it has helped us make great decisions with the help of quality objective data displayed in easily understood displays.
This information helps your Exercise Physiologist and other health professional to assist in developing and planning training sessions, recovery and management plans to help you to be active more effectively and efficiently, and to improve overall health outcomes by staying active for longer!
What to know more? Our team at Move for Better Health and iNform Health and Fitness Solutions can provide further information to help you incorporate these readily available health and fitness apps to your daily and exercise routine to assist in tracking and monitoring your training and management programs and goals.
The summer of cricket has been an exciting one, and if you’re involved in the game you’ve probably seen and played lots of cricket by now!
Cricket is played globally and is the second-most popular spectated sport behind football (also known as soccer in Australia – sorry AFL and rugby fans!).
Cricket is quite a unique sport which is played across three main formats at a semi-professional and professional level – T20, one-day and test matches. T20 is the shortest format of cricket, and involves up to 20 overs (six balls per over) bowled by each team, compared to one-day matches where each team could bowl up to 50 overs each. Test matches are the longest format and can last five days with each team batting twice and 90 overs bowled each day.
The variety of different match formats, and a range of skills needed (running, throwing, catching, bowling, batting, jumping etc) can increase a person’s risk of overuse and impact injuries.
Injuries were most commonly sustained by bowlers (41.3%), followed by fielders and wicket keepers (28.6%). Injuries were more commonly reported at the start of the cricket season.
Players less than 24 years old were found more likely to sustain an overuse and bowling related injury, compared to an older or more experienced player.
Injuries to the lower body accounted for approximately 49.8% of all total injuries, followed by the back (22.8%), upper body (23.3%) and neck (4.1%) areas. The most common injuries sustained in cricket are:
Involvement and communication between your health professional and coach staffing is very important to minimise risk of injury and for the management following an injury. A Physiotherapist will be able to assist to identify potential contributing factors that may increase your risk of injury and implement appropriate strategies to address these factors.
Strategies may include:
For further information on preventing and managing cricket related injuries please contact us. Our team of expert health professionals at Move for Better Health will be able to assist in developing a management plan to support your sporting goals.
Arora, M, Shetty, S & Dhillon, M 2015, ‘The shoulder in cricket: what’s causing all the painful shoulders?’, Journal of Arthroscopy and Joint Surgery, vol. 2, no. 2, pp. 57-61.
Dinshaw, P, Rao, N & Varshney, A 2018, ‘Injuries in cricket’, Sports Health, vol. 10, no. 3, pp. 217-222.
Orchard, J, Blanch, P, Paoloni, J, Kountouris, A, Sims, K, Orchard, J & Brukner, P 2015, ‘Cricket fast bowling workload patterns as risk factors for tendon, muscle, bone and joint injuries’, British Journal of Sports Medicine, vol. 49, no. 16, pp. 1-6.
Low back pain is a very common musculoskeletal complaint, however despite how common it is within our society, there are many misconceptions regarding its assessment and management.
The Chartered Society of Physiotherapy, a union group in the United Kingdom for Physiotherapists, have developed four common myth busters about lower back pain. They are based on what we know from the latest research evidence and clinical practice in the assessment and management of low back pain.
People fear twisting and bending but it’s essential to keep moving. Gradually increase how much you are doing, and stay on the go.
Back pain shouldn’t stop you enjoying exercise or regular activities. In fact, studies found that continuing with these can help you get better sooner including using weights where appropriate.
Sometimes it will, but most often it won’t. Also, even people without back pain have changes in their spine so scans can cause fear that influences behaviour, making the problem worse.
This was the established view but more recent research has changed our thinking. Modern physio takes a holistic approach that helps people understand why they are in pain, and the reason is often not because there is damage to the body.
For further information you can visit the Chartered Society of Physiotherapy’s website to view the supporting evidence behind each myth buster. Move Physio has years of experience in assessing and managing lower back pain. If you have or know someone with lower back pain and would like more information please don’t hesitate to contact us at Move for Better Health.
Chartered Society of Physiotherapy, 2016, Back pain myth busters, Chartered Society of Physiotherapy, viewed 5th November 2019, <https://www.csp.org.uk/conditions/back-pain/back-pain-myth-busters>
Improving your movement reaction time may not be something you think to work on when you’re exercising. Few people realise how important it is to incorporate this type of training into their exercise routine, especially when it comes to:
The ‘Clock Yourself’ app is a fun, easy to use training method which has been developed by Australian Physiotherapists for this purpose.
This app is based on best clinical evidence and provides guidance and instruction on how you can train movement reaction time at home, and also gives you another way the brain and body.
Increasing age, low levels of physical activity and presence of multiple medical conditions all influence a person’s movement reaction time, mobility and balance. These factors can increase the risk of falling over.
However, with appropriate training, the influence of these risk factors can be reduced due to our body and brain’s incredible capacity to continue and learn new skills, and sharpen our ability to adapt in different environments.
Clock Yourself was inspired by a familiar mental model – ‘a clockface’ – which serves as a foundation of 12 intuitive coordinates to begin our training, with no equipment required!
The complexity of training activities are continually progressed across five levels by modifying exercise intensity, and thought processing demands.
Training activities are designed to work on stepping speed, physical and cognitive agility, and ability to adapt to varying situations in a fun and engaging environment for all age groups.
Clock Yourself can be used as a form of rehabilitation following injury, prehabilitation to prevent an injury or fall, or a warm up for athletic training. The possibilities are open to the creative mind!
For more information on this exciting training method feel free to talk to one of our friendly Physiotherapists at Move for Better Health, or you can visit the Clock Yourself website here.
Sam Campagnale is a Move Physiotherapist, and is familiar with Clock Yourself. He can help you to incorporate it into your exercise routine (at home or in our supervised Pilates or Gym classes), to ensure you’re safe and comfortable with setting up and using the app.
If you’d like to see Sam to set up the Clock Yourself app, or to refine your exercise routine, you can:
Nitz, J, Stock, L & Khan, A 2013, ‘Health-related predictors of falls and fractures in women over 40’, Osteoporosis International, vol. 24, no. 2, pp. 613-621.
Nolan, M, Nitz, J, Choy, N & Illing, S 2010, ‘Age-related changes in musculoskeletal function, balance and mobility measures in men aged 30-80 years’, The Aging Male, vol. 13, no. 3, pp. 194-201.
Okubo, Y, Schoene, D, Lord, S 2017, ‘Step training improve reaction time, gait and balance and reduces falls in older people: a systematic review and meta-analysis’, British Journal of Sports Medicine, vol. 51, no. 7, pp. 1-9.
We’ve been told to RICE (rest, ice, compress, elevate) or POLICE (protection, rest, ice, compress, elevate) immediately after an injury. But it’s time for immediate PEACE then LOVE to optimise your recovery following an acute injury.
Protection – modify by unloading or restricting your movement and activities for 1-3 days. Prolong rest should be minimised as this can influence recovery timeframes following an injury. A study by Kilroe (2020) found that a muscle could reduce in size by approximately 5% following one week (approximately 0.8% per day) of a period of immobilisation using crutches and a brace.
Elevation – elevate the injured body part higher than the heart as often as you can during the day.
Avoid anti-inflammatories – there is some discussion to minimise taking anti-inflammatory medications and icing an injured area due to its potential influence on initial tissue healing. However it is recommended to discuss with your health and/or medical professional about how medication or icing may or may not have a role in your management plan following injury.
Compression – use an appropriate fitted and sized elastic bandage (such as tubigrip) or taping to reduce swelling.
Education – minimise reliance on passive treatments and avoid unnecessary medical investigations during the early stages of your recovery following injury. Your physiotherapist will be able to assist you to gain an understanding on what is your injury, how to appropriately manage load, and how to minimise reaggravation of the injury. Your Physiotherapist will also be able to guide when further medical investigations (such as imaging) may be required as a part of your management plan.
Load – commence gradual return to movement and normal activities as guided by your pain. Activities will be modified during the early stages of your management however should be progressively loaded and progressed to build tissue health and tolerance as your symptoms settle.
Optimism – beliefs about the injury and associated feelings and emotions can influence your overall recovery. Speak to your Physiotherapist to gain an understanding of your injury and to establish a management plan with clear expectations.
Vascularisation – commence pain-free aerobic based activities (such as cycling, swimming, walking etc) with the aim to increase blood flow to repairing tissues after a few days following injury.
Exercise – develop an exercise program with your Physiotherapist to restore mobility, endurance, strength and proprioception and control. Have a discussion with your Physiotherapy to understand appropriate pain responses to and following exercise, and how to guide exercise progressions. It’s no longer ‘no pain no game’ but instead ‘know your pain to gain’!
If you’re not sure how to manage an injury that may be muscle, ligament of joint related, and want to see one of our other Physiotherapists for this issue, you can:
Dubois, B & Esculier, J 2020, ‘Soft-tissue injuries simply need peace and love’, British Journal of Sports Medicine, vol. 54, no. 2, pp 3-5.
Kilroe, S, Fulford, J, Jackman, S, Van Loon, L & Wall, B 2020, ‘Temporal muscle-specific disuse atrophy during one week of leg immobilization’, American College of Sports Medicine, vol. 52, no. 4, pp. 944-954.