Author: Michael Ranger

Overuse injuries are a common type of injury that can occur when you overuse a muscle, tendon, or joint. They can be caused by repetitive movements, such as running, typing, or playing sports. Overuse injuries can be painful and debilitating, but they are often treatable with physiotherapy.

Physiotherapy can help to treat overuse injuries by:

• Reducing pain and inflammation
• Promoting healing
• Strengthening muscles and tendons
• Improving flexibility and range of motion
• Teaching you how to move and exercise safely
• Helping you to return to your daily activities and sports

Physiotherapists can also help you to identify and address the underlying causes of your overuse injury, such as poor posture, muscle imbalances, or improper training techniques. This can help to prevent your injury from recurring in the future.

How physiotherapy works for overuse injuries

Physiotherapy for overuse injuries typically involves a combination of different treatments, such as:

• Manual therapy: Manual therapy techniques, such as massage and joint mobilization, can help to reduce pain and inflammation, improve range of motion, and promote healing.
• Exercise therapy: Exercise therapy is an important part of treating overuse injuries. Exercises can help to strengthen muscles and tendons, improve flexibility, and retrain your body to move correctly.
• Education: Physiotherapists can also teach you about your injury and how to prevent it from recurring. They can also give you advice on how to modify your activities to avoid aggravating your injury.

Research on the effectiveness of physiotherapy for overuse injuries

There is a growing body of research that supports the effectiveness of physiotherapy for overuse injuries. For example, a 2013 study published in the British Journal of Sports Medicine found that physiotherapy was more effective than rest alone in reducing pain and improving function in people with Achilles tendinitis.

Another study, published in the Journal of Orthopaedic & Sports Physical Therapy in 2016, found that physiotherapy was effective in reducing pain and improving function in people with rotator cuff tendinitis.

When to see a physiotherapist for an overuse injury

If you have an overuse injury, it is important to see a physiotherapist as soon as possible. Early treatment can help to reduce the severity of your injury and speed up your recovery.

You should also see a physiotherapist if:

• Your pain is severe or does not improve with rest and over-the-counter pain relievers
• You have difficulty performing your daily activities or sports
• You have any swelling or redness in the injured area
• You have any numbness or tingling in the injured area
• Your injury recurs after you have tried to treat it yourself

Physiotherapy is an effective treatment for overuse injuries. It can help to reduce pain and inflammation, promote healing, and strengthen muscles and tendons. Physiotherapists can also teach you how to move and exercise safely, and help you to return to your daily activities and sports.

If you have an overuse injury, it is important to see a physiotherapist as soon as possible for early treatment.

https://www.sciencedirect.com/science/article/pii/S2095254620301526

Exercise is one of the best things you can do for your mental health. It has been shown to reduce stress, anxiety, and depression, improve mood, and boost self-esteem. Exercise can also help you sleep better and have more energy.

How does exercise improve mental health?

There are a number of ways that exercise improves mental health. One way is by releasing endorphins. Endorphins are hormones that have mood-boosting effects. Exercise can also help to reduce stress hormones, such as cortisol.

Another way that exercise improves mental health is by distracting you from negative thoughts. When you are focused on your workout, you are less likely to be dwelling on negative things. Exercise can also help to improve your self-esteem. When you achieve fitness goals, you feel good about yourself and your accomplishments.

What types of exercise are best for mental health?

All types of exercise are beneficial for mental health, but some types of exercise may be more beneficial than others. Aerobic exercise, such as running, swimming, and biking, is particularly good for reducing stress and anxiety. Aerobic exercise also increases endorphin production.

Strength training is another type of exercise that is good for mental health. Strength training can help to improve your self-esteem and body image. It can also help to reduce stress and anxiety.

Yoga and Pilates are also good types of exercise for mental health. Yoga and Pilates can help to improve your flexibility, balance, and strength. They can also help to reduce stress and anxiety.

How much exercise do I need to improve my mental health?

The Centers for Disease Control and Prevention (CDC) recommends that adults get at least 150 minutes of moderate-intensity aerobic activity or 75 minutes of vigorous-intensity aerobic activity each week. They also recommend that adults do muscle-strengthening activities that work all major muscle groups (legs, hips, back, abdomen, chest, shoulders, and arms) on two or more days a week.

However, even small amounts of exercise can have a positive impact on your mental health. If you are new to exercise, start slowly and gradually increase the amount of time you spend exercising each week.

Tips for getting started with exercise

If you are new to exercise, here are a few tips to get you started:

• Start slowly and gradually increase the amount of time you spend exercising each week.
• Choose activities that you enjoy and that fit into your lifestyle.
• Find an exercise buddy or join a fitness class to help you stay motivated.
• Set realistic goals.
• Listen to your body and take breaks when needed.

Here are some additional tips for making exercise a part of your daily routine:

• Schedule exercise time into your day just like you would any other important appointment.
• Exercise with a friend or family member to make it more fun and social.
• Find an activity that you can do indoors or outdoors, so that you can exercise no matter what the weather is like.
• Reward yourself for exercising regularly.

Exercise is a great way to improve your mental health. It is important to find activities that you enjoy and that fit into your lifestyle. Even small amounts of exercise can have a positive impact on your mood, stress levels, and overall well-being.

file:///C:/Users/foots/Downloads/10.4324_9780203780749_previewpdf.pdf

https://www.research.ed.ac.uk/files/27771965/PA_mechanisms_review_Pediatrics_Resubmission_.pdf

https://d1wqtxts1xzle7.cloudfront.net/80971255/download-libre.pdf?1645109312=&response-content-disposition=inline%3B+filename%3DPhysical_Activity_Interventions_Effects.pdf&Expires=1698282932&Signature=SRN4r~Ph5mzk53vxFFUI2XwodQFMBXwvUkR23rbEx51-81CzbiGPqKDtgpzqZdx0urzP1Wv4RP1LuDBE6Q1EuSIp25HjKH~Um5inoQEmWExKL4zoBKUvG51CjeWKieQ6WyrasVpkSh-yS-kpdULutVtwmE5N9wYdE2RKENQOn-GtgR2tg-zTDDHdnJVGInrGTUwmE7LH0-K7kp~YVamJInHGAfuml~aAzegVbGn8UrxRbQ1QvFYgntq6EzsnPbr0M0CVCfJGVeftT6kMKfUzhOnAtgq2D7azuEGTn4Deu8K~RGpuYdwNXwEcUQgu~Ujodw5DNfIglXMsPX5EOOEr1Q__&Key-Pair-Id=APKAJLOHF5GGSLRBV4ZA

Conservative ACL rupture management – A review – Matthew Delaney

A newly published study from Filbay et al (2023) shows promising results with the use of the
cross bracing protocol (CBP) after ACL injury. The aim of the study was to assess MRI
evidence of ACL healing, patient reported outcomes and knee laxity in individuals after ACL
rupture managed with the CBP.

The study included 80 participants of which 72% showed evidence of ACL healing at the 3
month MRI after completing the CBP as well as improved patient reported outcome
measures. Combined with the results of the KANON trial we see that these patients with
ACL healing on scan have better knee function and quality of life than those managed non-
operatively with ACL discontinuity. Further to this the study noted return to sport rates that
are higher that some studies with ACL reconstructed individuals 74% compared to 55% at
the 12 month mark.

It is important to consider that as part of this study individuals were excluded if they had
any concomitant injuries that require surgery (eg: bucket handle meniscus tear) or had a
history of DVT due to the period of immobilisation in the protocol. Of those individuals that
had minor meniscus injuries 98% of them had symptomatic resolution after the bracing
protocol.

The authors did note that though favourable outcomes were shown further research is
needed to investigate whether the characteristics of the ACL rupture observed on MRI is
associated with the likelihood of ACL healing. Factors such as partial or complete femoral
avulsion, the displacement distance of the ACL outside the intercondylar notch and the gap
distance between the ruptured ACL stumps may affect the healing process.

It’s also Important to consider the bracing protocol itself. The has been published along
with the study. The first four weeks of the bracing protocol are non-weight bearing and your
knee is locked in 90° from there the range of motion and weight bearing capacity are
gradually increased over a further eight weeks whereby you are able to take the brace off at
the 13 week mark. Depending on individuals’ lifestyles and ability to adhere to non-weight-
bearing and brace wearing this may affect personal decision-making.

This study shows promising results for ACL healing in appropriate circumstances. The further
research suggested for your study will indicate whether or not this will be applicable in the
long-term for non-operative management of ACL tears.

See below to read the full study
CBP Protocol for ACL rupture

If you need help with your ACL rehabilitation get in contact with us today!

A recently published article from the British Journal of Sports Medicine discusses
rehabilitation after ACL reconstruction. A systematic review of the 140 studies was
conducted and then clinical guidelines are made via expert consensus with a panel of 9
practioners. The review is aimed to be utilised by physiotherapists during the rehabilitation
of clients after ACL reconstruction.
The review is broken into 5 categories summarised by the infographic below:

Timing and Structure
– Preoperative rehabilitation may improve post-op outcomes such as quads strength
and knee range of motion. A visit to your physiotherapist is recommended prior to
your surgery.
– Both supervised and unsupervised exercise programs can be suitable provided the
patient has access to appropriate equipment and is motivated. All programs should
be individualised.
– Functional criteria should be used to progress rehabilitation whilst being mindful of
graft healing timeframes.
Modalities
– Cryotherapy is inexpensive, low risk and demonstrates high levels of patient
satisfaction in early stage post-op.
– Neuromuscular electrical stimulation can be used in the very early phase post-op to
increase muscle activation and reduce disuse atrophy.

– Blood flow restriction training may be used in the early phases to improve hamstring
and quadriceps strength in patient are struggling with knee pain or high loads.

Exercise Initiation
– Active range of motion, weight bearing and static quadriceps activation should
begin as early as possible in recovery. This should be done within patient tolerance
levels and whilst being mindful of surgical indications.
– Leg press between 0-45 degrees knee flexion and eccentric quadriceps (on a stepper
or eccentric cycle) between 20-60 degrees can be started from week 3, with open
chain exercises between 45-90 degrees knee flexion clear to start from week 4
without compromising graft integrity.

Strength and Motor Control training
A combination of closed and open kinetic chain exercise is more effective than either in
isolation. Monitor for anterior knee pain during open kinetic chain exercises and adjust
loading accordingly.
Using eccentric strengthening as part of a program can elicit improved strength and
functional outcomes after anterior cruciate ligament (ACL) surgery.

Motor control, strength training, plyometric training, agility training and core stability
exercises are all integral parts of the rehabilitation and should be combined in the
rehabilitation protocol to improve outcomes.
Aquatic therapy may be used in the early phase of rehabilitation to improve subjective knee
function. It is recommended to commence around 3-4 weeks post op once wounds are
healed.

Return to Activity
Returning to driving is recommended once the patient can safely apply the brake as
required in an emergency this will be at approximately 4–6 weeks after right-sided ACLR and
approximately 2–3 weeks after left-sided ACLR.

Returning to running is criteria driven with the consensus stating the following:
– 95% knee flexion range of motion (ROM).
– Full extension ROM.
– No effusion/trace of effusion.
– Limb symmetry index (LSI)>80% for quadriceps strength.
– LSI>80% eccentric impulse during countermovement jump.
– Pain-free aqua jogging and Alter-G running.
– Pain-free repeated single-leg hopping (‘pogos’).
Returning to sport minimum criteria for a professional athlete returning to full training is
listed below. This should then be followed by a gradual return into full match play. It is
important to note that not all clinicians will have access to isokinetic testing.

– No pain or swelling.
– Knee full ROM.
– Stable knee (pivot shift, Lachman, instrumented laxity evaluation).
– Normalised subjective knee function and psychological readiness using patient-
reported outcomes (most commonly the International Knee Documentation
Committee subjective knee form (IKDC), the ACL-Return to Sport after Injury scale
(ACL-RSI) and Tampa Scale of Kinesiophobia).
– Isokinetic quadriceps and hamstring peak torque at 60°/s should display 100%
symmetry for return to high demand pivoting sports. Restore (as a minimum)
preoperative absolute values (if available) and normative values according to the
sport and level of activity.

– Countermovement jump and drop jump>90% symmetry of jump height and
concentric and eccentric impulse. Reactive strength index (height/time)>1.3 for
double leg and 0.5 for single leg for field sport athletes (higher for track and field).
– Jumping biomechanics—normalise absolute and symmetry values for moments,
angles and work in vertical and horizontal jumps especially in sagittal and frontal
plane at hip, knee and ankle.
– Running mechanics—restoration of>90% symmetry of vertical ground reaction
forces and knee biomechanics during stance during high-speed running and change
of direction.
– Complete a sports-specific training programme.

If you are looking for advice regarding your sporting injury please make an appointment
with us today.

Reference: Kotsifaki R, Korakakis V, King E, et al Aspetar clinical practice guideline on
rehabilitation after anterior cruciate ligament reconstruction British Journal of Sports
Medicine 2023;57:500-514.

It is great to see more and more women participating in sports, particularly in AFL. Unfortunately, as a result there have also been a large increase in the number of injuries seen as well. Common injuries for females during sports occur in the legs (ankles, knees and hips), as well as concussion injuries.

On the top of the list is non-contact ACL injuries. We’ve all heard of the dreaded ACL injury, which can knock athletes out of competitive play for a good year. Stats from the AFL report that females can be up to 5x more likely to obtain leg injuries, and over 9x more likely to obtain an ACL injury when compared to males. As with all things health related, prevention is better than a cure which is why the Prep-to-Play program was developed.

The Prep-to-Play program was created by experts on and off the field to help reduce the risk of injuries, as well as promote participation across all age groups and abilities.

The program includes all aspects of play, including:

Appropriate warm-up.

A good warm up has moved beyond simple static stretches in isolation. This helps prep not just the muscles and joints for sports-specific movement and requirements, but the whole body for game play. The Prep-to-Play warm up program can be performed in a matter of 10 minutes, and is recommended before every training and match. Aspects of the warm-up include hip/leg mobility, acceleration/deceleration, jumping, change of direction, contact, and balance drills.

Football skills.

It may seem obvious that high level training and game play relies heavily on the skills of an athlete. This can come from hours and hours on the field, but also can come from regular refinement and awareness of our movement and technique. Training how we land after a jump, how we tackle, how we receive a tackle, how we handle a ball. These can all influence our risk of injuries. The Prep-to-Play program incorporates skills that prepare players on how best to approach certain situations, for example protecting vulnerable body areas such as your head and neck during tackles or even avoiding tackles where possible.

Strength training.

This one is a no brainer, and is something we already do quite well but requires regular input. Strengthening muscles that help you run faster, make you more agile, jump higher, kick further, brace yourself in contact situations will all help to make your overall game play better.

Education.

Whilst time during play and training is crucial, we can’t downplay the importance of education. Knowledge on knowing how long to recover, what is considered acceptable soreness, when to pull back following an injury, nutritional aspects, and managing physical/mental stress is all part of Prep-to-Play’s education component.

Having a chat with your coach and health care professionals is all part of what makes a successful game and experience for all those involved in Women’s AFL.

Differentiating hip and groin pain and dysfunction in assessment can be a mine field.

Below are some suggestions of clinical indicators for different areas of discomfort and the tests that are most likely to confirm the true source of the pain.

Hip flexor related pain
– Pain and/or weakness with resisted hip flexion
– Pain and/or weakness with resisted straight leg raise
– Positive thomas test
– Tenderness on palpation

Sacroiliac joint related pain
Need at least two positive tests for SIJ to potentially be source of symptoms:
– Distraction
– Compression
– Thigh thrust
– Sacral thrust

Inguinal related pain
– Pain location in the inguinal canal region
– Tenderness of the inguinal canal
– Pain with coughing and sneezing
– Pain with abdominal contraction
– No palpable inguinal hernia present
– Will often have no pain on resisted hip flexor strength testing → this is often how to differentiate between hip flexor related pain and inguinal related pain

Adductor related pain
– Pain and/or weakness with resisted adduction
– Pain with adductor stretching
– Tenderness on palpation

Pubic related pain
– Presence of pain across pubic region
– Tenderness on palpation of the pubic symphysis and the immediately adjacent bone

Intra articular hip related pain
– Pain with hip ROM → in particular hip flexion and internal rotation
– Pain with FADIR
– Pain with FABER
– Positive Scour test
– Antalgic gait pattern
– Mechanical symptoms such as catching, locking, clicking or giving way.

Greater trochanteric pain syndrome
GTPS encompasses multiple diagnoses including external snapping hip, trochanteric bursitis and gluteus medius and gluteus minimis tendinopathy or tearing and mainly affects women in the 40-60 year old age bracket.

– Presence of pain at the lateral hip, with symptoms potentially radiating to the level of the buttock and lateral thigh
– Pain often worsens with single leg weight bearing activities such as putting on pants or getting in/out of the bath, walking, stair climbing, and/or lying on the affected side.
– Tenderness on palpation specifically on the lateral or posterior aspect of the greater trochanter
– Pain with 30 second single leg stance
– Pain with resisted FADER
– Pain with resisted abduction
– Pain with resisted external rotation test

If your hip or groin are bothering you and you would like to have any of the above tests completed to confirm your area of injury, book an appointment with your physio today.

In exciting news for the Physio Plus family, Physio Plus Cheltenham is now open.

Principal Physiotherapist Matt Delaney will be heading up proceedings, continuing the fantastic work started by Stephen King years ago while the practice was operating as The Injury Rehab Centre.

Located at 1/296 Charman Road, Cheltenham, Victoria, 3912 we are in close proximity to all the best things that Cheltenham has to offer.

We look forward to providing more details in the coming weeks and keep an eye out on our locations page.