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Gluteal Tendinopathy – By Nicholas Musso

What is Gluteal Tendinopathy? 

The gluteal tendons are the fibres that connect the gluteal muscles to your hip. Gluteal tendinopathy is an injury or pathology of these tendons, most commonly it is a result of repeatedly overloading the tendon. While pain may come on suddenly, tendinopathies actually develop over a period of time, and pain will most often come at a later point. Because of this, tendinopathies are considered to be overuse injuries rather than acute injuries and are usually managed differently. For further general information on tendons and tendinopathy please refer to the “What is a tendon and tendinopathy” blog.

What are the symptoms?

Gluteal tendinopathy usually causes pain and tenderness on the outside of the hip, as well as loss of full movement and reduction in strength in the hip muscles. Pain can be local to the hip or spread further down the outside of the leg.

You may also get pain during certain activities which place more load on the tendon, these include:

  • Climbing stairs
  • Standing on one leg
  • Crossing your legs
  • Standing up from a chair
  • Lying on your side (particularly at night time)

Your pain may also increase with more demanding tasks such as jumping and hopping. Your physiotherapist will also be vigilant for determining there may be other causes for your hip pain.

What are the risk factors?

Gluteal Tendinopathy is primarily seen in post-menopausal women, with some researchers suggesting that 25% of women after the age of 55 will experience it at some point due to changes in anatomy and bioechanics. However, anyone can develop gluteal tendinopathy, it is not an age or gender-specific injury.

If you have had a previous injury (e.g. to the knee or ankle), the muscles surrounding those areas may not be working optimally even though the injury itself has healed. This can lead to increased stress being placed on physical structures further up or down the body (such as the gluteal tendon) which is overloaded and gradually increases in symptoms.

It is not uncommon to see people present with Gluteal Tendinopathy following a large increase in the amount of exercise being completed without being prepared for the increase in load i.e. mid-way through a sporting preseason, or in late January with a New-Years resolution spike in exercise. Runners who train on hills are particularly at risk.

How is it diagnosed?

A physiotherapist will be able to complete a comprehensive assessment of your problem area including taking a detailed history, previous medical and injury history, as well as a full physical assessment to determine the diagnosis and true cause of your problem.

It is unlikely that you will require a scan, as researchers have found that there is a poor link between findings on scans and pain symptoms. However, in rarer cases, your doctor or therapist may request an ultrasound or MRI scan if they suspect that your problem will require longer-term management.

What are my treatment options?

Physiotherapy will include a variety of treatment options, however the most important treatment is exercise therapy. This may seem counterintuitive as it is excessive loading that caused these symptoms, however load is also the answer! More specifically, it is putting the right amount of load through the tendon and gradually increasing the capacity of the tendon that is essential for promoting proper repair. While this is the primary treatment for promoting long-lasting improvement, physiotherapy treatment will also be focused on relieving the painful symptoms. There are a variety of techniques that may be suitable for you, including:

  • Icing
  • Medical management as prescribed your GP or pharmacist
  • Shockwave therapy
  • Rest from activity if required
  • Modification of current activity (i.e. load management)
  • Managing lifestyle factors that may be contributing to your pain such as climbing stairs,
  • Stretches (stretches may not always be useful and may sometimes increase your pain, these will be prescribed as the therapist deems suitable)

Book an appointment today for your assessment!

Blog by Nicholas Musso (Physiotherapist)

Osgood Schlatter’s Disease

What it is

Osgood Schlatter’s Disease, or “tibial tuberosity apophysitis”, is a common condition affecting children and teenagers where the bone at the site of the tibial tuberosity growth plate is inflamed. It is characterised by a gradual, non-traumatic onset of knee pain that worsens rapidly. It most commonly affects physically active children, particularly boys, but any child can develop the condition.

It is a fairly common condition, with estimates that 15-20% of athletic children will experience it at some point, and up to 5% of non-athletic children. Despite this, many parents are unaware of the signs and symptoms, the management on the condition and the long term prognosis for their child. This blog will help explain the nature of the condition and management strategies used by physiotherapists.

 

What causes it

Osgood Schlatter’s Disease is an inflammation and subsequent pain in the growth plate or “epiphyseal plate” in the tibial tuberosity, which is a bony prominence at the front of the shinbone. Growth plates are found at the ends of developing bones and contain cartilage cells that form into adult bone. This process occurs during a growth spurt in children and is how their bones grow and usually occurs in “spurts” over a two-year period.

When this process is occurring the growth plates are weaker as they have not fully formed into adult bones. In this period of rapid growth, a child’s bones grow faster than their muscles causing them to be become tight. In the instance of Osgood Schlatter’s disease the quadriceps muscles and patellar tendon are pulled tight, resulting in pain and inflammation where it attaches to the weakened tibial tuberosity.

Signs and Symptoms:

The most common symptom is intense pain just below the front part of the knee, which presents on activities such as jumping, squatting, running, kicking, climbing stairs and kneeling. The pain tends to start off relatively mild and then increase in intensity until the patient is unable to effectively complete the task due to pain. In addition to pain on activity, the tibial tuberosity may be swollen and tender, even at rest.

In 20-30% of cases, children will experience these symptoms in both knees. In later stages, the growth plate itself may enlarge which tends to look like a bump on the tibial tuberosity. This will often stay even after the condition resolves.

Risk factors

The largest risk factor for developing a patella tendinopathy includes acute changes in load for jumping based tasks. Often such load changes include competing in a tournament, increased playing/training frequency, alterations in shoe-wear or alternations in playing surfaces. Weight gain can also be a contributing factor as this places extra load onto the joints. Patella tendinopathy is a highly prevalent condition in younger, jumping athletes, less than 30 years old.

Factors that can contribute to it

  • Active boys from 11-15 years old are the most likely to experience Osgood Schlatter’s Disease, but girls aged 8-13 years can also be affected. If a child plays multiple sports, they are more likely to experience OSD.
  • Having chronically tight thigh muscles can also make you more likely to experience Osgood-Schlatter’s Disease.
  • Activities involving repetitive, strong quadriceps contractions produce the highest risk. Children who participate in jumping, running, and kicking sports such as football, netball, basketball, soccer etc. are most at risk.

Diagnosis

An accurate diagnosis can usually be made based on the symptoms by a physiotherapist, imaging often won’t be required. An X-ray may or may not show bony fragments at the site of attachment from the patellar tendon to the tibial tuberosity. It is important to see a qualified practitioner for diagnosis, however, as there are several alternative diagnoses that you may be experiencing, including:

  • Sinding-Larson-Johansson syndrome (a similar condition affecting the bottom of the kneecap as opposed to the tibial tuberosity)
  • Patellar tendinopathy
  • Patellofemoral pain
  • Infrapatellar bursitis
  • Fat pad injury
  • Fracture of tibial tuberosity
  • Slipped capital femoral epiphysis

Treatment

The treatment will depend on the findings of the physical assessment, but will likely include pain relief, activity modification, supervised exercise and stretching.

Perhaps the most important treatment we can provide is activity modification. Osgood Schlatter’s is a self-limiting condition, which usually means that the pain experienced during activity is directly related to the amount of inflammation at the tibial tuberosity, rather than a sign of ongoing damage being caused. Activity modification involves modifying the duration, intensity, frequency or type of activity the patient undergoes in order to “manage” symptoms. If the pain is quite severe then rest from strenuous activity may be recommended for a short period of time.

Other treatments may involve strengthening of the muscles surrounding the knee, icing, low intensity activity such as walking and swimming. Stretching, massaging and foam rollers may be used to help to lengthen the tight quadriceps muscles.

Prognosis

As previously mentioned, Osgood Schlatter’s, while painful, is a mostly self-limiting condition. The typical lifespan of the condition lasts for a few weeks to a few months, however in some scenarios people experience symptoms for up to two years.

Once the condition has resolved, most people will not have any ongoing effects, however a small portion of patients will experience an enlargement of the tibial tuberosity, and some will have ongoing discomfort while kneeling on the affected leg.

 

 

At Total Physiocare Heidelberg, Reservoir, Camberwell and Footscray we treat many knee and overuse sporting injuries.

Book an appointment today for your assessment!

Blog by Nicholas Musso (Physiotherapist)

Running Retraining – Blog by Matt Francis (Podiatrist/Physiotherapist)

The weather is warming up, the days are getting longer and summer is on the horizon. This is the time of year we tend to see people becoming more active and start running.

Running is a fantastic form of exercise, with proven benefits in both mental and physical well being. Little wonder more than 3,000,000 Australian’s participate in running as a form of exercise each year. Despite this a high number of runners, up to 85%, sustain an injury each year.

There are many injuries with many diverse treatment options, making knowing what’s wrong and how to fix it difficult!

The most common injury associated with running is patellofemoral pain or “knee cap pain”, accounting for 39% of all running injuries. It typically presents as pain around the front of the knee, gets worse as you run and can even be aggravated by climbing stairs and sitting for long periods after running. There are many well known and commonly used treatment options, including:

  • Education on load management and self management
  • Strengthening exercises
  • Taping or braces
  • Footwear or inserts

With recent evidence we are learning that there is a new form of treatment that may be equally as effective. Enter Gait Retraining, or “Running Retraining”. Running Retraining involves visual and verbal feedback on a patients running technique whilst running on a treadmill. Over a period of weeks, patients progress from running short distances, to longer distances, with reducing amount of feedback, proven to assist runners at decreasing pain.

Here at Total Physiocare we also use slow motion video gait analysis to analyse a patients gait or “technique” to further enhance the process and enable you to have a better understanding of your condition.

Running Retraining can focus on a number of aspects of one’s gait, including:

  • Cadence (number of steps per minute)
  • Stride length (how far in front of your body you stride)
  • Knee and hip position
  • Foot strike pattern/position

Running Retrainng has been proven to be an effective treatment option for both knee cap pain and medial tibial stress syndrome or “shin splints”. It can also be useful for an number of other conditions, including:

Running Retraining typically occurs over a number of weeks and can be done by its self or as part of a comprehensive treatment and management plan for injured runners.

Interested in finding out more about Running Retraining and how it can help you return to running? Or even if your just interested in starting running?

At Total Physiocare Heidelberg, Reservoir, Camberwell and Footscray we can help!

By Matt Francis – Physiotherapist & Podiatrist

Book an appointment today for your assessment!

Patella Tendinopathy – Blog by Christian Bonello

The patella tendon is a continuation of the quadriceps tendon and has a role in connecting the quadriceps femoris (4 quadriceps muscles at the front of the thigh) to the tibial tuberosity of the shin. The patella tendon has a principle role in transmitting force through the lower limb, particularly in powerful jumping movements.

Patella tendinopathy is defined as a pathology or injury of the patella tendon, commonly due to overuse mechanisms. For further information please refer to the “What is a tendon and tendinopathy” blog.

Symptoms:

The main symptoms of a patella tendinopathy is pain and tenderness localised to the inferior pole of the patella (ie bottom of knee cap). Patients often report load-related pain that increases with the demand on the knee extensors. Notably this includes activities that store and release energy in the patellar tendon such as jumping and change of direction activities.

Prevalence:

Patella tendinopathy is highly common in jumping athletes with a 45% prevalence reported in basketball players, 32% reported in volleyball players and is common in AFL ruckman. Conversely patella tendinopathy only has a 2.4% prevalence in “in-season” soccer players due to the altered demands of the sport.

Risk factors:

The largest risk factor for developing a patella tendinopathy includes acute changes in load for jumping based tasks. Often such load changes include competing in a tournament, increased playing/training frequency, alterations in shoe-wear or alternations in playing surfaces. Weight gain can also be a contributing factor as this places extra load onto the joints. Patella tendinopathy is a highly prevalent condition in younger, jumping athletes, less than 30 years old.

Diagnosis:

Patella Tendinopathy is medically diagnosed by a physiotherapist.

A physiotherapist will conduct a strength and lower limb power assessment to highlight any differences between the symptomatic and unaffected side, and as a comparison to dominate limb function. Palpation may reveal localised pain and tenderness over patella tendon.

In rare cases, ultrasound may be utilised in the diagnosis of the condition, however is not often required as there is a poor correlation between imaging findings and patient reported symptoms and level of function.

Treatment:

Multiple interventions can be utilised in the treatment of a patella tendinopathy but should primarily be gym based. As the condition can become chronic and often debilitating, treatment is most successful when commenced early.

Your physiotherapist will guide the appropriate management based on your assessment findings and the severity of symptoms which may include:

– Rest from aggravating exercises

– Graduated strengthening exercises (starting with static contractions and building through range with resistance to power based activities)

– Taping

– Load  management strategies or advice

At Total Physiocare Heidelberg, Reservoir, Camberwell and Footscray we treat many knee and overuse sporting injuries.

Book an appointment today for your assessment!

Blog by Christian Bonello (Physiotherapist)

Posterior Cruciate Ligament (PCL) Injury

What is the Posterior Cruciate Ligament?

The Posterior Cruciate Ligament (PCL) is a ligament inside the knee joint. The PCL attaches to the shin bone (tibia) and to the thigh bone (femur). Along with the anterior cruciate ligament (ACL), these ligaments provide stability to the knee.

The main role of the PCL is to prevent the shin bone from sliding backwards on the thigh bone.

Mechanism of Injury

A direct blow to the upper area of the shin bone is the main cause of a PCL injury. In the general public this is seen during motor vehicle accidents where the top of the shin hits the dashboard. In the sporting population, PCL injuries occur when the athlete falls onto their bent knee causing the shin to hit the ground first. This type of mechanism is common in:

  • Football
  • Soccer
  • Basketball
  • Skiing

Signs and symptoms

  • Pain and/or swelling immediately following the injury
  • Difficulty walking
  • The knee may feel unsteady. It may feel like it is going to give way

Grading of Injury

PCL injuries are often graded I, II, III. Grade I and II are partial tears of the PCL whilst a grade III signifies a complete rupture of the ligament

Grade I – The PCL is overstretched resulting in a small partial tear. The knee remains stable.

Grade II – More of the PCL is torn when compared to a grade I. The ligament is now loose. The knee may start to feel unstable at this grade.

Grade III – This PCL is completely torn. The knee joint is now unstable.

Assessment

Isolated PCL injuries are uncommon. It is more likely for additional injuries to occur to other structure of the knee. These include damage to the meniscus and/or medial and lateral collateral ligaments and even the ACL.

A thorough physiotherapy assessment is required to discover the extent of the injury and if any other structures are damaged. After gaining you subjective history, your physiotherapist will put you through a series of special tests to determine the extent of the injury.

After a knee injury, you may be referred for an MRI scan. This is often necessary to confirm a PCL injury and other associated injuries. Your physiotherapist, doctor or surgeon can refer you for this scan. You may require a X-Ray if an avulsion fracture (small component of bone pulled away by the ligament) is suspected.

Treatment

The PCL can be treated either conseratively or surgically. This is dependent on the grading of the PCL injury and and other associated injuries.

In the immediate stages following a knee injury, it is advisable to follow the POLICE principle for the initial 48-72 hours. This involves Protection, Optimal Loading, Ice, Elevation and Referral for medical management. It is also advisable to follow the NO HARM program to reduce further bleeding and swelling into the joint: NO Harm, Alcohol, Running or Massage

Conservative Management – May include other injuries as well

Patient who have grade I or II PCL tears usually receive conservative treatment. This treatment can consist of a period of immobilisation of the knee with bracing. During the initial period of rehabilitation it is important to focus on strengthen both the quadriceps and hamstring muscles and to regain full movement of the knee.

Sport and skill specific training is crucial in the latter stages of rehabilitation in order to provide ongoing stability to the knee and to provide a successful return to sport or activity.

Surgical Management

Injuries which involve other structure of the knee and Grade III PCL injuries are likely to require surgical intervention. If a period of conservative management has failed to provide stability to the knee, surgery may also be required.

Similar to that of the ACL, the PCL can be reconstructed arthroscopically. This involves the use of tissue grafts to rebuild you PCL. The graft can be taken from another part of your body, often the hamstring or quadriceps tendon, or from another human donor (cadaver). It can take several months for the new ligament to fully integrate with the bones of your knee.

Rehabilitation

Regardless of whether you have opted to treat your PCL injury surgically or conservatively, it is important you participate in a rehabilitation program under the guidance of your physiotherapist.

The aims of physiotherapy are to:

  • Restore range of motion of your knee
  • Improve strength of the surrounding muscles
  • Address poor biomechanics
  • Improve jumping and landing strategies
  • Skill Retraining/ Sport specific activities
  • Return to Sport
  • Prevent Re-injury

At Total Physiocare we treat hundreds of knee injuries and work closely with multiple orthopaedic surgeons in order to accurately diagnose, manage and rehabilitate clients following an acute knee injury. 

Book an appointment today for your assessment!

Blog By Ryan Harris (Physiotherapist)

Injury Screening Assessment for Runners at Total Physiocare

At Total Physiocare, we treat countless runners presenting with injuries that could have easily been prevented. Hence, we have developed a gap FREE running injury screening tool with the ultimate aim of identifying those that are at risk of injury before an injury strikes! Whether you’re  a casual runner or elite athlete, this assessment is appropriate for you.

What does the assessment involve?

The assessment will be carried out at Total Physiocare Heidelberg by Physiotherapists Kara Giannone or Louise Holland. The assessment will firstly involve gaining a thorough understanding of the athlete’s running history, existing and pre-existing injuries and running goals. This will be followed by a comprehensive analysis of:
– Posture
– Running technique and biomechanics of movements
– Strength
– Power
– Endurance
– Joint range of movement

What happens next?

The physiotherapist will then provide yourself and if applicable, your running coach/personal trainer, with a summary of any risk factors that may be predisposing you to injury. If you are identified as being at risk of injury, strategies can then be put in place to intervene before an injury develops and ultimately keep you doing what you love – running! By improving these risk factors, there is also likely to have a flow on effect in improving your running technique and ability.

How do I organise my gap FREE running injury assessment?

To find out more or organise your assessment, please give Total Physiocare Heidelberg a call on 9457 7474.

Book an appointment today for your assessment! (Only available in Heidelberg)