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

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

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

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

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

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

First — It’s Not Really “Inflammation”

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

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

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

Degenerative tendon problems do not.

What’s Actually Happening?

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

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

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

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

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

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

Without mechanical stimulus:

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

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

Natural History: Does It Just Go Away?

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

However, that doesn’t mean:

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

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

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

So while time helps, structured intervention helps more.

What About Cortisone Injections?

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

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

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

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

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

A 2021 systematic review of systematic reviews concluded:

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

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

Why Might Cortisone Underperform Long Term?

Corticosteroids:

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

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

What About PRP?

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

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

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

When compared directly to corticosteroid injections:

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

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

Important Caveats

PRP:

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

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

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

So What Actually Works Best?

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

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

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

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

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

Effective rehab addresses:

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

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

Why It Takes Time

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

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

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

Add to that:

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

And recovery timelines extend further.

The Takeaway

Tennis elbow takes time because:

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

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

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

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

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

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

Until next time, Praxis What You Preach…

📍 Clinics in Teneriffe, Buranda, and Carseldine

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

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

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

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

Overview

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

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

Week-by-Week ACL Rehab Milestones

Prehab: Starting Strong Before Surgery

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

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

Weeks 0–2: Pain, Protection, and Range

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

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

Weeks 2–6: Regain Motion and Begin Strength

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

Checkpoint: Full ROM with independent walking and neuromuscular control.

Weeks 6–12: Strength Foundation

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

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

Weeks 12–20: Power and Plyometric Preparation

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

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

Weeks 20–36: Agility and Functional Sport Movements

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

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

Months 9–12: Return-to-Sport Preparation

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

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

Practical Insights for Patients

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

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

Why Brisbane Athletes Choose Praxis Physiotherapy

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

Conclusion

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

Until next time – Praxis What You Preach

📍 Clinics in Teneriffe, Buranda, and Carseldine

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

References

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

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

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

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

Understanding Rotator Cuff Pain in Active Populations

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

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

Tailored Treatment Backed by Clinical Evidence

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

Key strategies include:

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

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

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

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

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

The Evidence on Rehabilitation & Prognosis

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

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

Return to Sport: Measured, Not Rushed

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

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

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

Prevention: Not an Afterthought

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

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

Conclusion

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

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

📍 Clinics in Teneriffe, Buranda, and Carseldine

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

References

  1. Desmeules, F. et al. (2025). Rotator Cuff Tendinopathy: Diagnosis, Nonsurgical Medical Care, and Rehabilitation: A Clinical Practice Guideline. Journal of Orthopaedic & Sports Physical Therapy, 55(4), 235–274.
  2. Wilk, K.E. et al. (2009). Shoulder Injuries in the Overhead Athlete. Journal of Orthopaedic & Sports Physical Therapy, 39(2), 38–54.
  3. Cools, A.M. et al. (2021). The Challenge of the Sporting Shoulder: From Injury Prevention Through Sport-Specific Rehabilitation Toward Return to Play. Annals of Physical and Rehabilitation Medicine, 64, 101384.
  4. Chester, R. et al. (2013). Predicting Response to Physiotherapy for Musculoskeletal Shoulder Pain: A Systematic Review. BMC Musculoskeletal Disorders, 14, 203.
  5. Liaghat, B. et al. (2023). Diagnosis, Prevention, and Treatment of Common Shoulder Injuries in Sport: Grading the Evidence. British Journal of Sports Medicine, 57, 408–416.
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.

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. Book with us today!

If you’re interested in how stress fractures affect other athletes — like fast bowlers in cricket — read more 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

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.

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.

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.

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.

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.

Shoulder Stabilisation and Bankart Repair: Your Path Back to Sport

Shoulder Stabilisation and Bankart Repair: Your Path Back to Sport

by | May 1, 2025 | Return to Sport, Shoulder, Sports Injury, Surgery

Recovering from a shoulder stabilisation surgery, particularly a Bankart repair, can feel like navigating a winding trail. At Praxis Physiotherapy, we understand that athletes don’t just want to heal – they want to return stronger, more confident, and ready for action. This blog explores the key milestones in overhead and contact sport rehabilitation and the compelling evidence that supports structured physiotherapy.

Understanding Shoulder Stabilisation and Bankart Repair

The Bankart repair is a surgical intervention for traumatic anterior shoulder dislocations, which are most common in young, active populations – particularly those involved in contact or overhead sports. This procedure reattaches the torn labrum to the glenoid, restoring joint stability. While the surgery addresses structural instability, it is only the first step. Rehabilitating the shoulder to perform under high-stress, dynamic sporting conditions is where physiotherapy becomes crucial (Coyle et al., 2022).

 

Rehabilitation Phases: Beyond the Basics

Rehabilitation after Bankart repair generally progresses through four overlapping phases:

1. Protection & Early Mobility (0–6 weeks)

Initial goals include reducing pain and inflammation while protecting the repair. Gentle passive and assisted range-of-motion exercises begin, with sling use gradually tapered.

2. Strength Building (6–12 weeks)

Isometric and light resistance training begins. Scapular control and rotator cuff strengthening are vital. Coyle et al. (2022) found wide variability in when strengthening begins, from 1 to 12 weeks, underscoring the importance of tailored plans.

3. Advanced Control & Load Tolerance (12–20 weeks)

This phase introduces overhead activity simulation, plyometrics, and proprioceptive drills. Neuromuscular training improves shoulder resilience, especially under rapid direction changes and contact stress (Ialenti et al., 2017).

4. Return to Sport (20+ weeks)

Athletes progressively re-engage in sport-specific drills, initially non-contact, then full-contact scenarios. Full return to competitive play often occurs around 5–6 months, but timelines vary based on sport demands (Kasik et al., 2019).

 

The Evidence: Why Physiotherapy Matters

  • A systematic review by Rossi et al. (2021) revealed that 27% of athletes failed to return to sport post-surgery. Most cited fear of reinjury, not physical limitation, as the main barrier. Targeted rehab can address both physical readiness and confidence.
  • Kim et al. (2023) showed that factors such as shoulder strength, proprioception, and psychological readiness were predictive of successful return. Structured physiotherapy addresses all three.
  • The American Journal of Sports Medicine confirms that progressive loading, especially for overhead and contact tasks, enhances long-term outcomes and reduces recurrence rates (Kim et al., 2023).
  • Alsomali et al. (2021) and Stone & Pearsall (2014) agree that sport-specific milestones are crucial, with a general return-to-contact timeline of 16–24 weeks depending on the sport.

Back in the Game: What Sets Our Approach Apart

At Praxis Physiotherapy, our shoulder rehabilitation programs don’t just follow protocols – they evolve with the athlete. We incorporate evidence-based practices and tailor each phase to your sport, position, and performance goals. Whether you’re a rugby forward or a volleyball setter, our rehab plan adapts to your demands.

We emphasise:

  • Early and progressive exposure to overhead mechanics
  • Integrated neuromuscular training for dynamic stability
  • Gradual and safe return-to-contact drills
  • Psychological readiness assessments to overcome fear of reinjury

 

Summary Timeline for Return to Sport

PhaseTimeframeFocus
Protection & Early Mobility0–6 weeksPain control, protected motion
Strength & Motor Control6–12 weeksRotator cuff & scapular strengthening
Overhead & Contact Prep12–20 weeksPlyometrics, proprioception, advanced drills
Return to Sport20–26+ weeksGradual return to contact and full intensity

Final Thoughts: Your Comeback Starts with the Right Team

Recovering from shoulder stabilisation surgery is not just about healing – it’s about coming back better. Evidence clearly shows that structured, progressive physiotherapy is essential for returning to sport safely and confidently.

At Praxis Physiotherapy, we’re here to guide that journey every step of the way. If you are ready to get started, book online today.

Until next time, Praxis What You Preach…

📍 Clinics in Teneriffe, Buranda, and Carseldine

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

References
  • Coyle, M., Jaggi, A., Weatherburn, L., Daniell, H., & Chester, R. (2022). Post-operative rehabilitation following traumatic anterior shoulder dislocation: A systematic scoping review. Shoulder & Elbow, 15(5), 554–565.
  • Ialenti, M. N., Mulvihill, J. D., Feinstein, M., Zhang, A. L., & Feeley, B. T. (2017). Return to play following shoulder stabilization: A systematic review and meta-analysis. Orthopaedic Journal of Sports Medicine, 5(9)
  • Kasik, C. S., Rosen, M. R., Saper, M. G., & Zondervan, R. L. (2019). High rate of return to sport in adolescent athletes following anterior shoulder stabilisation: A systematic review. Journal of ISAKOS, 4(1), 43–50.
  • Kim, M., Haratian, A., Fathi, A., Kim, D. R., Patel, N., Bolia, I. K., … & Weber, A. E. (2023). Can we identify why athletes fail to return to sports after arthroscopic Bankart repair? A systematic review and meta-analysis. The American Journal of Sports Medicine, 51(9), 2480–2486.
  • Rossi, L. A., Tanoira, I., Brandariz, R., Pasqualini, I., & Ranalletta, M. (2021). Reasons why athletes do not return to sports after arthroscopic Bankart repair: A comparative study of 208 athletes with minimum 2-year follow-up. Orthopaedic Journal of Sports Medicine, 9(7)
  • Alsomali, K., Kholinne, E., Nguyen, T. V., Cho, C.-H., Kwak, J.-M., Koh, K.-H., & Jeon, I.-H. (2021). Outcomes and return to sport and work after open Bankart repair for recurrent shoulder instability: A systematic review. Orthopaedic Journal of Sports Medicine, 9(10)
  • Stone, G. P., & Pearsall, A. W. (2014). Return to play after open Bankart repair: A systematic review. Orthopaedic Journal of Sports Medicine, 2(2),
Jumper’s Knee (Patellar Tendinopathy)

Jumper’s Knee (Patellar Tendinopathy)

by | May 17, 2022 | Knee, Return to Sport, Sports Injury, Tendon

Do you play a jumping sport such as volleyball, basketball or AFL? Have pain in the front of your knee when jumping, landing or changing direction? Have you lost some jumping power recently? Well read on friends as you may have a grumbly knee tendon.

Summary:

  • Patellar tendinopathy is summarised clinically as pain and dysfunction in the patellar tendon
  • Most commonly affects jumping athletes from adolescence to early middle age.
  • Return to sport can be slow with physio useful as a front line management tool
  • Often requires prolonged rehabilitation centred around education, strength training and load management

Jumper’s knee (or patellar tendinopathy) as its name suggest predominantly affects athletes who engage in sports which require large volumes of jumping. Jumping dynamically loads the knee and places large loads on the patellar tendons due the large and repeated requirements of the thigh muscles (quadriceps). These include sports that require repeat jump / landing efforts and/or high volumes of load during training and competition. Elite adolescent male athletes tend to be at a higher risk, especially if you play volleyball.

Mid Potion Achilles Tendinopathy Location

Like most injuries, patellar tendinopathy reflects an overload of the tissue and a failed healing response. Tendons tend to most susceptible to long periods of dynamic loading given their role in storing and releasing energy like a spring. The stiffer the spring, the more effective the spring and the more punishment it can take before the function deteriorates.

This injury is one that can be mild or moderate in nature and as such allow playing to some degree. As such, player’s tend to not to miss a lot of games like more “traditional” injuries such as ankle sprains or hamstring tears. It can typically slowly present and have a “warm up phenomena” (as in it can get better during a game), however aches after activity and the next morning. The pain is often at the very bottom of the knee cap, and on the space between the kneecap and the top of the shin bone where the tendon lies.

Key management strategies include ensuring the correct diagnosis and an understanding of tendon pathology (for more on tendon pathology, check out this blog). From there, pain management strategies and workload management is a key tenant to rehabilitation. Above and beyond workload management and good patient education, we at Praxis Physio also test the strength and range of the hip, knee and ankle musculature as well as jumping / landing biomechanics to understand where the likely reasons are for your knee pain.

After a comprehensive assessment, targeted and graduated strengthening is provided. The premise of these early phases are to reduce pain, improve strength, improve function, increase power (specifically the energy storage potential of the tendon) then finally sports specific training and management on symptoms.

As someone who has had an 18 month history of patellar tendinopathy, I personally can attest to the frustration this injury provides. I made many mistakes along my rehabilitation journey – though this was before I was a physiotherapist and took a clinical interest in tendinopathies. Thankfully, the research has come a long way in the last decade, so if you are having ongoing knee pain that you suspect is jumper’s knee, book in with us so we can get you jumping back to your best.

Until next time, Praxis What You Preach…

📍 Clinics in Teneriffe, Buranda, and Carseldine

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