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Why Tennis Elbow Takes So Long to Get Better (And What Actually Works)

Why Tennis Elbow Takes So Long to Get Better (And What Actually Works)

by | Feb 21, 2026 | Elbow, Pain, Sports Injury, Tendon

Ifyou’ve had tennis elbow (also called lateral epicondylalgia), you’ll know it’s not just a “sore elbow.”It’s pain when lifting a coffee cup. Pain shaking hands. Pain turning a door handle. Pain gripping the gym bar or picking up your kids.

And frustratingly, it can hang around for months. So why does tennis elbow take so long to improve? And are injections like cortisone really the quick fix people hope they are?

Let’s unpack it during this installment of Praxis What You Preach

First — It’s Not Really “Inflammation”

Despite the name lateral epicondylitis, most modern research shows that tennis elbow is not primarily an inflammatory condition.

Histological studies consistently demonstrate degenerative tendon changes such as disorganised collagen, increased fibroblasts and vascular changes — rather than classic inflammatory cells. In other words, it’s more accurate to call it a tendinosis or tendinopathy rather than a true “-itis” condition (Herd & Meserve, 2008; Pathan & Sharath, 2023).

This distinction matters. Inflammatory problems (like a sprained ankle in the first few days) often respond quickly to anti-inflammatory treatments.

Degenerative tendon problems do not.

What’s Actually Happening?

In around 90% of cases, the extensor carpi radialis brevis (ECRB) tendon is involved (Pathan & Sharath, 2023). This tendon is heavily loaded during gripping and wrist extension — especially repetitive tasks like typing, manual labour, racquet sports, or gym training.

Over time, repeated micro-loading can exceed the tendon’s capacity. When the tendon fails to adapt effectively, it begins to:

  • Lose collagen organisation
  • Develop microtears
  • Show reduced tensile capacity
  • Become painful with load

This process develops gradually. And that’s one key reason recovery isn’t instant.

“But I’ve Rested It — Why Is It Still Sore?”

Because tendons don’t heal well with complete rest. They need progressive, appropriate load to stimulate remodelling.

Without mechanical stimulus:

  • Collagen alignment worsens
  • Tendon capacity reduces
  • Grip strength declines
  • Pain can actually persist longer

This is why high-quality physiotherapy programs focus on graded strengthening, tendon capacity rebuilding, and load modification, rather than pure rest (Pathan & Sharath, 2023; Yelland et al., 2019).

Natural History: Does It Just Go Away?

Tennis elbow is often described as “self-limiting.” Some reports suggest many cases improve within 8–12 months (Houck et al., 2019), and older literature even suggested high rates of improvement at one year (Herd & Meserve, 2008).

However, that doesn’t mean:

  • It resolves quickly
  • It resolves optimally
  • It resolves without recurrence
  • It resolves without strength deficits

Up to 10% of patients develop persistent symptoms severe enough to consider surgery (Yelland et al., 2019).

And in working adults, particularly manual workers, the functional and economic impact is significant.

So while time helps, structured intervention helps more.

What About Cortisone Injections?

Corticosteroid injections are still widely used for tennis elbow. They are:

  • Relatively inexpensive
  • Quick to administer
  • Often very effective for short-term pain relief

And the evidence supports that. Multiple systematic reviews demonstrate that corticosteroid injections are more effective than other treatments in the short term (typically under 12 weeks) (Houck et al., 2019).

The problem? The long term. The same high-level evidence shows that corticosteroid injections:

  • Provide only temporary benefit
  • Are associated with worse long-term outcomes compared to physiotherapy or even a wait-and-see approach (Coombes et al., 2013)
  • Are less effective than platelet-rich plasma (PRP) in the intermediate and longer term (Houck et al., 2019; Kemp et al., 2021)

A 2021 systematic review of systematic reviews concluded:

  • Cortisone = better short-term pain relief
  • PRP = better long-term pain relief and improved function (Kemp et al., 2021)

From a cost-effectiveness perspective, physiotherapy was favoured as a first-line option, while corticosteroid injections showed greater variability and lower probability of being cost-effective over 12 months (Coombes et al., 2013).

Why Might Cortisone Underperform Long Term?

Corticosteroids:

  • Suppress inflammation
  • Reduce pain rapidly
  • Do not improve tendon structure
  • May temporarily weaken tendon tissue

In degenerative tendinopathy, masking pain without improving load capacity can lead to premature return to aggravating activities, and recurrence. For this reason, corticosteroid injections are rarely our first-line strategy at Praxis.

What About PRP?

Platelet-Rich Plasma (PRP) is a biological injection derived from your own blood. It contains concentrated platelets and growth factors intended to stimulate tissue repair.

The evidence is not perfect but it is increasingly supportive in certain contexts.

A large systematic review and meta-analysis found that PRP resulted in improvements exceeding minimal clinically important difference (MCID) thresholds across commonly used outcome measures (VAS, DASH, PRTEE) from 4 weeks through to 104 weeks in many studies (Niemiec et al., 2022).

When compared directly to corticosteroid injections:

  • Cortisone tends to win early
  • PRP tends to win at 3–12 months (Houck et al., 2019; Kemp et al., 2021)

The 2021 review in the International Journal of Sports Physical Therapy concluded that PRP appears to be a more effective long-term treatment option for patients who have failed conservative care (Kemp et al., 2021).

Important Caveats

PRP:

  • Is not a magic bullet
  • Has variability in preparation methods
  • Works best when combined with appropriate load rehabilitation

At Praxis, if PRP is considered, it is typically:

  • For recalcitrant cases
  • After structured rehab has failed
  • Integrated into a progressive strengthening program

So What Actually Works Best?

High-quality evidence consistently supports physiotherapy-directed exercise programs for both short- and long-term improvement (Yelland et al., 2019; Pathan & Sharath, 2023).

Manual therapy combined with exercise has demonstrated meaningful clinical benefits compared to placebo or corticosteroid injection (Yelland et al., 2019).

There is also evidence supporting certain manipulative therapy techniques for symptom reduction (Herd & Meserve, 2008), though exercise remains the cornerstone of recovery.

Importantly, a well-designed physiotherapy program is not just:

  • “Do some wrist curls”
  • “Stretch your forearm”
  • “Wear a brace”

Effective rehab addresses:

  • Tendon load tolerance
  • Grip strength deficits
  • Kinetic chain contributions (shoulder and cervical loading)
  • Work or sport-specific demands
  • Progressive capacity building
  • Assessment of cervical and local nerve contributors to pain and dysfunction

We don’t give away all the details publicly, but it’s far more nuanced than a generic exercise sheet.

Why It Takes Time

Tendons remodel slowly. Unlike muscle tissue, which may respond in weeks, tendon adaptation can take:

  • 8–12 weeks for meaningful structural adaptation
  • 3–6 months for substantial capacity restoration
  • Longer in chronic cases

And if the condition has been present for 6–12 months already, the tissue changes are well established.

Add to that:

  • Poor early management
  • Repeated cortisone injections
  • Ongoing load without strength progression
  • High occupational demands

And recovery timelines extend further.

The Takeaway

Tennis elbow takes time because:

  • It is primarily degenerative, not inflammatory (Herd & Meserve, 2008; Pathan & Sharath, 2023)
  • Tendons adapt slowly
  • Quick fixes often don’t address load capacity
  • Short-term pain relief is not the same as long-term recovery

Cortisone may reduce pain quickly — but does not appear to be the best long-term solution (Houck et al., 2019; Coombes et al., 2013).

PRP shows more promising longer-term outcomes in persistent cases (Niemiec et al., 2022; Kemp et al., 2021) — but still works best when combined with progressive rehabilitation.

Tennis elbow rarely improves by accident — it improves with the right load, at the right time.

If you’re tired of resting, taping, or chasing temporary fixes, our team can guide you through a structured, evidence-based program designed to rebuild tendon capacity and reduce recurrence.

Book an appointment at one of our Brisbane clinics today and start moving forward with a clear plan.

Until next time, Praxis What You Preach…

📍 Clinics in Teneriffe, Buranda, and Carseldine

💪 Trusted by athletes. Backed by evidence. Here for everyone.

Rotator Cuff Repair: A Physiotherapy Guide on Recovery and Rehabilitation

Rotator Cuff Repair: A Physiotherapy Guide on Recovery and Rehabilitation

by | Jun 12, 2025 | Pain, Shoulder, Surgery

What to Expect from Rotator Cuff Repair: A Physiotherapy Perspective on Recovery and Rehabilitation

Rotator cuff repair surgery is a common and highly effective intervention for individuals suffering from persistent shoulder pain, weakness, or dysfunction due to a torn rotator cuff. Many patients turn to Google with phrases like “rotator cuff surgery recovery timeline,” “shoulder rehab exercises,” or “physiotherapy after shoulder surgery” when looking for answers about what comes next (that may have brought you here!).

While surgical techniques have advanced significantly, the rehabilitation process that follows is equally important in determining a successful outcome. In this Praxis What You Preach blog, we outline what patients can expect from physiotherapy after rotator cuff repair, based on current evidence, clinical best practice and our years of experience dealing with post operative patients.

Phase 1: Protection and Pain Management (Weeks 0–6)

The early stage of rehabilitation focuses on protecting the surgical repair, minimising pain, and reducing inflammation. Patients are typically placed in a shoulder immobiliser or sling for 4–6 weeks to allow early tendon-to-bone healing (Sgroi & Cilenti, 2018; Nikolaidou et al., 2017).

  • Passive Range of Motion (PROM) may begin within this phase under the supervision of a physiotherapist to prevent stiffness while avoiding strain on the healing tendon (Conti et al., 2009).
  • Key goals include:
    • Pain control (using ice, medication, or electrotherapy)
    • Preventing stiffness through gentle PROM in safe planes
    • Maintaining mobility of the elbow, wrist, and hand

“Excessive immobilisation can contribute to shoulder stiffness and muscle atrophy, yet too much movement too soon may compromise tendon healing” (Littlewood et al., 2015).

Phase 2: Controlled Mobilisation (Weeks 7–11)

Once the tendon is more securely integrated with bone, the sling is discontinued and patients begin active-assisted and then active range of motion (AAROM → AROM).

  • Exercises now include:
    • Assisted shoulder flexion and external rotation
    • Scapular control and retraction exercises
    • Isometric strengthening for deltoid and scapular stabilisers

This phase is critical to restoring functional movement without overloading the healing tendon. A slow and structured progression is essential. According to Bandara et al. (2021), protocols that are milestone-based (rather than time-based alone) yield better individualised outcomes.

“Criteria to progress should include pain-free PROM and AROM without compensation or shoulder shrug” (Sgroi & Cilenti, 2018).

Phase 3: Strengthening and Neuromuscular Control (Weeks 12+)

At approximately 12 weeks, patients typically progress to resisted exercises that begin to strengthen the repaired rotator cuff and surrounding musculature. At this stage:

  • Isotonic rotator cuff and scapular muscle training begins
  • Progressive resistance exercises (e.g. banded ER/IR, rows)
  • Incorporation of proprioception and dynamic control (e.g. rhythmic stabilisation, closed-chain activities)

The focus shifts from range of motion to building load tolerance and functional strength. Exercise selection considers tendon healing biology, which shows more mature tendon-to-bone healing around the 12–16 week mark (Nikolaidou et al., 2017; Conti et al., 2009).

“Initiation of functional loading early in the rehabilitation programme does not adversely affect clinical outcome, provided it is gradual and well-monitored” (Littlewood et al., 2015).

Phase 4: Return to Activity and Sport-Specific Rehabilitation (Month 4+)

From four months onwards, many patients begin returning to higher-level tasks depending on their goals:

  • Overhead activities for daily life or sport
  • Plyometric and ballistic loading for athletes
  • Work conditioning or manual labour readiness

At Praxis Physiotherapy, we tailor this phase to your individual goals—whether that’s lifting your toddler, swinging a golf club, or returning to competitive sport.

Some protocols extend formal physiotherapy through months 6–12 for more complex tears or high-functioning individuals.

Communication and Individualisation are Key

Every patient recovers at a different rate depending on:

  • Size and chronicity of the tear
  • Surgical technique
  • Pre-existing stiffness or atrophy
  • Adherence to rehabilitation and exercise

Close collaboration between surgeon, physiotherapist, and patient is essential for long-term success (Sgroi & Cilenti, 2018; Nikolaidou et al., 2017).

“There is strong evidence that early initiation of rehabilitation does not adversely affect clinical outcomes, but should always be individualised” (Littlewood et al., 2015; Bandara et al., 2021).

Final Thoughts 

Rotator cuff repair is only the beginning of the journey. At Praxis Physiotherapy, we provide evidence-based, goal-oriented care from day one post-op through to full return to work, life, and sport.

If you’re preparing for rotator cuff surgery or are currently in recovery, book an appointment at one of our Brisbane locations to begin a structured and personalised rehabilitation program. Begin your recovery the right way.

Until next time, Praxis What You Preach

📍 Clinics in Teneriffe, Buranda, and Carseldine

💪 Trusted by athletes. Backed by evidence. Here for everyone.

Your Guide to Total Knee Replacement Surgery

Your Guide to Total Knee Replacement Surgery

by | Jun 1, 2025 | Knee, Pain, Surgery

 Total knee replacement (TKR) is a life-changing procedure for individuals suffering from chronic knee pain, typically caused by osteoarthritis. At Praxis Physiotherapy, we understand that total knee replacement (TKR) surgery is a major decision. As such, we are committed to helping patients navigate their surgical journey and maximize outcomes through tailored prehabilitation and rehabilitation programs.

This guide is designed to walk you through what to expect before and after surgery, how physiotherapy plays a crucial role, and the advanced, evidence-based services we offer to support your journey.

Why Physiotherapy Matters

Physiotherapy isn’t just something you do after surgery—it’s a vital part of your preparation. Prehabilitation (prehab) that begins around six weeks before surgery can improve muscle strength, mobility, and balance, leading to quicker, more successful recoveries post-surgery (Domínguez-Navarro et al., 2020).

Similarly, post-operative physiotherapy supports improved pain relief, better joint function, and faster return to daily activities (Artz et al., 2015), (Fatoye et al., 2021).

Pre-Surgery: Building a Strong Foundation

It’s easy to think, “Why do physio now when the knee is being replaced anyway?” But strengthening and conditioning your body beforehand significantly boosts your post-surgery recovery, helping you get back on your feet faster and with greater confidence. We can address any questions or concerns you may have leading up to the surgery.

Timeline: Ideally begins 6-8 weeks prior to surgery.

Goals:

  • Strengthen muscles around the knee
  • Improve joint mobility
  • Enhance balance and proprioception
  • Educate on post-operative exercises

Key Interventions at Praxis:

  • Reformer Pilates: Our modified prehab programs integrate Pilates to build core stability and lower limb strength. It’s a safe, adaptable way to enhance neuromuscular control before surgery (Levine et al., 2009).
  • Balance Training: Proven to improve post-surgical function when combined with strength training [(Domínguez-Navarro et al., 2020)].
  • Education: We prepare you with strategies to navigate the early post-op period, including mobility aids and pain management.

  • Expert Manual Therapy: Enhances joint mobility, reduces pre-surgical stiffness, and prepares surrounding tissues for optimal post-surgery performance.

Early Post-Op Phase (0-6 weeks)

Immediately following surgery, your primary goals will be managing pain, reducing swelling, and restoring basic mobility.

Many assume recovery only begins once the surgical pain fades—but getting moving early is critical. Guided physiotherapy helps you regain mobility safely, reduce complications, and build confidence from the very start.

Expect:

  • Supervised sessions with focus on safe movement and circulation
  • Gentle range-of-motion and isometric exercises
  • Gait retraining using assistive devices

Evidence-based benefit: Early mobilisation and physiotherapy within days of surgery improve short-term outcomes (Isaac et al., 2005).

Mid to Late Post-Op Phase (6 weeks – 6 months)

At this stage, the intensity of therapy increases to target long-term function. Don’t settle for “good enough” recovery. This phase is where you rebuild your strength, stability, and full mobility—setting the stage for lasting function and confidence in your new joint.

Our Therapeutic Arsenal Includes:

  • Blood Flow Restriction (BFR) Training: Using pneumatic cuffs, we simulate high-load training effects using light resistance. Safe and effective for improving strength post-TKR (Piva et al., 2019).
  • Functional Strength & Balance Training: Tailored to your activity goals.
  • Reformer Pilates: Reactivated in this phase to support low-impact, whole-body conditioning.
  • Access to On-Site Gym Facilities: Ensures continuity and transition from rehab to independent exercise.

Patients receiving a combination of manual therapy and exercise had better functional outcomes than those receiving exercise alone (Karaborklu Argut et al., 2021), a practice we fully embrace at Praxis.

Clinical Expertise You Can Trust

Praxis Physiotherapy works in close collaboration with orthopaedic knee surgeon Dr. Kelly Macgroarty, ensuring a seamless continuum of care. However, we welcome referrals from any orthopaedic surgeon.

You’re not alone in this process. Our experienced team is with you every step of the way—offering expert care, tailored planning, and hands-on support backed by evidence and close collaboration with your surgical team

Our clinicians are highly skilled in post-TKR rehabilitation and stay up-to-date with the latest evidence-based interventions.

What Does the Research Say?

Recent studies underscore the critical value of physiotherapy before and after knee replacement surgery. Prehabilitation, including strength and balance training, has been shown to improve early recovery outcomes [(Domínguez-Navarro et al., 2020)]. Combining manual therapy with exercise yields superior functional gains compared to exercise alone [(Karaborklu Argut et al., 2021), (Abbott et al., 2013)]. Blood Flow Restriction (BFR) training and Pilates have emerged as safe, effective adjuncts to conventional rehabilitation protocols [(Levine et al., 2009), (Piva et al., 2019)]. While short-term improvements in pain and mobility are well-documented, the long-term benefits of physiotherapy interventions vary across studies, highlighting the importance of personalized care and follow-up [(Artz et al., 2015), (Fatoye et al., 2021)].

What Makes Praxis Different?

  • Prehab programs starting 6+ weeks before surgery
  • Use of advanced modalities: BFR cuffs, Reformer Pilates
  • Access to gyms within our clinics
  • Close collaboration with top orthopaedic surgeons
  • One-on-one care tailored to your surgical timeline and goals

Ready to Begin Your Journey?

Total knee replacement doesn’t have to mean months of struggle and guesswork. With the right physiotherapy strategy—starting before your surgery—you can dramatically improve your mobility, reduce pain, and return faster to the activities you love. Reach out to Praxis Physiotherapy today to schedule your pre-operative assessment or post-surgical consultation. Let us guide your recovery with confidence, care, and clinical expertise.

Until next time, Praxis What You Preach…

📍 Clinics in Teneriffe, Buranda, and Carseldine

💪 Trusted by athletes. Backed by evidence. Here for everyone.

References

  • Artz, N. et al. (2015). Effectiveness of physiotherapy exercise following total knee replacement: systematic review and meta-analysis. BMC Musculoskeletal Disorders.
  • Domínguez-Navarro, F. et al. (2020). Preoperative strengthening and balance training. Knee Surgery, Sports Traumatology, Arthroscopy.
  • Fatoye, F. et al. (2021). Clinical and cost-effectiveness of physiotherapy interventions. Archives of Orthopaedic and Trauma Surgery.
  • Karaborklu Argut, S. et al. (2021). Exercise and manual therapy vs exercise alone. PM&R.
  • Levine, B. et al. (2009). Pilates for rehabilitation after total joint arthroplasty. Clinical Orthopaedics and Related Research.
  • Piva, S. et al. (2019). Later-stage exercise vs usual care. JAMA Network Open.
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    ACL Reconstruction Rehab – Week-by-Week Recovery Guide with Praxis Physio

    ACL Reconstruction Rehab – Week-by-Week Recovery Guide with Praxis Physio

    by | May 17, 2025 | ACL, Knee, Return to Sport, Sports Injury

    Overview

    ACL reconstruction surgery marks the beginning of a structured rehabilitation journey. At Praxis Physiotherapy, located in Teneriffe, Carseldine, and Buranda, we provide an evidence-based approach to guide patients from surgery to sport. Backed by over a decade of experience with football teams across Brisbane and collaborative ties with local knee surgeons, our programs are scientifically informed and results-driven.

    Research has shown that a phased, criterion-based rehab plan reduces complication rates and improves return-to-sport outcomes (Shelbourne & Nitz, 1990). The following week-by-week overview reflects current best practice from leading ACL rehab literature.

    Week-by-Week ACL Rehab Milestones

    Prehab: Starting Strong Before Surgery

    If you’re waiting for ACL surgery and your knee has no complicating factors like meniscal locking, there’s good evidence that doing some early rehab — before going under the knife — can significantly improve your recovery trajectory. This phase, often called “prehab,” aims to reduce swelling, restore full knee extension, activate the quadriceps, and build general lower limb strength.

    Research shows that patients who enter surgery with better quadriceps strength and full range of motion recover faster and regain function more effectively post-operatively (Eitzen et al., 2010). In fact, one study in the British Journal of Sports Medicine found that even just 5 sessions of targeted prehab improved early post-op outcomes like walking speed, strength, and self-reported function (Failla et al., 2016).

    Weeks 0–2: Pain, Protection, and Range

    Early rehabilitation begins with swelling and pain management, protection of the graft, and restoration of knee extension. Controlled range-of-motion (ROM) exercises and quadriceps activation, particularly of the vastus medialis, are prioritised. Patients often use crutches to maintain safe gait patterns. Early introduction of blood flow restriction (BFR) training supports muscle maintenance without joint overload (Zazirnyi et al., 2020).

    Checkpoint: Achieve full extension and minimal swelling by Week 2.

    Weeks 2–6: Regain Motion and Begin Strength

    Once inflammation is controlled, attention shifts to regaining full ROM, normalising walking gait, and initiating basic strength exercises such as mini-squats and heel raises. Use of closed kinetic chain exercises is supported for their functional benefit and reduced joint stress (Awad et al., 2017).

    Checkpoint: Full ROM with independent walking and neuromuscular control.

    Weeks 6–12: Strength Foundation

    Patients now begin progressive resistance training using clinic gym equipment, including leg presses, Romanian deadlifts, and lunges. Core strength and dynamic control are emphasised. Light cardio via cycling or elliptical may be introduced. Pilates reformers are utilised at Praxis for controlled joint loading and core development.

    Checkpoint: Strength symmetry reaching 70% of non-injured leg; competent single-leg stance.

    Weeks 12–20: Power and Plyometric Preparation

    This phase involves development of reactive strength and neuromuscular readiness. Jump landing, eccentric hamstring training, and lateral movement patterns are introduced. Key focus is on building capacity for eventual cutting and pivoting movements.

    Checkpoint: Successful hop tests, 80% limb symmetry, and controlled change-of-direction drills.

    Weeks 20–36: Agility and Functional Sport Movements

    Higher-level drills simulate sport-specific movements. Patients perform acceleration/deceleration tasks, direction changes, and reactive decision-making. Plyometrics are progressed in intensity and volume. According to Damian & Damian (2018), phase-specific drills improve psychological readiness and functional return to play (Damian & Damian, 2018).

    Checkpoint: Limb symmetry >90% in strength and hop metrics.

    Months 9–12: Return-to-Sport Preparation

    This stage addresses psychological readiness and simulates sport-specific loading. Functional and fatigue testing are conducted, often including contact drills. Clearance depends on achieving objective strength and control measures (Shelbourne & Patel, 1996).

    Checkpoint: Refer for return-to-sport testing (detailed in a separate blog).

    Practical Insights for Patients

    ACL rehab can be a long and often isolating journey. Many patients report psychological challenges, especially during the early and middle stages when progress may feel slow. At Praxis, we recognise that motivation is a vital part of recovery. Our goal isn’t just to return you to pre-injury levels — it’s to help you become a more resilient, stronger athlete than before. Many ACL injuries stem from non-contact mechanisms linked to strength, control, and movement quality. By targeting these factors throughout rehab, we aim to reduce reinjury risk and elevate athletic performance in the long term.

    ACL rehabilitation is about restoring whole-body function, not just healing a ligament. At Praxis Physiotherapy, we use a combination of BFR, Pilates reformers, and in-house rehab gyms to deliver tailored and progressive programs. Our partnerships with Brisbane’s knee specialists ensure timely updates and coordinated care transitions.

    Why Brisbane Athletes Choose Praxis Physiotherapy

    • Proven protocols developed with elite Brisbane football teams
    • Direct lines of communication with top knee surgeons
    • BFR and Pilates integrated into post-op care
    • Ongoing strength and functional assessments across all phases

    Conclusion

    A structured, evidence-backed approach to ACL rehab dramatically improves recovery outcomes. At Praxis Physiotherapy, we offer a seamless, week-by-week program from day one post-op through to full sport readiness. Our comprehensive model ensures that Brisbane athletes receive the highest standard of care at every stage. If you’re ready to get your rehab underway, book with us! 

    Until next time – Praxis What You Preach

    📍 Clinics in Teneriffe, Buranda, and Carseldine

    💪 Trusted by athletes. Backed by evidence. Here for everyone.

    References

    1. Shelbourne, K.D., & Nitz, P. (1990). Accelerated rehabilitation after anterior cruciate ligament reconstruction. Am J Sports Med.
    2. Zazirnyi, I.M., et al. (2020). Our Point of View at Rehabilitation After ACL Reconstruction. Feofaniya Hospital.
    3. Damian, C. & Damian, M. (2018). Futsal Player Rehabilitation after ACL Reconstruction. Revista Românească.
    4. Awad, O.B. et al. (2017). A Systematic Review of ACL Reconstruction Rehabilitation. Egyptian Journal of Hospital Medicine.
    5. Shelbourne, K.D., & Patel, D.V. (1996). Rehabilitation after autogenous bone-patellar tendon-bone ACL reconstruction. JBJS Am.

    From Pitch to Pressing: Leading the Way in Shoulder Pain Recovery

    From Pitch to Pressing: Leading the Way in Shoulder Pain Recovery

    by | May 10, 2025 | Return to Sport, Shoulder, Sport, Sports Injury

    Understanding Rotator Cuff Pain in Active Populations

    Shoulder pain, particularly rotator cuff (RC) injuries, is one of the most common complaints among athletes and active individuals. The rotator cuff, comprising the supraspinatus, infraspinatus, teres minor, and subscapularis, stabilises the shoulder and enables dynamic overhead movement. Athletes in cricket, tennis, AFL, and CrossFit are especially prone to strain this system through repetitive, high-load movements (Desmeules et al., 2025).

    At Praxis Physiotherapy, we specialise in managing rotator cuff injuries with precision. Our expertise spans throwing athletes, tennis players at our Coops Club location, contact sports like AFL, and recreational CrossFit athletes — ensuring tailored care across sporting domains.

    Tailored Treatment Backed by Clinical Evidence

    Current guidelines recommend avoiding over-reliance on imaging and emphasize active rehabilitation. Many rotator cuff cases can be effectively managed without surgery, using structured, progressive rehab programs including resistance training, neuromuscular re-education, and load management (Desmeules et al., 2025).

    Key strategies include:

    • Individualised education about the condition and recovery timeline
    • Isometric and isotonic strengthening of shoulder stabilizers
    • Use of validated outcome tools (e.g., handheld dynamometry, ROM apps) to track progress
    • Selective adjuncts, such as manual therapy or taping, when needed for short-term symptom relief

    In persistent or complex cases, our close collaboration with shoulder and knee surgeon Dr. Kelly Macgroarty ensures a seamless escalation pathway and expert review.

    man throwing yellow, blue, and red Mikasa ballThe Athletic Shoulder: Why Sport-Specific Rehab Matters

    The demands placed on a shoulder in throwing or overhead sports are extreme. During a cricket bowl or tennis serve, angular velocities can reach 7000–7500°/s, and forces on the shoulder joint can exceed bodyweight (Wilk et al., 2009). These actions demand both mobility and stability—a balance referred to as the “thrower’s paradox.”

    Our assessments go beyond the shoulder joint, considering the entire kinetic chain — from trunk control to hip mobility — to ensure optimal movement integration and minimize overload (Cools et al., 2021).

    The Evidence on Rehabilitation & Prognosis

    Recent guidelines emphasize exercise-based rehab as the most effective first-line intervention. Strength gains and symptom reduction are typically seen within 12 weeks if appropriately dosed (Desmeules et al., 2025). Furthermore, the longer pain persists, the lower the likelihood of full recovery from physiotherapy alone (Chester et al., 2013).

    In terms of injury prevention, shoulder-focused warm-up programs — such as FIFA 11+, the Oslo Shoulder Program, and sport-specific throwing drills — have shown a moderate to large effect size in reducing injury risk (Liaghat et al., 2023).

    Return to Sport: Measured, Not Rushed

    Our return-to-sport protocols are designed to ensure both readiness and resilience. We use objective criteria:

    • Strength benchmarks (e.g. ER/IR ratio)
    • Symmetry comparisons
    • Fatigue tolerance testing
    • Sport-specific drills and reactive control

    Whether you’re pressing overhead in a CrossFit WOD, tackling in AFL, or ramping up bowling loads in cricket, our protocols ensure a safe and confident return.

    Prevention: Not an Afterthought

    Our clinic philosophy incorporates injury prevention from the first session (PREVENT | PREPARE | PERFORM). For athletes at our Coops tennis facility, we screen for scapular dyskinesis and GIRD (glenohumeral internal rotation deficit). For CrossFitters, we optimise loading strategies and lifting technique.

    Prevention is an ongoing cycle: screen, intervene, reassess. It’s not just about avoiding injury—it’s about building capacity and sustaining high performance (Cools et al., 2021).

    Conclusion

    Rotator cuff pain doesn’t have to be a long-term setback. With expert diagnosis, individualised rehab, and a sport-specific return plan, most athletes recover without surgery. At Praxis, we combine cutting-edge evidence with clinical experience — and our collaboration with orthopaedic surgeon’s and sports medicine practitioners means you’re in expert hands every step of the way. For more on throwing specifically, check out our blog where we put the Praxis team to the test!

    Ready to take control of your shoulder pain? Book an appointment today and let our team guide you back to strength, confidence, and performance.

    📍 Clinics in Teneriffe, Buranda, and Carseldine

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    References

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