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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

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: Causes, Treatment & How to Get Back to Running Stronger

Shin Splints: Causes, Treatment & How to Get Back to Running Stronger

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

Key Takeaways

  • Shin splints (MTSS) are an overuse bone stress injury.

  • Training load errors are the biggest contributor.

  • Hip strength and force control play a major role.

  • Early management prevents stress fractures.

  • Strength + smart loading beats rest alone.

    Mid Potion Achilles Tendinopathy Location

    Shin Splints

    Shin splints, known in the research as medial tibial stress syndrome (MTSS) are one of the most common running injuries we see at Praxis Physiotherapy across our Teneriffe, Buranda and Carseldine clinics.

    If you’re noticing a dull ache along the inside of your shin that worsens with running, skipping or sport, you’re not alone. The good news? With the right plan, shin splints are highly manageable — and preventable.

    Let’s break down what’s actually happening, why it develops, and what you can start doing today.

    What Are Shin Splints (Medial Tibial Stress Syndrome)?

    Shin splints are an overuse bone stress injury affecting the inner (medial) border of your tibia (shin bone).

    What does it feel like?

    • Aching pain along the lower inside shin

    • Sharp pain when running or jumping

    • Tenderness to touch along the bone

    • Morning stiffness or pain when first starting activity

    Unlike a stress fracture (which is more focal and severe), shin splints usually present as a broader area of tenderness along the bone.

    What’s Actually Happening? (The Pathology Explained Simply)

    MTSS is no longer thought to be just an “inflammation” problem.

    Current evidence suggests shin splints develop due to repetitive loading that exceeds the bone’s capacity to adapt. When running loads increase too quickly, the tibia experiences repeated bending stress. If recovery isn’t adequate, this leads to:

    • Bone stress reaction

    • Irritation of the periosteum (bone lining)

    • Localised pain along the medial tibia

    If ignored, MTSS can progress to a tibial stress fracture, which requires significantly longer time away from running.

    That’s why early management matters.

    Why Do Shin Splints Develop?

    A large systematic review by Winkelmann et al. (2016) identified over 100 potential risk factors for MTSS, with several consistently seen in clinical practice.

    Key Risk Factors Supported by Research

    1. Training Load Errors
    Rapid increases in running volume, intensity, or frequency are one of the strongest contributors.
    (Winters et al., 2013; Nielsen et al., 2012)

    2. Higher Body Mass Index (BMI)
    Greater body mass increases tibial loading forces.

    3. Biomechanical Factors

    • Increased navicular drop (foot pronation)

    • Greater plantarflexion range

    • Hip muscle weakness and poor pelvic control

    4. Previous History of MTSS
    Recurrence risk is higher without proper rehabilitation.

    Importantly flat feet alone are rarely the sole cause.

    What we often see clinically is this chain reaction:

    Poor hip control → knee collapses inward → foot over-pronates → increased traction stress on medial tibia.

    The foot is often the victim, not the culprit.

    Why Rest Alone Isn’t Enough

    Yes — rest reduces pain. But rest does not improve:

    • Load tolerance

    • Running capacity

    • Strength deficits

    • Movement control

    This explains why shin splints are common in recreational runners but less frequent in well-structured training programs. Higher-level athletes typically follow progressive loading plans that allow bone and tendon adaptation.

    Research consistently supports graded loading and strengthening as key components of recovery (Moen et al., 2012).

    .

    How to Manage Shin Splints (Early Stage Tips)

    If your symptoms are mild to moderate, here are evidence-informed starting points:

    1️⃣ Relative Rest (Not Complete Rest)

    Reduce running volume by 30–50%.
    Avoid sharp increases in load.
    Swap some runs for cycling or swimming temporarily.

    2️⃣ Strengthen the “Shock Absorbers”

    Focus on:

    • Calf strength (bent and straight knee)

    • Tibialis posterior strengthening

    • Glute medius and hip control exercises

    • Single-leg stability work

    Improving hip strength can reduce tibial loading by improving force control through the limb.

    3️⃣ Manage Running Workload

    Follow the “10% rule” cautiously.
    Allow recovery days between harder sessions.
    Avoid sudden terrain changes (e.g., grass → concrete).

    4️⃣ Consider Footwear

    Ensure shoes are not worn out (>600–800km).
    Orthotics may help some individuals — but only after assessment.

    When Should You See a Physio?

    Seek professional assessment if:

    • Pain persists longer than 2–3 weeks

    • Pain becomes sharp and localised

    • Hopping on one leg is painful

    • Symptoms worsen despite reducing load

    Early intervention reduces the risk of progression to stress fracture.

    How Praxis Approaches Shin Splints

    At Praxis, we don’t treat “shin splints.”
    We treat your specific loading problem.

    Your plan may include:

    ✔ Comprehensive running and strength assessment
    ✔ Individualised load management plan
    ✔ Targeted strength and control program
    ✔ Manual therapy where appropriate
    ✔ Gradual return-to-run progression
    ✔ Prevention strategy for long-term performance

    Because no two runners load the same way, and no two recovery plans should be identical.

    If you’re dealing with shin splints, or want to prevent them from coming back, our team can help.

    Book an in-depth running and lower limb assessment today.

    📍 Clinics in Teneriffe, Buranda & Carseldine
    📞 (07) 3102 3337
    💻 Book online

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

    The Praxis Team.

    PREVENT | PREPARE | PERFORM

    References

    • Winkelmann ZK et al. (2016). Risk factors for medial tibial stress syndrome in active individuals. Journal of Athletic Training, 51(12), 1049–1052.

    • Winters M et al. (2013). Medial tibial stress syndrome: a critical review. Sports Medicine, 43(12), 1315–1333.

    • Moen MH et al. (2012). Treatment of medial tibial stress syndrome: a systematic review. Sports Medicine, 42(11), 965–981.

    • Nielsen RO et al. (2012). Training errors and running-related injuries. International Journal of Sports Physical Therapy, 7(1), 58–75.

     

    Images:

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

    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

    Fact or Fiction – Preseason Training

    Fact or Fiction – Preseason Training

    by | Nov 22, 2019 | Gym and Strength, Return to Sport, Sports Injury

    Answer – FACT

    With preseason training just around the corner, this blog is a timely reminder that turning up to preseason training consistently will give athletes the best chance of being able to play most games next year.

    Murray et al (2017) reported that AFL players who completed <50% of pre-season training were 2x more likely to sustain in-season injury than those who completed >85%! This is not just relevant to elite AFL, it is relevant to all sports of all levels (even more so)! So what’s the take home message? For the best chance to be able to play week in/week out during the competitive phase of the season, consistency during preseason is vital.

    If you had injuries last season or are trying to make this your best season yet, see us to make sure you are ticking all the boxes!

    #praxisphysio #preventprepareperform #factorfictionfriday #preseasontraining #praxispwhatyoupreach #afl #sportsphysio #preventprepareperform

    References:

    Murray NB, et al. Relationship Between Preseason Training Load and In-Season Availability in Elite Australian Football Players. Int J Sports Physiol Perform. 2017.

    Chronic Groin Pain (Athletic Pubalgia)

    Chronic Groin Pain (Athletic Pubalgia)

    by | Oct 26, 2019 | Gym and Strength, Hip, Pain, Return to Sport, Sports Injury

    GROIN PAIN

    Groin pain, referred to also as athletic pubalgia, is a common problem for a number of athletes, particularly those who engage in sports that require specific use (or overuse) of lower abdominal muscles and the proximal muscles of the thigh. Predominantly, these activities centre around kicking sports such as AFL and soccer, as well as long distance running. Ice hockey is also a well renowned sport in which chronic groin pain occurs. All these sports involve repetitive energetic kicking, twisting, turning or cutting movements, which are all risk factors for causing pubalgia.

    SUMMARY:

    • Four structures are commonly implicated in the causes of groin pain
    • Adductor muscles
    • Pubic bone
    • Abdominal wall
    • Iliopsoas
    • Understanding which of these four structures is causing your pain is key in effective management
    • Exercise therapy and activity modifications should be the mainstay of treatment
    • Absolute rest has been shown to be ineffective
    • Steady gradual progressions through strength and function, tailored to your goals, is key to successful management
    Mid Potion Achilles Tendinopathy Location

    ROLE OF HIP ADDUCTORS (groin muscles)

    Similar to other joints in the body, the hip relies on muscular control for stability and movement. At the hip, there are five key planes of movement; flexion, extension, abduction, adduction and rotation.

    The adductor muscles are a large group of muscles located on the inner side of the thigh, attaching from below the knee, along the shaft of the femur and into the pubic bone of the pelvis.

    While acute tears of the adductor muscle is common, more long standing pain is usually the result of an overload of the adductor tendon that attach to the pelvis. This is called an adductor tendinopathy. Adductor enthesopathy is common disorder which effects the bony attachment point of the tendon, with a slight structural difference from tendinopathy, however, management is similar in both cases

    MANAGEMENT OPTIONS

    Exercise:

    Strength and functional based exercise are the core management strategies for adductor tendinopathy, and have been shown to increase function, decrease pain and reduce likelihood of injury [4].

    Activity Modification:

    Activity modification, especially in the acute phase or when symptoms are significantly affecting function, is key in reducing load on the affected structures and allowing tissues to adapt. [1]

    Rest:

    While activity modification is important, absolute rest has been shown to be ineffective in the management of adductor tendinopathy, and does not promote adequate tissue repair. [1,2]

    Other:

    Other conservative measures such as manual therapy, electrotherapy and stretching have been [1] explored, with reduced effect compared exercise prescription. Surgical management is also a potential option, with some positive results emerging for groin pain, though specific evidence [10] around adductor tendinopathy is limited. [10]

    WHY IS EXERCISE IMPORTANT?

    Exercise has been shown to increase tendon turnover, meaning in the first 24-36 hours there is a reduction in tendon integrity, but after that there is an overall increase in integrity and strength. Other benefits include: increased blood flow, increase in growth factors, and a reduction in altered pain processes in the brain [14].

    WHAT’S THE BEST EXERCISE?

    Isometric exercise has been shown to be effective in short term pain relief. Current evidence is unclear as to the best long term exercise strategies, with evidence supporting both eccentric and heavy-slow isotonic exercise. [12]

    EXERCISE PLAN

    The Copenhagen Adductor Program [9], with the below dosage, has been shown to significantly improve adductor strength, as well as being effective in groin injury prevention. It is important to note that though the program is eight weeks long, most effective tendon[12] adaptations take ≥ 12 weeks, and a tailored dosage should be discussed with your physiotherapist towards the end stage of rehabilitation.

    Depending on how the symptoms affect your function, a reduction in training, running and kicking may also be required. Example progressions are noted below in the running program, in order of loading on adductors.

    ADDITIONAL STRENGTH AND PROGRAMS

    While targeted strengthening to the adductors is key, global strengthening around the hip may also aid in a reduction of loading to the tendon. Thorough assessment of your strength through all five movements noted previously is needed, as well as a tailored training program to resolve any discrepancies.

    As symptoms reduce and function improves, part practice of painful activities, can be beneficial to reload structures, for example, banded kicking movements in preparation for return to soccer.

    SUMMARY

    In chronic adductor tendinopathy, tendon adaptations take time. It is important to understand this as you begin your rehab journey and not progress more than your body can tolerate. Steady gradual progressions through strength and function, tailored to your goals, is key to successful management.

    As always, if you have a history of groin pain or are concerned about performance in your chosen sport, contact us today and chat to one of our friendly and knowledgeable physiotherapist to ensure you can Prevent. Prepare. Perform. Alternatively you can book online here

    Till next time, Praxis what you Preach

    📍 Clinics in Teneriffe, Buranda, and Carseldine

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

    References: 

    1.  Almeida, M.O., et al., Conservative interventions for treating exercise‐related musculotendinous, ligamentous and osseous groin pain. Cochrane Database of Systematic Reviews, 2013(6).
    2. Bohm, S., F. Mersmann, and A. Arampatzis, Human tendon adaptation in response to mechanical loading: a systematic review and meta-analysis of exercise intervention studies on healthy adults. Sports Medicine – Open, 2015. 1(1): p. 7.
    3.  Brukner, P., Brukner & Khan’s clinical sports medicine / Peter Brukner … [et al.]. Sports medicine series, ed. K. Khan. 2012, North Ryde, N.S.W: McGraw-Hill Australia.
    4. Charlton, P.C., et al., Exercise Interventions for the Prevention and Treatment of Groin Pain and Injury in Athletes: A Critical and Systematic Review. Sports Med, 2017. 47(10): p. 2011-2026.
    5. Frizziero, A., et al., The role of eccentric exercise in sport injuries rehabilitation. Br Med Bull, 2014. 110(1): p. 47-75.
    6. Griffin, V.C., T. Everett, and I.G. Horsley, A comparison of hip adduction to abduction strength ratios, in the dominant and non-dominant limb, of elite academy football players. Journal of Biomedical Engineering and Informatics, 2015. 2(1): p. 109.
    7. Haroy, J., et al., The Adductor Strengthening Programme prevents groin problems among male football players: a cluster-randomised controlled trial. Br J Sports Med, 2019. 53(3): p. 150-157.
    8. Harøy, J., et al., Infographic. The Adductor Strengthening Programme prevents groin problems among male football players. British Journal of Sports Medicine, 2019. 53(1): p. 45.
    9. Haroy, J., et al., Including the Copenhagen Adduction Exercise in the FIFA 11+ Provides Missing Eccentric Hip Adduction Strength Effect in Male Soccer Players: A Randomized Controlled Trial. Am J Sports Med, 2017. 45(13): p. 3052-3059.
    10. Jorgensen, S.G., S. Oberg, and J. Rosenberg, Treatment of longstanding groin pain: a systematic review. Hernia, 2019.
    11. Kohavi, B., et al., Effectiveness of Field-Based Resistance Training Protocols on Hip Muscle Strength Among Young Elite Football Players. Clin J Sport Med, 2018.
    12. Lim, H.Y. and S.H. Wong, Effects of isometric, eccentric, or heavy slow resistance exercises on pain and function in individuals with patellar tendinopathy: A systematic review. Physiother Res Int, 2018. 23(4): p. e1721.
    13. Machotka, Z., S. Kumar, and L.G. Perraton, A systematic review of the literature on the effectiveness of exercise therapy for groin pain in athletes. Sports Med Arthrosc Rehabil Ther Technol, 2009. 1(1): p. 5.
    14. Magnusson, S.P., H. Langberg, and M. Kjaer, The pathogenesis of tendinopathy: balancing the response to loading. Nat Rev Rheumatol, 2010. 6(5): p. 262-8.
    15. Rio, E., et al., Tendon neuroplastic training: changing the way we think about tendon rehabilitation: a narrative review. British Journal of Sports Medicine, 2016. 50(4): p. 209.
    16. Thorborg, K., et al., The Copenhagen Hip and Groin Outcome Score (HAGOS): development and validation according to the COSMIN checklist. Br J Sports Med, 2011. 45(6): p. 478-91.
    17. Wei, A.S., et al., The effect of corticosteroid on collagen expression in injured rotator cuff tendon. The Journal of bone and joint surgery. American volume, 2006. 88(6): p. 1331-1338.

    Kicking Goals! Praxis looks at AFL kicking mechanics

    by | May 24, 2019 | Return to Sport, Sport, Team Praxis

    KICKING

    As per usual the Praxis team delved into an area of clinical interest to better understand the demands of our athletes. Last session we discussed throwing technique which you can read about here.

    SUMMARY

    • There are differences in kicking techniques when accuracy or distance is the focus.
    • More accurate kickers had tended to be more “head over the ball” with significantly:
    • greater hip flexion in both limbs
    • greater knee flexion in the support limb throughout the kicking movement and greater anterior pelvic tilt at heel contact
    • Longer kick distances were associated with:
    • greater foot speeds and shank angular velocities at ball contact,
    • larger last step lengths, and
    • greater distances from the ground when ball contact occurred.
    • To increase kicking distance:
    • increasing foot speed and shank angular velocity at ball contact, increasing the last step length, and
    • optimising ball position relative to the ground and support foot are recommended.
    • Injuries to the quadriceps are often associated with kicking

    Given our longstanding association with AFL clubs around Brisbane, this week we looked at kicking kinematics (joint angles and relationships) with respect to both accurate and long kicks. Further, we discussed how to best rehab someone with a kicking based injury and helping them return to their chosen kicking sport (AFL, Rugby, Soccer, Gridiron etc).

    ACCURACY:

    The first paper we looked at was from Dichiera and colleagues (2006). Their study involved kicking an AFL football 15m at a target. They found that accurate kickers focussed more on larger hip flexion, anterior tilt and stance leg knee flexion. This best can be described as a “head over the football” approach.

    They hypothesise that knee flexion is an important limb length adjustment mechanism which lowers the centre of gravity. During kicking, an increased stance leg knee bend would lower the centre of gravity somewhat throughout the movement. Lowering the centre of gravity is one way of increasing the stability of the body, a principle which is emphasised in many other areas in sports biomechanics.

    DISTANCE:

    Kicking for distance was associated with greater foot speeds and shank angular velocities at ball contact, larger last step lengths, and greater distances from the ground when ball contact occurred in a study performed by Ball (2008). This was more of a “lean back” strategy utilised by the kickers. Knee angular velocity at ball contact was measured at almost 1400 degrees per second! That kind of speed understandably places the knee extensors (i.e the quadriceps) at greatest risk for kicking injuries.

    Ball (2008) outlined some basic coaching instructions to guide those seeking larger distances in their kicks. He suggested:

    • increasing foot speed and shank angular velocity at ball contact by increasing approach speed such that the hip of the kick leg is moving faster towards the target during the last step.
    • increasing the last step length but this step should be proportional to approach speed as over-striding is likely to be detrimental to the kick
    • Optimising ball position relative to the ground and support foot was also recommended though contact too high may result in a high kick, not a long kick.

    From a physiotherapy perspective, we discussed:

    • Players have adequate hip extension range as to not to not overload lumbar spine and hip extensors (e.g hamstrings) especially in the presence of larger running and sprinting volumes typical in AFL and soccer
    • Hip flexor strengthening to improve the drive of swing leg through the kick and running
    • How to best reintegrate an athlete who sustained an injury whilst kicking back to full training and competition
    • Preventative exercise such as jump lunges and reverse nordics for quadriceps tissue resilience
    • How lumbopelvic control can help a kicker with both accuracy and distance

    In summary, another Brisbane winter’s morning was successfully utilised by the Praxis team. We hope you enjoyed the read! For any injuries that you or your teammates need assessed and sorted fast, contact us.

    Until next time, continue to Praxis What You Preach

    – Team Praxis

    ​Prevent. Prepare. Perform.

    References:

    1. Dichiera, A., Webster, K. E., Kuilboer, L., Morris, M. E., Bach, T. M., & Feller, J. A. (2006). Kinematic patterns associated with accuracy of the drop punt kick in Australian Football. Journal of Science and Medicine in Sport, 9(4), 292-298.
    2. Ball, K. (2008). Biomechanical considerations of distance kicking in Australian Rules football. Sports Biomechanics, 7(1), 10-23.