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Sydney Sports & Orthopaedic Physiotherapy

Welcome to our Blog

At Sydney Sports and Orthopaedic Physiotherapy we want to stay connected. In addition to this website, our Facebook page, our LinkedIn account and our newsletter, we thought that a BLOG would be a great way to share our thoughts on Physiotherapy, Pilates, Common Injuries and other topics of interest.

You can follow your favourite physio here and stay up to date with latest news, trends and thoughts from the accessible and highly trained staff here at Sydney Sports and Orthopaedic Physiotherapy. Enjoy.

Just a simple ankle sprain?!

Ankle sprains are one of the most common injuries presenting to Accident and Emergency department and can occur in the young or old, active or sedentary populations.

Approximately 80% of all ankle sprains occur to the outside of the ankle. Symptoms include pain, swelling, bruising and joint stiffness. The picture below shows a typical lateral ankle sprain after 1 week.


A recent review of 23 studies by Hoch and McKeon (2013) found that the reoccurrence rate of re-spraining was as high as 70%.  Another study by Wikstrom et al (2013) found that 30% of people who suffer a lateral ankle sprain go on to develop chronic ankle instability (recurrent episodes of spraining). Even more worrying is that 2/3rds of those with chronic ankle instability develop post-traumatic osteoarthritis of the ankle.

Given the above figures you would expect that physiotherapy clinics would see a large amount of acute ankle sprains each week. Surprisingly we don’t, and this is most likely due to the fact that the vast majority of sprains improve by 4-6 weeks. However, people generally measure improvement by their pain levels and/or how much swelling or bruising is present.  Recent studies have demonstrated that patients who suffer from chronic ankle instability have alterations in their sensorimotor system and muscle activation patterns are delayed.

All of the above research says that ankle sprains should not be thought of as a simple injury that gets better naturally. The role of physiotherapy in the management of an ankle sprain should look further than just reducing pain and swelling. Strength of lower limb muscles such as the peroneals, restoring hip control and explosive power of the calf muscles are some of the important components of ankle rehabilitation that need consideration for weeks, sometime months past the point of resolution from pain and swelling. Several studies have demonstrated that a strength and balance rehabilitation program for patients with chronic ankle instability can be an effective treatment for improving function.

So next time you have a “simple” ankle sprain, be sure to engage in a rehabilitation program that looks for returning strength and function, and does not concentrate purely on reducing pain and swelling.

Posted in Ankle and Foot, Exercise Programs, Physiotherapy, Uncategorized | Tagged , , , , , | Leave a comment

Winter Sports Injuries – Part 2 – The Knee

Injury: Sprained Medial Collateral Ligament (MCL).  This is the second most-common skiing injury and again it’s the knee that comes out second best!

How it Happens:  Usually this injury occurs when you fall forward and catch the inside edge of the tip of the ski.  Especially if the bindings don’t release.

Prevent it/Fix it: Unlike the ACL, at least the MCL has some blood supply and can generally repair itself with the right rehabilitation help. Still, the best bet is to try and avoid the injury in the first place.  The most important rule here is to ensure your bindings are working correctly.  At the outset, you should have a ski mechanic do a release-check on your bindings. Also, there are simple self-checks, described on the net, that take a couple of minutes to perform and have been shown to reduce injuries by up to 25%.

Check out:

Happy skiing!

Posted in Brad McIntosh, Injury Prevention, Knee Pain, Physiotherapy | Leave a comment

Skins – New research – put it on AFTER training.

There has always been debate as to whether skins – or compression garments – actually do what they say they do.911LQSET__65247.1354594505.1280.1280

Well a recent 2013 study performed a meta-analysis of the current literature and showed that in fact there is more than just a placebo effect in using compression garments to manage recovery from exercise.  It showed that there was a statistical evidence of improvement in reduction of delayed onset muscle soreness (DOMS), improved muscle strength and power and reduced creatine kinase (a clinical sign of muscle damage as seen on blood tests).

But people remember the compression garment was applied AFTER exercise.  Not worn during.

In fact no studies currently prove the benefit of compression garments worn during exercise (although theoretically it would stimulate your skin and therefore be a valuable tool in assisting in positional control or proprioception).

So although wearing skins during exercise seems optional, wearing them for up to 72 hours POST exercise is definitely beneficial.

Posted in Injury Prevention, Physiotherapy, Stuart Baptist | Tagged , , , , , , , , , , , , , | Leave a comment

Links between the glutes and Achilles problems in runners

A recent study by Smith et al (2013) found that male runners with Achilles tendinopathy had altered neuromuscular control of their gluteal muscles when running, compared to healthy controls. Neuromuscular control of the gluteals relates to the ability of the brain and body to ‘fire’ or ‘activate’ the buttock muscles.

The researchers used dynamic electromyography on fourteen male runners with Achilles tendinopathy and nineteen healthy runners, and found that there was a significant delay in the gluteus medius and gluteus maximus muscle activation at heel strike for the runners with injury, and these muscles did not work for as long (shorter duration).

The gluteal muscles are responsible for controlling motions of hip extension, abduction and external rotation, which are important for lower limb biomechanics as well as ability to produce energy down the whole leg. For example, the knee collapsing inwards at the hip related to poor gluteus medius activity can affect ankle/foot motion and cause compensations such as overpronation (foot rolling in). Poor quality hip extension for propulsive forward motion may contribute to problems such as overwork through calf musculature and the Achilles tendon.

Further studies need to investigate a causal effect from these findings, however the research highlights the importance of considering proximal gluteal control in runners with Achilles problems in providing best rehabilitation from the current injury and prevention of future injuries. Running analysis combined with functional tests and muscle length/strength tests can assist in determining whether ‘lazy glutes’ may be a contributing issue.

For further information on the study, see:

Smith M, Honeywill C, Wyndow N, Crossley K and Creaby M (2013) ‘Neuromotor control of gluteal muscles in runners with Achilles Tendinopathy’, Medicine & Science in Sports & Exercise, DOI: 10.1249/MSS.0000000000000133.

There is some further information regarding Achilles tendinopathies on our website, at

Posted in Ankle and Foot, Common Injuries, Injury Prevention, Kerry Jacobs, Physiotherapy, Pilates, Running, Uncategorized | Tagged , , , , | Leave a comment

No Pain, No Gain? Your Guide to Common Gym Injuries

“I regret that workout.” Said no-one. Ever.

Incorrect, Funny T-shirt Man.

Anyone who has injured themselves during a weights session in the gym suffers regret. The problem is that not enough people understand what set them up for injury in the first place.

I know we’ve all looked covertly at fellow gym members purely to cringe at their choice of exercise technique, but have you ever wondered if you’ve been the subject of those “inconspicuous” looks?

The fact is, most gym-based injuries are preventable.  Here are a few tips on how to prevent the most common injuries that we see in the clinic.

Lower Back Pain

The most common gym generated problems we see in the clinic are lower back injuries. We know the spine provides a versatile range of function; it provides us with an incredible range of movement and can bear significant amounts of load, all while protecting the spinal cord. The problem is that the spine is vulnerable when not used properly.

Lower back injuries are likely to happen with load plus the loss of the neutral lumbar curvature. Typical culprit exercises include poorly performed squats, dodgy kettle-bell swings or bent-over exercises set up with lumbar flexion instead of hip flexion, such as rows or cable exercises. While I’m not saying these exercises are bad, I am saying they can be done badly!

And while we’re here, another movement to check: picking up and putting away your weights…

Crappy squat

Loss of lumbar lordosis (the backwards curve in the lower back) can be a big problem.

Neck Pain

In a similar way to how the lower back can be injured, the neck can be vulnerable when put into sub-optimal positions. The typical movement responsible is called cervical protrusion, or poked-chin posture, under load. Think about those times you’ve tried to squeeze out that last squat, that extra chin-up or that last of push-up (the one where your nose touches the floor, but your chest is still six inches away!)

Next time you are straining for those final reps, check yourself and the position your neck is in.

Bad push up

Does it count as a rep if you can touch your chin to the floor?

The Shoulder

While injury to backs and necks can come on suddenly, shoulder pain more commonly develops over time and exercise programming is often to blame. Usual overload points in the shoulder include the rotator cuff and the long-head-of-biceps tendon, while common conditions you may have heard of include subacromial impingement, biceps tendonitis or rotator cuff tendinopathy.

For all of you (actually, mainly the guys), if the only body parts you’re working on are the ones you can see in the mirror, you’re in trouble. Shoulder function relies heavily on the balanced function of both anterior and posterior musculature. Over time, poor programming can lead to the shoulder girdle becoming rounded, changing the entire dynamic of its musculature. Spend some time thinking about how to best balance the front and the back, the pushers and the pullers.

An additional issue worth considering is leverage, the shear forces created at the shoulder with different exercises. Big levers created with simple exercises (movement of a single joint – such as flies or straight-arm shoulder raises) cause an enormous amount of load on the stabilising shoulder structures. In comparison, compound exercises (multi-joint movements such as presses or rows) disperse load more effectively across a number of joints and can offer the advantage of strengthening of a wide range of muscle groups, rather than trying to strengthen one muscle at a time.

Sore Shoulder

Ouch! I should have listened to my physio.

While injuries do happen, most are avoidable. It is worthwhile spending some time planning the way in which you exercise and this is certainly where physio is at its most effective. Not only will you spend less time in recovery mode, you may just make those strength gains more quickly and without the biomechanical barriers that cause the injuries in the first place.

Posted in Exercise Programs, Injury Prevention, Physiotherapy, Uncategorized | Leave a comment

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