Common Injuries

CERVICAL SPINE (NECK) INJURIES

Headaches

There are many different types of headaches and often these can result from neck disorders.

Signs + Symptoms

  • Headaches which does not respond to migraine medications
  • Neck pain or stiffness
  • Pain, pins and needles, or numbness in arm or down to the hand
  • Reduced neck range of movement
  • Headache may be brought on by a neck position
  • Dizziness or blurred vision

Causes

  • The nerves which carry information from the neck into the brain can often get confused with the nerves travelling from the head. This can mean the signals can also get confused, resulting in neck pain being perceived in the head as a headache.
  • Headaches can also be caused by trauma to the neck

Treatment

  • Headaches can be treated by a physiotherapist using a combination of techniques:
    • Education and advice about your condition and any necessary behaviour modifications
    • Manual therapy techniques to return range of motion/control and also reduce pain/stiffness in the neck
    • Exercise therapy to return strength and coordination to the neck

Whiplash

Injury with a sudden acceleration-deceleration force on the neck.

Signs + Symptoms

  • Neck pain
  • Neck stiffness
  • Headache
  • Shoulder, arm and upper back pain
  • Dizziness or altered vision
  • Altered sensation
  • Hearing difficulties
  • Difficulty speaking, swallowing or concentrating

Cause

  • Generally occurs from a sudden, traumatic event involving acceleration-deceleration forces, such as a car crash

Diagnosis

  • Whiplash is diagnoses through a combination of injury history and clinical tests, which can be performed by a physiotherapist

Treatment

  • Physiotherapists will create an individualised treatment program to facilitate healing including:
    • They will provide education and advice about the condition, and will encourage you to continue with your normal routine as much as possible
    • Manual techniques such as joint mobilisation to reduce stiffness
    • Dry needling
    • Exercises to encourage flexibility, strength, control and good posture
    • Vestibular rehabilitation depending on symptoms
    • Soft tissue massage
    • Neck muscle control exercises
    • Neural gliding techniques depending on symptoms

LUMBAR SPINE (LOWER BACK) INJURIES

Non-Specific Lower Back Pain (NSLBP)

NSLBP is pain primarily in the lower back without a specific spinal disease or cause.

Signs + Symptoms

  • Back ache and stiffness
  • Stiffness worse in the morning, ache worse end of the day
  • Pain onset usually with a quick movement, such as turning in bed
  • Pain/stiffness worse with sustained sitting or standing
  • Weight gain

Causes

There are various theories about the cause of NSLBP but currently the exact cause is unknown. Often this pain does not occur as a result of and trauma or specific event, it usually presents with a gradual onset.

Diagnosis

  • NSLBP can be diagnosed through a thorough assessment by a physiotherapist.

Treatment

  • NSLBP can be effectively treated by a physiotherapist:
    • Advice, education and teach self-management techniques to prevent further reoccurrences of back pain and enable you to return to work and daily activities pain-free
    • Mobilisations and manual techniques of the lower back to decrease pain and improve range of motion
    • Exercises to strengthen and stretch back muscles
    • Heat and massage therapy to help relieve pain and decrease any muscle tightness

Nerve Impingement/Pinched Nerve

Nerve impingement in the lower back can result from compression or pressure on the nerve as it exits the spine.

Signs + Symptoms

  • Pain in the lower back (area of compression)
  • Pain radiating down into the legs or buttocks
  • Pins and needles, and/or numbness in the legs or buttocks
  • Weakness and/or loss of sensation in the legs or buttocks

Causes

  • Nerve impingement can occur as a result of compression in the spine. This can be due to an impaired blood supply, extra bony growth, or swelling. Compression can occur as a result or repetitive or sustained postures.

Diagnosis

  • Disc or nerve impingement in the lower back can be diagnosed by a physiotherapist.

Treatment

  • Impingements can be effectively treated by a physiotherapist through a range of methods:
    • Education and advice in regards to correct posture, pain management and work set up to help minimise reoccurrence of pain
    • Manual techniques to reduce the compression and open up the affected joint, helping to minimise pain and other symptoms
    • Exercises and stretches to help improve range of motion and decrease pain in the affected area

Spondylolisthesis

Spondylolisthesis occurs when one vertebra moves forward or back (subluxes) in relation to the vertebra below.  There are five major classifications of spondylolisthesis, the two most common being isthmic and degenerative.

Signs + Symptoms

  • Presentation of this condition will depend on the type and cause of subluxation
  • Classification: Isthmic
    • Gradual onset of pain with repeated loading
    • Back ache
    • Morning stiffness
    • Pain at night after activity
    • Pain with sustained standing, walking or running
  • Classification: Degenerative
    • Long history of back ache
    • Pain with standing, walking or running

Cause

  • Spondylolisthesis can occur as a result of degenerative changes in the spine over time
  • It can also occur with an injury to the spinal vertebra
  • Rarely, it can also occur as a result of trauma or be present from birth

Diagnosis

  • Spondylolisthesis can be diagnosed by a physiotherapist and through medical imaging

Treatment

  • Spondylolisthesis can be effectively treated by a physiotherapist with techniques including:
    • Education and advice in regards to correct posture, pain management and work set up to help minimise pain
    • Manual therapy techniques to relieve stiffness and pain
    • Self-management techniques for flare ups of pain or symptoms

Spondylolysis

Spondylolysis is a stress injury to the pars commons (edge of spinal vertebra) that occurs commonly in adolescent and young athletes. Frequently, it can be asymptomatic, but can cause a gradual onset of pain in the lower back.

Signs + Symptoms

  • Pain in the lumbar spine
  • If there is also a bulging disc associated with the condition- there may also be nerve impingement symptoms present
  • Increased lower back pain with prolonged standing, sitting or bending forward

Cause

  • Repeated mechanical stress with sports involving extension or rotation movements can result in a bony stress reaction which can later result in a stress fracture

Diagnosis

  • Spondylolysis can be diagnosed by a physiotherapist. They may also recommend you have a medical imaging scan, such as an X-Ray or CT

Treatment

  • Treatment of spondylosis will depend on the stage and degree of the injury and may include a variety of techniques from your physiotherapist:
    • Recommendations for activity modification or rest from particular sport/work related activities to help maximise healing
    • Posture and movement education to reduce pain and aggravating actions
    • Manual techniques to improve muscle length, tightness and joint stiffness
    • Exercise therapy to correct lower back and pelvic biomechanics to take load off the injury area in the long term

SHOULDER INJURIES

Acromioclavicular (AC) Joint Sprain

The acromioclavicular joint (AC Joint) is the joint between your collarbone and shoulder blade. It allows overhead and across the body movements of your arm. An AC Joint sprain occurs with separation or disruption to the joint.

Signs + Symptoms

  • Pain on the top of the shoulder
  • Pain with heavy lifting, overhead or across the body movements
  • Swelling
  • Reduced shoulder movement

Cause

  • AC Joint Sprains are usually caused by a collision where the person’s shoulder hits a hard surface, commonly the point of the shoulder hitting the ground during a football tackle
  • It could also be injured during a fall onto an outstretched arm

Diagnosis

  • AC Joint sprain can be accurately diagnosed by a physiotherapist through a thorough physical assessment

Treatment

  • Physiotherapist may use techniques such as:
    • Education and advice regarding your condition
    • Pain relief modalities such as ice, taping or anti-inflammatory medication in consult with your doctor
    • Exercises and stretches to encourage normal shoulder range
    • Exercises to strengthen the shoulder control muscles
    • Postural control exercises for optimal shoulder positioning
    • Exercises to improve daily functional use of the shoulder

Bankart Lesion

A Bankart lesion is damage to the anterior inferior glenoid labrum of the shoulder following an anterior shoulder dislocation. A Bankart lesion is also commonly seen with a Hills Sachs Lesion during the same mechanism.

Signs + Symptoms

  • Shoulder pain without a specific point
  • Worsening pain when reaching behind your back
  • Weakness of shoulder muscles
  • Feeling of shoulder instability

Cause

  • A Bankart lesions occurs with repetitive shoulder subluxations which damage the connective tissue around the shoulder
  • It is more common with overhead activities and sports, such as tennis or volleyball

Diagnosis

  • Bankart lesions are difficult to detect via any manual physiotherapy tests. If suspected, a physiotherapist may recommend an MRI scan to detect the lesion.

Treatment

  • Bankart lesions most commonly require surgery in order to avoid recurrent dislocations of the shoulder
  • Physiotherapy is important post-surgical procedure in order to re-gain muscle length, range of motion at the shoulder and strength/control of the shoulder to return to work/sporting activities

Hill Sachs Lesion

A Hill Sachs lesion is a compression fracture of the humeral head which most commonly occurs during anterior shoulder dislocations. Hill Sachs lesions occur in 50% of first time shoulder dislocations.

Signs + Symptoms

  • Shoulder pain without a specific point
  • Reduced shoulder range of motion
  • Weakness and loss of shoulder function

Causes

  • Hill Sachs lesions ordinarily occur during anterior shoulder dislocations. As the shoulder dislocates the head of the humerus (arm bone) jams up into the shoulder joint causing the lesion

Diagnosis

  • Hill Sachs lesions are difficult to diagnose specifically via any manual physiotherapy tests. If suspected, a physiotherapist may recommend an MRI or a CT scan to detect the lesion.

Treatment

  • Treatment for Hill Sachs lesions can vary from conservative to surgical treatment depending on the severity of the fracture (how much bone is lost) and also how unstable the shoulder joint is (functional instability and how many dislocations have occurred)
  • An orthopaedic surgeon will best advised which path is necessary depending on all the factors
  • Physiotherapy is important in each case either as the main conservative treatment or following surgery to improve the muscle strength/control around the shoulder to increase the functional stability of the joint

Shoulder Rotator Cuff Tear

This is a tear of the shoulder rotator cuff tendons. It may be a partial (some of the muscle fibres) or a full thickness (all of the fibres) tear.  The rotator cuff is a group of 4 muscles which are responsible for controlling, moving and stabilising your shoulder.

Signs + Symptoms

  • Partial thickness tear: mild to moderate pain or weakness with shoulder movements
  • Full thickness: severe pain, weakness and inability to lift arm away from the body

Causes

  • Rotator Cuff tears can occur as a result of trauma such as with a fall, or lifting a heavy weight. These tears can also occur over time with repetitive overuse

Diagnosis

  • Rotator Cuff Tears can be diagnosed through a range of tests completed by a physiotherapist. They may also refer you to have a diagnostic ultrasound or an MRI to show the location and/or severity of the tear

Treatment

  • Treatment of rotator cuff tears can either be conservative or surgical depending on the severity of the tear and its impact on the function of the shoulder
  • If the tear is large or involving multiple tendons surgery may be required followed by a period of physiotherapy to return muscle length, strength, control and function at the shoulder
  • For small or partial tears a conservative method can be effective and can involve:
    • Education and advice regarding your condition
    • Pain relief using ice or anti-inflammatory medications in consultation with your doctor
    • Manual therapy including soft tissue release and joint mobilisation to reduce pain
    • Prescription of exercises to encourage full shoulder range of motion
    • Exercises to encourage correct technique and muscle control when performing shoulder movements

Shoulder Rotator Cuff Tendinopathy

Injury to the tendons of the shoulder rotator cuff. Can occur with repetitive stress loading to the tendons resulting in the tendon becoming swollen and painful. If this stress continues for too long the tendon can start to break down and become degenerative.

Signs + Symptoms

  • Gradual onset of shoulder pain
  • Dull pain, especially when reaching overhead or behind your back
  • Often occurs in over 40s
  • Pain with lying on the shoulder
  • Pain reduces with warming up

Causes

  • Working with hands above shoulder height
  • Repetitive, load bearing arm movements

Diagnosis

  • Rotator Cuff Tendinopathy can be diagnosed through a combination of tests performed by a physiotherapist

Treatment

  • A physiotherapist may use a variety of techniques to treat rotator cuff tendinopathy including:
    • Education and advice regarding your condition
    • Pain relief prescription, such as ice or anti-inflammatory medications in consult with your doctor
    • Massage for pain relief and to help improve the shoulder range of motion
    • Prescription of strengthening and stretching exercises
    • Exercises to encourage correct technique and muscle control when performing shoulder movements

Shoulder Bursitis

Bursitis is inflammation of the bursae (fluid filled sacs) which are located in the shoulder joint. Bursae lubricate the joint and cushion surfaces between bones.

Signs + Symptoms

  • Pain on the outside of the shoulder
  • Worsening pain with lying on the affected shoulder
  • Increased pain when lifting the arm above your head e.g. reaching up to a shelf or washing your hair
  • The pain may spread down to your elbow or wrist

Causes

  • Shoulder bursitis can occur due to repetitive overuse or as a result of a traumatic event, such as a fall

Diagnosis

  • A physiotherapist can accurately diagnose shoulder bursitis using a combination of manual tests

Treatment

  • A physiotherapist will use several techniques to facilitate healing of this condition. It is important to complete the rehabilitation program and not return to sport or work too soon as shoulder bursitis is likely to reoccur if not completely healed.
  • Techniques which may be used include:
    • Education and advice regarding your condition
    • Ice for pain and swelling relief
    • Taping or use of a brace to reduce pain and support the joint
    • Posture retraining to encourage correct shoulder movements, improve shoulder control, and reduce pain.
    • Exercises to encourage stretching and strengthening of the shoulder joint
    • Exercises to support and stabilise the joint and enhance muscle control

Shoulder Impingement

Shoulder impingement is a condition where the muscle tendons become compressed, pinched or trapped within the shoulder. With repeated trapping of the tendons, the shoulder can become irritated and inflamed, resulting in painful shoulder movements. It can also result in thickening of the muscle tendons and reduction of the space (sub-acromial space) within the shoulder joint.

Signs + Symptoms

  • Pain lifting arm above shoulder height
  • Pain at the front and side of shoulder, especially when arm is in an overhead position
  • Pain when lying on impinged shoulder side
  • Pain at rest with condition progression
  • Gradually worsening pain
  • Shoulder weakness especially when attempting to reach or lift
  • Loss of range of movement at the shoulder, especially raising the arm in front and to the side, as well as loss of ability to put hand behind back

Causes

  • Shoulder Impingement may occur in people who are born with a smaller subacromial space, meaning they are more likely to squash and irritate the tendons as they run through the sub acromial space
  • Osteoarthritis and some bony conditions can also cause narrowing of the subacromial space, which can result in impingement of the muscle tendons
  • Shoulder impingement can also occur over time as a result of repetitive overhead activity, trauma, poor posture or previous injury.

Diagnosis

  • Shoulder impingement can be diagnosed through a combination of tests performed by a physiotherapist

Treatment

  • Shoulder impingement can be effectively treated by a physiotherapist using a range of techniques including:
    • Education and advice regarding your condition
    • Icing of the shoulder when painful and acutely inflamed
    • Strengthening exercises for the back and shoulder
    • Stretching exercises to improve range of motion of the shoulder
    • Manual therapy techniques e.g. massage or joint mobilisation to improve pain, tightness and stiffness at the shoulder

ELBOW INJURIES

Golfers Elbow (Medial Epicondyalgia)

Golfer’s elbow is an overuse Injury to the muscles on the inside of your forearm.

Signs + Symptoms

  • Hand, wrist and/or finger pain with grip
  • Pain with wrist flexion (stretch)
  • Soreness on inner elbow
  • Swelling

Causes

  • This is causes by damage to the muscle where it attaches to the bones at the elbow
  • Whilst it can affect anyone, it is more likely to occur in the 35-50year old bracket

Diagnosis

  • Diagnosis of golfers elbow can be accurately made by a physiotherapist

Treatment

  • Golfers elbow can be effectively managed with physiotherapy through:
    • Advice and education about the condition and management
    • Pain relief e.g. through the application of ice
    • Taping or bracing to support the area and facilitate healing
    • Exercises to gently stretch the tissue
    • Exercises to strengthen the muscles of the elbow and wrist
    • Exercises to facilitate movement of upper limb nerves
    • Mobilisations of the wrist and elbow joints

Tennis Elbow (Lateral Epicondylalgia)

Tennis elbow is an overuse injury of the muscles on the outside of the forearm which are used to extend the wrist. It most commonly affects people aged 30-50 but can occur in anyone, not just tennis players!

Signs + Symptoms

  • Pain on back of forearm, on outside part of elbow (lateral epicondyle)
  • Pain in the wrist extensor muscles when trying to lift or twist objects or move wrist backwards
  • Tightness of wrist extensor muscles
  • Pain in wrist extensor muscles when doing repetitive tasks

Causes

Tennis elbow occurs as a result of degeneration of the muscles which extend the wrist.  Overuse of these muscles can cause microscopic tears in the muscle tendon where it attaches into the elbow. If these tears are not completely healed before further stress is placed on the muscle, overuse can result in degeneration of the tendon.

Diagnosis

  • Tennis elbow can be diagnosed through a combination of tests performed by a physiotherapist

Treatments

  • Tennis elbow can be effectively treated by a physiotherapist through techniques such as:
    • Advice and education about the condition and management
    • Pain relief e.g. through the application of ice
    • Taping or bracing to support the area and facilitate healing
    • Exercises to gently stretch the tissue
    • Exercises to strengthen the muscles of the elbow and wrist
    • Exercises to facilitate movement of upper limb nerves
    • Mobilisations of the wrist and elbow joints

Thrower’s Elbow

Thrower’s elbow is a sprain of the medial (inside) ligament of the elbow which occurs when the ligament is stretched beyond its usual limits

Signs + Symptoms

  • Pain on the inside of the elbow
  • Pain can occasionally also be present on the outside of the elbow
  • Pain during or after throwing
  • Noticeable decrease in throwing speed/distance (weakness)
  • Restriction to movement at the elbow

Causes

  • Throwers elbow occurs with damage to the bones, muscles, tendons and/or ligaments of the elbow
  • Strain to the ligament is most common in throwers, and occurs when the medial ligament is stretched beyond its usual limit
  • It may be the result of repetitive throwing or poor technique
  • More likely to occur in athletes participating in throwing or overhead sports, such as javelin or baseball

Diagnosis

  • Thrower’s elbow can be diagnosed through a combination of tests performed by a physiotherapist

Treatment

  • Tennis elbow can be effectively treated by a physiotherapist through techniques such as:
    • Advice and education about the condition, management and prevention
    • Pain relief e.g. ice
    • Taping or bracing to support the joint
    • Exercises to promote correct throwing techniques and muscle imbalances
    • Elbow and wrist mobilisations to decrease any pain or swelling and stretch the affected tissues

WRIST & HAND INJURIES

Carpal Tunnel Syndrome

Carpal tunnel syndrome is a painful hand and wrist condition caused by compression of the median nerve which runs through the tunnel between your hand/wrist bones.

Signs + Symptoms

  • Pain in the wrist, hand or fingers
  • Numbness, especially at the end of the day or with wrist flexion
  • Pins and needles in the hand and fingers
  • Swelling at the wrist and hand
  • Weakness, especially with grip
  • Cramping

Cause

  • Carpal tunnel can occur when the space within the tunnel decreases, for example with wrist swelling after a traumatic injury
  • It can also occur with enlargement of the structures (nerve and tendons) passing through the tunnel

Diagnosis

  • Carpal tunnel can be clinically diagnosed through a series of assessment techniques completed by a physiotherapist

Treatment

  • Carpal tunnel can be effectively treated by a physiotherapist using techniques such as:
    • Education and advice regarding your condition
    • Prescription of a wrist splint to wear at night or during work
    • Manual techniques and mobilisations to open the carpal tunnel
    • Nerve exercises to encourage unrestricted range
    • Exercises to strengthen grip
    • Exercises to strengthen hand, wrist, forearm and elbow muscles
    • Exercises to encourage control of fine motor and hand dexterity skills

De Quervain’s Tenosynovitis

De Quervain’s tenosynovitis is an injury where two tendons on the thumb-side of the wrist become trapped as they pass through their tendon sheaths, causing inflammation of the tendons and resulting pain.

Signs + Symptoms

  • ‘Sharp, shooting’ pain and swelling at the bottom of the thumb
  • Pain increased with grip or pinching the thumb with another finger
  • Pain increased with thumb or wrist movement
  • Pain may spread further up the forearm or down the hand if untreated

Cause

  • De Quervain’s Tenosynovitis is caused by a combination of overuse and overload of the tissues
  • Repeated grasping, pinching, or squeezing can lead to damage – a sudden increase in these activities (such as increasing sport load or lifting) can cause an overuse injury
  • Overloading the tissues by holding the load at an angle which further compresses or traps the tendons
  • It affects women 10 times more than men, and commonly affects new parents who improperly lift their infant
  • It usually affects people between the ages of 30-50

Diagnosis

  • A physiotherapist can accurately diagnose De Quervain’s Tenosynovitis using a thorough physical assessment and special testing

Treatment

  • De Quervain’s can be effectively treated by a physiotherapist using techniques such as:
    • Education and advice regarding your condition
    • Immobilisation of the thumb in a splint for 3-4 weeks to allow for healing of the affected tissues
    • Rest from activities which increase the pain
    • Massage and mobilisations to enable the tendons to glide through the tendon sheaths more easily
    • Exercises to strength and stretch damaged tissue
    • Taping to support the injured area

Mallet Finger

Mallet finger is a deformity of the finger where the extensor tendon (tendon that straightens the finger) is damaged.

Signs + Symptoms

  • Swelling and pain around the top knuckle after the initial injury
  • Top of the finger is bent and cannot be straightened voluntarily

Cause

  • A mallet finger injury occurs when the finger extensor tendon is torn from its attachment on the finger bone
  • Commonly occurs when a ball or another object strikes the tip of the finger forcibly bending it

Diagnosis

  • A mallet finger injury can be diagnosed from a thorough physical exam performed by a physiotherapist

Treatment

  • Treatment of a mallet finger injury can be either conservative or surgical depending upon the level of damage
  • The conservative approach involves a splinting program to hold the finger in full extension, allowing the ends of the tendon to heal
  • If the damage is too large and the tendon may have possibly broken a small piece of bone off the finger surgery may be required to reattached the tendon to the finger bone
  • After the healing of the tendon, a physiotherapist can prescribe a rehabilitation program including:
    • Exercises and mobilisations to prevent other joints from becoming stiff
    • Exercises to strengthen the finger muscles
    • Coordination and dexterity retraining of the hand and fingers

Triangular Fibrocartilage Complex (TFCC) Injuries

The TFCC is a cartilage structure located on the “pinky” finger side of the wrist. Its role is to cushion and support the carpal bones in the wrist, whilst also providing stability when the hand grasps or the forearm rotates.

Signs + Symptoms

  • Pain along the wrist on the “pinky” finger side
  • Pain with activities which cause wrist/forearm rotation, such as turning a key to unlock a door
  • Swelling around the wrist
  • Clicking or crackling around the wrist
  • Weakness of the wrist muscles
  • Feeling of instability or catching within the wrist

Cause

  • A TFCC tear can occur from a traumatic event involving compression and twisting of the wrist such as during a fall on an outstretched hand
  • TFCC injuries may also occur due to degenerative change usually in the older population and due to repetitive overloading over a long period of time

Diagnosis

  • TFCC injuries can be diagnosed by a physiotherapist through a thorough physical examination and may also require an MRI

Treatment

  • TFCC injuries can be either treated conservatively or surgically depending on the size of the tear of the nature of the injury.
  • Large, complex or degenerative tears are usually treated surgically with good results. Rehabilitation after surgery involves 2-4 weeks in splint followed by a guided physiotherapy program to return function and movement.
  • Conservative treatment usually involves rest in a splint for approximately 4 weeks in conjunction with anti-inflammatories before commencing a physiotherapy rehabilitation program
  • Physiotherapy rehabilitation following either conservative or surgical treatment could involve:
    • Advice regarding activity modification and rest
    • Pain relief and swelling management prescription, such as ice
    • Post-operative rehabilitation programs
    • Strengthening and stretching exercises
    • Exercises and mobilisations to improve wrist range of motion

HIP INJURIES

Hip Femoroacetabular impingement (FAI)

Hip FAI is a condition where mechanical mismatch occurs between the ball and socket bones of the hip joint, leading to a pinching of the surrounding tissues.

There are two types of FAI:

  • Cam – bump on the surface of the ball, which gets caught/jams into the socket
    • Typically affects young, athletic men e.g. rowers, footballers
  • Pincher – occurs with a deeper hip socket, causing a pinch when the hip is bent
    • Typically affects middle aged women – less common

Signs + Symptoms

  • Hip or groin pain – usually deep
  • Reduced hip range of motion
  • Pain with prolonged sitting or walking

Cause

  • FAI usually occurs as a result of abnormal growth and development, with growth or a bump manifesting or an anatomically deeper hip socket present as the body matures.

Diagnosis

  • FAI can be clinically diagnosed through a series of assessment techniques completed by a physiotherapist

Treatment

  • Your physio may use the following treatment techniques to facilitate healing of the FAI:
    • Education and advice about the condition
    • Pain relief e.g. ice
    • Massage
    • Manual therapy techniques (mobilisations)
    • Dry needling
    • Exercises to stretch the joint and improve the joint’s range of motion
    • Exercises to encourage correct hip movement and control

Femoral Head (Hip) Avascular Necrosis

Femoral head Avascular Necrosis occurs when the ball of the femur (femoral head) loses blood supply at the hip and as result begins to die.

Signs + Symptoms

  • Pain around the hip joint
  • Hip joint movement restriction
  • Pain referring down the leg
  • Pain with walking or weight bearing, especially stairs

Causes

  • Avascular Necrosis can occur as a result of a traumatic injury e.g. hip dislocation
  • It can also occur due to non-traumatic causes such as excessive alcohol use, chronic corticosteroid use and blood clots or damage to blood supply to the femur
  • Other conditions which may be associated with avascular necrosis include: Diabetes, HIV/AIDS, Sickle Cell Disease, Chemotherapy or radiation therapy, autoimmune diseases or vasculitis

Diagnosis

  • Avascular Necrosis often presents similarly to other conditions, so it is important to have an accurate diagnosis. A physiotherapist will use the physical examination and clinical history to gauge an idea of the diagnosis, but may refer or recommend an X-Ray or MRI for definite diagnosis of avascular necrosis.

Treatment

  • Surgery is usually recommended for this condition
  • Physiotherapy has been shown to be effective in post-operative rehabilitation for hip muscle strength, length and control

KNEE INJURIES

Knee Anterior Cruciate Ligament (ACL) Injury

The ACL is a ligament in the knee which stabilises the knee and prevents twisting and excessive movement of the tibia (shin bone) and femur (thigh bone) at the knee.

Causes

  • An ACL injury most commonly occurs when pivoting (twisting) or landing from a jump on the knee
  • It is more commonly seen in females compared to males, and more often in high demand sports such as soccer, netball, basketball, rugby, hockey or gymnastics

Signs + Symptoms

  • Feeling on knee instability (giving way)
  • May be painful
  • May have heard or felt a pop during the incident
  • Swelling at the front of the knee

Diagnosis

  • An ACL tear or rupture can be diagnosed from the history of the injury and clinical tests performed by a physiotherapist. They may also refer for an MRI for confirmation.

Treatment

  • ACL injuries do not always require surgery!
  • A physiotherapist can provide conservative ACL rehabilitation, as well as post-operative ACL rehabilitation depending on the severity of damage to the ACL.
  • They may use techniques such as:
    • Education and advice about the condition
    • Pain relief e.g. ice
    • Exercises to strength the muscles around the knee
    • Exercises to stabilise the leg
    • Manual techniques to improve knee alignment and range of motion
    • Exercises to improve balance, power and agility
    • Gait and running re-education
    • Exercises to encourage muscle control during regular and sports specific activities e.g. hopping and landing

Patella Tendinopathy (Jumper’s Knee)

Jumper’s knee is an overuse injury of the knee where the patella tendon becomes damaged over time due to a variety of factors, often linked to sport and training load.

Signs + Symptoms

  • Pain over the patella tendon
  • Reduced quadricep muscle strength
  • Pain increased with jumping, landing or running
  • Gradual onset of pain
  • Patella tendon may appear thicker compared to the unaffected side

Cause

  • Most patella tendinopathies occur as a result of gradual wear and tear from overuse and/or ageing
  • The following factors may also contribute to the development of patella tendinopathy
    • Rapid increase in training intensity or amount
    • Training or playing on rigid surfaces
    • Tight quadriceps and hamstring muscles
    • Poor or abnormal lower limb biomechanics

Diagnosis

  • Jumper’s knee can be diagnosed from the history of the injury and clinical tests performed by a physiotherapist

Treatment

  • Patella Tendinopathy can be successfully treated with physiotherapy through techniques including:
    • Education and advice about the condition e.g. potential risk factors, flare up management
    • Pain and swelling relief e.g. heat or ice
    • Taping or bracing to support the knee joint
    • Manual techniques and mobilisations to facilitate full knee range
    • Exercises to stretch and strengthen muscles around the knee
    • Exercises to encourage correct/normal knee biomechanics

Patellofemoral Pain Syndrome (PFPS)

PFPS is a general classification for anterior (front) of knee pain that generally occurs over time.

Signs + Symptoms

  • Gradual onset of knee pain
  • Stairs, squats, kneeling or running commonly worsen the pain
  • Pain with sustained knee bending

Cause

  • Exact cause is unknown but is usually attributed to a combination of factors, such as overuse or overloading the joint, joint abnormalities, muscle weakness and/or tightness

Diagnosis

  • PFPS can be diagnosed from the history of the injury and clinical tests performed by a physiotherapist

Treatment

  • PFPS can be effectively treated with physiotherapy through techniques including:
    • Education + advice about the condition e.g. flare up management, risk factors
    • Pain relief e.g. ice
    • Taping or bracing
    • Manual therapy techniques to improve joint and soft tissue function
    • Exercises and stretches aimed at improving muscle length and strength
    • Exercise to improve coordination of hip, knee and ankle movements through activity e.g. running and jumping

ANKLE & FOOT INJURIES

Achilles Tendinopathy

Achilles tendinopathy is the inflammation and overuse micro-tears of the Achilles tendon, which occurs most commonly in joggers and jumpers.

Signs + Symptoms

  • Pain and stiffness in back of the leg/ankle
  • Loss of strength of calf muscles
  • Increased pain with use
  • Swelling, tenderness or warmth in area if inflamed

Causes

  • Achilles tendinopathy is a an overuse injury which occurs with repetitive action
  • A tendon injury can occur gradually or can happen suddenly, especially if the tendon has been damaged over time
  • Over-training or unaccustomed use can result in a tendon injury
  • Changes in training surfaces
  • Weak eccentric muscle strength
  • Tight hamstrings, calf muscles and Achilles tendon
  • Poor supportive footwear, constantly wearing high heels, or a recent change in footwear

Diagnosis

  • Achilles tendinopathy can be clinically diagnosed through a series of assessment techniques completed by a physiotherapist

Treatment

  • Achilles tendinopathy can be successfully treated by a physiotherapist
  • Education and advice about the condition e.g. recommend rest from aggravating activities
  • Pain relief e.g. ice or heat
  • Bracing or taping
  • Dry needling
  • Stretching and strengthening exercises
  • Soft tissue massage and manual therapy techniques
  • Balance, power, proprioception and agility exercises

Ankle Sprains

An ankle sprain is the stretching and possible tearing of the ligaments around your ankle through a sudden twisting or fall onto the ankle in an awkward position. Ankle sprains can come in three grades ranging from just minor fibre tear or irritation (grade 1) up to complete rupture of the ligament (grade 3).

Signs + Symptoms

  • Commonly, pain on the outside or front of the ankle
  • Swelling or bruising may be present
  • Pain or difficulty with weight bearing or walking
  • Restriction in range of movement
  • Sensation of giving way or instability at the ankle

Causes

  • Ankle sprains occur when the ankle is taken out of its normal range of movement
  • The most common ligament injury occurs with rolling inwards of the ankle, especially after landing on an uneven surface

Diagnosis

  • Ankle sprains can be diagnosed through a combination of tests performed by a physiotherapist
  • It is important to have an ankle sprain properly diagnosed as depending on which ligament is injured and the severity of the damage the treatment may vary accordingly

Treatments

  • Ankle Sprains can be effectively treated by a physiotherapist using techniques such as:
    • Education and advice about the condition
    • Manual therapy and mobilisation of the ankle and foot joints
    • Management of pain and swelling
    • Bracing or taping
    • Muscle strengthening to help protect the ankle joint
    • Gait re-education and muscle coordination control training
    • Balance retraining
    • Massage

Plantar Fasciitis

The plantar fascia is a thick band of tissue running along the sole of your foot. For a range of reasons damage can be cause to the plantar fascia resulting in persistent pain.

Research now shows that small micro-tears occur most commonly where the plantar fascia attaches to the calcaneus (heel bone) being the reason behind all of the pain.

Signs + Symptoms

  • Pain under the heel or foot arch
  • Pain in the morning or after rest
  • Pain improves as you warm up

Cause

  • Plantar fasciitis is usually either causes by traction or compression injuries
  • Traction (stretching) forces resulting in the fascia overstretching. This is usually a result of either poor foot biomechanics or weakness of foot arch muscles
  • Compression, such as landing on a sharp object, can bruise the plantar fascia

Diagnosis

  • Plantar faciitis can be diagnosed through a combination of tests performed by a physiotherapist

Treatment

  • Plantar fasciitis can be treated by a physiotherapist using a combination of techniques:
    • Education and advice about your condition and any necessary behaviour/footwear modifications
    • Pain relief e.g. ice
    • Improve the range of motion available at the foot and ankle
    • Exercises to establish foot muscle control, as well as leg and calf control
    • Exercises to restore normal foot biomechanics, especially in walking and running

ADOLESCENT INJURIES

Severs Disease

Severs is a growing disorder of the ankle where the growth plate at the heel, where the Achilles tendon attaches, becomes inflamed and very painful due too much tension at the area as the body is growing.

Signs + Symptoms

  • Heel pain
  • Limping
  • ‘Awkward’ running style
  • Increased pain with tip toe standing

Cause

  • Common cause of heal pain in growing children
  • Usually occurs during growth periods of adolescence
  • More common in active children

Diagnosis

  • Severs Disease can be clinically diagnosed through a series of assessment techniques completed by a physiotherapist

Treatment

  • Physiotherapist may use a combination of techniques to facilitate healing
    • Education and advice about the condition e.g. reduction in physical activities which cause pain
    • Pain relief treatments e.g. ice
    • Range of motion exercises
    • Exercises to encourage muscle control of foot arches
    • Exercises to strengthen and stabilise calf and leg muscles
    • Exercises to improve functional activities, such as running and landing
    • Assessment and treatment of foot biomechanics and footwear

What should you do if you think you have these injuries?

Make an appointment at Lexington Physio on 9836 3432 for an assessment, advice and treatment.

Call Us Book your appointment today! Call Lexington Physio on (02) 9836 3432

Australian Physio Hicaps Medicare Sports Medicine DJO Global

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