Musculoskeletal Injuries

ACL Tear/Rupture

“ACL” refers to the Anterior Cruciate Ligament within the knee joint. It is located behind the kneecap and acts to provide stability to the knee whilst moving and pivoting.  An ACL injury occurs when the femur (Thigh bone) moves forward in relation to the rest of the joint, causing the ACL to overstretch and tear.ACL injuries occur more often in non-contact accidents whereby the person is pivoting, decelerating or landing from a jump yet can also occur when someone or something falls onto the knee.

Although the occurrence of ACL injuries is vast, this often devastating injury is largely preventable with muscular and neuromuscular exercise training.

ACL Injury Treatment

Once the injury is established, the first (and often only) treatment strategy considered is surgical ACL repair. This involves repair of reconstructing the ACL with a graft to provide stability for the knee.With the incidence of surgical reconstructions and revisions (Secondary ACL surgeries) in Australia being amongst the highest in the world and lead studies finding no significant difference in reported outcomes between surgery and conservative (Exercise) treatment, it is high time for considering exercise as the first treatment strategy. This treatment involves gradual progression through evidence based flexibility, balance and strength exercises with an objective of returning to pre-injury function. This has been shown to not only successfully provide stability for the knee, but also allow reconnection of ACL tissue in some cases. It has also been repeatedly proven to improve surgical outcomes. Therefore if function is not achieved with conservative treatment it has increased your chances for success with surgical treatment, making for perfect pre-operative preparation and minimising recovery times.

Medial Epicondylitis (Golfer’s Elbow)

Medial Epicondylitis (often referred to as “Golfers elbow”) is a common overuse injury of the forearm soft tissue causing pain, discomfort and/or inflammation on the medial (inside) of the elbow and forearm.

Medial Epicondylitis is characterised as an overuse injury rather than an impact condition. Continuous movement (specifically gripping and rotation) of the forearm can cause microscopic tears in the tissue leading to inflammation and pain. Although it has earned its colloquial title from the sport this injury is not limited to Golfer’s, In fact 95% of individuals who are diagnosed with medial epicondylitis haven’t ever picked up a club.

Symptoms of Medial Epicondylitis include:
– Pain or swelling on the inside of elbow and wrist
– Pain when grasping or gripping objects
– Stiffness/soreness when straightening your arm
– Pain when rotating the forearm or wrist
Symptoms can be acute or have a delayed onset and range from mild discomfort to pain and avoidance of function if not treated correctly.

Golfer’s Elbow Treatment

Practical treatments of medial epicondylitis include range of motion and strengthening protocols for the wrist and forearm extensors (particularly for the extensor carpi radialis brevis). Current research indicates that progressive, incremental strengthening regimes are an effective treatment tool for increasing pain free function and mitigating the progression of the condition.
Individuals who engage in active rehabilitation early are often able to return to function with minimal discomfort within two weeks. If the condition is not conservatively managed early, alternative treatment modalities can be used with severe cases such as steroidal injections, autologous blood injections and surgery.

Lateral Epicondylalgia (Tennis Elbow)

Lateral Epicondylalgia (often referred to as “Tennis Elbow”) is a common overuse injury of the forearm soft tissue causing pain, discomfort and/or inflammation on the lateral (inside) of the elbow and forearm.

Lateral Epicondylalgia is characterised as an overuse injury rather than an impact condition. Continuous movement (specifically gripping and rotation) of the forearm can cause microscopic tears in the tissue leading to inflammation and pain. It can also occur due to a current increase in load, or use of your forearm above and beyond your normal amount of activity. Although it has earned its colloquial title from the sport this injury is not limited to tennis players. In fact, more than 95% of individuals who are diagnosed with lateral epicondylalgia haven’t ever picked up a racket.
Symptoms of Lateral Epicondylalgia include:

– Pain or swelling on the outside of the elbow and wrist
– Pain when grasping or gripping objects
– Stiffness/soreness when straightening and bending your arm
– Pain when rotating the forearm or wrist, such as opening jars and doors

Symptoms can be acute or have a delayed onset and range from mild discomfort to severe pain and avoidance of function if not treated correctly.

Tennis Elbow Treatment

Practical treatments of lateral epicondylalgia include range of motion and strengthening protocols for the wrist and forearm extensors (particularly for the extensor carpi radialis brevis). Current research indicates that progressive, incremental strengthening regimes are an effective treatment tool for increasing pain free function and mitigating the progression of the condition.
Individuals who engage in active rehabilitation early are often able to return to function with minimal discomfort within two weeks. However, it is worth noting that pain may persist for some time afterwards. If the condition is not conservatively managed early, alternative treatment modalities can be used with severe cases such as steroidal injections, autologous blood injections and surgery but current research states this should be avoided for at least 12 weeks.

Patellofemoral Pain Syndrome (Runner’s Knee)

Patellofemoral Pain Syndrome (often referred to as “Runner’s Knee”) is a common overuse injury of the knee soft tissue causing pain, discomfort and/or inflammation about the patella or kneecap.

Patellofemoral Pain Syndrome is characterised as an overuse injury rather than an impact condition. Normal daily tasks such as running, walking, climbing up and down stairs / hills, as well as squatting become painful with Patellofemoral Pain Syndrome. It typically occurs after a sudden increase in load, or use of your legs above and beyond your normal amount of activity. Although it has earned its colloquial title from the sport this injury is not limited to runners and can occur even with a sudden increase in walking or gym activities.
The pain develops typically due to an imbalance between the muscles of the hips and thighs which move the knee and kneecap, resulting in a shift in the direction the kneecap moves during bending and straightening of the knee. Usually your kneecap slides in a groove created between your thigh and shin bone at the knee joint with no issues. When it is “grumpy” due to a sudden change in your physical activity levels, the kneecap no longer slides smoothly causing pain and discomfort.
Symptoms of Lateral Epicondylalgia include:

– Pain or swelling about your kneecap which can extend to the sides or even back of your knee
– Pain when squatting, walking, running, jumping, navigating stairs and hills
– Stiffness/soreness when straightening and bending your knee
– Pain and/or stiffness/tightness in your thighs and hips

Symptoms usually occur only with the above movements, typically disappearing as quickly as they start. They can be acute or have a delayed onset and range from mild discomfort to severe pain and avoidance of function if not treated correctly.

Patellofemoral Pain Treatment

Practical treatments of Patellofemoral Pain Syndrome include range of motion, flexibility and strengthening protocols for the surrounding muscles, including the gluteals, hamstrings, quadriceps and calves. Current research indicates that progressive, incremental strengthening regimes are an effective treatment tool for increasing pain free function and mitigating the progression of the condition.
Individuals who engage in active rehabilitation early are often able to return to function with minimal discomfort within 1-2 months. However, it is worth noting that pain may persist for some time afterwards. The current consensus for the best treatment method is a combination of exercise therapy, manual therapy, taping and foot orthotics. Surgery will not fix this condition. The general time taken to get better ranges from 2 weeks to 3-4 months depending on the case.

Achilles Tendinopathy

Achilles Tendinopathy is a common overuse injury of the Achilles tendon causing pain, discomfort and/or inflammation about your tendon and heel.
 
Achilles Tendinopathy occurs when there has been a spike in the amount of exercise or physical activity you are doing. This tends to occur after a layoff and sudden return to exercise, such as in middle-aged people, or in physically active people who have suddenly upped the ante in their exercise routine. It occurs in sports/exercise with repetitive jumping or running, overusing the tissues leading to inflammation and pain.

It can also occur due to:

  • Change in training surface
  • Lack of training variation
  • Incorrect footwear
  • Excessive intensity or distance increase

Symptoms of Achilles Tendinopathy include:

– Pain or swelling on the bottom portion of your Achilles into your heel
– Pain with walking, running, jumping or steps
– Stiffness/soreness when straightening and bending your ankle
– Pain worse at night and/or first thing in the morning

Symptoms can be acute or have a delayed onset, ranging from mild discomfort to severe pain and avoidance of function, lasting for years if not treated correctly.

Achilles Tendinopathy Treatment

Practical treatments of Achilles Tendinopathy include range of motion and strengthening protocols for the ankle, calf and leg muscles. Current research indicates that progressive, incremental strengthening regimes are an effective treatment tool for increasing pain free function, enabling a return to your job, sport or recreation activities.

You should be able to make a return to these within 2-4 weeks depending on the severity. You will then be able to perform at your fullest with time over the next few months or so. However, your pain may continue for a while then though you are able to function at a much higher level than before.

The addition of manual therapy has also shown to assist with pain relief to help you return to the painful tasks quicker.

If the condition is not conservatively managed early, alternative treatment modalities can be used with severe cases such as steroidal injections and autologous blood injections but current research states this should be avoided for at least 12 weeks.

Ankle Sprain

An ankle sprain, also known as a rolled ankle or twisted ankle, is a very common injury, often arising from playing sport. A Rolled Ankle occurs when your ankle is forced beyond its normal range of motion resulting in an injury to the surrounding ligaments. The most common ligaments injured are the ones on the outside of your ankle. These are injured with a force that causes your ankle to roll inwards where your body then ‘goes over’ it.

Ankle injuries are often considered trivial injuries which will get better without any effort but this is not the case. Australian research has shown around one third of ankle sprains become chronic up to seven years after the injury (Anandacoomarasamy & Barnsley, 2005).**

Common causes of a Rolled Ankle include:

  • Playing sports that involve jumping, running, twisting, changing of direction or pivoting movements
  • Uneven surfaces
  • Wearing inappropriate footwear for the task
  • Previous ankle injuries
  • Poor physical condition such as poor overall fitness, being overweight, and reduced ankle strength and flexibility

Symptoms of a Rolled Ankle include:

  • Pain with placing your weight onto the ankle and with walking
  • Tenderness to touch
  • Ankle stiffness
  • Bruising
  • A popping or cracking sound at the time of injury
  • Poor balance and feeling instability about the ankle

There are three types of Rolled Ankles:

  • Grade I: only a few ligament fibres are torn – often return to sport within 2-4 weeks
  • Grade II: less than 50% of ligament fibres are torn – often return to sport within 8 weeks
  • Grade III: a complete tear of the ligament – often return to sport about 12 weeks

Ankle Sprain Treatment

Rolled Ankle injury treatment is split between acute and later stages management.

Acute management involves following the acronym PEACE. This stands for Protect, Elevate, Avoid Anti-Inflammatories, Compression and Ice, and Education (from the health professional). Basically, avoid activities that worsen your pain, do the activities that you can and rest from ones you can’t, and then elevate, compress and ice the ankle when resting. Pain medication may help too.

After a few days of the above, you can then give your ankle LOVE. This stands for Load, Optimism, Vascularisation and Exercise. Basically, resume normal activities as much as possible based off of your symptoms, maintain a positive outlook and begin a strengthening, mobility and balance exercise program under the supervision of a health professional.

Doing the above should ensure you do not have ongoing issues in the years to come. In fact, engaging in the above often results in people returning to normal activities within a couple of weeks (if it is a grade I injury)

Neck Pain

Neck Pain is one of the most common injuries as it is one of the most moveable parts of our body, allowing us to rotate our head both ways as well as look up and down. Most causes of neck pain are benign with the most common type of injuries being a muscle strain or spasm, or a minor sprain of one of the 21 joints in the neck.

Other common causes of neck pain include nerve compression, arthritis causing a stiff neck, whiplash and wry neck. Whiplash is a form of neck pain that occurs typically after a motor vehicle accident where the sudden stop causes a whipping motion to your neck. Fractures can also occur.

Symptoms may vary depending on the cause of your neck pain. These include:

  • Pain and/or pins and needles/numbness/tingling in your neck, down your arm and shoulder blade
  • Pain and/or difficulty with rotating your head, looking up and/or down
  • Tenderness to touch about the neck muscles
  • Neck stiffness
  • Headaches

Occasionally you can also have dizziness, light-headedness, nausea, blurred vision, and jaw pain.

Neck Pain Treatment

Neck Pain treatment depends upon the issue causing the pain. Acute neck pain often gets better within a few days to 4-6 weeks. If nerve compression occurs then this can take up to 12+ weeks to get better.

General treatment involves being screened for any fractures or emergencies, followed by pain relief and exercises. Pain relief is achieved via manual therapy from a physiotherapist, pain medication and early gentle mobility/strength exercises. As your symptoms subside and function improves, a progressive exercise program will get you back to your previous levels of health and function.

Unless an emergency, surgery should be avoided in the first instance as the vast majority of neck pain can get better with the above approach. Surgery and injections may be of benefit with time if the above approach is proven to be ineffective beyond 12 weeks of pain and loss of function.

To discuss musculoskeletal injuries or treatment in more detail, book a consult and discuss treatment options by booking below or filling out the “We’ll call you” section.