“Warming up before sport: Why you’re probably doing it all wrong!”

If you want to perform at your best — on the court, on the field or on the pitch– you need to know how to get your body ready for intense activity. Yet most people, even many high level sports people, don’t understand the basics of a good warm up. 

So how do you warm up best? With some slow, sustained general body stretches, right?


Most studies show little or no benefit in a generalised, non-specific stretching program to prevent injury.

Scientific evidence indicates that active warm-up, as opposed to slow passive stretching, is the best injury preventative.  In other words, get moving!  So the puppy in the photograph could probably be doing things a little better!

dog stretching

You will also need to do some core muscle activation, and some sports-specific drills.

An example of an active warm-up that focuses on the leg muscles might include the following activities:

  • A slow 400 metre jog to start the process
  • Next, do a few minutes of light movements.  These should concentrate on (a) relaxed gentle movement (b) all the way to the end of range (c)  in each direction (d) for all your joints. Make sure that you move your spine and neck  as well as your limbs.  If you have any specific muscle imbalances or physio-prescribed exercises/stretches, now is an ideal time to work on them.
  • Now perform some exercises to activate your core muscles (if you know how … if you’re unsure than please contact us directly). This is an important step to awaken them for the task ahead, which is unfortunately often omitted.
  • Now move to an active phase. Start with half a dozen 40-60m runs at 50% pace, walking back in between. Slowly increase your stride length with each repetition.  Activate your core muscles as you run.
  • Add another half a dozen “run through” sprints of 40-60 metres, beginning at 50% pace, and increasing by 10% each repetition.
  • Perform 3-5 backwards jogs over 20 metres, and then a similar set of sideways runs.
  • Finally, add sports-specific skills (e.g. kicking: start at 20m, then increase to full strength over 20 kicks.)

By the time you have completed  this warm up, your muscles and joints will be loose, your core muscles activated and ready to protect your joints, and your cardiovascular system will be ready to go.  You’ll hit the playing field in peak condition, and not only will you help to prevent injuries – both short and long term – but you’ll be ready to fire from the first whistle.



What has a Mythical War Hero got to do with Heel Pain?

In Greek mythology, Achilles was a Greek hero of the Trojan War. Achilles was the greatest warrior of Homer’s Iliad. Legend states that Achilles was invulnerable in all of his body except for his heel. He even died because of a wound on his heel. The term Achilles’ heel has come to mean a point of weakness.

However, most runners and athletes who need to run or jump will know that Achilles heel is better known as Achilles Tendinitis and it is both painful and effects your sporting performance.
Achilles Tendonitis
What is Achilles Tendinitis?

Achilles Tendinitis is a term that commonly refers to an inflammation of the Achilles tendon.  It is an overuse injury that is common in sports that require running or jumping. Most experts now use the term Achilles tendinopathy to include both inflammation and micro-tears. But many doctors may still use the term tendonitis, tendinitis or tendinosis out of habit.

What are Tendons?
Tendons are the tough fibres that connect muscle to bone. Most tendon injuries occur near joints, such as the shoulder, elbow, knee, and ankle. A tendon injury may seem to happen suddenly, but usually it is the result of many tiny tears to the tendon that have happened over time.

What Causes Achilles Tendonitis?

Most tendon injuries are the result of gradual wear and tear to the tendon from overuse or ageing. Anyone can have a tendon injury, but people who make the same motions over and over in their jobs, sports, or daily activities are more likely to damage a tendon.

Sometimes a tendon injury can happen suddenly. You are more likely to have a sudden injury if the tendon has been weakened over time.

Common Causes of Achilles Tendonitis

  • Over-training or unaccustomed use – “too much too soon”
  • Sudden change in training surface – e.g. grass to bitumen. Soft sand works your calves and achilles very hard
  • Flat (over-pronated) feet
  • High foot arch with tight Achilles tendon
  • Tight hamstring (back of thigh) and calf muscles
  • Toe walking (or constantly wearing high heels)
  • Poorly supportive footwear, or changing from shoes with a high heel cup to a lower one, which puts more stretch and strain on the achilles.
  • Hill running.
  • Poor eccentric strength

What are the Symptoms of Achilles Tendonitis?

  • Achilles tendonitis may be felt as a burning pain at the beginning of activity, which gets less during activity and then worsens following activity. The tendon may feel stiff first thing in the morning or at the beginning of exercise.
  • Achilles tendonitis usually causes pain, stiffness, and loss of strength in the affected area.
  • You may have more pain and stiffness during the night or when you get up in the morning.
  • The area may be tender, red, warm, or swollen if there is inflammation.
  • You may notice a crunchy sound or feeling when you use the tendon.
How is Achilles Tendonitis Diagnosed?
Your physiotherapist can usually confirm the diagnosis of Achilles tendonitis in the clinic. They will base their diagnosis on your history, symptom behaviour and clinical tests.
Achilles tendons will often have a painful and prominent lump within the tendon.
Achilles tendinitis Further investigations include US scan or MRI. X-rays are of no use in the diagnosis.

What are the Aims of Achilles Tendonitis Treatment?

Achilles tendonitis is one of the most common problems that we see at PhysioWorks and it is unfortunately an injury that often recurs if you return to sport too quickly – especially if your rehabilitation program is not completed.
Your calf muscle is a large powerful group of muscles that can produce sufficient force to run, jump and hop. Your achilles tendon attaches your calf muscle to your heel bone. It is a tendon or non-contractile soft tissue structure, which does have a different level of blood supply and function, which does alter the rehabilitation from a calf tear.
Researchers have concluded that there are essentially 7 stages that need to be covered to effectively rehabilitate these injuries and prevent recurrence.

Phase 1 – Early Injury Protection: Pain Reduction & Anti-inflammatory Phase

As with most soft tissue injuries the initial treatment is RICE – Rest, Ice, Compression and Elevation.
In the early phase you may be unable to walk without a limp, so your Achilles tendon needs some active rest from weight-bearing loads. You may need to be partial-weight-bearing, and use crutches, a wedged achilles walking boot or heel wedges to temporarily relieve some of the pressure on the Achilles tendon. Your physiotherapist will advise you on what they feel is best for you.
Ice is a simple and effective modality to reduce your pain and swelling. Please apply for 20-30 minutes each 2 to 4 hours during the initial phase or when you notice that your injury is warm or hot. Anti-inflammatory medication (if tolerated) may help reduce your pain and swelling. However, it is best to avoid anti-inflammatory drugs during the initial 48 to 72 hours when they may encourage additional bleeding. Most people can tolerate paracetamol as a pain reducing medication.
As you improve a kinesio (stetchy) style supportive taping will help to support the injured soft tissue.

Phase 2: Regain Full Range of Motion

If you protect your injured Achilles tendon appropriately the torn tendon fibre will successfully reattach. Mature scar formation takes at least six weeks. During this time period you should be aiming to optimally remould your scar tissue to prevent a poorly formed scar that will re-tear in the future.
It is important to lengthen and orientate your healing scar tissue via massage, muscle stretches, neurodynamic mobilisations and eccentric exercises. Signs that your have full soft tissue extensibility includes being able to walk without a limp and able to perform Achilles tendon stretches with a similar end of range stretch feeling.

Phase 3: Restore Eccentric Muscle Strength

Calf muscles work in two directions. They push you up (concentric) and control you down (eccentric). Most Achilles injuries occur during the controlled lengthening (eccentric) phase. Your physiotherapist will guide you on an eccentric calf strengthening program when your injury healing allows.

Phase 4: Restore Concentric Muscle Strength

Calf strength and power should be gradually progressed from non-weight bear to partial and then full weight bear and resistance loaded exercises. You may also require strengthening for other leg, gluteal and lower core muscles depending on your assessment findings. Your physiotherapist will guide you.

Phase 5: Normalise Foot Biomechanics

Achilles tendon injuries can occur from poor foot biomechanics eg flat foot. In order to prevent a recurrence, your foot will be assessed. In some instances you may require a foot orthotic (shoe insert)  Your physiotherapist will happily discuss the pros and cons with you.

Phase 6: Restore High Speed, Power, Proprioception & Agility

Most Achilles tendon injuries occur during high speed activities, which place enormous forces on your body (contractile and non-contractile). In order to prevent a recurrence as you return to sport, your physiotherapist will guide you with exercises to address these important components of rehabilitation to both prevent a recurrence and improve your sporting performance.
Depending on what your sport or lifestyle entails, a speed, agility, proprioception and power program will be customised to prepares you for light sport-specific training.

Phase 7: Return to Sport

Depending on the demands of your chosen sport, you will require specific sport-specific exercises and a progressed training regime to enable a safe and injury-free return to your chosen sport.
Your PhysioWorks physiotherapist will discuss your goals, time frames and training schedules with you to optimise you for a complete return to sport. The perfect outcome will have you performing at full speed, power, agility and function with the added knowledge that a through rehabilitation program has minimised your chance of future injury.

What Results Should You Expect?

There is no specific time frame for when to progress from each stage to the next. Your Achilles tendonitis rehabilitation status will be determined by many factors during your physiotherapist’s clinical assessment.
You’ll find that in most cases, your physiotherapist will seamlessly progress between the rehabilitation phases as your clinical assessment and function improves.
It is also important to note that each progression must be carefully monitored as attempting to progress too soon to the next level can lead to re-injury and frustration.
The severity of your tendon injury, your compliance with treatment and the workload that you need to return to will ultimately determine how long your injury takes to successfully rehabilitate.

Can Your Achilles Tendon Rupture?

The worst case scenario is a total rupture of your Achilles tendon. Treatment in this case usually requires surgery, plaster or a walking boot for at least six weeks. Most of these injuries take six months or more to adequately rehabilitate.
Achilles tendon rupture

The best advice is to seek early advice from your physiotherapist to do all you can to avoid this nasty rupture happening in the first place.

More info about Achilles tendon rupture.
Contact our clinic directly

How do I treat a muscle tear?

What happens when I tear a muscle?

Muscle pain can be caused by any strain, injury or tear. The most commonly injured areas are the high speed/load muscles such as your hamstrings, thigh (quadriceps), calf and biceps. Muscle tears can range from a mild strain, in which the fibres are stretched but not torn (grade one), a moderate strain (grade two), to a complete rupture (grade three). Funnily enough, grade three strains are often the least painful. Why? Because the rupture is complete, there is simply nothing left to hurt!

What’s the Best Treatment for a Muscle Strain?

Treatment options vary depending on the severity of your strain or tear. Until you’ve been accurately diag-nosed, use the following guidelines:

  • Ice and a compression bandage.
  • Elevate the region if it is swollen.
  • If it’s painful to walk you should be using crutches.
  • Reduce your training to a level where you feel no pain.
  • Seek the advice of your Physio.

hamstring tear

What Should You Do Next?

Returning to sport can be easy or complicated depend-ing on the muscle affected. Some muscle tears, such as hamstrings, are notoriously difficult to get right. Ideally you should undertake:

  • an assessment of your muscle function, core stability and biomechanics to avoid injury recurrence.
  • deep massage to ensure that any scar tissue doesn’t clump.
  • a muscle rehabilitation program that incorporates components of strength, endurance, flexibility and speed that is specific to your chosen sport.
  • a neural tissue dynamics assessment to ensure that no nerve tissue has become entrapped in the scar tissue.
  • application of a heat retainer to the area when you return to sport.
  • application of ice therapy after any training sessions.

If you suffer a muscle tear which fails to respond after a few days, or continues to niggle, please contact PhysioWorks for more specific advice.

To read more about muscle tears, see http://www.physioworks.com.au/regions/muscle-pain-amp-injury or contact us directly via http://www.physioworks.com.au/Bulimba/bulimba.htm or http://www.physioworks.com.au/Mansfield/mansfield.htm


What is Bursitis? How do I cure bursitis?

What is bursitis?

A bursa is a small, fluid-filled sac inside your body. It can be thought of as a self-contained bag with a lubricant and no air inside. If you imagine rubbing this bag between your hands; movement of your hands would be smooth and effort-less. That is what a bursa is meant to do; offer a smooth, slippery surface between two moving objects. Bursae are found where muscles and tendons glide over bones. Without the bursa between these surfaces, movements would be painful due to friction.

bursitis picture

Bursitis can cause pain in many areas, such as the shoulder, knee, hip and elbow.

When a bursa becomes inflamed, the bursa loses its gliding capabilities, and becomes more and more irritated and painful when it is moved. The added bulk of the swollen bursa causes more friction within an already confined space.

What Causes Bursitis?

  • Repetitive Irritation

Bursitis usually results from a repetitive movement or due to prolonged and excessive pressure. For example, people who have weak hip muscles and tend to sway as they walk can develop hip (trochanteric) bursitis. Similarly in other parts of the body, repetitive use or frequent pressure can irritate a bursa and cause inflammation.

  • Traumatic Injury

Another cause of bursitis is a traumatic injury. Following trauma, such as a car accident or fall, a patient may de-velop bursitis. Usually a contusion causes swelling within the bursa. The bursa, which had functioned normally up until that point, now begins to develop inflammation, and bursitis results. Once the bursa is inflamed, normal move-ments and activities can become painful.

  • Systemic Diseases

Systemic inflammatory conditions, such as rheumatoid arthritis, may also lead to bursitis. These types of condi-tions can make patients susceptible to developing bursitis.

How is Bursitis Treated?

Bursitis is a symptom caused by many other factors that if you don’t solve, will render you vulnerable to recurrences. Your physiotherapist is highly trained in identifying the biomechanical causes of bursitis. With the correct joint alignment and muscle balance, the bursitis can usually be cured permanently.

Back injury to Australia’s cricket captain Micheal Clarke

Today’s Australian newspaper ran an article on Michael Clarke’s lower disc injury. In the article, they discuss the opinion of  a physiotherapist on Clarke’s treatment. I feel that he raises some good points, particularly the one about over-reliance on CT scans and x-rays to diagnose the pain. (One study showed that 2499 out of every 2500 back x-rays are a waste of time.) He also mentions that much pain is caused by precipitated by poor muscle control – another well-accepted principle of treatment by most physios.  The full text of the article is below.

cricketby:Adam Shand

AT the end of a disastrous tour of India, Australia’s skipper Michael Clarke literally carries the burden of the nation’s expectations on his dodgy back.

While this weekend’s fourth Test in Delhi is the first match Clarke has missed through injury, the timing is ominous with back-to-back Ashes series looming.

Clarke’s “degenerative” back condition, a “bulging disc” first diagnosed when he was 17, has become an ever-present concern for the 31-year-old.

Leading Melbourne physiotherapist Geoff Fisher believes Cricket Australia must re-examine its protocols about managing injuries if Australia’s most valuable asset is to pay his way.

Fisher questions whether the team doctor should be in charge of diagnosing and overseeing treatment regimes for conditions like Clarke’s. “In sporting teams, doctors have become the front line of diagnosis for such pain but they are hopelessly out of their depth in dealing with musculoskeletal problems,” says Fisher.

“If the Australian team’s frontline response is medical then it will almost certainly fail.”

Fisher claims there is an over-reliance by sports doctors on CT scans and X-rays to diagnose pain. Scans often reveal abnormalities in the structure of a joint or limb, like Clarke’s bulging disc, he says.

“The doctor will say, ‘we see there is change in the structure of the joint. There’s evidence of wear and tear or abnormality. We can’t explain why it’s happening but we know it is happening because of the pain’.”

Studies have shown that up to 40 per cent of people have abnormalities in their spines that don’t automatically cause pain. Clarke’s pain, often described as his back “locking up”, may have nothing to do with discs or vertebrae. It may in fact be a protective response from the muscles of his back, not an injury at all.

It’s a problem that blights the lives of millions of people who spend too much time chair-bound or sitting in motor vehicles with knees elevated higher than hips. This places excessive strain on the postural muscles that keep the spine stable. Spinal muscles will attempt to control movement by an increase in tightness and tone.

“By reducing the range of movement, threats to the spine, are reduced. These responses are hard-wired and self-increasing, built into the neurology of the brain and spinal anatomy.”

The giveaway clue is that Clarke often suffers tightness in his hamstrings, Fisher says.

If Clarke’s problem is related to his spinal muscles, it is a treatable condition, using safe non-invasive manual therapies, says Fisher.

Working with triathletes, Fisher uses a variation of an Australian-devised therapy known as “continuous mobilisation” which might provide an alternative for Clarke.

Fisher’s method of manual therapy is designed to “turn off” the protective behaviour in the spine and the referred pain is often immediately relieved.

Fisher says that 95 per cent of his patients with chronic pain in their head, legs, knees, arms, feet or hands, are in fact suffering from “referred pain”. If, like Clarke, they haven’t suffered a trauma or arthritis, the source of the problem is invariably found in the lower back or neck where muscles have engaged in a protective response to guard the spine.

To learn more about back pain, please visit http://www.physioworks.com.au/store-1/books/back-pain-how-to-get-rid-of-it-forever


Knee pain in kids

Knee pain is common in childhood. From bumps and bruises to ‘growing pains’, many children develop symptoms as the years fly by. Let’s look at one particular condition, called Osgood‐Schlatter’s disease, to better understand how knee pain in kids should be treated.

Osgood‐Schlatter’s disease can cause knee pain in rapidly growing children. Typically, this problem involves a part of the knee called the tibial tuberosity, which is the bump of bone just below your knee cap. The muscle that attaches here, the quadriceps, actually starts to pull this protuberance off the main bone shaft.

Osgood schlatter's disease

Note how the quadriceps tendon is pulling the bone away from the tibia

Osgood‐Schlatter’s disease usually affects kids between 11 and 14 years old, as this is a time of rapid growth. As children go through these growth spurts, the muscles around the knee can become very tight, exacerbating the problem.

Other conditions that must be differentiated from Osgood‐Schlatter’s disease include patella problems, tendinitis and knee fractures.

Unfortunately, playing sport can add to the problem. Any activity can cause Osgood‐Schlatter’s, but it is more common in activities that involve a lot of jumping and quick changes in direction like basketball, volleyball, soccer and gymnastics.

The good news is that with the right know‐how it is easy to treat the pain. Physio can help to stretch tight muscles, strengthen the weak ones, and make sure that all of your biomechanics are correct.

step down exercise

The step-down exercise, which, when performed correctly, can help to cure Osgood-Schlatter’s disease

We can also check your walking pattern and knee‐cap angle/position, and advise on how to modify movements in activity that might be contributing to the problem. Thankfully, we have good success in treating Osgood‐Schlatter’s disease.

“Arthritis: the causes, symptoms, and a miracle cure”

Arthritis is a group of musculoskeletal conditions in which there is wearing and inflammation of the joints causing chronic pain, swelling and stiffness. Nearly 3.3 million Australians have a disability due to arthritis and related conditions, and more than half of these have chronic or recurrent pain.

The two most common forms of arthritis are osteoarthritis (OA) and rheumatoid arthritis (RA), but they are very different. RA is a disease, that can be detected via a blood test. In the RA disease process, the patient’s own immune system attacks the lining of their joints, causing pain, swelling and eventual deformity. Typically, it causes problems in the small joint such as the fingers.

Drug therapy, gentle exercise and occasional splinting are the best treatments. Joint replacement is some-times used. Thankfully, RA is rare.

Osteoarthritis (OA)

Conversely, OA is wear-and-tear, like rust in your joints. It typically effects large, weight bearing joints such as hips and knees. OA is far more common than RA—almost everyone of advancing years suffers some form of OA—our bodies simply weren’t designed to last that long!


Osteoarthritis vs rheumatoid arthritis: the differences

The Role of Exercise

Moderate, regular exercise has been proven to aid in the prevention of arthritis, and offers a host of benefits to sufferers. Exercise can reduce joint pain and stiff-ness, builds strong muscles around the joints and in-creases flexibility and endurance.

The Role of Physiotherapy

Patients with OA may benefit from joint mobilization, electrotherapy, hydrotherapy and muscle strengthening exercises. Localized, specific massage techniques can also break up the ’rust’ from the joint, greatly reducing the pain. Physiotherapy can reduce arthritic pain and reliance on drug therapy. Unlike pharmaceuticals, physiotherapy has few side effects or contraindications.

Although arthritis is a chronic disease, treatment and management techniques can control and reduce the effects of the condition, and prevent further deterioration. Almost like a miracle cure.

To read more about arthritis and its cures, see http://www.physioworks.com.au/Default.aspx?PageID=619824&A=SearchResult&SearchID=5389194&ObjectID=619824&ObjectType=1

Or visit us directly at http://www.physioworks.com.au/Bulimba/bulimba.htm or http://www.physioworks.com.au/Mansfield/mansfield.htm