Meniscus

Menisci are found in your knee resting between the thigh (femur) and the shin (tibia) bones. There is the medial on the inside and the lateral on the outside. They are made of cartilage and disperse forces across the knee joint, improve stability and allow the bones to glide against each other without damaging the bone.

Menisci can be injured/ torn from trauma or degenerative changes. Traumatic injuries usually occur with twisting on a grounded leg or from another player landing on the knee and are commonly associated with anterior cruciate &/or medial collateral ligament damage. A MRI will confirm a meniscal tear but other signs and symptoms can include joint line tenderness with swelling, decreased knee movement, positive physical tests and locking/ catching/ grating of the knee can be present.

The type of tear, the patient's activity level and their response to conservative treatment usually determines whether or not surgery is indicated. Surgery is usually required if locking, clicking or a lack of extension/ straightening is present. Surgery is usually arthroscopic (through small holes). The torn segment of the meniscus can be removed (meniscectomy) and the patient is able to full weight bear immediately after the surgery OR the meniscus can be stitched back together which requires a period of bracing and 6 weeks non-weight bearing. The patient progresses through post-op rehabilitation as indicated by the type of surgery they have had.

Knee-cap Pain

Patello- femoral Joint Syndrome refers to pain in and around the kneecap. It can vary in its presentation of pain, may/ may no have swelling, may/may not have a restriction in range and may/may not be tender on palpation. Aggravating factors can include, but aren't limited to, running, stairs, repeated bending/ straightening of the knee.

The cause of the pain can come from many sources such as knee cap position and movement, muscle function, hip and knee flexibility and movement, training errors and foot position/ abnormal biomechanics. Your Physiotherapist can assess these to determine cause and treatment plan. It can be easily treated if diagnosed and treated early before it becomes a chronic problem.

ITB Friction Syndrome

The iliotibial band/ tract is a thickening of the fascia that originates at the top of the hip and runs down the outside of the thigh to insert on the outside of the knee. The tensor fasciae latae and gluteus maximus muscles both insert into the ITB. 

ITB friction syndrome refers to pain felt on the outside of the knee which may radiate up the outside of the thigh. This condition occurs when there is friction between the ITB and the outside of the thigh bone near the knee. It can present as pain on the outside of the knee and/or the outside of the thigh felt when running, climbing stairs and/or repeated bending and straightening of the knee. There can be a sensation of tightness in the ITB and occasionally associated with a ‘snapping hip' where the muscles crosses the outside of the hip during running/ walking. The condition can be caused by inappropriate training and/or equipment, abnormal biomechanics, muscle weakness or tightness.

A physiotherapist can asses and tailor an individualised treatment programme to manage the presentation of the ITB friction syndrome and correct predisposing factors. It is also easily treated if diagnosed and treated early before it becomes chronic. Treatment aims to; decrease pain and inflammation, improve muscle flexibility, unload the ITB, correct faulty pelvic mechanics and training errors and to improve strength around the pelvis, hip and knee.

Cervico-genic Headaches

Headaches can occur for many reasons. There are many types of headaches so it is best to consult your Doctor before seeing a Physiotherapist. A cervico-genic headache is a condition where damage to joints, muscles, ligaments or nerves within the neck refers pain to the head causing a headache. They usually occur when excessive stress is placed on the upper joints of the neck either by trauma (eg. car crash), repetitive activities or poor posture. Pain can also be felt in the skin overlying the head, forehead, jaw line, back of ears and eyes. There can be a gradual onset of neck pain and headaches during the aggravating activity, however it may continue after the activity has ceased. The pain can last days, weeks or even months and be constant or intermittent.

These types of headaches can have a varied presentation but usually present as a constant dull ache at the back of the skull, although sometimes behind the eyes or temple region. Pain is usually one sided, but occasionally both sides. Signs and symptoms can include; neck stiffness and/or pain, difficulty moving their neck, pins and needles or numbness in upper back, shoulders, arms or hands and occasionally light-headedness dizziness, nausea and tinnitus (ringing in the ears). Patient's can be tender on palpation of the neck.

A patient with this condition can recover quickly with appropriate physiotherapy treatment and they can be taught how to look after their neck so that the headaches don't return. Recovery time depends on the patient's compliance to treatment and severity of the injury, it can vary from days to months.

Your physiotherapist can identify any contributing factors to the headaches such as poor posture, neck and truck stiffness, muscle imbalances/ weaknesses/ tightness, previous trauma, poor workplace set-ups, sleeping positions/ pillows, repetitive motions/ lifting or stress. Resting from aggravating activities allows healing to begin. Physiotherapists can treat underlying factors with hands on therapy, retrain good posture and  advise you as to which exercises are appropriate.

New Tape Technology

Dynamic Tape is a shift in taping philosophy from traditional rigid strapping and even Kinesiotape.  The tape is stretchy, so that when it elongates with movement of the body, potential energy is built up in the tape to give an elastic rebound effect.  This can be used to contribute to the biomechanics of the movement.  It can be applied to assist or resist certain movements to encourage correct movement patterns. Incorrect patterns can develop soon after injury and slow recovery. Dynamic tape is not meant to limit motion like rigid tapes do. It is designed to allow full range of motion with reduced load and stress on injured or overloaded tissues. 

Some applications of Dynamic Tape:

• Dynamic Tape can also assist with lymphatic drainage to help reduce swelling after injury. Reducing swelling can improve circulation and speed healing and recovery.
• It can also be used to inhibit (or 'downtrain') overactive muscles and trigger points that may also hinder performance and cause pain.
• The rebound effect can also be used to assist muscles in generating force to reduce their workload when they have been injured, overactive or overworked. 

Dynamic Tape can be used to treat many conditions. Some examples are: back pain, neck pain, tennis elbow, golfer's elbow, tendinitis/ tendinopathy, shoulder pain, rotator cuff problems, bunions, shin splints, hamstring or quadriceps tears, patellofemoral problems and many more.  

Contact Sportscare and talk to one of their experienced physiotherapists for more information! 

SIJ Dysfunction

The Sacroiliac joint is located in the lower back and joints the tail bone/ sacrum to the pelvic bones/ ileums. There are two SIJs on either side and their job is to transfer weight from the spine to the pelvis. If excessive forces are placed on these joints, injury/ dysfunction may occur. This can be from bending, sitting, lifting, twisting or from running/ jumping. It can be traumatic or from repetitive/ prolonged forces.

Signs and symptoms are usually one sided low back pain sometimes referring into the lower buttock, groin or thigh. In rare cases, pain may be felt on both sides. Symptoms are generally exacerbated with back or hip movements, eg. rolling in bed, stairs or running. This dysfunction is also commonly seen during pregnancy.

Subjective and objective examination from a physiotherapist is usually enough to diagnosis a sacroiliac dysfunction and most will heal well with physiotherapy, however this is largely dictated by patient compliance. Initially, rest from any activity that aggravates symptoms is the key as it allows healing to begin. The RICE regime should be followed in this initial phase.Patients should perform early postural, mobility and strengthening exercises as early as pain allows, to ensure the correct function of the SIJ. Your physiotherapist can advise how to do these and when they should be commenced.

Other in-clinic treatment may comprise of massage, mobilisation, taping/ bracing, acupuncture, muscle energy techniques, activity modification and postural re-education. Some patients will undergo a corticosteroid injection to alleviate symptoms (from a specialist). Recovery time will vary patient to patient depending on compliance with physiotherapy, duration and severity of the dysfunction. Care must be taken with a graduated return to activity. 

Elbow Overuse

Tennis elbow is a common overuse injury causing pain at the outer aspect of the elbow. The muscles that attach at the back of the forearm which extend (ie. bend back) the wrist and fingers have a common bony attachment at the outer aspect of the elbow (lateral epicondyle). When they contract, they place tension through this attachment. When this becomes excessive through repetition or high load, damage to the tendon occurs which leads to subsequent inflammation and degeneration of the tendon.

Tennis elbow is in fact seen more commonly in non-tennis players than tennis players. Patients usually describe repeated wrist extension against resistance in association to developing this condition, for example in sports such as tennis, squash, badminton and manual work such as carpentry, painting, chopping wood, sewing or working at a computer. It may also develop from other activities involving repetitive/ forceful gripping of the hand. A sudden increase in activity of change in equipment can also cause this condition.

Symptoms usually develop over a period of time. Pain is usually felt locally 1-2cm down from the elbow that is tender on palpation. It can range in severity and may keep the patient awake at night. It can increase to sharper pain with activity and in long standing cases muscles weakness and loss of grip strength may be present. Aggravating activities can include; opening a jar, driving, turning a door knob.

Tennis elbow usually settles well with physiotherapy; however this is largely dictated by the patient's compliance. The key component of treatment is rest from any activity that increases their pain until they are symptom free. Treatment usually also involves; following the RICE regime (rest, ice, compression, elevation), stretching and strengthening program and a graduated return to sport/activity. Sometimes the use of a tennis elbow brace/support can assist rehab.

This condition can recover within a few weeks if it hasn't been present for long. In more severe/chronic cases it can take up to 6months.

Sprained Ankle

A sprained ankle refers to damage of the soft tissue and ligaments of the ankle. The most commonly affected ligament is the one on the front/ outside part of you ankle (lateral ligament). Sprains most commonly occur with rapid changes in direction, especially on uneven ground like in sports such as: basketball, football, volleyball and netball, when the foot is turned inwards and downwards whilst weight is through it. A sprain may range from a small partial tear with minimal pain (grade I) to a complete rupture resulting in significant pain and immobility (grade III). Sometimes an audible snap or tearing sound is heard at the time of injury with subsequent pain and swelling and occasionally inability to weight bear. Bruising and stiffness can develop over the following days. A physiotherapist's questioning and examination is usually sufficient in the diagnosis of a sprained ankle however investigations such as x-ray/MRI/CT may be required to rule out other injuries (eg. fracture) or grade the tear.

Most sprained ankles heal well with Physiotherapy, however compliance by the patient dictates the rate of success. For the first 48-72hours treatment involves the R.I.C.E (rest, ice, compression & elevation) regime to reduce bleeding, swelling and inflammation. Anti-inflammatory medication may also be helpful at this time. As soon as pain allows the patient should perform ranging, strengthening and balance exercises to prevent stiffness, weakness and instability from developing. A gradual return to activity and sport should occur once pain- free. In minor to moderate sprained ankles (grades I-II) they usually return to sport in 2-6 weeks, however grade III tears require a longer period of rehab. Rarely is a surgical reconstruction of the ligament required when conservative measures fail.

Superior Labrum from Anterior to Posterior 

A SLAP tear is an injury to the labrum (the cuff of cartilage in the socket) of the shoulder. It stands for Superior Labrum from Anterior to Posterior. The SLAP tear occurs at the point where the tendon of the biceps muscle inserts on the labrum. This injury can occur and result from trauma, repetitive motion/ overhead activities, a fall onto an outstretched hand, a sudden pull to the shoulder when lifting a heavy object or a direct blow to the shoulder. Patients often complain of catching/ clicking/ locking sensation, pain at the front or on top of the shoulder that is aggravated with movement and a loss of range. A SLAP tear can be in association to a rotator cuff or biceps tear. There are several physical tests to indicate a SLAP tear but the best way to diagnose is by either MRI or arthroscopic investigation.

There are 4 types of SLAP tears:
 fraying of the labrum
 when the biceps tendon and labrum become detached from the socket joint attachment
 when the labrum has a flap of tissue hanging down into the joint.
 tear is when the labral tear extends into the biceps tendon

Some will respond to conservative treatment and others will require surgery. Surgery can usually be done arthroscopically and can be: a debridement (shave off torn portion, type I), SLAP repair (stitches labrum/ tendon back down- type II & III) or biceps tenodesis (relocation of the biceps tendon attachment- type IV). Post-op rehab depends on the surgeon and type of surgery but Physiotherapy is vital to regain full range and strength. Full recover is usually between 3-4 months.

MCL, Knee Joint

The Medial Collateral Ligament (MCL) is on the inside of the knee joint and spans from the end of the femur (thigh bone) to the top of the tibia (shin bone). It resists widening of the inside of the joint, or prevents "opening-up" of the knee. The MCL is usually injured when the outside of the knee joint is struck. This action causes the outside of the knee to buckle, and the inside to widen, which can stretch/ tear the MCL. It commonly occurs in downhill skiing or in contact sports when an opponent falls across the knee from the outside. An injury to the MCL may occur as an isolated injury, or it may be part of a complex injury to the knee involving the anterior cruciate ligament (ACL) or the meniscus.

There is pain over the ligament and it can swell and/or bruise 1-2 days after the injury. In more severe injuries, the knee may feel unstable. There are three grades of an MCL injury:

 I: being incomplete and mild with 1-2 weeks recovery,
 II: being incomplete and marked with 3-4 weeks recovery,
 III: complete and significant, usually with associated injuries requiring 6+ weeks recovery.

A MCL injury rarely requires surgery. Rehab will usually allow patients to return to sport, however the time it takes corresponds to the grade of the injury. Aims of treatment are to control pain and swelling, regain full range and strength, full weight bearing without limp and return to sport as indicated.

ACL, Knee Joint

The anterior cruciate ligament is in the centre of the knee joint where it connects the femur (thighbone) to the tibia (shinbone). It controls forwards movement of the tibia on the femur. If the tibia moves too far forwards, it can rupture the ACL. Sports-related injuries are the most common and usually occur when landing from a jump, pivoting, sudden deceleration (slowing down or stop) or hyperextension. It can also occur when another player falls across the knee. When the ACL is damaged, associated injuries can occur to the Medial Collateral Ligament (MCL), medial or lateral meniscus or an avulsion fracture of the tibial plateau where the ACL attaches.

At the time of injury, an audible pop/ crack may be heard with a feeling of giving way. There is usually pain and an inability to continue activity with swelling occurring within a short time from the injury. Residual restriction of movement and tenderness on palpation can occur. Diagnosis is most accurate with MRI however there are some physical tests a Physiotherapist/ Orthopod can perform to test the ACL and identify other damaged structures.

Treatment options are dependent on many factors such as associated injuries, demands on the knee and degree of instability. Surgical treatment involves replacing the torn ACL with a graft (from your own tendon) that reproduces the ligaments normal function. Post-operatively, the patient progresses through a rehabilitation of about 6-9 months working on movement, decreasing swelling, strengthening, balance, walking and later on returning to sport. Non-surgical management includes the same type of rehabilitation that occurs post-surgery.

Pan Pacific Swimming Championships California

Russell Smallwood - Team Physiotherapist

Russell Smallwood has just returned from the Pan Pacific swimming championships in California as the team physiotherapist for the Australian swim team.

His role involved providing physiotherapy and massage for the swimmers to help optimize performance and keep their injuries under control. Russell says the most common things he has to look after with the swim team are shoulder injuries, neck pain and low back pain.

Lower Limb Overuse, Shin Splint and Achillis Tendonitis

One of the primary reasons for lower limb overuse injuries such as ‘shin splints’ or achillis tendonitis is incorrect footwear. There are 4 main features of shoes that you need to be aware of when purchasing shoes.

1. Heel Cup – a good pair of running shoes have a firm heel cup to hold the heel in its optimal position at heel strike. Simply grip heel at back of shoe to gauge support. These cups are biased according to the ideal posture for the foot.

2.The twist flexibility of the shoes is important to either maintain support or alter flexibility where required. Hold shoe longitudinally and apply a rotary twist. Notice where the movement is occurring. In simple terms, for a mobile foot the shoes should have little movement through the mid foot (these shoes will often have a dual density soul or extra support bars), for a rigid supinator foot more movement is desired.

3. Cushioning of the soul is important to provide both shock absorption and support. Notice the depth and ‘squeeze ability’ of the EVA material that makes up the soul. For a stiff high arch you would like plenty of cushioning and an easy squeeze feel but for a mobile, excessively pronating foot you should look for more support, often from dual density materials.

4. Other features of shoes are often variations of these above features. It is important to remember no one brand has one shoe that will suit every foot. You should look at shoe structures and remember they must feel comfortable to you to wear.

Also remember some high profile brands will change the factories the shoes are produced at annually and consequently the features of the shoes can change year by year.

At Sportscare we provide a service to assess the suitability of shoes for you. Most retailers are supportive of this and will allow you to return or exchange unsuitable footwear. Check with the store and then make an appointment with us. 

Download Achillis Tendonitis information here.

Sportscare Posture Guide

There is no ideal posture for all but in simple terms you need to hold yourself against gravity.

Try this:- in standing make sure knees are soft (not locked out straight) and bone on outside of hips sits over ankles, shoulder blades remain broad with a line going from shoulders through hips to ankles and hold your head as though someone is lightly pulling up by a piece of string from the middle of your head.

Ideal sitting is a variation of this with the feet taking weight and the pelvis in neutral position.

Download Posture information here.

Dealing with Shin Splints

With the onset of the football season we have had a proliferation of medial shin pain – sometimes called shin splints.

If you have been suffering with pain and tightness along the inside of your shin and particularly if you have a rigid foot try this stretch.
 
Stand next to a wall and rest foot closest to the wall on a 45° angle up the wall with toes pushed firmly onto wall (it’s easier with shoes on).

Then push 1 knee forward over ankle and lean hip and knee towards the wall.

You are looking to feel a pull up the inside of the leg from ankle – not pain on outside of ankle. Play with position, ankle to wall if you can’t get the stretch.

If pain persists ring us for a biomechanical assessment and treatment possibly including fascial release or acupuncture.

Download Shin Splints information here