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Knee Pain

Knee Pain

by | Jan 7, 2020 | Knee, Pain

Do you have a good knee and a bad knee? Do your knees snap, crackle and pop? Do you ever wish you could walk for longer without pain or not be worried about how your knees will feel in the morning if you were living your life to the fullest? Knee pain is a very common condition that affects people of all ages. Typically knee pain is the result of an injury on the sporting field when we are younger but tend to be more degenerative in nature as we age.
Mid Potion Achilles Tendinopathy Location

Different knee injuries tend to have differing symptoms. Common symptoms include:

  • Aching, sharp, stabbing and/or catching pains
  • Large amounts of swelling or sometimes pockets of swelling
  • Warm to touch
  • Feelings of grating, grinding or even giving way
  • Pops and crunching noises
  • Unable to full bend or straighten the knee

The structures of the knee that are often implicated in knee pain are the patellar or quadriceps tendons, cartilage, meniscus, bursas, and even major ligaments such as the anterior cruciate ligament, otherwise known as the ACL.

Common injuries to the knee can be:

  • Osteoarthritis
  • Tendinopathy / Tendonitis
  • Bursitis
  • Knee cap pain (patellofemoral pain)
  • Meniscal tear (degenerative and acute tears)
  • Dislocated knee cap
  • Iliotibial band friction syndrome

Regardless of your symptoms and presentation, our highly trained Praxis physiotherapists have expertise in this area and will help identify the problem and work with you so that you will feel empowered to fix the problem. At Praxis Physio this is our point of difference, we promise to take the time to fix you using a range of modalities including advice, hands on manual therapies and of course strength and conditioning programming. In addition, we work in close collaboration with leading knee surgeons if this course of action is required.

 

There is no need to accept knee pain as ‘normal’. Call us now on (07) 3102 3337 or book online to have one of our physios develop a plan to reduce your pain and restore your function!

To read more about how running can help your knees (that’s right – running!) check out our related posts on running written by our published principal physio, Stephen.

Team Praxis,

PREVENT | PREPARE | PERFORM

FACT OR FICTION FRIDAY || All rotator cuffs tears need surgery.

FACT OR FICTION FRIDAY || All rotator cuffs tears need surgery.

by | Dec 28, 2019 | Pain, Shoulder, Surgery

Answer: FICTION. The devil is in the detail!

The rotator cuff is a group of 4 muscles that aid in providing stability through range for the shoulder joint, particularly overhead. There are multiple risk factors for RC tears, but most are down to overactivity of the shoulder joint decreased conditioning of the shoulder complex, which comes with age. In fact, cuff tears are common in individuals over the age of 40 with linear increase in incidence as we get older.

Pain with movement and function is one of the biggest symptoms of a rotator cuff tear. However, it is important to know that a sizeable portion of RC tears are actually asymptomatic and don’t cause the person any pain or discomfort! A study by Minagawa and Yamamoto in 2013 found that in a screening of 664 village residents, 147 subjects had RC tears on a medical imaging screening. Surprisingly 65% of them had no symptoms at all and didn’t have any shoulder complaints.

Mid Potion Achilles Tendinopathy Location

The two main ways of treating a cuff tear is either through conservative management with your physiotherapist or down the surgical route, which is also then followed by physiotherapy rehabilitation.

SO, back to the original question: “Do I need surgery?”. As always – it is a case by case decision!! There is no definitive evidence for supporting one over the other generally speaking!

However, it is vitally important to note that each option comes with their own pros and cons. Furthermore, it is important to remember that just as every person is different, each case of rotator cuff tear is different. Young vs old, acute vs degenerative RC tear, current and desired future function, pain levels, radiographic findings, previous history of shoulder trauma and the patient’s wishes are only some of the questions that aid in the decision process.

The best way to decide would be to contact us to asses you and discuss both options and what your goals of rehab are so that a tailored plan can be developed WITH you. To read more about RC tears, read our blog here

To get your shoulder back on track, book online or give us a call on (07) 3102 3337.

Team Praxis

PREVENT | PREPARE | PERFORM

FACT OR FICTION FRIDAY || Overuse injuries need rest and are because I’m doing too much

FACT OR FICTION FRIDAY || Overuse injuries need rest and are because I’m doing too much

by | Dec 20, 2019 | Gym and Strength, Pain, Return to Sport, Sports Injury

ANSWER: FICTION (Mostly – stay with us here) 🙊 Do you keep getting injured when you get back into your usual training after a period of rest 😤? The first graph shows a 65-day cycle of an Olympic athlete. The red lines indicate when the athlete was injured. Looking at the multi-coloured line, you can see that the injuries both occurred when the acute to chronic workload ratio was at its peak. Essentially that means that the loads that preceded the injury were too high relative to the longer term loading of the tissue 😫. This is typically called an overuse injury! Then along comes Mr/Ms physio and looks at the above cycle and says to the Olympian, “Come on mate, we can do better than this…” 😎 Ta da. The second graph shows the yellow section outlining the above 65-day period.
Mid Potion Achilles Tendinopathy Location

As you can see, training following this period is much more frequent and at higher intensities. So do we still assign the original injuries to overuse injuries given the athlete was able to handle much more relatively quickly after?! A better term would be a training load error and something that a sporting physio can help you with 👌. This is a particularly important thing to know given the holidays are just around the corner 🎅!

Get in touch with us if you want to train more with less injuries, or are looking to return to training! 📞(07) 3102 3337 or book online.

Team Praxis

PREVENT | PREPARE | PERFORM

Drew, M. K., & Purdam, C. (2016). Time to bin the term ‘overuse’ injury: is ‘training load error’ a more accurate term? Br J Sports Med, 50(22), 1423. doi:10.1136/bjsports-2015-095543

Stingers AKA Neural traction injuries

Stingers AKA Neural traction injuries

by | Dec 17, 2019 | Nerve Pain, Pain, Shoulder, Sports Injury

SUMMARY:

  • Stingers are essentially a tractioning of the neural system
  • This can cause pain, movement and sensation changes
  • Chronic traction to the nervous system can have a cumulative effect on nerve function
  • The more damage to the nerve, the more serious the outcome
  • We shouldn’t be as dismissive of “stingers”, particularly if they are recurrent
  • Physiotherapy has a role to play

STINGERS:

Stingers have been the catch cry of many contact sports over the years. Often dismissed as ‘just a stinger’, trauma to the nervous system should probably be taken a little more seriously, as we delve into detail today.

Stingers are most commonly experienced in contact sports whereby the shoulder of a players is forcefully depressed, as experienced with a tackle in NRL or union. A large range of motion over a short period of time can result in a ‘traction’ of the Brachial Plexus (a network of nerves formed from exiting branches of the spinal cord in the neck that transverse to the shoulder and arm). Thus network of nerves sends signals from your spinal cord to your shoulder, arm and hand and thereby providing feeling and movement to these regions.

BACKGROUND:

To understand a stinger injury, a clear understanding of nerves and nerve related injuries is required. A nerve is an enclosed, cable-like bundle of nerve fibres called axons, in the peripheral nervous system. A nerve provides a common pathway for the electrochemical nerve impulses that provide a number of functions, including getting our muscles to move!

Seddon and Sunderland present a five-grade classification scale for nerve related injuries[1-4]. Figure 1 illustrates the physiological changes that occur through each grade of injury. Essentially it outlines the greater amount of disruption to the anatomy of the nerve.

The more damage to the nerve, the more serious the outcome. Table 1 outlines the three different grades of stinger injuries.[4, 5] The most common stinger is a grade 1 injury, which represents a neurapraxia, or nerve stretch injury, without axonal disruption.[4] In an acute setting, this can result in motor and sensory loss/changes, which usually resolve within minutes.[1, 4] Grade 2 and 3 involve a higher degree of nerve injury, usually involving a crush, transection or compression mechanism.[1]

Chronic traction to the nervous system can have a cumulative effect on nerve function. This is termed “chronic stinger syndrome” and represents a distinct entity from acute stingers that may reflect long- standing structural changes of the subaxial spinal canal and chronic irritation/degeneration of the exiting nerve root complex.[4, 6]. This sounds complex but essentially means

Mid Potion Achilles Tendinopathy Location

A Clinical Example from Zac

“During a Gridiron match, a player was injured whilst making a tackle. I reviewed the player on field and he was unable to utilise his right upper limb (full paralysis) from shoulder down to his hand. The player was removed from the field immediately to be further assessed and monitored. A complete neurovascular assessment was performed, assessing motor function/strength, sensation, reflexes, and vascular status, as well was the cervical spine. Motor and sensation changes were the only deficits noted and were reviewed frequently. After roughly five minutes, the player demonstrated full upper limb motor strength and sensation, with nil lingering symptoms. In collaboration with the patient, it was decided he would return to match play immediately. The patient was monitored throughout the game and reported no further symptoms.”

Figure 2 shows a proposed decision tree when managing stinger injuries.[4] This clinical example outline above fits the Grade 1 Mild category as he was able to return to competition with nil lingering symptoms. Despite the lack of symptoms during the game, it is recommended the patient be reviewed again both after the game and weekly for two weeks to ensure a full resolution of symptoms.[4, 7]

The role for neural mobilisation?

Current non-surgical management involves rest, pain control and resistance training[4]. Though not explored within the literature, neural mobilization may have an important role in patients with persistent symptoms, such as Grade 1 moderate to severe, and more recurrent neuropraxias. Though not assessed in this specific population, there is evidence for neural tissue management being superior to minimal intervention for pain relief and reduction of disability in nerve related chronic musculoskeletal pain.[8] It is biologically plausible that recurrent neuropraxias may respond in a similar way, utilising neural mobilisation (tensioning or sliding) and mobilisation of surrounding structures.

Management of persistent Grade 1 injuries may differ slightly, specifically if the suspected mechanism of injury was through traction rather than compression. The nerve structures may have a heightened sensitivity to tensioning based techniques due to the similar mechanism of injury and may respond better acutely to sliding techniques which limit the strain on the nerve and focus on excursion. Tensioning techniques may be important in the sub-acute phase by loading the patient’s nervous system (i.e. increased strain) in preparation for return to function (i.e. tackling with acute traction on the brachial plexus).

In summary, perhaps we shouldn’t be as dismissive of “stingers”, particularly if they are recurrent for you! If you have any questions or would like to see one of our physios regarding your injury, feel free to contact us on (07) 3102 3337 or book online on our website

Till next time, Praxis what you Preach

Team Praxis

Prevent | Prepare | Perform

REFERENCES:

Menorca, R.M.G., T.S. Fussell, and J.C. Elfar, Nerve physiology: mechanisms of injury and recovery. Hand clinics, 2013. 29(3): p. 317-330.

Tsao B, B.N., Bethoux F, Murray B, Trauma of the Nervous System, Peripheral Nerve Trauma. 6th ed. In: Daroff: Bradley’s Neurology in Clinical Practice. 2012.

Sunderland, S., A classification of peripheral nerve injuries producing loss of function. Brain, 1951. 74(4): p. 491-516.

Ahearn, B.M., H.M. Starr, and J.G. Seiler, Traumatic Brachial Plexopathy in Athletes: Current Concepts for Diagnosis and Management of Stingers. J Am Acad Orthop Surg, 2019.

Feinberg, J.H., Burners and stingers. Phys Med Rehabil Clin N Am, 2000. 11(4): p. 771-84.

Presciutti, S.M., et al., Mean subaxial space available for the cord index as a novel method of measuring cervical spine geometry to predict the chronic stinger syndrome in American football players. J Neurosurg Spine, 2009. 11(3): p. 264-71.

Aldridge, J.W., et al., Nerve entrapment in athletes. Clin Sports Med, 2001. 20(1): p. 95-122.

Su, Y. and E.C. Lim, Does Evidence Support the Use of Neural Tissue Management to Reduce Pain and Disability in Nerve-related Chronic Musculoskeletal Pain?: A Systematic Review With Meta-Analysis. Clin J Pain, 2016. 32(11): p. 991-1004.

FACT OR FICTION FRIDAY || I’m too old to lift weights!

FACT OR FICTION FRIDAY || I’m too old to lift weights!

by | Dec 13, 2019 | Gym and Strength, Osteoarthritis

Answer: FICTION 🙊 Progressive strength training in the elderly (>60 years) is efficient, even with higher intensities, to improve bone health, pack on muscle and retain function. And not surprisingly, side effects are rare! Strength training increases muscle strength by increasing muscle mass, and by improving the recruitment of motor units, and increasing their firing rate. This is no different between younger and older gym goers.
Mid Potion Achilles Tendinopathy Location

It all comes down to how you train! Training with higher loads generally provokes marginally larger gains in muscle size. Intensity corresponding above 85% of the individual maximum voluntary strength can also illicit improved rate of force development compared to 60-80%. This is imperative for reducing frailty as we age.

It is now recommended that healthy old people should train 3 or 4 times weekly for the best results; persons with poor performance at the outset can achieve improvement even with less frequent training.

So if you are using age as an excuse – STOP! Don’t let your age be a barrier to trying new things or feeling strong. We are here to help with supervised sessions, a great network of PTs as well as our clinical reformer pilates classes which are a great way to start (or return) to strength training!

To book for a clinical pilates 1:1 session or to chat with a physio about how strength training can help you, head to our booking page or give us a call on (07) 3102 3337

Team Praxis

PREVENT | PREPARE | PERFORM

References:

Mayer, F., Scharhag-Rosenberger, F., Carlsohn, A., Cassel, M., Müller, S., & Scharhag, J. (2011). The intensity and effects of strength training in the elderly. Deutsches Ärzteblatt International, 108(21), 359.

Lopez, P., Pinto, R. S., Radaelli, R., Rech, A., Grazioli, R., Izquierdo, M., & Cadore, E. L. (2018). Benefits of resistance training in physically frail elderly: a systematic review. Aging clinical and experimental research, 30(8), 889-899.

FACT OR FICTION FRIDAY || Knee Pain and Scans

FACT OR FICTION FRIDAY || Knee Pain and Scans

by | Dec 6, 2019 | Knee, Osteoarthritis, Pain

Answer: FICTION 🙊

“Osteoarthritis” is a common term that gets used by our patients as an explanation of their knee pain. But is this always the case 🤔?

🔍In a recent systematic review estimates of osteoarthritis feature prevalence on MRI among asymptomatic uninjured knees were up to 14% in adults < 40 years, and up to 43% in adults > 40 years!

Whilst features on MRI imaging such as cartilage defects, meniscal tears and osteophyte lesions can potentially play a role if you have pain, this should always be interpreted in the context of your clinical presentation by a health care professional as these changes can be normal in an asymptomatic population – just like grey hair as we age 👴👵!

If you have knee pain and have resigned yourself to a ‘life sentence’, come and have a chat to one of our physios to ensure you aren’t robbing yourself of a full functioning future 🕺🏃🏌️🏄🏋️🏊🚴🏂🎾! Call 07 3102 3337 or book online 

#kneeoa #praxisphysio #factorfictionfriday #preventprepareperform #kneepain #kneeosteoarthritis #mri #fullfunctionfuture

Reference:

Culvenor AG, Øiestad BE, Hart HF, et al Prevalence of knee osteoarthritis features on magnetic resonance imaging in asymptomatic uninjured adults: a systematic review and meta-analysis British Journal of Sports Medicine 2019;53:1268-1278.

Shoulder Pain

Shoulder Pain

by | Dec 6, 2019 | Gym and Strength, Pain, Shoulder, Sports Injury

Do you have a ‘good’ and ‘bad’ shoulder? Have you been putting up with that grumbly shoulder for weeks, months or even years? Shoulder pain can but a real dampener on your activity levels – but it doesn’t need to!

We at Praxis, pride ourselves on taking the time to listen, assess and accurately diagnose your shoulder pains. Some of the more common complaints we hear are:

  • Sharp, dull, deep, aching pains around the shoulder
  • ‘Popping’ or ‘crackling’ sounds or feelings in the shoulder joint
  • Pain in the mornings after lying on that side
  • A feeling of the arm ‘separating’, ‘popping out’, ‘slipping’ or feeling unstable
  • Losing power when doing overhead tasks such as swimming, throwing or gym work
  • Pains, pins and needles and numbness down the arms or pain up into the neck
  • The shoulder feeling stiff and sometimes even “frozen”

So whether your symptoms are as a result of wear and tear or an acute trauma from sport, general life or occupation, we are here to help. The shoulder needs to be strong AND mobile so if yours isn’t, then contact us today on (07) 3102 3337 or book in online We are located at 4 convenient locations around Brisbane. Teneriffe, Woolloongabba, Bowen Hills and Carseldine.

Team Praxis,

PREVENT | PREPARE | PERFORM

Lower Back Pain

Lower Back Pain

by | Dec 3, 2019 | Lower Back, Pain

Sharp catch of pain? Ongoing aches? Trouble getting out of bed or with long car rides? Stiff and sore when you are bending over to pick things up? Referred pain into you legs?

If you’ve experienced any of these symptoms recently you are not alone. Lower back pain is a common ailment affecting people of all ages and lifestyles with up to 80% of us experiencing various symptoms in our lifetime. Lower back pain can be caused by various factors such as poor posture, muscle strain, joint pain or underlying medical conditions.

Back pain is complex. These aches and pains are usually a sign that your spine are not tolerating loads well and are more sensitive than usual. Symptoms could arise from a subtle change in muscle balance and biomechanics, altered postures, novel or increases in training intensity or even your thoughts arounds the fragility of your spine. Physiotherapy offers effective solutions for managing and alleviating lower back pain by assessing the root cause of the pain, educating you on what is happening and develop personalised treatment plans. We also employ techniques like manual therapy, exercises, and stretches to strengthen you, improve flexibility, return you to activity and desensitise the painful area. Physiotherapy also includes education on proper body mechanics and ergonomics to prevent future episodes in activities such as lifting, sports or activitities of daily living.

Mid Potion Achilles Tendinopathy Location

Whatever the cause, our highly trained Praxis physiotherapists have expertise in this area and will help identify the problem and work with you so that you will feel empowered to fix the problem. At Praxis Physio, this is our point of difference. We promise to take the time to fix you using a range of modalities including advice, hands on manual therapies, reformer pilates and of course strength and conditioning programming.

No need to accept back pain as ‘normal’ call us now on (07) 3102 3337 or book online to have one of our physios get you back on track before your pain becomes any worse.

Team Praxis,

PREVENT | PREPARE | PERFORM

Sporting Injuries

Sporting Injuries

by | Dec 3, 2019 | Pain, Return to Sport, Sports Injury

Are you a weekend warrior who is plagued by injury or an aspiring athlete trying to find that extra 1% or somewhere in between? We know how frustrating it can sitting on the side lines and not being able to be involved in the things that make you happy. All the Praxis team have (or still do) play sport of some description and understand the anguish that goes hand in hand with injuries. That is why we do what we do!

 

Praxis has an expert team who have been fortunate to travel the country and even the world with various sporting teams. Whether it is Stephen with Cricket Australia teams, Cam with the ICONZ Rugby, Zac with Netball or Emma with AFL Praxis has you covered.
Mid Potion Achilles Tendinopathy Location

We separate ourselves from other therapist because we know that specific, personalised and evidence based physiotherapy is the most effective and efficient method to getting you back to what you love doing quicker and better. Combine that with our years of experience in treating all athletes from the elite to the weekend warrior, and there is no sport we can’t help with!

In summary, we believe that specific, personalised and evidence based physiotherapy is the most effective and efficient method in

If you are looking to Prevent future dysfunction, Prepare for your activity and Perform at your best, the Praxis Team has you covered and will get you achieving your goals sooner! See one of expert team members today by giving us a call on (07) 3102 3337  emailing admin@praxisphysio.com.au or booking online.

Team Praxis

PREVENT | PREPARE | PERFORM

Shin Splints | Physio Guide to Medial Tibial Stress Syndrome

Shin Splints | Physio Guide to Medial Tibial Stress Syndrome

by | Nov 27, 2019 | Ankle and Foot, Return to Sport, Running Injuries, Sports Injury

SUMMARY

  • Shin splints are essentially an overuse injury
  • Numerous factors contribute to symptoms but mainly involving the poor control of force through the lower limbs
  • Important to stop symptoms to avoid developing stress fractures, which require lengthier time away from activity
  • Corrective strengthening exercises, relative rest, and workload management all seem to be treatment mainstays
  • Physiotherapy has a significant role to play in getting back to running and sport
Mid Potion Achilles Tendinopathy Location

SHIN SPLINTS

Shin splints, or as it’s referred to as in the literature, medial tibial stress syndrome (MTSS), is a common injury seen in the recreationally active and army populations. Symptoms typically consist of an aching pain to the lower medial (inside) part of the shin, that can be sharp when running or when inflamed. There can also be some pain and stiffness when you first walk around in the morning, or when you first start your activity.

Risk Factors:

Over 100 potential intrinsic risk factors of MTSS were identified in a recent systematic review [1] involving 21 different studies. Of those risk factors, nine were identified as having a moderate to strong occurrence in clinical practice. Out of these nine, the risk factors that result in the greater loads on the body (such as body mass index) or poorer acceptance of load with running were the most important.

A number of range of motion parameters were also identified. For example, larger plantar flexion range of motion (the movement of pointing your foot down) was identified. It has been hypothesized that the increased plantar flexion results in a greater likelihood of the individual landing on their forefoot rather than their rearfoot while running, possibly increasing the strain on the rear inside leg (posteromedial tibia). Forces on the inside of the shin bone explain the why pain may be present in that area.

Treatment:

Most people tend to simply rest which may decrease symptoms in the short-term, but it doesn’t address the direct cause! The condition is very commonly seen in recreational runners and not as much in your higher-level athletes. Why is this? It’s quite simple! As mentioned in our previous running blogs, the adherence to well-planned running workloads is what separates recreational runners from the competitive or non-injured. Planned training leads to adequate adaptation of the body to the demands placed upon it.

One of areas patients with shin splints focus on is poor “foot posture”. It is very common to hear the same old story, “I have shin splints because my feet are flat, I need orthotics to correct that”. The biggest problem with that approach is that not a lot of people realise that the reason that they are flat footed is not necessarily because of a defect in their feet! It may be because they have strength and control of their hips which is in turn is causing over pronation or flattening of their feet.

The diagram below demonstrates that perfectly!

As the hips cannot stay level during running, this may cause the knees to fall inwards and in turn causes pronation or flattening of the foot. Then, voila! You have increased tractional stress on the medial aspect of the tibia/shin bone. Yes, there is some evidence that poor foot posture can cause the problem, but only in combination with extrinsic risk factors such as over-training and rapid increases in workload.

Poor hip control and strength is also a precursor for many other musculoskeletal conditions such as lower back, hip, knee and Achilles pain. So if we could reduce the risk of these outcomes occurring in the future, why wouldn’t we try!

It is possible that MTSS is a condition where the simple treatment of rest is enough to reduce symptoms. Until proven otherwise, relative rest remains the number one treatment option for reducing your symptoms. However, If addressed early, MTSS can be managed with the combination of targeted strength routines, running workloads, manual therapy and ensuring adequate recovery time between training sessions.

If you are experiencing shin splints or are looking to prevent such injuries from reoccurring, please feel free to book online or give us a call (07) 3102 3337. You’ll receive an in depth assessment and treatment plan to help you achieve your goals and run better for longer!

Till next time, Praxis what you preach.

The Praxis Team.

PREVENT | PREPARE | PERFORM

Images:

The above images are owned by the “Trainer Academy (https://traineracademy.org/) ” and used in this article with thanks.

References:

[1] Winkelmann, Z., Anderson, D., Games, K., & Eberman, L. (2016). Risk factors for medial tibial stress syndrome in active individuals: An evidence-based review. Journal of Athletic Training, 51(12), 1049-1052. 10.4085/1062-6050-51.12.13