Ankle sprains are among the most common injuries we see at Praxis Physiotherapy. Whether you’re an AFL midfielder, a cricket fast bowler, or a weekend runner pounding the Brisbane River loop, lateral ankle sprains can derail performance and linger longer than they should.
At Praxis, we’ve rehabilitated hundreds of athletes across all levels, from juniors to pros. Our experience includes long-term roles with the Aspley Hornets AFL Club (since 2014), the Queensland Bulls, Australia A, and even the Australian Men’s Cricket Team. We bring these elite rehab principles to everyone — from sprained-ankle soccer kids to high-performance track athletes.
But despite how common they are, ankle sprains are often underestimated. Without proper rehab, they can lead to chronic ankle instability (CAI), impaired athletic performance, and even new injuries in other parts of the body.
What Actually Happens in an Ankle Sprain?
A lateral ankle sprain usually occurs when the foot rolls inward, stretching or tearing the ligaments on the outside of the ankle — most commonly the anterior talofibular ligament (ATFL). It often happens during sudden changes of direction, awkward landings, or stepping on uneven ground.
You might feel a pop or crunch, followed by swelling, bruising, and pain when walking or bearing weight. While it may seem like a “simple sprain,” it’s anything but — around 40% of people report long-term issues one year post-injury if not managed well.
Common Mistake: Rest, Ice, and… That’s It?
Too many people still follow the old R.I.C.E. (rest, ice, compression, elevation) model and assume the job is done. While these strategies can help in the first 48 hours, they’re far from sufficient for full recovery.
In fact, research has shown that inadequate rehab is a major contributor to chronic ankle instability — a condition marked by recurrent sprains, feelings of the ankle “giving way,” and reduced confidence in movement.
CAI can lead to altered biomechanics and poor neuromuscular control, increasing the risk of knee injuries, Achilles tendinopathy, or even hip and low back pain due to compensation.
Proper Rehabilitation Is Key — Here’s What the Evidence Says
Rehabilitation needs to start early and be progressive. High-quality clinical guidelines and systematic reviews strongly support the following strategies:
Functional Support and Early Mobilisation
Functional bracing (like an ankle brace or taping) is preferred over rigid immobilisation and should be used for 4–6 weeks . Early weight-bearing as tolerated leads to quicker return to activity and better outcomes .
Exercise Therapy
Neuromuscular training (balance, proprioception, and strength work) is the foundation of successful rehab. It improves ankle control, prevents recurrence, and reduces the risk of CAI. A wobble board, single-leg balance, hopping drills, and directional change exercises are all commonly used.
Manual Therapy
Joint mobilisations and soft tissue work may improve dorsiflexion range, decrease pain, and aid in functional recovery. At Praxis, we combine manual therapy with functional retraining to fast-track performance readiness.
Individualised Return-to-Sport Testing
Return to sport shouldn’t be based on time alone. We use objective testing — including single-leg hop symmetry, balance tests, and strength assessments — to ensure you’re not returning with deficits that could increase your reinjury risk.
The Cost of Incomplete Rehab: What Happens If You Don’t Get It Right?
A rushed or poorly structured rehab may get you back to activity temporarily — but it opens the door to:
Chronic Ankle Instability (CAI): Repeated sprains, perceived instability, and loss of ankle confidence.
Performance Limitations: Reduced agility, speed, and power due to poor proprioception and strength deficits.
New Injuries: Compensatory patterns can lead to medial tibial stress syndrome (shin splints), Achilles overload, or even ACL risk due to poor landing mechanics.
In elite sport, we see this cascade far too often. That’s why our rehab at Praxis isn’t just about the ankle — it’s about restoring whole-limb function and confidence under pressure.
Prevention: Keep Your Ankles Bulletproof
At Praxis Physiotherapy, we don’t just treat ankle sprains — we help prevent them. Our prevention approach includes:
Regular Balance and Plyometric Training: Incorporating single-leg exercises into gym and field work.
Proprioceptive Work: Using wobble boards, balance mats, and directional hopping.
Footwear and Bracing Advice: Particularly for high-risk sports like netball, football, and athletics.
Pre-season Screening and Performance Testing: For our affiliated sports clubs and athletic populations.
Evidence supports proprioceptive training as a proven strategy to reduce ankle sprain incidence by up to 35% in high-risk athletes.
Why Choose Praxis Physiotherapy?
Our exposure to elite sport has taught us what good rehab looks like — and we apply those same high standards to every patient. Our clinics are equipped with strength testing tools, reformer Pilates, and full gym access, giving you the tools to rebuild better.
We understand the mindset of athletes — from juniors chasing state squads to elite-level players returning from surgery. That’s why we tailor your program based on sport demands, movement patterns, and individual goals.
Whether you rolled your ankle playing touch footy or twisted it at work, we’re here to get you back — stronger, faster, and more confident than before.
Need Help with an Ankle Sprain?
If you’ve recently rolled your ankle or are dealing with ongoing instability, book a consultation at Praxis Physiotherapy. Let our team guide you through a structured rehab program grounded in sports science and elite clinical standards.
📍 Clinics in Teneriffe, Buranda, and Carseldine 💪 Trusted by athletes. Backed by evidence. Here for every body.
References
Ruiz-Sánchez et al. (2022). Management and treatment of ankle sprain according to clinical practice guidelines: A PRISMA systematic review. Medicine (Baltimore), 101(42)
Green et al. (2019). What is the quality of clinical practice guidelines for the treatment of acute lateral ankle ligament sprains in adults? BMC Musculoskeletal Disorders, 20(394)
Doherty et al. (2017). Treatment and prevention of acute and recurrent ankle sprain: an overview of systematic reviews with meta-analysis. BJSM, 51(2), 113–125.
We all crave the occasional indulgence. A mindless distraction or a little treat to reward our hard work…
Some people see massage as an indulgence, but the good news is that unlike many of the indulgences we crave, massage has several reported health benefits. Moreover, as health and wellness interventions go, massage appears to be a great deal! But as always, we delve a little deeper to what the evidence shows.
Massage has always, and remains to be, a popular treatment choice for athletes, coaches, and sports physical therapists. However, with several purported benefits delivered through numerous psychophysiological mechanisms, the evidence with regard to the effects massage is limited and equivocal (Arroyo-Morales et al 2011).
The practice of massage therapy involves kneading or manipulating a person’s muscles and other soft-tissue. It is a form of manual therapy that includes holding, moving, and applying pressure to the muscles, tendons, ligaments and fascia. The premise of how the mechanical pressure from the therapist during a massage can affect the patient is summarised into four proposed mechanisms (Weerapong et al 2005):
Biomechanical
The mechanical pressure may Increase muscle compliance resulting in increased range of joint motion, decreased passive stiffness and decreased active stiffness (Hopper et al 2004). Mechanical pressure also can increase blood flow by increasing the arteriolar pressure, as well as resulting in a higher muscle temperature from the effects of the rubbing.
Hoffman Reflex – how affecting the skin can affect the muscle via neural excitability
Neurological
Depending on the massage technique, mechanical pressure on the muscle is expected to increase or decrease neural excitability as measured by the Hoffman reflex. A study looking at massage on the calf (Morelli et al 1990) suggested the use of massage as an alternative to other therapeutic modalities such as passive muscle stretching and tendon pressure to decrease spinal motoneuron excitability (i.e increase muscle relaxation).
Physiological
Changes in parasympathetic activity (as measured by heart rate, blood pressure and heart rate variability) and hormonal levels (as measured by cortisol levels) following massage result in a relaxation response.
Psychological
A reduction in anxiety and an improvement in mood state also cause relaxation, and has been shown prior to sports to help lower performance anxiety.
Ultimately, what the above proposed mechanisms translate into a series of studied benefits on specific conditions. According to the Massage and Myotherapy Australia website, massage has also been shown to help:
Back pain
Arthritis
Insomnia
Headaches
Depression and anxiety
Constipation
High blood pressure
Chronic pain
All in all, massage provides good bang for buck when used in the appropriate setting. Our mantra at Praxis is Prevent Prepare Perform and as physiotherapists, we work in tandem with our qualified massage therapists to deliver the best results for a wide variety of conditions. Whilst, physiotherapy is focussed on the diagnosis and treatment of acute or chronic injuries, remedial massage enables a little more hands on time to truly address issues that our physiotherapists may have identified in their sessions. Further, massages offers a great medium for regular ‘tune-ups’ when the rigours of training and working take their toll.
We ensure that your massage experience is not only blissful, but productive for your rehabilitation as well. So if you have been swayed by the evidence, or just looking for that little reward, we are here to help!
Hopper D, Deacon S, Das S, et al. Dynamic soft tissue mobilization increases hamstring flexibility in healthy male subjects. Br J Sports Med. 2004;39:594–598
Weerapong, P., Hume, P.A. & Kolt, G.S. The mechanisms of massage and effects on performance, muscle recovery and injury prevention. Sports Med 2005; 35: 235
Morelli M, Seaborne DE, Sullivan SJ. Changes in h-reflex amplitude during massage of triceps surae in healthy subjects.J Orthop Sports Phys Ther. 1990;12(2):55-9.
Arroyo-Morales M1, Fernández-Lao C, Ariza-García A, Toro-Velasco C, Winters M, Díaz-Rodríguez L, Cantarero-Villanueva I, Huijbregts P, Fernández-De-las-Peñas C. Psychophysiological effects of preperformance massage before isokinetic exercise. J Strength Cond Res. 2011 Feb;25(2):481-8.
Osgood-Schlatter disease (OSD) (or tibial tuberosity traction apophysitis) is a common condition that affects the knee, primarily in adolescents and young athletes. OSD is more frequently experienced in males 12-15 years old who are involved in activities that require frequent running, jumping, kicking and decelerating, like football (Bezuglov et al 2022). The condition manifests as pain, swelling, and tenderness just below the knee, where the patellar tendon attaches to the tibial tuberosity. Discomfort and potential disruption of daily activities and sports participation is often the result.
A prerequisite for this condition is high loading. The repetitive stress placed on this area during physical activities leads to microtrauma and inflammation, causing symptoms. While the condition is generally self-limiting and tends to resolve as the affected individual completes the growth spurt, physiotherapy plays a pivotal role in effectively managing symptoms, promoting healing, and aiding in a smooth return to physical activities. Various conservative approaches have been studied and recommended in the scientific literature to manage symptoms and aid in the healing process. Interestingly, the condition is strongly associated with Sever’s disease, another growth and loading related injury associated with active young people (Schultz et al 2022). Read on for a general overview of the treatment options supported by scientific research.
Rest and Activity Modification
Rest is often a key component of initial treatment. Reducing or modifying activities that aggravate symptoms, such as avoiding high-impact sports or exercises, can help alleviate strain on the affected area and promote healing. According to a study published in the “Journal of Pediatric Orthopaedics,” activity modification was found to be an effective strategy in managing Osgood-Schlatter Disease, with a significant reduction in pain reported by participants who adhered to activity restrictions.
Physical Therapy and Stretching Exercises
Physical therapy plays a vital role in managing Osgood-Schlatter Disease. A study published in the “Journal of Orthopaedic & Sports Physical Therapy” emphasized the importance of a structured physical therapy program involving stretching exercises for the quadriceps, hamstrings, and calf muscles. These exercises aim to improve muscle flexibility, reduce tension around the knee, and address any muscle imbalances that might contribute to the condition.
Strengthening Exercises
Strengthening exercises focused on the quadriceps and surrounding muscles can help improve biomechanics and stabilize the knee joint. Research published in the American Journal of Sports Medicine highlighted the positive effects of a quadriceps-strengthening program in reducing pain and improving function in individuals with Osgood-Schlatter Disease.
Ice Therapy
Cold therapy, such as applying ice to the affected area, can help reduce inflammation and provide pain relief. A study published in the “Journal of Orthopaedic & Sports Physical Therapy” suggested that ice therapy can be beneficial when used in combination with other conservative treatments.
Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)
NSAIDs, such as ibuprofen, are commonly used to manage pain and inflammation associated with Osgood-Schlatter Disease. However, their use should be supervised by a healthcare professional such as your GP or pharmacist, and long-term or excessive use should be avoided.
Bracing and Taping
Some studies have explored the use of knee braces or taping techniques to offload the patellar tendon and reduce strain on the tibial tuberosity. While research on this aspect is limited, these approaches might offer temporary relief during activities. This can be trial and error as to which technique works best however compression over the tibial tuberosity seems to be the most common strategy.
Education and Activity Guidance
Educating patients and their parents about the condition, its natural history, and appropriate activity modification is crucial. A study in the “Journal of Pediatric Orthopaedics” emphasized the significance of patient education in improving adherence to treatment recommendations and facilitating symptom management.
It’s important to note that each individual’s response to treatment can vary, and a tailored approach is often necessary. In cases where conservative treatments do not provide sufficient relief, and severe pain or functional limitations persist, consultation with a Sports Physician or Orthopaedic surgeon may be warranted. Surgical intervention is rarely indicated and is typically considered only when symptoms are severe, long-lasting, and significantly affecting an individual’s quality of life.
In summary, Osgood-Schlatter Disease can pose significant challenges for adolescents and young athletes, affecting their quality of life and participation in sports. While the condition typically resolves with time and growth plate maturation, the discomfort and limitations it presents can be effectively managed and alleviated with the help of physiotherapy. If you or someone you know is dealing with this condition, get help from our friendly and qualified Praxis physios to individualise an appropriate rehabilitation plan.
Until next time, PREVENT PREPARE PERFORM
Team Praxis
References:
Bezuglov, E., Pirmakhanov, B., Ussatayeva, G., Emanov, A., Valova, Y., Kletsovskiy, A., … & Morgans, R. (2022). The mid-term effect of Osgood-Schlatter disease on knee function in young players from elite soccer academies. ThePhysicianandSportsmedicine, 1-6.
Ciatawi, K., & Dusak, I. W. S. (2022). Osgood-Schlatter disease: A review of current diagnosis and management. CurrentOrthopaedicPractice, 33(3), 294-298.
Schultz, M., Tol, J. L., Veltman, L., & Reurink, G. (2022). Osgood-Schlatter Disease in youth elite football: Minimal time-loss and no association with clinical and ultrasonographic factors. PhysicalTherapyinSport, 55, 98-
Today on the Praxis What We Preach blog, where we shed light on Achilles tendinopathy, a common condition affecting athletes and active individuals. In this article, we will explore the causes, symptoms, and effective treatment strategies for managing Achilles tendinopathy, empowering suffers to return to the things. I draw from personal experience from someone who has had Achilles pain limit my running!
Achilles tendinopathy refers to the degeneration or overload of the Achilles tendon, the band of tissue connecting the calf muscles to the heel bone (calcaneus). This condition primarily affects people engaged in activities involving repetitive jumping, running, or sudden increases in training intensity. Patients with Achilles tendinopathy often experience pain, stiffness, and swelling in the achilles, which can gradually worsen over time. Stiffness and pain is most commonly experienced first thing in the morning, after a long period of sitting or when the achilles has been compressed. Pain can occur in the “mid portion” (pictured below) on in the insertion (as it attaches to the heel bone). This is in an important distinction as these are rehabilitated differently!
Causes and Risks
Achilles tendinopathy typically results from a combination of intrinsic and extrinsic factors. Intrinsic factors include age, reduced flexibility, reduced calf strength / endurance and poor lower limb biomechanics. Extrinsic factors encompass inappropriate footwear, training errors (such as a spike or change in workload), and inadequate warm-up or cool-down routines. Additionally, individuals with systemic conditions like diabetes or rheumatoid arthritis may be more prone to developing Achilles tendinopathy. Understanding these factors is crucial for tailoring treatment plans to address the root causes and minimize the risk of recurrence. But in the most reductionist of terms, Achilles tendinopathy develops due in large part due to a mismatch between loading and the capacity of the tissue.
Diagnosis and Assessment
Accurate diagnosis of Achilles tendinopathy relies on a thorough clinical examination and patient history. Physiotherapists employ various assessment techniques, such as palpation, functional tests, and imaging modalities like ultrasound or MRI, to evaluate the severity and extent of the condition. A self administered questionnaire (VISA-A) can help evaluate symptoms and their effect on physical activity and in turn, the clinical severity. This comprehensive assessment helps determine the appropriate treatment approach, including targeted exercise programs, manual therapy, and other interventions.
Treatment Strategies
Physiotherapy plays a pivotal role in the management of Achilles tendinopathy. Treatment strategies focus on reducing pain, promoting healing, and improving function. These will include calf strengthening exercises, stretching routines and activity modification as frontline options. Moreover, physiotherapists can guide patients in proper footwear selection, gait retraining, and implementing preventive measures to minimize the risk of reinjury.
Rehabilitation and Prevention
Rehabilitation programs are essential for individuals recovering from Achilles tendinopathy. Gradual progression of exercise intensity, functional training, and sport-specific drills enable patients to regain strength, flexibility, and proprioception while minimizing the risk of relapse. Educating patients on proper warm-up and cool-down routines, appropriate footwear selection, and regular monitoring of training loads can significantly contribute to preventing Achilles tendinopathy in the future. One of the common errors patients make is making rehabilitation too easy, or returning to sport too quickly. Again, physiotherapy play a pivotal role in ensuring you undertake a graduated return to loading as the application of mechanical stress to the Achilles tendon promotes tendon healing and remodeling.
Conclusion
Achilles tendinopathy requires a comprehensive approach for effective management. As physiotherapists, our knowledge and expertise are invaluable in helping you overcome this condition and return to their active lifestyles. To discuss your Achilles issues with us to get you back to what you love doing, book online with Praxis today.
Patellofemoral Pain Syndrome (PFPS) is a common condition that affects the knee joint, particularly the area where the kneecap (patella) meets the thigh bone (femur). It is a prevalent issue among athletes, active individuals, and people with certain anatomical factors. In this Praxis What You Preach article, we will explore PFPS, its causes, symptoms, and available treatment options, shedding light on how physiotherapy can effectively manage and alleviate this condition.
What is PFPS?
Patellofemoral Pain Syndrome, also known as runner’s knee or anterior knee pain, occurs when the patella fails to glide smoothly over the femoral groove during knee movement. This causes irritation and inflammation in the patellofemoral joint, specifically the underlying bone, leading to pain, discomfort, loss of function and even swelling. PFPS can be triggered by multiple factors, such as overuse, muscle imbalances, poor biomechanics, weak hip and thigh muscles, improper footwear, and previous knee injuries. Essentially though it is the kneecap joints’ in ability to tolerate the load of the activities being undertaken.
Symptoms and Diagnosis
Common symptoms of PFPS include pain around or behind the patella, especially during activities that involve knee squatting, lunging, bending, climbing / descending stairs, or sitting for extended periods with knees bent (commonly called movie goers knee). These typically can occur when workloads have increased with activities such as running, cycling or weightlifting. Patients may also experience swelling, grinding or even stabbing sensations, and occasionally a feeling of knee instability. A physiotherapist will perform a comprehensive evaluation, considering the patient’s medical history, conducting a physical examination, and possibly using imaging tests, to accurately diagnose PFPS and rule out other potential causes of knee pain.
Treatment and Management
Physiotherapy plays a crucial role in managing and treating PFPS. The primary goal of physiotherapy is to exclude differential diagnoses, alleviate pain, improve knee function, manage aggravating workloads and prevent the recurrence of symptoms. Treatment plans are tailored after a comprehensive history taking and examination to the individual’s specific needs and should include the following components:
Pain Management: Initially, pain and inflammation may be managed through ice therapy, massage, stretching and non-steroidal anti-inflammatory drugs (NSAIDs).
Strengthening Exercises: Targeted exercises aim to strengthen the hip, thigh, and trunk muscles, which can help correct muscle imbalances and improve knee alignment and load tolerance.
Stretching and Flexibility: Stretching exercises can help improve flexibility in the muscles surrounding the knee joint, reducing strain on the patellofemoral joint.
Biomechanical Analysis: A physiotherapist may evaluate the patient’s movement patterns during functional activities such as jumping and running to identify any obvious faulty mechanics that contribute to PFPS. Corrective techniques, gait retraining may be employed.
Activity Modification and Rehabilitation: A gradual return to activities while maintaining a balance between rest and exercise is important to ensure proper healing and prevent re-injury.
Taping: taping has been shown to acutely help reduce symptoms by aiding in the improvement of kneecap tracking through the femoral trochlea (groove where the kneecap runs)
Prevention Strategies
To prevent the onset or recurrence of PFPS, individuals can incorporate the following strategies:
Regular strength and conditioning exercises to maintain muscle balance and strength of the lower limbs and trunk musculature.
Proper warm-up and cool-down routines before and after physical activities.
Gradual progression of activity levels and intensities to avoid overuse injuries.
Being aware of the early signs and symptoms and addressing them promptly.
Is my knee pain osteoarthritis?
In short, No. Patellofemoral Pain Syndrome (PFPS) is not the same as Patellofemoral Joint (PFJ) Osteoarthritis (OA). While both conditions involve the patellofemoral joint, they are distinct entities with different causes and characteristics. As mentioned, PFPS primarily involves pain and dysfunction in the patellofemoral joint, often caused by factors such as overuse, muscle imbalances, or poor biomechanics. It is commonly seen in younger athletes and active individuals. PFPS is characterized by pain around or behind the patella, especially during activities that involve knee bending or loading such as running.
On the other hand, PFJ OA refers to the degeneration and wearing down of the cartilage within the patellofemoral joint. This condition typically occurs in older individuals and is more common in those with a history of knee injuries or conditions such as patellar instability. The primary symptom of patellofemoral joint osteoarthritis is joint pain, stiffness, and swelling, which worsen over time. This pain can be at rest.
While both conditions can cause knee pain and affect the patellofemoral joint, the underlying mechanisms and treatment approaches differ. Physiotherapy plays a crucial role in managing both conditions, but the specific treatment plans and exercises may vary based on the individual’s diagnosis, symptoms, and physical examination findings.
In summary, Patellofemoral Pain Syndrome is a common knee condition that can significantly impact an individual’s daily activities. With a comprehensive physiotherapy approach involving pain management, strengthening exercises, and biomechanical analysis, PFPS can be effectively managed and treated, allowing individuals to regain pain-free movement and engage in their desired activities. If your knee cap pain prevents you from doing the things you want to do, book in with of our expert Praxis team members to discuss getting you back to function!
