Suffering any Sports Injuries?
Sports injuries are one of the most common injuries we treat at City Physio! Sports injuries include a variety of sport-related injuries such as ankle sprains and strains, back pain, knee pain and shoulder injuries as well as injuries that can occur off the field and impact sporting performance.
Sporting injuries are treated a little bit differently from other injuries as the require specific goal setting, diagnosis and rehabilitation plans to ensure the athlete returns safely and effectively back to their sport. The first treatment for a sports injury will involve a detailed history of how the injury occurred, the sports and activities played, training regime and specific requirements of the sport. From this, the Physiotherapist will determine an appropriate action plan to not just reduce pain, but to prevent recurrence, eliminate or control and contributing factors and return the athlete back to sport in the fastest, most efficient way!
The Physiotherapists at City Physio have significant Sports Physiotherapy backgrounds with extensive involvement in NSW Netball, Premier League soccer, local and district sport, Rugby Union as well as theatre and dance sports!
We treat both traumatic and overuse injuries such as.
An Ankle Sprain is one of the most common sporting injuries that we see! It often involves the athlete “rolling” or spraining their ankle which results in a tear or strain in the ligaments that hold the ankle together. Additionally, injury to the surrounding muscles and soft tissue is very common and needs to be considered. An accurate diagnosis of what specifically has been injured and to what degree is very important. This governs how long an athlete is off their sport, how long footwear choices may be limited and how the rehabilitation program will look. Low-grade sprains are usually 2-4 weeks, while more severe ankle sprains may require the athlete to limit their activity for upwards of 12 weeks! Learn More about Ankle Sprain here.
Achilles Tendonitis is an acute inflammation of the Achilles tendon at the back of the ankle. The Achilles is a very large tendon that attaches the calf muscles to the back of the heel providing forward and upward propulsion and thus Achilles tendonitis is very common in the active population. Generally speaking, Achilles tendonitis is a result in a change in the loading patterns of the calf and thus, the Achilles tendon. This may occur with a change in footwear, a sudden increase in running or a change in activity such as joining F45 or doing a large number of box jumps! This results in acute inflammation of the tendon fibers as they are being suddenly loaded at a rate higher than they can repair, which then causes pain and limits activity. In some cases, you may even notice a thickening or swelling-type node along the tendon itself. Learn More about Achilles Tendonitis and its treatment here.
Back pain is one of the most common complaints we see at City Physio! Back pain can include conditions such as sciatica, sacroiliac joint injuries (SIJ), disc bulges or herniations, facet joint problems, nerve injuries or just an ache that has crept up on you!Back pain can range from a vague ache that comes and goes, to sharp pain that is debilitating or limiting function or sport participation. It can be insidious in onset where the pain doesn’t seem to have come from a specific cause and just began creeping up, or very acute and stemming from a single activity or movement.Back pain can be localised and stay in a single area, move around or change throughout the day or with movements, or include complaints of “band like” tightness, stiffness, radiating pain, pins and needles and even numbness! Causes of back pain are equally broad, and in most cases are multifactorial.As the back is a very large area, an accurate assessment and diagnosis is very important. The most common things we look for in accurately diagnosing back pain are the quality of the pain, how it started and its location.
Secondarily we look to posture and symmetry. What does the standing, sitting and moving posture look like, and does it cause or lessen the symptoms? Is the movement symmetrical? Is the muscle bulk even from left to right, from front and back?For example in the low back, an imbalance in glute strength from left to right may place someone at an increased risk of developing low back pain. As does an imbalance of quadriceps to glute ratio! Being strong is important, but the muscles also have to work together in the correct order and ratio! Learn More about Back Pain here
A Groin Pain or Groin Strain (also known as a groin pull or groin muscle tear) is a strain or tear of any of the adductor muscles on the inside of the thigh and groin. Groin strain is most common in sports that require running and jumping, or sports where sudden direction change is common- such as soccer, football and hockey. Symptoms can include a sudden onset of pain on the inside of the leg or groin, and pain in the groin with running, leg lifting, bringing the legs together or deep side lunging movements. Learn more about Groin Pain Here.
A Hamstring Tear is a strain or tear of the hamstring muscles or tendons in the back of the thigh. It is a very common injury in runners and most codes of football as it includes the 3 large muscles connecting the hip to the knee that pull the leg backwards and bend the knee. You can injure the hamstrings anywhere along their length- all the way under the buttock where they attach into the pelvis, through their muscular bellies on the back of the thigh, or into their connection at the back and sides of the knee.
A hamstring injury can occur when the hamstring muscles are stretched beyond their limit. This is more common during sudden or explosive movements such as sprinting, slipping over or sudden acceleration. Learn more about Hamstring Tear here.
Knee Joint Injury
The knee joint is a very dense structure and very susceptible to injury with both everyday activities and sporting incident.
The knee joint comprises 4 bones: the thigh bone (femur), the shin bones (tibia and fibular) and the kneecap (patella). Together these bones create the foundations of the knee. These bones can be injured with a fall, impact or accident such as a car accident. Fractures of the knee are not the most common but they need to be treated seriously with bracing, casting and on occasion, surgery.
Connecting the 4 bones together are the ligaments. In the knee there are 4 most common ligaments: the ACL, the PCL, the MLC and the LCL. Together these ligaments hold the bones together and create a stable base for the muscles, and help to limit the joint moving into certain directions. Injuries to the knee joint ligaments often occurs with slip and falls, sporting accidents and sudden direction change. An accurate diagnosis of a ligament injury is very important as low-grade injuries are treated with physiotherapy alone, while more severe injuries may require bracing, surgery and a prolonged healing period. Learn More About Knee Joint Injury Here.
Runner’s knee is not just for runners! Runner’s knee refers to range of knee joint injuries that can be broadly called patellofemoral pain syndrome. Patellofemoral pain refers to pain or inflammation around the kneecap (patella) in its joint (the femur). It is generally considered a biomechanical injury but is can also come on as a result of a fall onto the knee, or a blow to the kneecap itself during sport.
Biomechanically speaking, several things can contribute to runner’s knee! We often see it due to over use or sudden increases in knee-stressing activities such as jump squats, box jumps, high intensity running or lunges. A sudden increase in activity or a change in activity may emphasise a muscle imbalance around the knee or pelvis which can cause the kneecap to track poorly resulting in pain. Additionally, things like hypermobility and flat feet can contribute to poor patella tracking. And so can being a female- due to the increased hip:knee angle.
Runner’s knee usually presents with pain in the front of the kneecap or front of the knee joint generally, pain with running, squatting, kneeling or pain getting up after periods of prolonged sitting, and is made significantly worse with walking downstairs or down hills!
Treatment requires a thorough and detailed assessment of lower limb mechanics from the pelvis to the foot! Often many components are at play in the development of Runner’s knee and so it is important to address all of them- lest the symptoms return in a few months!
Treatment might include specific strengthening exercises, muscle activation exercises, avoidance of or modification of aggravating activities, footwear recommendations, changes to running style or training, taping and ice to settle the inflammation.
Iliotibial band syndrome
The iliotibial band (ITB) is a thick band of fascia that runs from the outside aspect of the pelvis, along the outside of the thigh before crossing the outside of the knee and joining into the shin bone. Iliotibial band syndrome is inflammation of the outside of the knee where it crosses the lateral femoral condyle, a bony prominence on the outside of the knee, causing friction and pain. When the knee is bent, the ITB is located behind the lateral femoral condyle but as the knee straightens it moves forward on the condyle. If mechanics are not optimised this can cause a build-up of inflammation on the bony prominence resulting in pain as the knee bends and straightens. You will often hear it called ITB Friction Syndrome for this reason.
As the ITB connects the pelvis, knee and shin it is very susceptible to biomechanical overload when stability at the knee or pelvis is not optimised. This is especially common in long distance runners and cyclists, or when people rapidly increase their training and don’t have the stability around the hips and knees to cope with the increased loads.
Things like pelvic tilt, muscle balances around the knees and pelvis and sudden increases in training frequency, intensity or load can contribute to ITB syndrome. Training errors such as continual running on roads with a camber, or incorrect bicycle setup can also contribute to gradual overloading of the ITB.
Treatment in the initial stages revolves around accurate identification of any contributing factors, load or activity modification and pain relief. This can be done with manual therapy, taping, ice and anti-inflammatories Once any biomechanical factors have been identified, a progressive and specific strengthening or stretching program may be introduced.
Patello-femoral Pain refers to range of knee joint injuries that can be broadly called patellofemoral pain syndrome. Patellofemoral pain refers to pain or inflammation around the kneecap (patella) in its joint (the femur). It is generally considered a biomechanical injury but is can also come on as a result of a fall onto the knee, or a blow to the kneecap itself during sport.
Biomechanically speaking, several things can contribute to patella-femoral pain! We often see it due to over use or sudden increases in knee-stressing activities such as jump squats, box jumps, high intensity running or lunges. A sudden increase in activity or a change in activity may emphasise a muscle imbalance around the knee or pelvis which can cause the kneecap to track poorly resulting in pain. Additionally, things like hypermobility and flat feet can contribute to poor patella tracking. And so can being a female- due to the increased hip:knee angle.
Patello-femoral pain usually presents with pain in the front of the kneecap or front of the knee joint generally, pain with running, squatting, kneeling or pain getting up after periods of prolonged sitting, and is made significantly worse with walking downstairs or down hills!
Treatment requires a thorough and detailed assessment of lower limb mechanics from the pelvis to the foot! Often many components are at play in the development of patella-femoral pain and so it is important to address all of them- lest the symptoms return in a few months!
Treatment might include specific strengthening exercises, muscle activation exercises, avoidance or modification of aggravating activities, modifications to shoes or running style, taping and ice to settle the inflammation.
Bursitis is inflammation of a bursa. A bursa is a small, fluid filled sac that sits between bones and soft tissues (muscles, tendons and ligaments) that acts to cushion and assist joint movement. Bursitis can occur at nearly any joint but is most commonly seen at the knee, hip, elbow and knee
Bursitis is inflammation of the bursa due to overuse or friction on the bursa itself. When irritated, the bursa can swell causing pain and limiting movement. It can occur in a few ways- the bursa can become inflamed due to an impact such as a fall or blow, due to repetitive pressure or due to overuse.
A common cause of bursitis is overuse of a joint with poor mechanics or posture. This places unnecessary and repetitive strain on the joints, muscles and tendons that the bursa is designed to dissipate. Examples include bursitis at the shoulder (Subacromial Bursitis) where posture of the head, neck and shoulder itself is not ideal causing a pinching of the bursa on the outside of the shoulder. If this posture or arm movement is not corrected, the repetitive pinch of the bursa causes inflammation of the bursa overtime resulting in pain and dysfunction.
Additionally, weak gluteal muscles can cause a low grade friction of the bursa of the hip in runners (Trochanteric Bursitis) causing pain on the outside of the hip with walking and running.
Repetitive pressure can also cause irritation of the bursa. This is common with indoor soccer goalies who fall onto their knees repetitively, or with prolonged pressure on an elbow when leaning on a desk! Traumatic bursitis can also occur in the same way but with a larger single blow to the bursa. This is more common with a high velocity fall such as from a bicycle or while running and landing on a firm surface such as concrete or bitumen.
Other causes of bursitis can include infection, gout and other forms of inflammatory arthritis.
Treatment of bursitis depends on the cause! Treatment mainly aims to relieve the symptoms as much as possible and to unload the bursa so that it can heal. This requires accurate identification of the overloading factors- weakness, posture and any tightness placing pressure on the bursa. If bursitis was caused by a particular activity it is important that the mechanics of that activity are broken down and biomechanically, or ergonomically optimised.
Shin Splints is a broad overarching term used to describe shin pain. While the name can include everything from inflammation of the bone to muscle injuries, compartment syndrome, and even fractures, it is more widely used to refer to medial tibial stress syndrome.
Medial tibial stress syndrome is pain anywhere along the shin bone from the ankle to the knee. One of the most common causes of this pain is overuse or going into a new activity too quickly! The exact cause of the pain is unknown, but it is generally accepted that a rapid change in loading causes inflammation along where the shin muscles connect into the bone. Some recent research even suggests that it may be a stress reaction from the bone in response to the changing or increasing load. Learn more about Shin Splints here.
Shoulder injury and Shoulder pain are very common! The shoulder is comprised of 3 bones- the clavicle (collar bone), the upper arm bone (humerus) and the shoulder blade (scapula). Together these bones form the shoulder joint! These 3 bones, combined with a wide array of muscles, tendons and ligaments allow a wide range of motion to occur at the shoulder- from scratching your back to serving a tennis ball.
Due to the large range of motion, the shoulder requires a large amount of stability from the surrounding muscles and tendons. When everything doesn’t quite move how it should, forces can build up rather than dissipate causing pain and dysfunction.
Shoulder pain can occur only when the shoulder is moving, or in a specific position, or it can be painful all the time. Pain quality can range from sharp and searing, to a dull ache and even pins and needles. As most tasks require the involvement of 2 arms (opening a bottle, washing your hair, tucking a shirt in), shoulder pain can be quite disabling and interrupt function and sleep very quickly.
The most common shoulder injuries we see include rotator cuff injuries, bursitis, impingement, instability, and arthritis.
Rotator cuff injury
The shoulder is comprised of 3 bones- the clavicle (collar bone), the upper arm bone (humerus) and the shoulder blade (scapula). Together these bones form the shoulder joint! These 3 bones, combined with a wide array of muscles, tendons and ligaments allow a wide range of motion to occur at the shoulder- from scratching your back to serving a tennis ball.
Due to the large range of motion, the shoulder requires a large amount of stability from the surrounding muscles and tendons. This is where the rotator cuff comes in! The rotator cuff is a group of 4 muscles that surround the shoulder joint that keep the head of the humerus into the socket. A rotator cuff injury can cause a dull ache in the shoulder, cause pain with arm movement and sleeping on this side. Often referred to as the rotators, the rotator cuff is most used in motions that require full shoulder range or rotation type movements such as putting your hand behind your head or hand behind your back. This can make thinks like showering, washing hair and dressing painful and restricted.
Rotator cuff injuries are a common cause of shoulder pain. Most often they are caused by poor shoulder, head and neck posture placing extra strain on the rotator cuff muscles causing rotator cuff tendonitis. Rotator cuff injuries are also very common in people who perform repeated overhead movements. Occasionally, the muscles and tendons of the rotator cuff can tear as a result of a single injury, this is commonly referred to as a rotator cuff tear or a shoulder cuff tear. Significant tears may require surgery (rotator cuff repair), but smaller tears are often managed successfully with physiotherapy.
A stress fracture is an overuse injury as a result of increasing the amount or intensity of activity too rapidly. Stress fractures can be caused by unfamiliar surfaces such as a trail runner increasing their road running training, or a tennis player switching from clay to hardcourt. On occasion, they can be contributed to by improper equipment such as shoes.
Generally, stress fractures occur in weightbearing bones in the leg and foot with more than half of all stress fractures occurring in the lower leg. The repetitive action of tennis, running, gymnastics and basketball place these athletes at the highest risk of developing a stress fracture. In these activities, the repetitive stress of the foot impacting the ground can cause low levels of trauma. Studies have also shown that women are more likely to develop a stress fracture than their male counterparts- which is attributed at least in part to the prevalence of eating disorders and their impact on osteoporosis in female athletes.
Stress fractures cause pain with activity that generally subsides with rest. Occasionally the pain will wake them at night and not respond to over the counter painkillers and anti-inflammatory medications.
The most important part of treatment is rest. Rest may not mean complete inactivity but may involve switching out running for swimming, or jumping activities for Pilates for a minimum of 6-8 weeks. If the activity that caused the overload is resumed too quickly, larger, harder to heal stress fractures may result leading to chronic injury.
Tennis elbow is an inflammation of the tendons on the outside of the elbow. These muscles are the extensor muscles of the wrist and they all join a common tendon that joins the outside of the elbow. This attachment point at the elbow is called the lateral epicondyle, and thus the medical term for tennis elbow is lateral epicondylitis (meaning inflammation of the epicondyle).
Tennis elbow can cause pain right on the outside tip of the elbow, pain with carrying shopping bags or handling weights at the gym and the pain may even radiate down the arms towards the wrist. It is primarily associated with overuse of the extensor muscles, resulting in pain and inflammation at the attachment point into the elbow as the tendon becomes overloaded with time. While the name suggests it is common in tennis players, we most commonly see it in desk users with a poor ergonomic setup or gym users who do not stabilise the wrists adequately.
Treatment needs to identify the source of the low-grade overload. Often it is not obvious and may require some prolonged digging into desk postures and gym routines, but finding the cause is the most important. Treatment often includes manual therapy to unload the elbow, taping, dry needling and a progressive strengthening program to rebuild the elbow tendon strength as tolerated
No matter what your level of activity, you can be confident that City Physio will have a professional and personalised care to help you return to your training regime, meet your event targets and return to your very best. Make your online booking here today!