Anterior knee pain also referred to as "patellofemoral pain syndrome" is a common presentation I see at Acland Street Physiotherapy on a daily basis. It can often be referred to as "runner's knee" as it is a common injury presented in the running population due to oversuse. The patella is the knee cap while the femur is the thigh bone. The joint between the knee cap and thigh bone is called the patellofemoral joint, which acts as a lever in support of movement of your knees. During movement of the knees, the patella works by running up and down smoothly along the groove. The stability and control of this joint is primarily dependent on the biomechanical balance between the static and dynamic supporting soft tissue structures around it.
These soft tissue structures that are important to note that the ITB (iliotibial band) which is on the outside of the knee and the inner quadriceps muscle VMO (vastus medialis oblique) which is on the inside of the knee. An imbalance of these structures can lead to patello maltracking issues, causing movement dysfunction and the patella not running smoothly up and down in its groove. In addition to the knee, this involves a physical assessment of trunk control, hips and feet.
Often, this condition responds well to addressing overall lower limb biomechanics, patella taping, balance (proprioception) exercises, inner quadriceps activation and strengthening exercises, manual release of tight soft tissue structures in particular the ITB and TFL (tensor fascia latae).
An interesting insight based on my experience is that on many patient presentations, those who have tried to alleviate or treat patellofemoral pain syndrome have ignored hip strengthening exercises. A high quality research study (systematic review) in 2015 demonstrated that hip strengthening exercises can significantly reduce the intensity of pain as well as improve function and mobility.
When done with correct technique and form, deadlifts are the "king of all exercises" as they traditionally say! I highly recommend that non-body builders and non-hardcore gym-goers should also consider adding these potentially powerful exercises to your exercise regime, to enjoy a diverse range of health benefits. This does not exclude those who suffer from chronic diseases or health conditions such as lower back pain, arthritis, diabetes type II, heart conditions, osteoporosis, fibromyalgia, chronic obstructive pulmonary disease (COPD), cancer, high blood pressure and chronic pain.
The key reasons why I believe these exercises are unparalleled in terms of health benefits which are well documented in scientific research include:
1. They work out the most muscle groups at the same time of all strength exercises associated with weights.
2. As a result, they burn significant more calories, saving you time at the gym or at home.
3. They can in fact improve your core stability and posture when done correctly..
4. They can significantly improve your grip strength which results in performing your activities of daily living involving lifting and carrying with more ease.
5. They promote natural testosterone and human growth hormone production, promoting soft tissue healing, bone strength, muscle growth and weight loss. These hormones are critical to the healthy functioning of both females and males.
6. They can improve your running performance and efficiency, improve your ability to perform in sporting activities, even if you are a "weekend warrior"!
7. They provide a healthy stimulation to your neural system, improving your general functional strength and stamina.
8. Interestingly, deadlifts can also improve your cardiovascular or aerobic fitness.
Nonetheless, I do often see presenting at Acland Street Physiotherapy with patients suffering from lower back injuries associated with doing with deadlifts incorrectly - the clinical diagnoses range from muscle strains, sciatic nerve irritations, facet joint sprains, sciatica to slipped lumbar disc prolapse injuries.
There are many YouTube videos available online with "experts' showing how to perfect the deadlift technique however, I would highly recommend that you make a booking with a sports or musculoskeletal physiotherapist. An experienced physiotherapist will perform a comprehensive physical examination on you, take your medical history, before teaching you the appropriate form and technique, that is individualised to your personal needs. Each individual's anatomy and movement skills vary so it is important to get assessed properly by an expert.
ATTENTION GYM-GOERS AND ATHLETES: GRADUALLY EASE INTO EXERCISE POST-CORONAVIRUS AS ADVISED BY PHYSIOS
A week ago, there was an interesting news article via ABC News regarding physiotherapists warning gym-goers to gradually ease into exercise post-coronavirus. Experts are also predicting a rise in soft tissue injuries as Australians return to sport post coronavirus lockdown. This is relevant information as recently, I am seeing a significant increase in patient presentations associated with return to sport and return to gym/exercise injuries. Popular clinical diagnoses at my clinic have included sciatica, lower back pain, nerve impingement, lateral ankle sprains, shin splints, patella tendinitis, subacromial burisitis, rotator cuff tendinitis, tennis and golfer's elbow. This has not been a surprise as individuals who have been very active during social restrictions and lock down would experiencing muscular de-conditioning, reduced neuromuscular control and a loss in mobility. Soft tissues such as ligaments and tendons generally get weaker when there is inconsistent physical loading on them too.
Here are 6 key tips on how to get back into sport or gym workouts reducing the risk of injury
1. Slowly and gradually return to pre-coronavirus levels of exercise
2. Spend more time warming up by rehearsing exercise routines with significant less resistance or intensity (30% is the general guidelines for this)
3. It will likely take about 4-6 weeks before your body will get back to pre-coronavirus levels of performance if you consistently train
4. Watch your posture and technique more carefully using a mirror, physiotherapist or coach for feedback before you progress with higher levels of difficulty
5. Spend time time in between exercise sessions or workouts recovering or resting than you would usually
6. Do not feel like you need to urgently make up for lost time and leave the pride at the door
Bodyweight leg exercises are a great way to build up lower limb strength, prevent injuries and improve your overall physical fitness. A common question I get as a physio is: "Are squats or lunges more beneficial to do regularly?"
Firstly to answer this question, it is important to understand that both squats and lunges can be adjusted to preferentially activate certain muscle groups.
Squats and lunges both use your gluteals, hamstrings and quadriceps muscle groups. However, lunges involve leaning the body forward which activates more hamstrings and gluteals, while if you keep the body upright, you will activate the quadriceps more - for instance, when you perform a classic style squat. However, going lower down will activate more gluteals and hamstrings.
It is also interesting to note that single leg exercises such as lunges also preferentially activate the gluteal mininus, medius and core muscles specifically to assist with hip stabilisation. Lunges also changes your dynamic balance, compared to a squat which has a large stable base of support.
A 2018 research study demonstrated that 6 sets of 6-12 rep weighted squats can produce an endocrine system response, which may play a role in stimulating muscle growth and tissue regeneration.
I would recommend that you incorporate both lunges and squats in your exercise regime for more health benefits.
Here is a useful reference article explaining the common fitness mistakes associated with squatting, lunging and planking, written by a leading expert physiotherapy lecturer from the University of South Australia, Dr Steve Milanese. It provides some simple tips on correcting your technique.
Chronic pain can be severely disabling and is a common presentation at Acland Street Physiotherapy. It is a complex concept to understand and not a lot is known about it. The following is a YouTube video our physio Barry Nguyen frequently recommends to his clients to view to learn more about pain. This less than 5 minute video applying the latest scientific and clinical research and explains pain in plain English as well as practical tips on what you can do to help it!
In this environment as the COVID-19 pandemic worsens, you may prefer a telehealth option in the comfort and safety of your own own via your smartphone or computer.
It may be a surprise to you as physiotherapy is traditionally known and experienced as a very 'hands on', Barry Nguyen who has over 15 years sports and musculoskeletal injury experience as a physiotherapist can confidently conduct many physical tests through video observation and provide highly effective pain management and self-treatment programs (which includes exercises and DIY hands on therapy) digitally. It is true that he cannot massage you, but he can teach you or your family member or partner to do it under video supervision.
So how does the physiotherapy telehealth consultation work exactly?
1. Barry will take a detailed and full history of your injuries or health concerns
2. He will provide you with a provisional diagnosis of your condition
3. He will provide you with a comprehensive DIY physiotherapy treatment plan digitally via an app-based exercise prescription software a personalised home exercise and self-treatment program
4. He will provide you with comprehensive personalised advice via videos, documents and website links
5. Prescribed exercises and self-treatment techniques can be closely supervised, progressed and varied in real time via your smartphone or laptops camera
To access this service, you will need:
1. An internet connection and smartphone/laptop with a camera
2. An e-mail account
Please note this service is currently rebatable under a Medicare chronic disease management plan (care plan) or if you have Private Health Insurance cover.
If you are unsure if your injury or health concern is appropriate for telehealth, please contact us and speak to Barry to discuss.
There is emerging scientific research that training loads are directly correlated to injury risk.
Training load injuries are generally caused by:
Specifically, there are 2 types of training loads: External Loads and Internal Loads. External loads measure the amount of external workload eg. (running on the treadmill, weight lifting) to the individual while internal load measures the individual’s post exercise heart rate or rate of perceived exertion (RPE) as a response to the external workload.
Rate of Perceived Exertion Guides for Aerobic and Resistance Training
It is important to understand that to optimise performance, there needs to be a fine balance between training hard and overloading resulting in injuries and comprising performance. This sounds like common sense however to accurately monitor training loads is a challenging task given that it is associated with frequency, duration and intensity. Duration and frequency are relatively easy to measure however intensity could be measured by for example, how fast you are running, your heart rate, how much weight you are lifting with the barbell or the complexity or speed of the movements you are performing. Tracking your training loads is not just about managing the specific exercise you are doing but can help you determine when it may be appropriate for you to do some cross-training or vary your load.
Acute on Chronic Workload Ratio (ACWR)
For those who are a serious about injury prevention,a great way to find your training ‘sweet spot’ while minimising the risk of injury if you are serious about optimising performance is using the Acute on Chronic Workload Ratio calculator. Scientific research indicates a 0.8-1.3 ratio range is ideal. Injury risk increases at a 1.5 ratio or higher.
To calculate your ratio, multiply your rate of perceived exertion (RPE) after each exercise with the duration, intensity or frequency of the exercise session (external load). The Acute Workload is over a 7 day period. The Chronic Workload is over a 28 day period. The ratio is the result of dividing the Acute Workload by the Chronic Workload.
We often associate strength training with dedicated body builders, grunting and sweating away at the gym for hours working on their physical appearance. Barry Nguyen, a sports & musculoskeletal physiotherapist and health technologist shares with us other reasons why we should all participate in strength training.
1. Increase bone strength - Strength training stresses on your bones leading to increased bone density and reduce the risk of osteoporosis ('brittle bones').
2. Weight control - Strength training helps convert fat into lean muscle raising your basal metabolic rate. This helps you burn more calories even at rest.
3. Improve brain power - Some studies have suggested that strength training can help improve your memory and focus, particularly in older adults.
4. Manage chronic disease - Strength training can help alleviate the symptoms of chronic diseases including back and shoulder pain, osteoarthritis, heart failure and diabetes type II.
5. Improve stamina - Strength training can help you do more physical activities in your daily living without feeling tired and inefficient.
6. Boost your self-esteem - Strength training has been shown in studies to boost your self-confidence.
7. Improve posture - Strength training can help you move while performing your daily activities in a more relaxed and efficient manner.
8. A large number of research studies have demonstrated that strength training can improve running performance, efficiency and reduce the risk of injury. Below is a useful infographic summarising the benefits of strength training for recreational and elite runners based on the latest scientific research studies:
What is Dry Needling?
Dry needling is a form of therapy in which fine needles are inserted into myofascial trigger points (painful knots in muscles), tendons, ligaments, or near nerves in order to stimulate a healing response in painful musculoskeletal conditions. Dry needling is not acupuncture of Oriental Medicine, that is, it does not have the purpose of altering the flow of energy (“chi”) along traditional Chinese meridians for the treatment of diseases. In fact, dry needling is a modern, science-based intervention for the treatment of pain and dysfunction in musculoskeletal conditions such as neck pain, shoulder impingement, tennis elbow, carpal tunnel syndrome, headaches, knee pain, shin splints, plantar fasciitis, or low-back pain.
How does Dry Needling help?
After, you may have less pain, feel more relaxed and/or have better range of motion. You may also be able to do activities you couldn’t do before or experience reduced symptoms (such as pain) whilst doing them.
What are the Risks of Dry Needling and is it safe?
Drowsiness, tiredness or dizziness occurs after treatment in a small number of patients (1-3%) and if affected, you’re advised not to drive. Minor bleeding or bruising occurs after dry needling in 15-20% of treatments and is considered normal. Temporary pain during dry needling occurs in 60-70% of treatments. Existing symptoms can get worse after treatment (less than 3% of patients); however this is not necessarily a “bad” sign. Fainting can occur in certain patients (0.3%), particularly at the first treatment session when needling the head or neck regions. Dry needling is very safe; however serious side effects can occur in 0.01% of people. The most common serious side effect from dry needling is pneumothorax (lung collapse due to air inside the chest wall). The symptoms of dry needling induced pneumothorax commonly do not occur until after the treatment session, sometimes taking several hours to develop. The signs and symptoms of a pneumothorax may include shortness of breath on exertion, an increase in breathing rate, chest pain, a dry cough, bluish discoloration of the skin, or excessive sweating. If such signs and/or symptoms occur, you should immediately contact your physical therapist or physician. Nerves or blood vessels may be damaged from dry needling which can result in pain, numbness or tingling; however, this is a very rare event and is usually temporary. Damage to internal organs has been reported in the medical literature following needling; however, these are extremely rare events (1 in 200,000).
What can be done instead of Dry Needling?
You can choose not to do any treatment at this time and see if the condition gets better on its own. Other choices are: soft tissue mobilization alone, shockwave therapy, joint manipulation, and/or specific exercise
How will I feel after Dry Needling?
You may be sore right after treatment where Dry Needling was used. This does not always happen, but it is normal. Soreness may begin in a few hours or even the next day. The soreness may be different for each person. It usually feels like you had a hard workout at the gym. Soreness usually lasts 24-48 hours. Tell your physiotherapist at your next visit how long the soreness lasted.
Bruising from Dry Needling is possible. Some areas are more likely to bruise than others. The shoulders, chest, face and portions of the arms and legs are more likely to bruise than other areas. Large bruising is not common, but can happen. Use ice to help decrease the bruising. If you are worried, please call your physiotherapist
It is common to feel tired/fatigued, energized, emotional, giggly or “out of it” after treatment. This is normal and can last up to an hour or two after treatment. If this lasts more than a day contact your provider as a precaution. Rarely, Dry Needling may actually make your symptoms worse. If this continues past the 24-48 hours, keep note of it. This can help your therapist change your treatment plan if needed. This does not mean Dry Needling cannot help your condition
What should I do after my treatment?
It is highly recommended that you should drink more water for the next 24 hours after Dry Needling treatment. This helps avoid or reduce soreness. After dry needling treatment, try this if you wish. Please note that if it hurts or makes your symptoms worse, stop the activity.
What should I avoid after treatment?