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Hamstring

The problem

  • The hamstring is made up of a group of muscles including the biceps femoris (outside leg), semimembranosus (inside) and semitendinosis (inside) muscles, which act as extensors of the hip and flexors of the knee
  • Pain in the posterior thigh can have several causes:
  • Hamstring muscle strain/tear
  • Hamstring tendinopathy
  • Bursitis
  • Sciatic nerve entrapment, which frequently accompanies muscle and tendon injuries as the nerve adheres to scar tissue
  • Lumbar spine pathology such as disc lesions
  • Sacroiliac joint pain syndromes
  • A combination of these issues can cause hamstring pain. It is therefore critical to have your injury diagnosed and managed by a skilled sports medicine professional such as the SSOP physiotherapists.

What you can expect/look out for

  • An initial slight niggle or tightness in the back of the thigh that could be passed off as an ordinary ache from training
  • The pain doesn’t go away, rather worsening until training is no longer possible
  • Acute searing pain in the posterior thigh when increasing intensity or speed during training
  • After the injury there is usually a period of tightness, pain and fear of re-injury

Hints for self-management

  • Rest, Ice, Compression and Elevation should be followed for at least 72 hours immediately after the injury
  • Anti-inflammatory medication may reduce pain and swelling
  • Ice the injury
  • Gently stretch hamstrings, although this can exacerbate some hamstring conditions and should be applied judiciously

Management options

  • Physio will usually include massage and joint mobilisation, pelvic realignment, strength/endurance/plyometric exercise, and running technique analysis and re-training
  • Exercise and training directed at core stability is also likely to be included in your comprehensive rehabilitation plan

Interesting facts

  • Sometimes the adductor is added to the hamstring muscle group due to its similar function
  • While running, the hamstring is most active at three stages:
    1. as the leg swings through to decelerate and control hip flexion and knee extension
    2. to prepare the foot to hit the ground and stabilise the knee as foot contact is made
    3. to extend the hip and flex the knee at the end of the stance phase to propel the body forward
  • Problems usually occur at the end of the swing phase, as the hamstrings contract to control the hip and knee and get ready for landing, or at the stance phase as they contract forcefully to push the body forwards

 

 

At Sydney Sports and Orthopaedic Physiotherapy our highly qualified physiotherapists specialise in the assessment, treatment and prevention of neuromusculoskeletal injuries.


Contact us today – 9252 5770

 

This handout was prepared by Sydney Sports and Orthopaedic Physiotherapy and is intended as a general information service. Please note that the information provided is not intended as a substitute for advice from a registered physician or healthcare professional. If symptoms persist, please consult your doctor.

Anterior Cruciate Ligament Tears

The problem

  • The ACL is the stabilising ligament of the knee, and acts to prevent buckling of the knee
  • The mechanism of injury is usually from a pivoting action on a grounded foot, usually during sport
  • Injury can be as a partial or total rupture and management may change according to degree of damage
  • When the ACL is completely torn, surgery is a strong possibility to reconstruct the ligament

Interesting facts

  • A ‘pop’ or ‘crack’ sound is often heard during injury
  • Usually there is initial pain, although with a complete tear the pain subsides quickly (within minutes) but the knee often feels ‘unstable’, and may give way
  • Often ACL injuries can occur in combination with injuries to other structures such as the medial collateral ligament or medial meniscus

What you can expect/look out for

  • Immediate swelling and bruising of the knee
  • The knee will feel ‘unstable’ and may buckle or give way on you

Hints for self management

  • Initial injury management is as for most soft-tissue injuries;
  • Rest and immobilise, use crutches to assist with walking
  • Ice for 20 minutes every 2-3 hours for the first 3 days
  • Compress the area to manage swelling, with a bandage or tight leggings
  • Elevation, as able, lying on your back with leg elevated
  • Seek diagnosis by seeing your GP or visiting one of the experts at Sydney Sports & Orthopaedic Physiotherapy, and the decision to confirm with imaging such as MRI may be made at that time

Management options 

  • ACL tears require review by an Orthopaedic Surgeon
  • The surgeon will discuss with you both conservative and surgical options
  • With a partial tear or in an individual who does not play high-level sports, it may be decided to manage the knee non-surgically with physiotherapy and exercises – you will want to seek an expert knee physio to guide you through this process
  • A full tear may be managed with a surgical reconstruction, using a patellar tendon or hamstrings graft, or more recently with a synthetic ligament (LARS) 

More information

  • A knee reconstruction will mean time away from sport and significant rehabilitation
  • Return to sport in most cases is after 6 months 

 

 

At Sydney Sports and Orthopaedic Physiotherapy our highly qualified physiotherapists specialise in the assessment, treatment and prevention of neuromusculoskeletal injuries.


Contact us today – 9252 5770

 

This handout was prepared by Sydney Sports and Orthopaedic Physiotherapy and is intended as a general information service. Please note that the information provided is not intended as a substitute for advice from a registered physician or healthcare professional. If symptoms persist, please consult your doctor.

Bursitis

The problem

  • Bursae are fluid-filled sacs located between bones and tendons. They function to reduce friction and allow the tendons to glide more freely over the bone
  • When bursae become inflamed, movement of the tendon over the affected bursa becomes painful

Hints for self-management

  • Rest the affected joint
  • Avoid aggravating movements and activities
  • Ice and anti-inflammatory drugs to reduce inflammation

Interesting facts

  • There are approximately 160 bursae in the human body
  • Larger bursae are located near major joints, such as the shoulders elbows hips and knees. Example: Subacromial Bursitis

Management options

  • A corticosteroid may be injected into the affected bursa. In Australia, this is typically done under ultrasound guidance by a radiologist after being prescribed by your GP, Orthopaedic Surgeon or Sports Physician. This generally brings rapid relief.
  • Physiotherapy can help strengthen the muscles around the joint and correct any biomechanical faults to help reduce the risk of recurrence

What you can expect/look out for

  • An achy or stiff sensation in the affected joint
  • Increased pain with movement
  • Swelling and/or redness over the affected area

More information

  • Bursitis is most likely to occur in joints that perform repetitive motions, such as the shoulders, elbows, or hips. It may also develop in the knees, heels, or at the base of the big toes.
  • Bursitis is also likely to develop following an injury, which may be traumatic or a more chronic overuse/repetitive stress type injury due to faulty body mechanics. Bursitis is also more likely to occur during middle age and in individuals with rheumatic conditions.
  • It is not uncommon to experience recurrent flare ups

 

 

At Sydney Sports and Orthopaedic Physiotherapy our highly qualified physiotherapists specialise in the assessment, treatment and prevention of neuromusculoskeletal injuries.


Contact us today – 9252 5770

 

This handout was prepared by Sydney Sports and Orthopaedic Physiotherapy and is intended as a general information service. Please note that the information provided is not intended as a substitute for advice from a registered physician or healthcare professional. If symptoms persist, please consult your doctor.

ACL

The problem

  • The ACL is the stabilising ligament of the knee, and acts to prevent buckling of the knee
  • The mechanism of injury is usually from a pivoting action on a grounded foot, usually during sport.
  • Injury can be as a partial or total rupture and management may change according to degree of damage
  • When the ACL is completely torn, surgery is a strong possibility to reconstruct the ligament
 Hints for self-management
  • Initial injury management is as for most soft-tissue injuries;
  • Rest and immobilise, use crutches to assist with walking
  • Ice for 20 minutes every 2-3 hours for the first 3 days
  • Elevation, as able, lying on your back with leg elevated
  • Seek diagnosis by seeing your GP or visiting one of the experts at Sydney Sports & Orthopaedic Physiotherapy, and the decision to confirm with imaging such as MRI may be made at that time
Interesting facts
  • A ‘pop’ or ‘crack’ sound is often heard during injury
  • Usually there is initial pain, although with a complete tear the pain subsides quickly (within minutes) but the knee often feels ‘unstable’, and may give way
  • Often ACL injuries can occur in combination with injuries to other structures such as the medial collateral ligament or medial meniscus

Management options

  • ACL tears require review by an Orthopaedic Surgeon
  • The surgeon will discuss with you both conservative and surgical options
  • A full tear may be managed with a surgical reconstruction, using a patellar tendon or hamstrings graft, or more recently with a synthetic ligament (LARS)

What you can expect/look out for

  • Immediate swelling and bruising of the knee
  • The knee will feel ‘unstable’ and may buckle or give way on you

More information

  • A knee reconstruction will mean time away from sport and significant rehabilitation
  • Return to sport in most cases is after 6 months
  • Unloading the tendon in the initial phases will help with pain. These can include taping, heel raises and orthotics

 

 

At Sydney Sports and Orthopaedic Physiotherapy our highly qualified physiotherapists specialise in the assessment, treatment and prevention of neuromusculoskeletal injuries.


Contact us today – 9252 5770

 

This handout was prepared by Sydney Sports and Orthopaedic Physiotherapy and is intended as a general information service. Please note that the information provided is not intended as a substitute for advice from a registered physician or healthcare professional. If symptoms persist, please consult your doctor.

Muscle Strain

The problem

  • Acute strains occur from undue pressure or overstretching of a muscle which results in a tear and damage to the muscle fibres and/or its attaching tendons
  • Damage can occur to a small area causing a partial tear to the muscle fibres or a large portion of the muscle causing a complete rupture of the muscle belly. They are graded accordingly from 1 to 3
  • Muscle strains can occur in all muscles of the body during normal activities of daily life, work tasks etc, but most commonly present as a sporting injury
  • Typical symptoms are painswelling, weakness and bruising or discolouration around the site of injury
  • Chronic muscle strains can occur as small tears which happen over time with a continuously overloaded muscle

Interesting facts

  • The grading of acute muscle strains can determine the prognosis of the injury and helps to plan for return to sport
  • A bad grade 2 tear may take 2-3 months to completely heal
  • Depending on how many fibres are affected, grade 3 tears may require surgery

What you can expect/look out for

  • Expect to see swelling and bruising/discolouration, this may continue to worsen in the days following the injury
  • Pain, swelling and bruising usually subsides gradually over 1-3 weeks and the torn muscle begins to heal through scar tissue
  • In most cases, with proper treatment most people completely recover from a muscle strain

More information

  • If surrounding muscles and/or joints are not working properly, one particular muscle may be being overloaded which then precursors that muscle to injure with a smaller required force.

Hints for self-management

  • Initial management is as for most soft-tissue injuries
  • Rest, may involve immobilising the area, a sling for the arm or crutches for the leg
  • Ice the area with an ice-pack or ice-blocks wrapped in a tea-towel, for 20 minutes, every 2-3 hours over the next 72 hours
  • Compress the area with a bandage
  • Elevate the area above the heart i.e. a lower limb injury should be rested lying down with the foot up on a small stool/pillows

Management options

  • After a period of relative rest it is necessary to exercise the injured and surrounding muscles to regain full function
  • Exercises to stretch, strengthen and correct muscle imbalances are necessary
  • Deep tissue massage may be appropriate after an initial period of rest to release the thickened scar tissue

 

 

 

At Sydney Sports and Orthopaedic Physiotherapy our highly qualified physiotherapists specialise in the assessment, treatment and prevention of neuromusculoskeletal injuries.

 

 

Contact us today – 9252 5770

 

This handout was prepared by Sydney Sports and Orthopaedic Physiotherapy and is intended as a general information service. Please note that the information provided is not intended as a substitute for advice from a registered physician or healthcare professional. If symptoms persist, please consult your doctor.

Ankle Sprain

The problem

  • Ankle sprains generally occur from an injury where ligaments which support the ankle are damaged/torn
  • This leads to swelling, pain and restriction of movement
  • Once the ligament has been damaged, it is necessary to 1) allow time to heal, and 2) rehabilitate correctly to ensure return to normal function
  • Ligaments can take up to 12 weeks to heal, due to poor blood supply
  • The ligaments of the ankle are grouped into two categories: the Lateral Collateral Ligaments and the Medial Collateral Ligaments

Hints for self-management

  • Initial management should follow the RICER principles R: Rest I: Ice wrapped in towel (20mins every 2 hours for the first 48 hours post injury) C: Compression E: Elevation R: Review with a health professional
  • If there is excessive pain or pain that persists for more than a few days, this may indicate a more serious injury such as a fracture or a high ankle sprain; both which require medical attention immediately

Interesting facts

  • Injury to the lateral or outside ligaments of the ankle is more common than to the medial ligaments, as these are not as well supported by the bony structures of the ankle
  • Damaging ligaments will affect your ability to balance
  • Swelling can often persist in the ankle due to gravity
  • Many sports, including Netball, require athletes to tape their ankles before playing a game to help prevent the extremely high rate of injury

Management options

  • An x-ray can be taken to rule out a fracture
  • Conservative treatment such as support and strengthening exercises will be very effective in most ankle sprains
  • If a fracture or high ankle sprain is present, immobilisation +/- surgery may be required to allow healing

What you can expect/look out for

  • Pain
  • Swelling
  • Bruising
  • Difficulty walking
  • Restriction of range of movement

More information

  • Current evidence suggests that a combination of paracetamol and an NSAID (anti-inflammatory) may offer superior pain relief compared with either drug alone
  • Recent evidence suggests that controlled movement, together with ice and mobilization by your skilled physiotherapist can result in an earlier return to normal movement and function
  • Bracing or taping has been shown to assist in the prevention of recurrent ankle sprains. Neither bracing nor taping seems to be the better option, despite personal preferences for one or the other
  • http://orthopedics.about.com/cs/sprainsstrains/a/anklesprain.htm for more information

 

 

At Sydney Sports and Orthopaedic Physiotherapy our highly qualified physiotherapists specialise in the assessment, treatment and prevention of neuromusculoskeletal injuries.


Contact us today – 9252 5770

 

This handout was prepared by Sydney Sports and Orthopaedic Physiotherapy and is intended as a general information service. Please note that the information provided is not intended as a substitute for advice from a registered physician or healthcare professional. If symptoms persist, please consult your doctor.

Achilles Tendinopathy

The problem

  • The Achilles tendon is the large tendon at the back of the ankle that attaches the calf muscles to the heel.
  • The attachment of the Achilles tendon allows your heel to come up when walking, running, jumping, or standing on your toes. It also allows the power generated in your calf muscles to be transferred to a push off through your toes during these same activities.
  • Achilles tendinopathy often occurs as an overuse injury from activities such as running or jumping that strain the tendon

Hints for self-management

  • Decrease the intensity of your exercise routine
  • Cross train to decrease stresses through the Achilles tendon
  • Ice the area for 20 minutes after exercise, or when you feel pain
  • Anti-inflammatory medication may help to manage pain
  • Gently stretch the calf muscles

Interesting facts

  • The Achilles tendon is the largest tendon in the body.
  • Achilles tendinopathies account for about 11% of all running injuries.
  • Achilles tendinopathy can either be acute, occurring within a few days after a sudden increase in activity, or chronic, progressing over a period of weeks to months.

Management options

  • Braces/taping for support and to unload the tendon
  • Eccentric exercises to strengthen the tendon
  • Cortisone injections are rarely used around the achilles tendon but can be beneficial in some specific cases
  • Anti-inflammatory creams/patches or medication may be prescribed by your doctor
  • Autologous blood injections are currently undergoing trials to determine how helpful they can be 

What you can expect/look out for

  • Pain above the heel after running or other sports activity
  • Increasing pain associated with activities involving prolonged running, jumping, or stair climbing
  • Tenderness on palpation, possibly with a small swelling on the Achilles tendon
  • Tenderness and stiffness, especially in the morning, that improves with mild activity

More information

  • Help avoid developing future episodes of Achilles tendonitis by increasing running no more than 10% per week
  • Eccentric loading exercises have been proven to strengthen and remodel chronically damaged tendons
  • Ultrasound imaging can be used to differentially diagnose a tendon injury
  • Unloading the tendon in the initial phases will help with pain. These can include taping, heel raises and orthotics

 

 

At Sydney Sports and Orthopaedic Physiotherapy our highly qualified physiotherapists specialise in the assessment, treatment and prevention of neuromusculoskeletal injuries.


Contact us today – 9252 5770

 

This handout was prepared by Sydney Sports and Orthopaedic Physiotherapy and is intended as a general information service. Please note that the information provided is not intended as a substitute for advice from a registered physician or healthcare professional. If symptoms persist, please consult your doctor.

Iliotibial Band Friction Syndrome

The problem

  • The Iliotibial band runs down the outside of the thigh from the hip to the knee, with its main muscular attachments being the gluteus maximus and tensor fascia latae muscles. It crosses the knee and attaches to the tibia, so that every time we flex and extend the knee, it flicks over the lateral epicondyle of the femur.
  • In English, it rubs across the part of the knee that sticks out. This constant rubbing can lead to inflammation and pain on the outside of the knee, known as Iliotibial Band Friction Syndrome (ITBFS). 

Interesting facts

  • ITBFS accounts for 12% of running-related overuse injuries.
  • The two main causes of ITBFS are training/equipment errors and poor biomechanics.
  • Training Equipment Errors:
    • Rapid increase in distance covered
    • Training on crowned/sloped roads
    • Excessive time on the track
    • Poor footwear that allows excessive and prolonged pronation of the foot
    • Worn out footwear… as a guide, most shoes are good for 800km or 6 months
    • Biomechanics
    • Weakness and inflexibility in the gluteus medius has been noted in runners with ITBFS. With this the pelvis drops down on the side opposite the standing leg and tightens the ITB. Also, the knee rolls inwards & the ITB flicks over the lateral epicondyle with more ferocity.
    • Weakness in the hamstring and quadriceps is also common
    • Tightness of the ITB itself can be a factor, increasing pressure over the epicondyle at the knee 

What you can expect/look out for

  • A sharp burning pain on the lateral aspect of the knee frequently signals ITBFS.
  • You can’t run through it – it gets worse the further you go! 

Hints for self-management

  • While rest is important to allow the inflammation to settle, ITBFS will likely return unless some changes are made
  • Anti-inflammatory medication may help in the short-term

Management options

  • Deep tissue massage may provide some relief, albeit, only short-term.
  • A physiotherapist can tape the knee to provide support and relieve pain so you can continue training.
  • The key to fixing ITBFS is a well-designed biomechanical program that provides for strength and endurance of the gluteal muscles and assessment and re-training of biomechanical errors in your running style.  See the specialists at SSOP to set this program up and guide you through it.
  • If necessary, a corticosteroid injection can provide pain relief, if the knee is not settling with more conservative treatment.

At Sydney Sports and Orthopaedic Physiotherapy our highly qualified physiotherapists specialise in the assessment, treatment and prevention of musculoskeletal injuries.

 

 

Contact us today – 9252 5770

 

This handout was prepared by Sydney Sports and Orthopaedic Physiotherapy and is intended as a general information service. Please note that the information provided is not intended as a substitute for advice from a registered physician or healthcare professional. If symptoms persist, please consult your doctor.

Meniscus Injury

The problem

  • Within the knee joint there are two menisci located on the top of the tibia – one on the inside (medial meniscus) and one on the outside (lateral meniscus)
  • The menisci are made of cartilage and provide stability and cushioning to the knee
  • Meniscus injury usually occurs as a result of a forceful twist or rotation through the knee, especially when weight is on that leg and the foot is planted.
  • Degenerative changes of the knee may also contribute to meniscus injury 

Interesting facts

  • The medial collateral ligament of the knee has some attachments to the medial meniscus. It is for this reason, that people may experience a meniscus and ligamentous injury simultaneously

What you can expect/look out for

  • Swelling and stiffness
  • A popping or catching sensation
  • A locked sensation when trying to fully extend or bend the knee
  • Pain with weight bearing activities, especially those which involve twisting or rotation
  • The knee may feel unstable and/or buckling may occur, especially after swelling subsides 

Hints for self-management

  • Rest
  • Ice
  • Avoid aggravating activities 

Management options

  • Small tears may be managed successfully with a conservative approach – initially consisting of rest, followed by physiotherapy for a guided strengthening program
  • Larger tears may require arthroscopic surgery. In some cases the tear can be repaired, while in other instances the injured portion of the meniscus is trimmed and removed.

More information

  • The menisci have a relatively poor blood supply, with the outer portion, often known as the “red zone”, being the most vascularized. If the tear is small (<3mm) and located on the outer portion of the meniscus it has a better chance of healing than a tear that extends to an area with a poorer blood supply 

 

At Sydney Sports and Orthopaedic Physiotherapy our highly qualified physiotherapists specialise in the assessment, treatment and prevention of neuromusculoskeletal injuries.

 

 

Contact us today – 9252 5770

 

This handout was prepared by Sydney Sports and Orthopaedic Physiotherapy and is intended as a general information service. Please note that the information provided is not intended as a substitute for advice from a registered physician or healthcare professional. If symptoms persist, please consult your doctor.

Hip Pain

The problem

  • Hip pain can have a number of predisposing factors
  • Pain can arise from a variety of structures in the hip including: bone, ligament, capsule, muscle and cartilage
  • Knowing the nature of the pain (sharp on movement vs. dull ache at rest), onset of pain (acute injury or insidious onset) and the type of injury (twisting, falling etc) can help to determine which structures are the primary causes of the pain.
  • A common injury to the hip is a labral tear
  • A labral tear can occur from trauma, wear-and-tear, and/or degeneration of the cartilage as occurs in osteoarthritis
  • Pain can be referred to the hip from other structures such as the lower back, sacroiliac joint or pubic bone/symphysis

Interesting facts

  • Labral tears have become a more common finding in the last 10 years due to improved tests and treatment procedures
  • Repetition in sports such as soccer, gymnastics and ballet result in a high percentage of athletes with a labral injury
  • The hip is a ball and socket joint, surrounded by thick bands of tissue, which create a very stable and deep joint.

What you can expect/look out for

  • Pain with weight bearing
  • Tight and sore muscles which surround the hip including glutes, hip flexors, adductors and muscle in the groin
  • Locking/catching/clicking
  • Difficulty lying on the sore hip

Hints for self-management

  • Activity modification is initially important to reduce irritation to the hip joint
  • Anti-inflammatory medications may help to reduce swelling and pressure in the hip joint allowing more space for the ball to move in the socket and ultimately alleviating the pain experienced.
  • Slow onset of pain is more likely to indicate an overuse injury which causes inflammation or a degenerative-type of injury such as osteoarthritis
  • An acute injury will more likely indicate a tear/strain of muscles, ligaments or the labrum

Management options

  • Conservative management aims to strengthen the muscles that support the hip and loosen off tight structures, this decreases aggravating loading patterns
  • Surgery to correct labral tears and improve joint mechanics
  • Medication or injections to reduce inflammation
  • Rest to allow structures to heal

More information

  • The hip is made up of two bones: the femoral head or thighbone and the acetabulum or hip socket.
  • Other causes of hip pain can include bursa Inflammation (fluid filled sacks which provide lubrication between bones and ligaments)
  • Osteoarthritis is the most common cause of hip pain in people over the age of 50

 

At Sydney Sports and Orthopaedic Physiotherapy our highly qualified physiotherapists specialise in the assessment, treatment and prevention of neuromusculoskeletal injuries.


Contact us today – 9252 5770

 

This handout was prepared by Sydney Sports and Orthopaedic Physiotherapy and is intended as a general information service. Please note that the information provided is not intended as a substitute for advice from a registered physician or healthcare professional. If symptoms persist, please consult your doctor.