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Strong Bones, Strong Runner: Understanding and Treating Stress Fractures

Strong Bones, Strong Runner: Understanding and Treating Stress Fractures

by | May 8, 2025 | Return to Sport, Running Injuries, Sports Injury

Understanding Stress Fractures in Runners: Risk, Recovery, and Prevention

Stress fractures are a frustrating reality for many runners. Characterised by small cracks or severe bone reactions due to repetitive load, these injuries can derail training for weeks or months, and in some cases, end seasons or careers. While they are most commonly associated with endurance sports like distance running, the underlying mechanisms are multifactorial and complex. This blog explores the current understanding of stress fractures in runners — including emerging research, rehabilitation strategies, and how to lower your injury risk.

What Is a Stress Fracture?

A stress fracture is a type of bone stress injury (BSI), an overuse injury caused by the accumulation of microdamage in bone tissue due to repeated loading. Unlike acute fractures that result from a single traumatic event, stress fractures occur when repetitive sub-threshold forces — like running — outpace the bone’s capacity to repair itself (Hoenig et al., 2022).

Bone is a dynamic tissue that remodels in response to stress. However, when this remodeling process cannot keep up with microdamage accumulation — due to either an increase in training load or inadequate recovery — bone strength deteriorates. This can progress from a stress reaction to a stress fracture and, if untreated, to a complete fracture (Bergman & Kaiser, 2025; Coslick et al., 2024).

Why Are Runners So Prone?

Running, by nature, imposes repeated high loads on the lower limbs. The tibia (shin bone), metatarsals, femur, and pelvis are frequent stress fracture sites in runners (Hadjispyrou et al., 2023). Several factors contribute to the elevated risk in this group:

  • Training Errors: Rapid increases in volume or intensity, excessive hill work, or high mileage without adequate rest periods.

  • Bone Geometry: Martin & Heiderscheit (2023) found associations between proximal femur geometry and increased stress fracture risk, suggesting that individual anatomical differences can affect how load is distributed through the skeleton.

  • Energy Deficiency: Low energy availability, often associated with disordered eating or high training demands, can impair bone remodeling and increase injury risk — particularly in female athletes.

  • Surface and Footwear: Hard surfaces, old or inappropriate shoes, and poor running biomechanics can all contribute to abnormal load distribution and localized bone stress.

High-Risk vs Low-Risk Locations

Not all stress fractures are created equal. According to Coslick et al. (2024), stress fractures are categorized based on location and associated risk of complications:

  • Low-risk sites (e.g., posterior tibia, fibula, second metatarsal shaft) typically heal well with conservative treatment.

  • High-risk sites (e.g., anterior tibia, navicular, femoral neck, and sacrum) are more likely to progress to non-union or full fracture and may require surgical management.

A nuanced understanding of the fracture location helps guide both treatment duration and rehabilitation intensity.

The Cumulative Risk Concept

Traditional models have viewed stress fractures as the result of isolated risk factors. However, Hamstra-Wright et al. (2021) propose a more integrated concept: the cumulative risk profile. This model acknowledges that risk factors — like energy deficiency, training load spikes, biomechanics, menstrual history, and previous BSIs — rarely occur in isolation.

In this framework, stress fractures occur when the athlete’s “load capacity” is exceeded by their “training load.” What’s striking is that two runners could follow the same training program but respond very differently based on their individual capacity, bone density, and recovery habits.

Clinically, this means runners must be assessed holistically. It also underscores the importance of individualized training plans, particularly during return-to-run phases.

Diagnosis and Imaging

Early symptoms of a stress fracture include localized pain that worsens with activity and settles with rest. As the injury progresses, pain can persist with walking or even at rest.

Unfortunately, standard X-rays often miss early bone stress injuries. MRI is the gold standard, able to detect bone marrow edema (early stress reaction) before a fracture line develops (Coslick et al., 2024; Bergman & Kaiser, 2025). Bone scans and CT can also be used in specific cases.

Rehabilitation and Return to Running

The cornerstone of stress fracture management is load reduction — typically involving rest from impact activities for 4–8 weeks depending on the site and severity. During this time, runners can usually continue cross-training (e.g., cycling, swimming) to maintain cardiovascular fitness.

A gradual return-to-run program should be guided by symptom response, starting with walk–run intervals and progressing to continuous running. Strength and conditioning plays a vital role in both rehabilitation and prevention — building muscular resilience to offload bony structures. Calf, hip, and core-focused strength work can significantly reduce recurrence risk and should form part of a comprehensive return-to-run strategy. (You can learn more about how we use strength and conditioning at Praxis Physiotherapy to support our runners here)

Coslick et al. (2024) emphasises the value of a multidisciplinary approach involving physiotherapists, sports physicians, dietitians, and coaches.

Preventing Stress Fractures: What Runners Can Do

While not all BSIs are preventable, runners can reduce their risk by addressing modifiable factors:

  • Progress training gradually: Avoid spikes in weekly mileage (>10% per week) and ensure at least one rest day.

  • Fuel adequately: Runners with low energy availability are at significantly increased risk, particularly females with menstrual disturbances.

  • Build strength: Muscle fatigue reduces shock absorption. Strengthening the calves, glutes, and trunk can reduce bone loading.

  • Check your shoes and form: Replace runners every 500–800 km and consider a running gait assessment, especially if you have a history of injury.

  • Listen to your body: Early symptoms like persistent aching, pinpoint bony pain, or pain that lingers after a run shouldn’t be ignored.

Emerging Insights: Bone Shape and Load Distribution

Martin & Heiderscheit’s (2023) biomechanical analysis highlights the role of pelvis and femoral geometry in modulating stress distribution through the lower limb. This helps explain why some runners — even those with ideal training habits — may still suffer stress fractures. Their work supports the growing trend of using 3D imaging and gait analysis in injury risk profiling.

The Bottom Line

Stress fractures in runners are complex, multifactorial injuries that require a careful balance of training load, nutrition, and recovery. While new imaging and biomechanics research has enhanced our ability to diagnose and understand them, the best approach remains holistic — considering both the runner’s physiology and their environment.

pair of blue-and-white Adidas running shoes

At Praxis Physiotherapy, we manage bone stress injuries in athletes of all levels. Whether you’re dealing with your first tibial stress reaction or a sacral stress fracture during marathon prep, we can help guide your recovery and reduce your future risk.

If you’re interested in how stress fractures affect other athletes — like fast bowlers in cricket — read our blog on lumbar spine stress fractures here.

Until next time, Praxis what you Preach

📍 Clinics in Teneriffe, Buranda, and Carseldine

💪 Trusted by athletes. Backed by evidence. Here for every body. 

References

Bergman, R., & Kaiser, K. (2025). Stress Reaction and Fractures. In StatPearls. StatPearls Publishing. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK507835/

Coslick, A. M., Lestersmith, D., Chiang, C. C., Scura, D., Wilckens, J. H., & Emam, M. (2024). Lower extremity bone stress injuries in athletes: An update on current guidelines. Current Physical Medicine and Rehabilitation Reports, 12(1), 39–49. https://doi.org/10.1007/s40141-023-00456-6

Hamstra-Wright, K. L., Huxel Bliven, K. C., & Napier, C. (2021). Training load capacity, cumulative risk, and bone stress injuries: A narrative review of a holistic approach. Frontiers in Sports and Active Living, 3, 665683. https://doi.org/10.3389/fspor.2021.665683

Hadjispyrou, S., Hadjimichael, A. C., Kaspiris, A., Leptos, P., & Georgoulis, J. D. (2023). Treatment and rehabilitation approaches for stress fractures in long-distance runners: A literature review. Cureus, 15(11), e49397. https://doi.org/10.7759/cureus.49397

Hoenig, T., Ackerman, K. E., Beck, B. R., Bouxsein, M. L., Burr, D. B., Hollander, K., Popp, K. L., Rolvien, T., Tenforde, A. S., & Warden, S. J. (2022). Bone stress injuries. Nature Reviews Disease Primers, 8, 26. https://doi.org/10.1038/s41572-022-00352-y

Martin, J. A., & Heiderscheit, B. C. (2023). A hierarchical clustering approach for examining the relationship between pelvis–proximal femur geometry and bone stress injury in runners. Journal of Biomechanics, 160, 111782. https://doi.org/10.1016/j.jbiomech.2023.111782

Pain in the Neck: Why Your Neck Hurts and What To Do About It

Pain in the Neck: Why Your Neck Hurts and What To Do About It

by | May 1, 2025 | Massage, Neck, Pain

Neck pain is one of the most common reasons people seek physiotherapy – and for good reason. Whether it creeps in during long days at the desk, flares after a tough workout, or simply starts for no apparent reason, it can become an ongoing source of discomfort and limitation.

At Praxis Physiotherapy, we see patients every week with neck pain ranging from occasional stiffness to chronic, persistent aches. The good news? Physiotherapy – particularly manual therapy and targeted exercise – can make a real difference.

So, What Causes Neck Pain?

Most neck pain we treat is classed as “non-specific neck pain” (Verhagen 2021; Almalki et al. 2024). That means it doesn’t come from a single clear source like a fracture or disc bulge, but rather a combination of mechanical, postural, and sometimes psychosocial factors.

Risk factors include:

  • Prolonged static or awkward postures (like slouching over a desk)
  • High computer use (>75% of the workday)
  • Stress, anxiety, poor sleep or low mood
  • Lack of physical activity or poor muscle endurance (Cagnie et al. 2007; Louw et al. 2017)

Side view of senior man holding neck with visible discomfort, highlighting neck pain relief.

Importantly, neck pain often fluctuates – it might settle for weeks or months before flaring again. Up to 70% of people will experience neck pain in their lifetime, and around half of those will go on to experience recurring or chronic symptoms (Osborne et al. 2024).

What Actually Helps?

Let’s get straight to it. Here’s what the research says works – and what doesn’t.

Targeted Strengthening Exercises

A recent meta-analysis by Louw et al. (2017) showed strengthening exercises are consistently more effective than doing nothing. These exercises improve both pain and quality of life for office workers with non-specific neck pain.

Chen et al. (2018) reinforced this, finding the biggest improvements came from neck/shoulder-specific strength work done consistently. The same review highlighted that those who stuck to their program got the best results — a helpful reminder that consistency trumps intensity.

Interestingly, Osborne et al. (2024) found neck-specific resistance training not only helped pain but also changed how the nervous system processed pain – reducing hypersensitivity measured by QST (quantitative sensory testing). That’s not just “feeling better” – it’s a measurable shift in how your body interprets threat and discomfort.

Manual Therapy (With Exercise)

Close-up of a therapist giving a relaxing shoulder massage, enhancing wellness and stress relief.

Cervical and thoracic mobilisations – particularly when paired with exercise – help reduce pain and restore movement (Verhagen 2021; Damgaard et al. 2013). At Praxis, we’ll often use hands-on techniques in the early phase to loosen stiff joints or reduce muscle guard

ing, before layering in exercise to drive long-term change.

Manual therapy alone can offer short-term relief, but it’s the combination with exercise that produces meaningful, sustained improvement.

Close-up of woman using blue massage balls for neck relief against a wall.A Multimodal Approach

Combining manual therapy, strengthening, posture coaching, and education works better than relying on just one of these (Damgaard et al. 2013). This reflects our whole-person approach at Praxis – treating not just the neck, but the patterns, habits, and loads that contribute to the issue.

What About Stretching?

Stretching can feel good – and sometimes helps with short-term symptom relief – but strengthening is where the real long-term benefit lies (Louw et al. 2017). That said, we’ll often include mobility work alongside strengthening in the early phases of your rehab, especially if movement is limited or provoking.

And What Doesn’t Help?

Unfortunately, there’s still a lot of outdated advice and overreliance on passive treatments. Prolonged rest, neck braces, or relying solely on massage or dry needling – without addressing strength, posture, or movement – rarely produce lasting results.

Electrotherapy or ultrasound alone have limited evidence (Damgaard et al. 2013), and while they may provide short-term comfort, they don’t improve long-term function or resilience.

What You Can Expect at Praxis

Your physio will:

  1. Take a thorough history and assessment to rule out anything serious.
  2. Identify movement deficits, strength imbalances, or aggravating work setups.
  3. Use manual therapy to settle symptoms and restore range of motion.
  4. Build a personalised exercise plan focused on restoring strength and endurance.
  5. Offer ergonomic and postural coaching to help you load your neck better, not less.

Whether you’re a desk-bound professional, a busy parent, or an elite athlete – your neck pain deserves proper, evidence-based care.

Struggling with neck pain that just won’t go away? Let one of our experienced physios at Praxis guide you back to feeling and moving better – book today

Until next Praxis What You Preach..

📍 Clinics in Teneriffe, Buranda, and Carseldine
💪 Trusted by athletes. Backed by evidence. Here for everyone.

Pilates & Back Pain Rehab (Part 3 of 3): How Much Is Enough?

Pilates & Back Pain Rehab (Part 3 of 3): How Much Is Enough?

by | Apr 30, 2025 | Reformer Pilates

In the final part of our three-part blog series, we dive into one of the most common questions we’re asked at Praxis Physiotherapy: “How often should I do Pilates for my back pain?”

The short answer? It depends — but more isn’t always better.

What Does the Research Say?

Several studies have explored the ideal frequency of Pilates for managing chronic low back pain and improving quality of life:

  • A high-quality randomised trial found that two supervised sessions per week resulted in better pain and disability outcomes compared to one session, but three sessions per week didn’t add significant extra benefit (Miyamoto et al., 2018).

  • A more recent scoping review suggested that the most effective dose was 2–3 Pilates sessions per week, over at least 8–12 weeks, with each session lasting 50–60 minutes (Sivrika et al., 2024).

  • Other research found that while Pilates is more effective than minimal intervention, its long-term effects are similar to other forms of exercise when it comes to disability reduction (Lim et al., 2011).

Interestingly, even in postmenopausal women with osteoporosis, clinical Pilates performed twice weekly over 12 weeks improved physical performance, bone health, and quality of life (Angın et al., 2015).

In short: Twice a week for 8–12 weeks seems to be the sweet spot — balancing benefit with adherence.

Does That Mean Daily Pilates Is Too Much?

Not necessarily — but more frequent Pilates isn’t always better, especially in early rehab stages. Muscles and tendons need time to adapt, and overtraining can aggravate sensitive tissues.
In most cases, it’s smarter to focus on progressive challenge and good technique, rather than pushing volume too early.

The Praxis Approach

At Praxis, we use Pilates as a physiotherapy-led rehab tool, not just a workout. That means:

  • Exercises are tailored to your injury, goals, and stage of recovery

  • We combine matwork and reformer-based Pilates, adapting for pain or functional limitation

  • Programs scale over time — from pain relief to performance and everything in between

Many of our clients begin with once-weekly sessions, progressing to twice per week as tolerated. We also provide home-based exercises to support consistency without overloading the system.

So, How Often Should You Do Pilates?

Here’s our evidence-informed summary:

  • Start with 1–2 supervised sessions per week

  • Add 1–2 home sessions with guidance

  • Continue for 8–12 weeks, then reassess progress and goals

The most important part? Consistency, not perfection. And making sure every movement has a purpose.

Ready to get started?
Chat to our team at Praxis Physiotherapy — we’ll help tailor a Pilates plan that’s safe, effective, and backed by the latest research.

Until next time,  Praxis What You Preach!

References

Angın, E., Erden, Z., & Can, F. (2015). The effects of clinical Pilates exercises on bone mineral density, physical performance and quality of life of women with postmenopausal osteoporosis. Journal of Back and Musculoskeletal Rehabilitation, 28(4), 849–858. https://doi.org/10.3233/BMR-150604

Lim, E. C. W., Poh, R. L. C., Low, A. Y. H., & Wong, W. P. (2011). Effects of Pilates-based exercises on pain and disability in individuals with persistent nonspecific low back pain: a systematic review with meta-analysis. Journal of Orthopaedic & Sports Physical Therapy, 41(2), 70–80. https://doi.org/10.2519/jospt.2011.3307

Miyamoto, G. C., Costa, L. O. P., Cabral, C. M. N., & Costa, L. C. M. (2018). Efficacy of two Pilates exercise programs for patients with chronic low back pain: A randomized controlled trial. Brazilian Journal of Physical Therapy, 22(2), 137–143. https://doi.org/10.1016/j.bjpt.2017.09.004

Sivrika, M., et al. (2024). Different doses of Pilates-based exercise therapy for chronic low back pain: a scoping review. Applied Physiology, Nutrition, and Metabolism, [Ahead of print]. https://doi.org/10.1139/apnm-2021-0462

Navigating Knee Osteoarthritis: A Physio-Centric Pathway to Strength and Mobility Before Surgery

Navigating Knee Osteoarthritis: A Physio-Centric Pathway to Strength and Mobility Before Surgery

by | Apr 22, 2025 | Knee, Reformer Pilates

Knee osteoarthritis (OA) is one of the most common causes of chronic pain and mobility restriction in Australians over 45. Whether you’re a weekend warrior, an active grandparent, or someone just trying to keep up with the daily demands of life, OA can slowly erode your confidence in movement — long before X-rays show the full extent of joint degeneration.

At Praxis Physiotherapy, we take a forward-thinking, collaborative approach to managing knee OA. Working closely with renowned orthopaedic knee surgeon Dr. Kelly Macgroarty and drawing from our extensive experience with high-performance athletes and everyday patients alike, we believe the journey toward better knees starts well before surgery — and, for many, might even avoid or delay it altogether.

What is Knee Osteoarthritis?

Knee OA is a progressive condition involving the breakdown of joint cartilage and underlying bone, typically leading to:

  • Pain during or after activity

  • Morning stiffness or stiffness after rest

  • Swelling and inflammation

  • Loss of flexibility and range of motion

  • Difficulty with stairs, kneeling, or prolonged standing

Radiographic OA becomes more common with age, but symptoms often precede visible changes on X-ray. Up to 30% of people over 65 show radiographic OA, yet many remain functionally capable — highlighting the importance of early, movement-based interventions (Naja et al., 2021).

Why a Physio-Led Model Before Knee Replacement?

Surgery is not the first or only option. A large systematic review of 19 randomized controlled trials found that non-surgical interventions such as physiotherapy, platelet-rich plasma (PRP), and structured exercise were associated with meaningful improvements in pain and function over 12 months (Naja et al., 2021). Physiotherapy, in particular, is consistently supported by international guidelines as a first-line treatment (Fransen et al., 2015; Bennell et al., 2014).

Traditionally, knee OA rehab has emphasised quadriceps strengthening — and for good reason, as quadriceps weakness is strongly linked to OA-related pain and disability. However, more recent research suggests that focusing exclusively on the quadriceps may be too narrow. Programs that include hip (gluteal), hamstring, and calf muscle strengthening are now shown to be superior in improving functional outcomes, especially for activities like walking, stair climbing, and maintaining balance (Bennell et al., 2014). This broader approach addresses the full kinetic chain around the knee, optimises joint load distribution, and better supports long-term movement efficiency.

At Praxis, our physios:

  • Assess gait, strength, joint mobility, and function

  • Design individualised exercise programs targeting quadriceps, glutes, and calf strength

  • Implement manual therapy techniques to restore joint mobility

  • Provide pain education, load management advice, and real-world strategies

  • Monitor progress and adjust programs over time

This proactive approach not only builds resilience in the knee but also prepares the joint and surrounding muscles should surgery eventually be required.

Booster Sessions: Keeping Gains, Lowering Costs

An often-overlooked strategy is the use of booster physiotherapy sessions — structured follow-ups after an initial rehab program. Research by Bove et al. (2018) showed that exercise programs with booster sessions at 3, 6, and 12 months were not only more clinically effective but also more cost-effective over a two-year period compared to standard physiotherapy care.

At Praxis, we now embed these booster sessions into long-term OA management. They help patients:

  • Maintain strength and conditioning gains

  • Stay accountable with home programs

  • Troubleshoot new symptoms early

  • Reduce future health care costs and medication reliance

What About Injections and Other Adjuncts?

We often collaborate with GPs and orthopaedic specialists to incorporate adjunct treatments where the evidence supports it:

  • Platelet-rich plasma (PRP) injections showed significant long-term benefit for pain and function, with improvements of ~20 points on the WOMAC index. PRP ranked just behind stem cells as the most effective non-surgical treatment in a large 2021 network meta-analysis (Naja et al., 2021).

  • Hyaluronic acid (HA) injections have shown mixed results. A review of overlapping meta-analyses concluded that HA is likely safe and modestly effective, especially in early-stage OA, although guideline recommendations remain inconsistent (Xing et al., 2016).

Ultimately, our philosophy is to build strong knees first, and complement physiotherapy with interventions like PRP or HA only when clinically indicated and appropriately timed.

Surgical Collaboration 

In more advanced cases, where conservative management fails, we work closely with Dr. Kelly Macgroarty, one of Queensland’s leading knee surgeons. Our relationship allows:

  • Streamlined triage for surgical consultation

  • Shared prehabilitation planning to improve surgical outcomes

  • Integrated post-operative rehab, using in-clinic gym equipment and reformer Pilates to accelerate return to function

This continuity ensures you’re never left navigating knee OA alone — whether your journey stays entirely within physio care or progresses to surgical management.

Why Praxis Physiotherapy?

At Praxis, we’ve built our care model around best-practice guidelines, decades of elite sport and private practice experience, and a shared goal of keeping our patients active, independent, and thriving.

Our Teneriffe, Carseldine and Buranda clinics offer:

  • In-clinic rehab gyms

  • Reformer Pilates for joint-friendly loading

  • Real-time strength testing technology

  • Physios with elite sports and post-surgical rehab experience

Take the First Step

If you or someone you love has been told you’re “heading for a knee replacement,” don’t wait. There is so much we can do to reduce pain, improve function, and build confidence in your knees — surgery or not.

Book an appointment today at one of our Brisbane clinics and start your journey to stronger, more resilient knees.

Interested in ACL specific rehab? Check our guide on return to sport after ACL injury

Until next time, Praxis What You Preach!

📍 Clinics in Teneriffe, Buranda, and Carseldine

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

References

  • Bove, A. M., Smith, K. J., Bise, C. G., et al. (2018). Exercise, manual therapy, and booster sessions in knee osteoarthritis: cost-effectiveness analysis from a multicenter randomized controlled trial. Physical Therapy, 98(1), 16–27.

  • Fransen, M., McConnell, S., Harmer, A. R., Van der Esch, M., Simic, M., & Bennell, K. L. (2015). Exercise for osteoarthritis of the knee: a Cochrane systematic review. British Journal of Sports Medicine, 49(24), 1554–1557.

  • Bennell, K. L., Dobson, F., & Hinman, R. S. (2014). Exercise in osteoarthritis: moving from prescription to adherence. Best Practice & Research Clinical Rheumatology, 28(1), 93–117.

  • Naja, M., Fernandez De Grado, G., Favreau, H., et al. (2021). Comparative effectiveness of non-surgical interventions in the treatment of patients with knee osteoarthritis: a PRISMA-compliant systematic review and network meta-analysis. Medicine, 100(49), 

  • Xing, D., Wang, B., Liu, Q., et al. (2016). Intra-articular hyaluronic acid in treating knee osteoarthritis: a PRISMA-compliant systematic review of overlapping meta-analyses. Scientific Reports, 6, 32790.

ACL Rehabilitation: The Role of Physiotherapy in Returning to Life, Activity, and Sport

ACL Rehabilitation: The Role of Physiotherapy in Returning to Life, Activity, and Sport

by | Apr 22, 2025 | ACL, Gym and Strength, Knee, Return to Sport, Running Injuries

On today’s Praxis what you Preach, we cover a very common injury here in Australia – the Anterior Cruciate ligament (ACL) injury. At Praxis Physiotherapy, we understand that recovering from ACL reconstruction is more than just healing a knee — it’s about restoring confidence, movement, and returning to the activities and lifestyle that matter most to each person. Physiotherapists are uniquely placed to guide this journey from surgery through to return to everyday function, recreation, and sport.

What is an ACL Rupture?

The ACL is one of the key stabilising ligaments of the knee, crucial for controlling rotation and forward movement of the tibia. An ACL rupture typically occurs during sudden changes in direction, pivoting, or awkward landings — common in sports like AFL, soccer, basketball, and netball. It most often affects young, active individuals, particularly females, due to biomechanical and hormonal factors. While not all ACL injuries require surgery, those with complete ruptures who wish to return to cutting or pivoting sports usually undergo ACL reconstruction. Regardless of the surgical decision, structured rehabilitation guided by a physiotherapist is essential for a successful recovery and long-term knee health.

The Importance of Physiotherapy in ACL Rehab

Research shows that while around 80% of individuals return to some form of sport after ACL reconstruction, only 65% return to their preinjury level and just 55% to competitive levels (Andrade et al. 2020). Physiotherapy plays a vital role in improving these outcomes by guiding progressive rehabilitation and using structured criteria-based progressions.

Physiotherapy-led rehabilitation should begin early, with emphasis on knee mobilisation, weight-bearing as tolerated, and initiation of neuromuscular training (Andrade et al. 2020). The BJSM systematic review of clinical guidelines for ACL rehab supports early kinetic chain exercises (both open and closed), strength training, cryotherapy, and neuromuscular stimulation when indicated (Andrade et al. 2020).

From Healing to Performance: A Continuum

Recovery after ACL surgery should follow a continuum from impairment-based care to performance restoration. This includes early pain and swelling control, progressive strength and range of motion restoration, motor control retraining, and sport-specific preparation. At Praxis, we follow a phase-based rehabilitation model tailored to individual needs. These needs may include the type of surgical graft used, concurrent injury (e.g meniscus / MCL), the operating surgeon’s post-op protocols, the patient’s goals, sport-specific demands, timelines for return to competition, and previous levels of function — all of which require thoughtful and collaborative clinical decision-making.

Unfortunately, studies show that many patients are discharged before meeting strength or performance benchmarks — particularly in strength-focused exercises like the split squat, squat, or deadlift, which play a vital role in ACL rehab progression. For example, performing around 22 single-leg sit-to-stands is one such late-stage benchmark that reflects adequate quadriceps strength and control before return to sport (Welling et al 2018). Nichols et al. (2021) found that most published rehabilitation protocols emphasize endurance and hypertrophy without progressing to the strength or power needed to reduce reinjury risk. This underlines the need for physiotherapists to include high-intensity, sports specific strength training and late-stage performance metrics as patients near return to sport.

Addressing Muscle Atrophy and Weakness

Quadriceps atrophy remains a key barrier to recovery post-ACL reconstruction. Evidence supports adjunct interventions such as neuromuscular electrical stimulation and blood flow restriction (BFR) training to combat muscle loss, particularly in the early post-operative period (Charles et al. 2020). BFR combined with low-load resistance exercise has been shown to reduce muscle wasting and promote strength gains when higher loads are contraindicated — we explore this more in our Blood Flow Restriction Training blog. We use this frequently at Praxis Physiotherapy in both reformer pilates and early gym based settings. 

The Role of the Physio: More Than Just Exercise

Our job as physiotherapists goes beyond prescribing exercises. We support patients through the emotional and motivational challenges of recovery, address fear of re-injury, and help them develop the confidence to return to sport or physically demanding jobs. We tailor plans based on functional goals, sport-specific needs, and personal circumstances.

At Praxis, this also means working closely with coaches, GPs, surgeons, and families to ensure clear communication and aligned expectations. For sporting patients, this might include on-field rehab or comprehensive return-to-play assessments in collaboration with clubs and teams.

A Collaborative, High-Performance Rehabilitation Environment

At Praxis Physiotherapy, we bring high-performance rehab principles to all patients — not just elite athletes. Our team has provided physiotherapy services to the Aspley Hornets AFL Club since 2014, giving us deep insight into the physical and mental demands of competitive sport. We apply this same standard of care to everyday athletes, weekend warriors, and anyone seeking to return to an active lifestyle.

We also work closely with orthopaedic knee and shoulder surgeon Dr. Kelly Macgroarty, including in-room triage consulting, ensuring a seamlessly integrated, evidence-informed rehabilitation pathway. This collaboration allows us to align surgical timelines, post-op considerations, and physiotherapy progressions — from day one to return to sport.

Our clinical culture is shaped by exposure to elite-level sports environments, including AFL, representative athletics, and professional national cricket programs. But rather than highlight individual accolades, we’re most proud of the high clinical standards and systems-based approach that ensure our entire team delivers the same quality of care — no matter who walks through the door.

Each of our Brisbane based clinics includes access to gym facilities and reformer Pilates equipment, allowing for real-world, function-driven exercise. These resources support patients to not only recover structurally but also return to high levels of strength, coordination, and performance in line with the latest evidence-based guidelines.

A Message to Our Patients

Whether you’re an athlete aiming for competitive return or someone wanting to run after your kids again, we bring the same level of care and attention to your ACL rehab. Recovery is not just about timelines — it’s about building back strength, movement, and trust in your knee. Ready to get started with your own recovery plan? Explore the ACL physiotherapy services at Praxis and book an appointment today.

Until next time, Praxis What You Preach…

📍 Clinics in Teneriffe, Buranda, and Carseldine
💪 Trusted by athletes. Backed by evidence. Here for everyone.

For more insights into long-term knee health, including non-surgical rehab, check out our Knee Osteoarthritis blog.

References

Andrade R, et al. (2020). How should clinicians rehabilitate patients after ACL reconstruction? A systematic review of clinical practice guidelines. Br J Sports Med, 54(9), 512–519.

Kochman M, et al. (2022). ACL Reconstruction: Which Additional Physiotherapy Interventions Improve Early-Stage Rehabilitation? Int J Environ Res Public Health, 19(23), 15893.

Charles D, et al. (2020). A systematic review of the effects of blood flow restriction training on quadriceps muscle atrophy and circumference post ACL reconstruction. Int J Sports Phys Ther, 15(6), 882–889.

Nichols ZW, et al. (2021). Is resistance training intensity adequately prescribed to meet the demands of returning to sport following ACL repair? A systematic review. BMJ Open Sport Exerc Med, 7(1), e001144.

Welling W, Benjaminse A, Gokeler A, Otten E, & Seil R. (2018). Low rates of patients meeting return to sport criteria 9 months after anterior cruciate ligament reconstruction: a prospective longitudinal study. Knee Surg Sports Traumatol Arthrosc, 26(12), 3636–3644.

Ankle Sprains: Don’t Let a Simple Injury Turn into a Long-Term Problem

Ankle Sprains: Don’t Let a Simple Injury Turn into a Long-Term Problem

by | Apr 22, 2025 | Ankle and Foot, Return to Sport, Running Injuries

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​.

gray concrete statue of a man

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.

The Benefits of Remedial Massage

The Benefits of Remedial Massage

by | Jan 5, 2024 | Massage, Recovery

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!

BOOK YOUR MASSAGE HERE

Until next time – Prevent. Prepare. Perform

References:

  1. 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
  2. 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
  3. 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.
  4. 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.

https://www.massagemyotherapy.com.au/Home

Osgood Schlatters Disease – More than just growing pains in the adolescent knee

Osgood Schlatters Disease – More than just growing pains in the adolescent knee

by | Aug 3, 2023 | Knee, Return to Sport, Running Injuries

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-

Achilles Tendinopathy: How to treat your Achilles Pain

Achilles Tendinopathy: How to treat your Achilles Pain

by | Jul 31, 2023 | Ankle and Foot, Return to Sport, Running Injuries, Tendon

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!

Mid Potion Achilles Tendinopathy Location

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.

Until next time, Praxis What Your Preach.

Team Praxis

Capping kneecap pain – Your guide to Anterior Knee Pain (Patellofemoral Pain Syndrome)

Capping kneecap pain – Your guide to Anterior Knee Pain (Patellofemoral Pain Syndrome)

by | Jul 11, 2023 | Knee, Return to Sport, Running Injuries

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!

Until next time,

Praxis What You Preach

Team Praxis