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Physio Opinion: Groin Strains VS Tendinopathies

8/8/2020

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Groin strains or tendinopathies generally occur with sports such as martial arts, football or ice hockey. The muscle belly-tendon part of the adductor tendon or where this tendon inserts to the pubic (hip) bone is generally tender when pressure is placed on it. The adductor longus muscle is the most commonly injured. Common risk factors to increasing the risk of injury the groin muscles include a weakness in adductor muscles and a core muscle weakness (tranversus abdominals).  

The key differences between groin strains and tendinopathies are notably:
  • Strains are acute in nature (a couple of days to a week)
  • Tendinopathies are generally chronic (symptoms occurring for greater than 3 months)
  • Strains are generally tender where the muscle-tendon junction
  • Tendinopathies are generally tender where the tendon attaches to the pubic bone

These injuries can respond very well to physiotherapy management which may include dry needling, manual therapy, extracorporeal shockwave, core stability, stretching and eccentric strengthening rehabilitation programs. Note for that groin related tendon injuries, exercise rehabilitation can take 3-6 weeks before full recovery can occur. 


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What is Plantar Fasciitis or "INNER HEEL PAIN"?

7/19/2020

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Plantar fasciitis or "inner heel pain" can be a very painful condition that is the result of degeneration of the plantar fascia origin on the inside of the heel bone as well as the surrounding soft tissue supporting structures. The plantar fascia has a key role in providing arch support and shock absorption during weight bearing activities such as standing, walking and running. 

It is often caused by an overuse or repetitive strain injury. Specifically, overuse causes micro-tears of the plantar fascia. Common risk factors include:
  • Loss of ankle dorsiflexion (ankle mobiility/stiffness)
  • Over-pronated feet 
  • Lifestyle or occupational factors that involve prolonged standing, walking or running
  • Improper footwear or shoes
  • High BMI or being overweight
  • Diabetes Type II

Before consider a cortisone injection, plantar fasciitis generally responds well to physiotherapy treatment including manual therapy, extracorporeal shockwave therapy, dry needling, stretches and specialised high load strengthening exercises.

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Most common shoulder complaint: do you have subacromial pain syndrome?

7/17/2020

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Subacromial pain syndrome is a non-traumatic one sided condition of the shoulder. This common condition is two thirds of all shoulder complaints at Acland Street Physiotherapy. This condition is more prevalent as you age. It usually causes pain localised around the acromion (bony process of the shoulder) when lifting the arm. Usually one or structures are injured within the subacromial space. 

Common conditions that cause subacromial pain syndrome include:
  • Subacromial bursitis
  • Calcific tendinopathy
  • Rotator cuff tendinitis or tendipathy
  • Rotator cuff tears
  • Biceps tendinopathy 
  • Rotator cuff tendon degeneration

The above conditions often respond very well to physiotherapy treatment which includes manual therapy, dry needling, extracorporeal shockwave therapy, exercise programs involving stretching, strengthening the rotator cuff and stabilising the scapula (shoulder blades).
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CAN SHOCKWAVE THERAPY HELP FIX YOUR PAINFUL TENDONS AND LIGAMENTS?

6/9/2020

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Tendons and ligaments have poor blood supply as they do not have direct blood vessels travelling through them. As a result of the poor blood supply, they are generally slow to heal. Shockwave Therapy has been clinically proven to naturally accelerate healing by targeting injured soft tissues with acoustic waves through:
  1. New blood vessel formation
  2. Reversing chronic inflammation
  3. Stimulating collagen production
  4. Dissolution of calcified fibroblasts
  5. Dispersion of pain mediator “Substance P”
  6. Release of trigger points 
Its use is now growing in common musculoskeletal injury management amongst leading physiotherapists.

Clinical Indications:
  • Shoulder tendinopathies - both calcified and noncalcified
  • Lateral and medial tendinopathies of the elbow - “Golfer’s” and “Tennis” Elbow
  • Greater trochanter pain syndrome
  • Patellar tendinopathy - “Jumper’s” Knee 
  • Achilles Tendinopathy
  • Plantar fasciitis 

Contraindications:
  • Application over brains, eyes, major nerves, major blood vessels, lungs and gut
  • Open wounds/post surgical wounds
  • Implanted devices such as a pacemaker 
  • Emphysises ie. open growth plates 
  • Pregnant women 
  • Blood clotting disorders (including thrombosis)
  • Patients taking oral anti-coagulants
  • If the patient has received a Steroid injection within 6 weeks
  • Tumours present at treatment site 
  • Infections or skin abrasions at the treatment site
  • Under 18 patients except in the treatment of Osgood-Schlatter disease

Frequently Asked Questions regarding Shockwave Therapy

When should you consider Shockwave Therapy?

Shockwave Therapy is often considered as an alternative to surgery when traditional conservative management with a physiotherapist or podiatrist fails, as it is non-invasive, safe and can be highly effective for tendinopathies. Leading physiotherapists often combine traditional exercise rehabilitation and manual treatment with shockwave therapy to optimise outcomes. 


Are there any particular restrictions after treatment?
You are generally advised to rest from physical activity for about 48 hours after each treatment session. 

What is the latest evidence for Shockwave Therapy? 
The best evidence for the use of Shockwave Therapy was available for tendon disorders and tendon calcifications in a “comprehensive rehabilitation framework.” (The Journal of Bone and Joint Surgery: February 7, 2018 - Volume 100 - Issue 3 - p 251–263)

Randomised control trial for Achilles Tendinopathy: Eccentric loading alone was less effective when compared with a combination of eccentric loading and repetitive low-energy shock-wave treatment. (The American Journal of Sports Medicine 2017 Volume: 37 issue: 3, page(s): 463-470_

Systematic Review on Shockwave Therapy and Soft Tissue Injuries: There is evidence that Shockwave Therapy is effective for a number of soft tissue musculoskeletal conditions, particularly for plantar fasciitis, calcific tendinitis. There is a low level evidence for lack of benefit for non-calcific rotator cuff disease and mixed evidence in lateral epicondylitis. (British Journal of Sports Medicine 2014; 48 1521-1521)

3. How will you incorporate Shockwave Therapy into a physiotherapy consultation?
As per normal routine, the patient will require a 40 minute initial consultation to conduct a comprehensive examination and require 20 minute follow up sessions. 3-5 weekly treatments may be required with shockwave therapy. A standard exercise rehabilitation as well as potentially other physiotherapy treatment techniques if clinically indicated.


FREQUENTLY ASKED QUESTIONS

1. Does the treatment hurt?

You will generally feel discomfort. Treatments last for about 5 minutes so they are generally tolerable. The dosage can also be adjusted by the physiotherapist to cater for comfort. However in general, the higher the dose, the more effective the treatment outcomes.


2. How many sessions will I need?

3-5 in general depending on the condition, its severity, patient tolerance and tissue response. Often, patients will feel immediate relief after the first session. 

3. Will I feel pain after the treatment?
You will often feel discomfort within 2 hours after the treatment. This is generally tolerable and not functionally limiting.

2 Comments

    Author


    ​Barry Nguyen
    ​Founder & Head Physio

    Barry is an Australian qualified physiotherapist with over 19 years clinical experience in sports and musculoskeletal injuries.
    ​
    Many of my patients and GPs whom I work with use this resource! 

    Got a question for Barry?

    Feel free to join his "Ask Barry The Physio" 
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