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Exercise Rehabilitation Sydney: Injury to Peak Performance

Sun, 27 Sep 2026 00:00:00 GMT

Rehabilitation from Injury to Peak Performance

Most people who get injured focus entirely on pain relief. They stop when the pain stops, head back to sport or the gym too soon, and wonder why the same injury comes back three months later. Exercise rehabilitation is the discipline that closes this gap. It is not stretching on a treatment table or icing a sore joint. It is a structured, progressive process that rebuilds capacity from the tissue level up, using load, movement, and clinical decision-making to take you from injured to performing at your best. At an elite exercise rehabilitation Sydney clinic like Alexandria Physiotherapy and Sports Injury, the goal is never just to get you out of pain. The goal is to get you back to full function, with less risk of it happening again.

Quick Takeaways

What Is Exercise Rehabilitation?

Exercise rehabilitation is the clinical application of targeted physical activity to restore function after injury, surgery, or illness. It is distinct from general fitness training because every exercise choice is driven by a specific clinical objective: reducing tissue stress at one stage, rebuilding tensile strength at another, and restoring sport-specific movement patterns at the final stage.

The evidence base for exercise rehabilitation is clear. Passive treatments such as massage, dry needling, and manual therapy play an important role in the early stages of care, but they do not create the tissue adaptation needed for a durable return to function. Active rehabilitation, anchored in graded exercise , is what changes the long-term outcome.

At Alexandria Physiotherapy and Sports Injury, the treatment approach is evidence-based, hands-on, and places a strong emphasis on patient education alongside exercise rehabilitation. The clinic is fully equipped with a functional gym, which allows rehabilitation to progress far beyond basic movement drills and into the kind of loading that actually mirrors the demands of your sport, job, or lifestyle.

The Five Phases of Rehabilitation: Acute to Elite Performance

Rehabilitation does not follow a single straight line. It moves through distinct phases, each with its own goals, appropriate exercises, and progression criteria. Jumping phases is the primary reason people re-injure themselves.

Phase 1: Acute Phase (Protection and Pain Control)

In the first days after injury, the priority is protecting the damaged tissue and managing the inflammatory response. Exercise at this stage is gentle, aimed at maintaining circulation and preventing the deconditioning that comes from complete rest. Isometric contractions, range-of-motion work within a pain-free arc, and controlled weight-bearing are typical tools.

A common mistake in this phase is doing too much too soon under the belief that pushing through pain accelerates recovery. It does not. Poorly managed early loading prolongs the inflammatory phase and can convert a straightforward soft tissue injury into a more complex rehabilitation problem.

Phase 2: Subacute Phase (Restoring Mobility and Early Strength)

As acute pain and swelling settle, the focus shifts to restoring range of motion and introducing progressive strength work. Exercises become more active, joint mobility is challenged through larger movement arcs, and basic neuromuscular control work begins. The injured tissue is now ready to accept some load, and this is when rehabilitation starts to feel like purposeful exercise rather than just gentle movement.

Phase 3: Strength and Functional Loading Phase

This is where the real work happens. Progressive resistance training is introduced to rebuild the strength, power, and endurance deficits caused by both the injury and the time spent protecting it. Exercises become compound and functional. A knee injury rehabilitation program, for example, will involve loaded squatting, single-leg work, and controlled landing mechanics.

For athletes, this phase also reintroduces the cardiovascular demands of their sport. Letting fitness erode completely during rehabilitation creates a second injury risk when they return to full training.

Phase 4: Sport-Specific and Conditioning Phase

Movement now mirrors the actual demands of the athlete's sport or physical occupation. Running progressions, direction-change drills, overhead loading for throwing athletes, deceleration mechanics for field sport players. The rehabilitation environment needs to match these demands, which is exactly why an on-site rehab gym matters at this stage.

Phase 5: Return to Performance Phase

The final phase focuses on maximising athletic potential, not just returning to a pre-injury baseline. Speed, power output, reactive agility, and sport-specific skill integration are developed. Objective performance benchmarks are measured and compared to pre-injury data or normative standards for the athlete's sport and age group. Clearance to full competition is confirmed at this point, using agreed clinical criteria rather than guesswork.

Pro tip: Ask your physiotherapist to document your entry-point strength and movement measures at assessment. These become your benchmark for every phase, and they are the only objective way to confirm you are actually ready to progress.

Progressive Loading: The Engine of Recovery

Every tissue in the body adapts to load. Tendons become stiffer and more resilient when exposed to progressive tensile stress. Muscle fibres rebuild and hypertrophy in response to resistance training. Bone remodels along lines of mechanical force. None of this happens with rest alone, and it does not happen if the load is too low to stimulate adaptation.

Evidence from sports medicine research shows that excessive load progression, particularly increases greater than roughly 10 to 15 percent per week, significantly elevates reinjury risk. The optimal zone sits between sufficient stimulus for adaptation and insufficient stimulus to cause overload. Identifying that zone for each patient, at each phase, is the core clinical skill in exercise rehabilitation.

At Alexandria Physiotherapy and Sports Injury, progressive loading is not left to guesswork. Programs are designed with specific sets, reps, load parameters, and tempo, and they are modified at each session based on the patient's response. This is not the same as handing someone a sheet of generic exercises and reviewing them in two weeks.

Pro tip: Soreness at 24 to 48 hours after a rehabilitation session is normal and expected. Pain during exercise or pain that does not resolve within 24 hours of a session is a signal that load needs to be reviewed. Keep a simple log of your post-exercise response and share it with your physio at every appointment.

Rehab Gym vs. Treatment Table: Why the Difference Matters

Rehabilitation that stays on the treatment table has a ceiling. Manual therapy, dry needling, and passive modalities have genuine value in the early stages of care. But they cannot replicate the mechanical demands of running, jumping, lifting, or changing direction at speed. At some point, the patient has to do those things under clinical supervision before they do them unsupervised in their sport or job.

This is the core argument for an integrated rehab gym Alexandria model. When physiotherapists can watch a patient perform loaded squats, lateral bounds, or throwing patterns in a gym environment, they catch compensatory movement patterns and strength asymmetries that are completely invisible during a manual therapy assessment.

The comparison below outlines how different rehabilitation environments handle the key demands of recovery:

Alexandria Physiotherapy and Sports Injury operates the integrated model. The clinic's fully functional gym sits within the same facility as the clinical treatment space, meaning the transition from hands-on care to supervised exercise happens within a single appointment and under the same clinical eye.

Return to Sport Criteria: What Actually Clears You to Play

Return-to-sport decision-making is more nuanced than most patients expect. Feeling ready is not enough, and being pain-free is not enough. Research supports a multi-domain approach to clearance that covers several distinct areas.

Strength and Symmetry

Side-to-side strength asymmetry is one of the most reliable markers of incomplete recovery. For lower-limb injuries in particular, the injured limb typically needs to demonstrate strength output within a specific percentage of the uninjured side before progressive return to full training is appropriate. The exact threshold varies by injury type and sport, but the principle is consistent across the literature.

Neuromuscular Control and Movement Quality

Strength alone does not guarantee safe return. Neuromuscular control , the ability of the nervous system to coordinate muscle activation for joint stability during dynamic movement, is a separate quality that needs specific assessment. Landing mechanics, deceleration control, and reactive agility tasks are used to evaluate this.

Sport-Specific Fitness

An athlete who has been sidelined for eight weeks cannot absorb the cardiovascular and mechanical demands of a full training session, even if their injured tissue is completely recovered. Return to sport follows a graded exposure model: modified training first, then full training, then limited game time, then full competition. Each step is confirmed before the next is added.

Psychological Readiness

Fear of reinjury is clinically significant and well-documented as a risk factor for actual reinjury. Athletes who return to sport with high kinesiophobia, the fear of pain and movement, demonstrate altered movement patterns that increase mechanical risk. Psychological readiness is assessed as part of the return-to-sport process at Alexandria Physiotherapy, not treated as an afterthought.

Common Injuries Treated with Exercise Rehabilitation in Sydney

Exercise rehabilitation applies across a wide spectrum of injuries. The principles remain consistent: accurate diagnosis, phase-appropriate loading, and objective clearance criteria. The specific program is different for every injury and every person.

The injuries most frequently managed through structured exercise rehabilitation at a Sydney sports physiotherapy clinic include:

ACL injuries and post-surgical reconstruction. ACL rehabilitation is one of the most evidence-demanding areas of sports physio. Return-to-sport timelines in the literature consistently show that strength asymmetry and psychological readiness are better predictors of reinjury than time alone.
Hamstring strains. Recurrent hamstring injury is almost always a rehabilitation failure, not a tissue failure. The injury recurs because the athlete returns to sport before the muscle has regained eccentric strength at full range.
Rotator cuff injuries. Whether post-surgical or conservatively managed, shoulder rehabilitation requires meticulous progressive loading of the rotator cuff and periscapular musculature before any return to overhead or throwing activity.
Ankle sprains. Lateral ankle sprains are among the most under-rehabilitated injuries in sport. Most people stop care when swelling resolves, leaving proprioceptive deficits that drive chronic instability and repeated sprains.
Lower back pain. Exercise rehabilitation for lower back pain is the most well-supported intervention in the evidence base. A tailored program addressing strength, movement control, and load tolerance consistently outperforms passive treatment alone.
Patellofemoral pain and patellar tendinopathy. Both conditions require careful progressive loading protocols that manage patellofemoral joint stress while gradually rebuilding tendon and muscle capacity.

Across all of these, the thread is the same. The injury itself is only the starting point. The quality of the rehabilitation program determines the outcome.

Performance Enhancement: What Happens After You Have Recovered

Many athletes make the mistake of stopping rehabilitation at the point of clinical discharge. They return to sport, feel fine, and assume the job is done. What they miss is the opportunity that rehabilitation creates.

Returning to baseline after injury means returning to the same movement patterns, strength levels, and physical habits that either contributed to the injury or failed to prevent it. A proper injury to performance physio model does not stop at baseline. It uses the rehabilitation process as a platform to build qualities the athlete may not have had before they were injured.

This is especially relevant for athletes who have never done structured strength and conditioning work. A hamstring strain in a field sport athlete, properly rehabilitated, can become the trigger for building genuine posterior chain strength for the first time. A shoulder injury in a throwing athlete can lead to the kind of rotator cuff and scapular stability work that actually improves throwing velocity and endurance.

The physiotherapists at Alexandria Physiotherapy and Sports Injury bring extensive experience from elite sporting environments. That means the same performance standards applied to professional athletes in the NSW Blues program and other high-level sporting organisations are applied to every patient who walks through the door, regardless of their level of competition.

Pro tip: Before your final discharge session, ask your physiotherapist to outline the three to five physical qualities most likely to reduce your injury risk going forward. This becomes your off-season or maintenance training target, and it is far more specific than a generic fitness program.

Frequently Asked Questions

How long does exercise rehabilitation take?

The timeline depends entirely on the injury type, severity, your pre-injury fitness level, and your rehabilitation goals. A straightforward ankle sprain might be fully rehabilitated in six to eight weeks. An ACL reconstruction with a return-to-high-level-sport target typically requires nine to twelve months of structured rehabilitation. A useful rule: time estimates from your physiotherapist are always more reliable than generic timelines you find online, because they are based on your actual assessment findings.

Can I do exercise rehabilitation if I am not a competitive athlete?

Absolutely. Exercise rehabilitation is appropriate for anyone with a musculoskeletal injury or functional limitation, whether you are a weekend recreational runner, a tradesperson with a shoulder injury, or an office worker with chronic lower back pain. The program is scaled to your demands and your goals. The principles of progressive loading, movement quality, and objective progression are the same regardless of your level of activity.

What is the difference between a physiotherapist-supervised gym program and a regular gym program?

A physiotherapist-supervised rehabilitation program is designed around your specific injury, your movement assessment findings, and your clinical phase. Every exercise choice has a clinical rationale. Load parameters are set to drive tissue adaptation without exceeding your current capacity. Movement errors are corrected in real time. A regular gym program, even a well-designed one, does not account for these factors, and it cannot detect the compensatory patterns that create secondary injury risk.

What does an initial exercise rehabilitation assessment involve?

At Alexandria Physiotherapy and Sports Injury, the initial assessment includes a detailed injury history, a thorough movement screen, strength and range-of-motion testing, and a discussion of your functional goals. From this, a stage-appropriate rehabilitation program is designed. You will leave the first appointment with a clear understanding of your injury, your current deficits, and what the rehabilitation program is designed to address.

How do I know when I am ready to return to sport or full training?

Readiness is determined across multiple domains: strength symmetry between sides, quality of movement under load, sport-specific fitness, and psychological confidence. Your physiotherapist will use objective tests, not just symptom reports, to make this decision. At Alexandria Physiotherapy, clearance to return to sport follows clinical criteria, and you will always know exactly what you need to demonstrate before the next step is taken.

Does Medicare or private health insurance cover exercise rehabilitation in Sydney?

Physiotherapy services in Australia are covered by most private health insurance extras policies, and rebate amounts vary by fund and policy level. Medicare covers a limited number of physiotherapy visits for patients under a GP's Chronic Disease Management plan. It is worth confirming your specific rebate with your insurer before your first appointment. Alexandria Physiotherapy accepts most major health funds.

I had the same injury before and it came back. What is different this time?

Recurrent injury almost always signals incomplete rehabilitation the first time around. The tissue healed enough to stop hurting, but the strength, neuromuscular control, and load tolerance deficits were never addressed. This time, the difference is an objective assessment of exactly what is still deficient, and a program designed to address those deficits fully, not just until symptoms resolve. This is the core of what evidence-based exercise rehabilitation delivers.

If you have been through the cycle of injury, partial recovery, and reinjury, we would genuinely like to hear what has and has not worked for you. Leave a comment below or reach out to the team at Alexandria Physiotherapy and Sports Injury to discuss your specific situation.

References

Sports Rehabilitation Phases: A Literature Review covering the stages of exercise rehabilitation for injured athletes
Evidence-based guide to graded return-to-sport criteria after musculoskeletal injury
Clinical guide to progressive exercise program design in physiotherapy rehabilitation
Evidence-based load progression protocols for returning to strength training after injury
PubMed research on graded stress-exposure frameworks for return-to-sport rehabilitation decisions

Ankle Sprain Physio Sydney: Elite Recovery Protocol

Sat, 26 Sep 2026 00:00:00 GMT

Ankle Sprain Recovery

Ankle sprains are the most underestimated injury in sport. Athletes roll their ankle, apply some ice, rest for a week, and walk back onto the field thinking the job is done. It is not. Chronic ankle instability develops in up to 40% of people who experience a lateral ankle sprain, largely because the initial rehabilitation was rushed, incomplete, or focused only on pain relief rather than full neuromuscular restoration. If you are looking for ankle sprain physio in Sydney and want the same structured, criteria-based approach used with elite athletes, this guide lays out exactly what that process looks like from day one through return to sport.

Quick Takeaways

Understanding Ankle Sprains: Grades, Ligaments, and Why Classification Matters

Before any treatment decision is made, the injury needs to be accurately classified. The lateral ankle is the most vulnerable structure, comprising three ligaments: the anterior talofibular ligament (ATFL) , the calcaneofibular ligament (CFL), and the posterior talofibular ligament (PTFL). The ATFL is the weakest of the three and is almost always the first to be damaged. The most common mechanism is inversion combined with excessive ankle supination in forced plantarflexion, the classic "rolled ankle" position where the joint is at its most unstable.

Ankle sprains are classified into three grades. Grade I is a mild injury involving an incomplete tear of the ATFL. Grade II is a moderate injury with a complete tear of the ATFL, with or without a partial tear of the CFL. Grade III is severe, with complete tears of both the ATFL and the CFL. Grades I and II respond well to structured functional treatment. Grade III injuries may require a short period of protection, typically no more than 10 days in a brace, before functional rehabilitation begins.

Why does accurate grading matter? Because the rehabilitation timeline, the loading parameters, and the return-to-sport criteria all change based on the severity of tissue damage. A Grade I sprain in a fit athlete can resolve to full function in two to three weeks with the right program. A Grade III sprain in the same athlete may require six weeks of structured physiotherapy before unrestricted sport is safe. Treating both with the same "rest and ice" approach means the Grade I athlete is held back unnecessarily and the Grade III athlete is cleared too early.

Pro tip: If you have significant swelling, bruising extending into the midfoot, or cannot bear weight within the first 24 hours, get assessed by a physiotherapist before assuming it is a minor sprain. High-grade sprains, syndesmotic injuries, and osteochondral damage are frequently mismanaged when self-diagnosed as "just a rolled ankle."

The PEACE and LOVE Protocol: Why RICE Alone Is Not Enough

The RICE protocol, which stands for Rest, Ice, Compression, and Elevation, has been the default first-aid response to ankle sprains for decades. The problem is not that RICE is harmful. The problem is that it only addresses the first 48 hours of a healing process that spans weeks. The PEACE and LOVE framework provides a complete continuum of care from the moment of injury through functional restoration.

PEACE covers the immediate phase. Protection means avoiding activities that increase pain in the first couple of days. Elevation reduces oedema by positioning the ankle above heart level. Avoid anti-inflammatory modalities in the early phase, as some inflammation is part of the necessary healing response. Compression using a bandage or sleeve limits swelling. Education ensures the athlete understands the process and does not rush or panic.

LOVE covers the subsequent management phase. Load means returning to controlled movement early, as active and passive mobilisation reduces pain, prevents venous stasis, and improves local circulation to accelerate oedema clearance. Optimism is a clinical factor as much as a psychological one, since a positive but realistic outlook influences rehabilitation outcomes. Vascularisation through early aerobic activity supports tissue healing. Exercise, meaning targeted strength and neuromuscular training, is the core of long-term recovery.

At an evidence-based sports injury clinic in Alexandria, this framework is not just philosophy. It changes the specific interventions applied on day one versus day seven versus week four, and it prevents the common pattern of early pain relief followed by premature return followed by re-injury.

Phase One: Acute Management (Days 1 to 5)

Protecting the Joint Without Immobilising It

The acute phase is about protecting the injured tissue while keeping the ankle moving within a pain-free range. Total immobilisation slows recovery. For most Grade I and II sprains, the athlete should be weight-bearing as tolerated from day one, using crutches only if the pain makes full weight-bearing impossible. A rigid brace or compression sleeve provides external support without stopping movement entirely.

Elevation matters more than most athletes give it credit for in the first 48 to 72 hours. Keeping the ankle above the level of the heart for extended periods is one of the most effective ways to limit swelling, which directly affects how quickly the athlete can begin loading the joint. An ankle that is still significantly swollen at day five is an ankle where early rehabilitation has been mismanaged.

What Your Physio Is Actually Assessing

A thorough initial assessment at this stage involves more than confirming the sprain. Your physiotherapist should rule out fractures using the Ottawa Ankle Rules, assess for syndesmotic injury, check for any signs of osteochondral damage, and screen for peroneal tendon involvement. These are not rare complications. They are frequently missed when assessment is superficial or when the athlete self-manages for the first week without professional input.

Manual therapy techniques applied early, including subtalar distraction, medial subtalar glide, and lateral subtalar glide, are used to reduce pain and begin restoring the normal joint mechanics that are disrupted after a sprain. These are not passive treatments. They are targeted clinical interventions that set up the next phase of rehabilitation.

Phase Two: Subacute Rehabilitation and Load Introduction (Days 5 to 21)

Once the acute inflammatory response has settled and the athlete can bear weight comfortably, the focus shifts to restoring range of motion, beginning strength work, and introducing the early foundations of proprioceptive training. This is the phase where most non-elite athletes stop their rehabilitation. Pain is manageable, the ankle "feels okay," and the temptation to return to normal activities is strong. Stopping here guarantees incomplete recovery.

Range of Motion Restoration

Dorsiflexion range of motion is consistently one of the most important factors in both ankle sprain recovery and future recurrence prevention. Limited dorsiflexion is a documented risk factor for re-injury. Active ankle circles, towel stretches, and progressive weight-bearing calf stretches are introduced during this phase, with the specific range targets adjusted based on what the uninjured ankle can do. Symmetry is the goal, not an arbitrary angle measurement.

Early Strength and Calf Loading

The calf complex, specifically the gastrocnemius and soleus, provides the primary dynamic support for the ankle during sport. Isometric calf work begins in the subacute phase, progressing to double-leg calf raises, then single-leg calf raises as pain and strength allow. The single-leg heel raise test is used as a clinical milestone: the ability to perform this exercise with control and without compensation indicates the calf complex is absorbing load appropriately.

Peroneal muscle strengthening is equally important and often overlooked in generic ankle rehabilitation. The peroneals are the primary dynamic stabilisers of the lateral ankle, and they are directly stressed during the inversion mechanism that causes the sprain in the first place. Resistance band eversion exercises, progressing in resistance and speed, are a non-negotiable part of this phase.

Pro tip: Do not wait until you have zero pain before starting peroneal strengthening. Working within a pain-acceptable range (typically 3 out of 10 or less) accelerates recovery compared to waiting for full pain resolution before loading the tissue.

Phase Three: Functional Strength and Neuromuscular Control (Weeks 3 to 6)

This is the phase that separates comprehensive rehabilitation from superficial recovery. The ankle may feel close to normal at this point. The athlete can walk without pain, has most of their range of motion back, and calf strength is improving. But the neuromuscular system, specifically the brain-to-ankle communication that tells the joint where it is in space and how to respond to sudden changes in surface or direction, has not fully recovered.

Proprioception Training: The Non-Negotiable Element

Proprioceptive deficits persist long after structural healing is complete. This is the underlying mechanism behind chronic ankle instability and repeat sprains. Proprioception training starts with static single-leg balance on a stable surface, progresses to unstable surfaces, then to dynamic balance challenges. The Y-Balance Test is used as both a training tool and a clinical milestone. The modified Stork Balance Test assesses static proprioceptive capacity. Both must be passed before progressing to higher-load activities.

The progression logic is clear: proprioceptive skills (sensory perception, afferentiation, joint position sense) are fundamental abilities that must be restored before any high-load activity like running, cutting, or jumping is reintroduced. Training these skills early and progressing them systematically is what distinguishes protocols that prevent re-injury from protocols that merely treat the immediate sprain.

Sport-Specific Loading and Running Mechanics

Running is a milestone, not a given. The transition back to running is a specific clinical decision based on calf strength, proprioceptive capacity, and observed running mechanics, not just the absence of pain. A qualitative running analysis is performed to check that the athlete is not compensating with altered hip or knee mechanics that could load the ankle abnormally or transfer stress to adjacent structures.

Once straight-line running is established with good mechanics, agility work, change-of-direction drills, and sport-specific loading are introduced progressively. Hop tests, including single-leg triple hops and lateral hop sequences, are used to assess dynamic load capacity and guide the final progression to full training.

Phase Four: Return-to-Sport Criteria and Testing

Return-to-sport decisions made on time alone are insufficient. A criteria-based approach uses objective functional performance tests to determine when an athlete is genuinely ready for unrestricted participation. This is the standard used with professional athletes, and it should be the standard applied to every athlete regardless of level.

The key return-to-sport markers include: passing proprioception tests on both static and dynamic balance assessments, demonstrating symmetrical single-leg calf endurance, completing hop test sequences with limb symmetry indices within accepted clinical ranges, and performing sport-specific movement patterns without pain, compensation, or reported apprehension.

External ankle support, whether bracing or supportive taping, is recommended during sport for at least 12 months following a significant lateral ankle sprain. This is not a sign of incomplete recovery. It is a recognised protective measure while the proprioceptive system and mechanical stability continue to consolidate over the longer term. Athletes who follow this guidance consistently show lower re-injury rates.

If you are in Sydney and have been cleared to return to sport by someone who just asked "how does it feel?" without conducting any functional testing, you have not been properly assessed. The team at Alexandria Physiotherapy and Sports Injury uses structured, criteria-based discharge protocols for exactly this reason.

Comparing Rehabilitation Approaches: What the Evidence Actually Supports

Not all ankle sprain rehabilitation is equal. Below is a comparison of the three main approaches seen in clinical practice, from the most superficial to the most comprehensive.

The criteria-based elite protocol is not more complicated than standard care. It is more thorough and more disciplined. It treats every phase of recovery with specific intent rather than waiting for symptoms to subside and calling it done.

The Mistakes That Set Athletes Back by Weeks

After treating athletes at every level, including those competing in professional sporting competitions, the mistakes that derail ankle sprain recovery are remarkably consistent. They are not obscure errors. They are predictable, preventable, and worth naming directly.

Returning to sport based on pain, not function. Pain is one of the last things to resolve in an ankle sprain. But neuromuscular control and proprioception recover on a different, often longer timeline. An ankle that feels fine on a straight walk can still fail catastrophically on a sidestep, a landing, or an uneven surface. Functional testing exists precisely to catch the gap between "pain-free" and "structurally ready."

Skipping the proprioception phase because it "feels like easy exercise." Single-leg balance work does not look impressive. Athletes who train hard resist spending time on what feels like a beginner activity. This is a short-sighted view. The research is unambiguous: proprioceptive training is the single most important factor in preventing chronic ankle instability and recurrence. Skipping it because it feels simple is one of the most costly decisions an athlete can make.

Over-relying on passive treatments and ignoring active rehabilitation. Ultrasound, massage, and other passive modalities have a role in early management, but they do not rebuild the neuromuscular system. Athletes who spend the majority of their physiotherapy time on passive treatments and minimal time on progressive loading are extending their recovery unnecessarily.

Not addressing the whole kinetic chain. Hip abductor weakness, reduced hip external rotation control, and poor gluteal activation all contribute to abnormal ankle loading mechanics. A thorough ankle sprain rehabilitation program includes assessment and, where necessary, treatment of the entire lower limb, not just the ankle.

For athletes and active professionals in inner Sydney who want access to the standard of care used with elite sporting organisations, Alexandria Physiotherapy and Sports Injury offers exactly that. The clinic's founding physiotherapists have more than 20 years of experience at professional sporting organisations, and that experience directly informs how every ankle injury is assessed and managed.

Frequently Asked Questions

How long does it take to recover from an ankle sprain with physiotherapy?

Recovery time depends on the grade of the sprain. A Grade I ankle sprain treated with a structured physiotherapy program can resolve in two to three weeks. Grade II sprains typically require four to six weeks of rehabilitation before return to full sport. Grade III sprains with complete ligament tears can take six to twelve weeks depending on the athlete's baseline fitness, adherence to the program, and whether complications such as osteochondral damage are present. Time estimates based on pain alone are misleading. Functional testing drives the return-to-sport decision, not calendar weeks.

What is the difference between ankle sprain physio in Sydney and simply resting at home?

Resting at home addresses pain and swelling in the short term. It does nothing to restore the neuromuscular control, proprioception, and tissue strength that prevent re-injury. Clinical physiotherapy includes accurate grading of the injury, manual therapy to restore joint mechanics, a structured and progressive exercise program, functional performance testing, and criteria-based return to sport. Athletes who manage ankle sprains with rest alone have significantly higher rates of chronic ankle instability and recurrence compared to those who complete a full physiotherapy program.

Can I exercise with an ankle sprain, or does it need complete rest?

Complete rest is rarely necessary and often counterproductive. The current evidence-based approach supports controlled loading and movement from an early stage. Upper body training, pool-based exercise, and stationary cycling that does not load the ankle in a provocative way can all be continued from very early in the rehabilitation process. Weight-bearing exercise for the lower limb is introduced progressively based on pain levels and tissue tolerance. A physiotherapist will guide you through what is appropriate at each stage.

When should I see a physio after rolling my ankle rather than waiting to see if it gets better?

See a physiotherapist within 24 to 48 hours of the injury if you have significant swelling, bruising that extends into the foot, difficulty bearing weight, or pain directly over the bone. These are signs that the injury may be more serious than a straightforward ligament sprain, and early professional assessment can rule out fractures, syndesmotic damage, and tendon injuries that require specific management. Even if the injury is confirmed as a simple Grade I sprain, getting an early assessment and a structured program will accelerate your recovery compared to self-managing with rest alone.

Why do ankle sprains keep recurring even after the pain has resolved?

Recurrent ankle sprains are almost always the result of incomplete rehabilitation. When the neuromuscular system is not fully retrained, the ankle loses its ability to respond quickly and correctly to unexpected movements, surface changes, or perturbations. The ligaments may have healed structurally, but the joint-position sense and reactive muscle control are still impaired. This is why proprioceptive training and functional performance testing are essential, not optional, components of every ankle sprain rehabilitation program. Chronic ankle instability develops in up to 40% of people who have had a lateral ankle sprain, and the vast majority of those cases are preventable with complete rehabilitation.

Is bracing or taping necessary after an ankle sprain, and for how long?

External ankle support during sport is recommended for at least 12 months following a significant lateral ankle sprain. This is not a permanent crutch. It provides a protective external restraint while the proprioceptive system and mechanical stability of the ankle continue to consolidate. Your physiotherapist will guide you through the appropriate type of support, which may be a lace-up brace, a semi-rigid brace, or supportive taping, and when it is appropriate to reduce reliance on external support in lower-risk settings.

Have you been through ankle sprain rehabilitation before, and did it address proprioception and functional testing, or did it stop at pain relief? Share your experience in the comments below.

References

Rugby Physiotherapy Sydney: Elite Principles for You

Fri, 25 Sep 2026 00:00:00 GMT

Physiotherapy for Rugby

Most people assume elite rugby physiotherapy is a world apart from everyday injury recovery. It is not. The same principles that keep a professional forward playing through a gruelling NRL season, or that guide the NSW Blues through a State of Origin campaign, are directly applicable to a weekend runner with a recurring hamstring strain or a desk worker dealing with a shoulder impingement. The gap between elite and everyday care is not about the principles. It is about access. At Alexandria Physiotherapy, we deliver rugby physiotherapy Sydney standards to every patient who walks through our doors, drawing on more than two decades at the highest levels of professional sport.

Quick Takeaways

What Makes Elite Rugby Physio Different

Elite rugby physiotherapy is not defined by access to ice baths or expensive equipment. It is defined by the quality of clinical decision-making and the structure of the recovery program. Professional rugby players follow meticulously planned recovery and injury-prevention protocols throughout the season , built around the demands of their position, their injury history, and the match schedule. What separates elite care from a generic six-session course of treatment is exactly that level of structure and individualisation.

At Alexandria Physiotherapy, the clinical team was built on the foundation of real elite sporting environments. Head physiotherapist Eddie Farah serves as the current Head Physiotherapist for the NSW Blues, and alongside co-founder Steve Velovski, has led the physiotherapy program at the South Sydney Rabbitohs NRL club for over a decade. Their work also extends to Australian Rugby, the NSW Waratahs, and Olympic athletes. That is not a marketing point. It means the clinical standards, assessment protocols, and rehabilitation philosophies used with community patients in Alexandria are the same ones road-tested in high-stakes professional environments.

The core difference in elite rugby physiotherapy comes down to three things: the quality of the initial assessment, the precision of load management throughout recovery, and the commitment to functional, sport-specific rehabilitation rather than symptom management alone. These are not luxuries. They are what actually gets people better.

Load Management: The Principle Most Everyday Patients Ignore

Load management is probably the most misunderstood concept in injury recovery, and it is the one elite rugby programs get most right. The principle is straightforward: the amount of mechanical stress placed on healing tissue must be carefully controlled at each stage of recovery. Too little load and the tissue heals slowly and weakly. Too much and you extend the injury or create new damage.

In professional rugby, this is applied with precision. Training volumes, contact drills, and match minutes are all periodised around tissue healing timelines. Research on acute injuries in elite rugby highlights that training loads should be carefully periodised and recovery protocols individually structured to reduce injury risk and accelerate return to play. Community patients rarely receive this level of structure, which is why so many end up stuck in cycles of partial recovery and re-injury.

What Load Management Looks Like in Practice

For a recreational runner with a calf strain, load management means progressing from walking to jogging to running at specific intervals based on tissue tolerance, not on how the calf feels on a given morning. For a gym-goer with a rotator cuff injury, it means structured overhead loading progressions rather than simply avoiding pressing movements until the pain goes away.

The most common mistake is treating pain as the only guide. Pain reduction happens significantly faster than tissue healing. A patient who feels 80 percent better at week three of a hamstring rehabilitation program is not 80 percent ready to return to sport. The tissue is still remodelling, and loading it as if it were fully healed is a reliable way to re-injure it.

Pro tip: If your current physio has not discussed a clear loading progression timeline with you, including specific benchmarks you need to hit before returning to your activity, ask for one. Load management planning is standard in elite rugby environments and should be standard in your recovery too.

Neuromuscular Retraining: Beyond Just Resting the Injury

One of the clearest lessons from elite rugby physiotherapy is that the body's nervous system takes damage in an injury just as surely as the physical tissue does. When you sprain an ankle, you do not just damage the ligament fibres. You disrupt the proprioceptive nerve endings that tell your brain where that ankle is in space. If you only treat the ligament and ignore the neuromuscular deficit, you are leaving yourself highly vulnerable to the same injury recurring.

Neuromuscular re-education aims to retrain this brain-muscle connection. In practice, this means exercises focused on balance and joint position sense, agility drills, and progressive plyometric work. At the elite level, physiotherapists incorporate sensory integration drills, balance challenges, and dual-task training to rebuild neuromuscular control. The same work, scaled appropriately, is what everyday patients need after any moderate-to-significant injury.

Why This Matters More Than Most People Realise

The neuromuscular deficit after injury is often invisible. The tissue looks healed on imaging. The pain is gone. The patient feels ready. But put them in a reactive, unpredictable movement situation and the deficit becomes clear immediately. This is why so many ankle sprains recur, why ACL reconstructions have disappointing re-injury rates in patients who skipped the latter stages of rehabilitation, and why lower back injuries become chronic in people who only ever treated the acute episode.

Elite rugby clubs do not discharge a player until they can demonstrate reactive neuromuscular control under sport-specific conditions. The equivalent for a recreational runner is demonstrating single-leg stability and dynamic loading capacity before returning to running. For a construction worker, it means controlled strength and movement quality under a load that mirrors their work demands.

Pro tip: Neuromuscular retraining is not the same as general strengthening. If your rehabilitation consists only of resistance exercises with no balance, proprioception, or reactive movement component, you are missing a significant portion of what makes elite-level recovery actually work. Talk to your physio at Alexandria about whether your current program includes this.

Soft Tissue Therapy and How It Fits Into a Structured Plan

Massage and soft tissue work occupy a specific and well-defined role in elite rugby physiotherapy. They are not the treatment. They are preparation for treatment. Soft tissue therapy techniques such as massage and myofascial release help reduce perceived muscle soreness, improve mobility, and support efficient movement patterns. That is exactly what they should do, and nothing more.

The problem in community physiotherapy is that soft tissue therapy is often the entirety of the treatment session, with a few exercises attached as an afterthought. In an elite rugby environment, hands-on work is used to reduce restriction and improve tissue quality so that the patient can then engage effectively in the active rehabilitation work that builds real capacity. The order matters, and the proportion matters.

Soft Tissue Therapy at Alexandria

At Alexandria Physiotherapy, massage therapy is delivered as part of a comprehensive plan, not as a standalone service for people who want to feel better for a few days. When Eddie Farah and Steve Velovski built the clinic on the principles developed at the South Sydney Rabbitohs, they brought exactly this philosophy with them: hands-on care serves the active rehabilitation goal, and every technique used should be connected to a clear clinical reason.

For athletes managing high training loads, this might mean regular soft tissue work to maintain tissue quality and reduce the cumulative effects of training. For someone recovering from a soft tissue injury, it means targeted work on the specific restrictions that are limiting movement or loading tolerance. For someone managing a chronic condition, it might mean periodic myofascial release as part of a long-term management strategy that also includes exercise and load modification.

Return-to-Activity Protocols: The Elite Standard

Return-to-play protocols in professional rugby are among the most rigorously structured systems in all of sports medicine. They exist for a reason: returning a player too early is worse than keeping them out longer. An improperly rehabilitated ankle sprain can lead to future joint degeneration. A poorly managed hamstring strain leads to a re-tear at three times the original severity. These are not hypothetical risks. They are documented patterns that elite physiotherapists spend careers trying to prevent.

The framework used at the elite level moves through clear phases: reducing acute inflammation and pain, restoring full range of motion, rebuilding strength to symmetrical levels, completing sport-specific loading and reactive work, and then a graduated return to full activity under monitored conditions. Each phase has entry and exit criteria based on objective measures, not just how the patient feels.

Applying This Standard Outside Professional Sport

The direct translation for everyday patients is this: your return to the gym, to running, to your recreational sport, or to the physical demands of your job should follow the same phased logic. It needs entry and exit criteria. It needs objective benchmarks. A physiotherapist who clears you to return based on a brief chat and a pain rating of two out of ten is not applying elite standards of care.

At Alexandria Physiotherapy and Sports Injury, the return-to-activity process is structured around the same principles used with NRL players and elite rugby athletes. This means your hamstring rehabilitation has specific strength benchmarks before you return to running. Your rotator cuff rehabilitation has overhead loading benchmarks before you return to overhead sport. Your knee rehabilitation has dynamic stability benchmarks before you return to court sport or contact activity.

Treating sport and activity as the outcome, rather than pain resolution as the outcome, fundamentally changes how rehabilitation is structured, and how effective it is.

Comparing Recovery Approaches

Not all recovery approaches are built the same way. Understanding the difference between a passive, symptom-focused approach, a standard active rehabilitation model, and the elite-informed model used at Alexandria helps clarify what you should expect from your physiotherapy care.

The distinction between standard active rehabilitation and elite-informed physiotherapy is not always about what techniques are used. It is about the precision with which they are programmed, progressed, and connected to the patient's actual activity demands.

Frequently Asked Questions

Do I need to be a rugby player or an athlete to benefit from elite physiotherapy principles?

No. The principles of load management, neuromuscular retraining, and structured return-to-activity protocols apply to anyone recovering from a musculoskeletal injury. Whether you run recreationally, play social sport, work a physically demanding job, or simply want to stay active and pain-free, the same clinical logic applies. Elite physiotherapy principles are about the quality of the approach, not the level of the athlete.

What is the difference between seeing a sports physiotherapist and a general physiotherapist?

A sports physiotherapist with genuine high-performance experience brings a deeper understanding of activity demands, tissue loading principles, and return-to-sport protocols. They are more likely to set objective benchmarks for your recovery rather than relying on pain levels alone, and more likely to incorporate neuromuscular retraining as a structured component of your program. At Alexandria Physiotherapy, the clinical team's background includes the NRL, NSW Blues State of Origin, Australian Rugby, the NSW Waratahs, and Olympic athletes, and that experience shapes how every patient is assessed and treated.

How long does elite-standard injury rehabilitation typically take?

This depends entirely on the injury, the tissue involved, and what you are returning to. Soft tissue injuries such as muscle strains typically move through acute, loading, and return-to-activity phases over four to twelve weeks. More complex injuries involving ligaments, cartilage, or post-surgical rehabilitation take longer. What elite-standard care changes is not necessarily the timeline but the quality of the outcome at the end of it. Patients who complete a properly structured program are significantly less likely to re-injure the same area.

Is massage therapy enough on its own to recover from a sports injury?

It is not. Soft tissue therapy reduces muscle soreness, improves mobility, and prepares tissue for loading. But it does not rebuild tissue strength, restore neuromuscular control, or address the movement patterns that contributed to the injury in the first place. In an elite rugby environment, hands-on therapy is a component of a broader program, never the program itself. The same standard applies to community patients at Alexandria Physiotherapy.

What should I expect at my first appointment at Alexandria Physiotherapy?

A thorough assessment of the injured structure, including grading the severity and identifying any contributing factors in your movement, strength, or load history. From there, you will receive a clear explanation of what is injured, why it happened, and a structured plan for recovery that includes specific milestones. You should leave that first appointment understanding exactly what is wrong and what the path forward looks like. That clarity is a direct product of the high-performance clinical culture the clinic was built on.

Can elite physiotherapy principles help with chronic or recurring injuries, not just acute ones?

This is actually where elite principles are most valuable for everyday patients. Many chronic injuries are the direct result of an acute injury that was never properly rehabilitated, typically because load management was ignored, neuromuscular deficits were not addressed, or the patient returned to activity before tissue readiness criteria were met. Applying a structured, evidence-based approach to a chronic problem means going back to the fundamentals and rebuilding the capacity that was never properly established in the first place. It is more demanding than treating an acute injury, but it produces lasting results.

If you have been managing a persistent injury or want to know whether your current rehabilitation is meeting elite standards, share your experience in the comments or get in touch with the team at Alexandria Physiotherapy directly.

References

Lower Back Pain at Work: A Desk Worker's Guide

Thu, 24 Sep 2026 00:00:00 GMT

Lower Back Pain at Work

Lower back pain is not a minor inconvenience for Sydney's office workers. It is one of the most common reasons people book appointments for lower back pain physiotherapy in Sydney , and the numbers tell a clear story. Research consistently shows that one-year prevalence rates for lower back pain among office workers range from 31% to 51%, with many sufferers experiencing recurring episodes that compound over time. If you sit for the majority of your working day and your lower back aches by mid-afternoon, this is not a normal cost of doing a desk job. It is a clinical problem with specific, treatable causes, and this guide lays out exactly what you need to know to address it.

Quick Takeaways

Why Desk Work Causes Lower Back Pain

The spine is built for movement. When you remove movement from the equation for six, eight, or ten hours a day, the structures that support your lower back start to fail in predictable ways. The lumbar discs lose their normal hydration cycle because they depend on movement to pump nutrients in and waste products out. The deep stabilising muscles, particularly the multifidus, switch off under prolonged static load. Hip flexors shorten and pull the pelvis into anterior tilt. None of this happens dramatically or suddenly, which is exactly why people miss the warning signs.

The problem for most desk workers is not that they are doing something acutely harmful. It is that they are doing the same mildly harmful thing for thousands of hours a year. That accumulation is what turns a manageable stiffness into a clinical case of lumbar dysfunction.

The Role of Sedentary Posture in Disc Loading

Sitting, particularly in a forward-flexed position, increases intradiscal pressure beyond what standing produces. When this is held for extended periods without relief, the posterior structures of the lumbar spine, including the facet joints and the annulus fibrosus of the intervertebral discs, are under consistent compressive and shear load. Over time this contributes to disc irritation, facet joint inflammation, and the kind of diffuse aching that desk workers describe as "that dull ache that never fully goes away."

Muscle Inhibition from Sitting Too Long

A less discussed but clinically significant issue is that prolonged sitting actively inhibits the muscles you need to protect your lower back. The gluteal muscles switch off when you sit on them for hours. The hip flexors adaptively shorten. The deep spinal stabilisers reduce their activity because the chair takes over the job of keeping you upright. When you finally stand, walk, or try to exercise, those muscles are not functioning at full capacity, which is why lower back injuries are so common during apparently low-risk activities like picking something up off the floor or reaching for an overhead shelf.

The Real Cost of Ignoring Desk-Related Back Pain

Musculoskeletal conditions, including lower back pain, are the leading cause of years lived with disability in Australia. For working-age Australians, back pain is not just a health issue. It directly affects productivity, concentration, sleep quality, and the ability to exercise, which creates a downward spiral where pain reduces activity and reduced activity makes pain worse.

The "push through it" approach is one of the most counterproductive things a desk professional can do. Pain that is ignored for weeks often becomes pain that requires months of treatment. The tissue changes that accompany chronic lower back pain, including altered movement patterns, reduced disc health, and neural sensitisation, are significantly harder to reverse than the acute presentation that could have been addressed in a few targeted sessions of physiotherapy.

For athletes and active professionals, there is an additional cost. A lower back that is irritated by desk work will perform poorly during sport, training, or recreational activity. The compensatory movement patterns your body adopts to manage pain at a desk translate directly into poor mechanics during exercise, increasing injury risk across the board.

Ergonomic Setup: What Actually Matters

There is a lot of noise in the ergonomics space, and a significant amount of it is product-driven rather than evidence-driven. The core principles of a desk setup that reduces lower back load are straightforward, and most of them cost nothing to implement. For professionals in the Alexandria and Sydney area looking for practical back pain treatment , the first step is always a proper assessment of how your workstation is set up and how you are using it.

Chair and Seated Position

Your chair height should allow your feet to rest flat on the floor with your hips at roughly 90 to 100 degrees of flexion. The lumbar support should sit at the natural curve of your lower back, not at your mid-back. The back of the chair should be reclined slightly past 90 degrees, closer to 100 to 110 degrees, because a perfectly upright seated position actually increases lumbar disc pressure compared to a slight recline.

Most people set their chair incorrectly and then blame their back. The chair is rarely the primary problem. The primary problem is how long you stay in it without moving.

Screen, Keyboard, and Monitor Position

Your monitor should be at eye level so your neck is in a neutral position. Craning your neck forward or downward for hours shifts your head forward relative to your shoulders, which transfers load down the chain into your thoracic and lumbar spine. Your keyboard and mouse should be close enough that your elbows sit at roughly 90 degrees and your shoulders are not rounded forward or elevated.

Pro tip: If you work on a laptop without a separate monitor, invest in a laptop stand and an external keyboard. Laptop-only setups force a compromise between neck position and wrist position that no ergonomic adjustment can fully resolve.

Movement Breaks as a Clinical Priority

The single most evidence-supported ergonomic intervention is not a piece of equipment. It is breaking up prolonged sitting. Research on sitting-reduction interventions in desk-based workers demonstrates that reducing sustained sedentary time leads to measurable reductions in musculoskeletal pain. The practical target is to avoid sitting for more than 30 continuous minutes without a brief positional change, even if that change is simply standing at your desk for two minutes.

Pro tip: Set a recurring reminder on your phone or computer for every 25 to 30 minutes. Stand, walk to fill a glass of water, or do a few standing lumbar extensions at your desk. This is not a wellness suggestion. It is a clinical recommendation backed by the same research base that informs physiotherapy practice.

Exercises That Work for Office-Related Lower Back Pain

Exercise therapy is one of the most robustly supported interventions for lower back pain in office workers. A systematic review examining physical exercise programs for office workers found that structured exercise improved lower back pain symptoms while also producing improvements in flexibility, range of motion, and quality of life. The key word is "structured." Generic stretching without a clinical rationale is less effective than a targeted program designed around your specific presentation.

Deep Stabiliser Activation

The multifidus and transverse abdominis are the primary deep stabilisers of the lumbar spine. In people with chronic lower back pain, these muscles show measurable inhibition and atrophy even when superficial abdominal muscles appear strong. The classic "brace" style of core engagement used in gym settings does not specifically target these muscles. A physiotherapist will teach you how to activate them with precision, which is the foundation of any effective rehabilitation program.

Hip Flexor and Thoracic Mobility Work

Tight hip flexors from prolonged sitting pull the pelvis forward into anterior tilt, which compresses the lumbar facet joints and increases the arch of the lower back. A half-kneeling hip flexor stretch held for 60 to 90 seconds, performed three to four times per day, meaningfully reduces this tension over time. Pairing this with thoracic rotation exercises helps redistribute spinal movement across more segments, reducing the concentration of load at the lumbar level.

Glute and Posterior Chain Loading

Bringing the gluteal muscles back online is a non-negotiable part of office worker rehabilitation. Glute bridges, single-leg deadlifts, and band-resisted clamshells are staples of any well-designed lower back program. They do more than strengthen the glutes. They restore the normal pattern of posterior chain muscle recruitment that prolonged sitting disrupts.

When to See a Physiotherapist and What to Expect

If your lower back pain has lasted more than two weeks, is getting progressively worse, is disrupting your sleep, or is radiating into your buttock or leg, book an appointment with a physiotherapist. These are not alarm bells, but they are signals that your body needs more than a self-directed exercise routine.

For athletes, the threshold should be lower still. A lower back that is irritated during desk work and is then loaded during sport or training is at higher risk of a more significant injury. Seeing a physio proactively, before the pain becomes severe, is simply good performance management.

What Happens in a Physiotherapy Assessment

A thorough assessment for desk-related lower back pain includes a detailed history of your work habits, movement analysis, postural assessment, strength and flexibility testing of the key muscle groups, and a neurological screen to rule out nerve involvement. From that, a specific diagnosis is made. Not "back pain" as a generic label, but a precise understanding of which structures are involved and why.

At Alexandria Physiotherapy and Sports Injury Clinic , assessment goes beyond the symptomatic area. Because we work with athletes and physically active professionals, we understand that lower back pain rarely exists in isolation. Hip mechanics, thoracic mobility, and foot and ankle function all influence how load is distributed through the lumbar spine, and a comprehensive assessment captures that full picture.

Evidence-Based Treatment Techniques

Physiotherapy interventions for lower back pain that have strong clinical evidence behind them include manual therapy (joint mobilisation and manipulation), targeted exercise therapy, soft tissue techniques including massage therapy , and education around posture and movement. Research comparing these interventions consistently shows that combining manual therapy with exercise therapy produces better outcomes than either approach alone. The best physiotherapy is never one-dimensional.

For persistent or chronic lower back pain, a structured rehabilitation program that progresses over weeks is the standard of care. Expecting resolution in a single session is unrealistic. Expecting meaningful improvement within four to six focused sessions is entirely reasonable for most presentations.

Comparing Treatment Approaches

Not all approaches to desk-related lower back pain deliver the same results. Here is how the three most common strategies compare across the dimensions that matter most for working professionals.

The comparison above makes the clinical case clearly. Ergonomic upgrades and generic fitness both have a role, but neither delivers what targeted physiotherapy does. For desk workers whose lower back pain is interfering with their work output, their sport, or their general quality of life, the physiotherapy-led approach is the most efficient path to a durable outcome.

Frequently Asked Questions

How long does it take for office worker lower back pain to resolve with physiotherapy?

Most desk workers with non-complicated lower back pain see significant improvement within four to six weeks of consistent physiotherapy. This assumes active participation in the home exercise program and the ergonomic adjustments recommended in session. Chronic presentations, where pain has been present for more than three months, typically require a longer program of eight to twelve weeks. The sooner you start, the shorter the timeline.

Is it safe to keep working at my desk while getting treatment for lower back pain?

In the vast majority of cases, yes. Continuing to work while managing lower back pain with physiotherapy is appropriate and recommended. Your physiotherapist will advise you on workstation modifications, movement strategies, and any activities to temporarily avoid. Stopping work entirely is rarely indicated and can actually slow recovery by reducing activity levels and increasing anxiety around movement.

What is the difference between an office worker physio appointment and a standard back pain appointment?

A good physiotherapist approaches desk-related back pain with a full understanding of the postural demands, sitting mechanics, and muscle inhibition patterns specific to sedentary work. This means the assessment includes how you sit, how you move between tasks, and the ergonomic context of your workstation, not just the location of your pain. At Alexandria Physiotherapy and Sports Injury Clinic, this is standard practice because we understand the specific demands of professional and workplace-based lifestyles.

Should I get a standing desk to help my lower back pain?

A height-adjustable desk can be a useful tool if you already have the right exercise foundation in place. By itself, a standing desk shifts the load from sitting to standing but does not eliminate it. Many people who switch to a standing desk without guidance end up with foot, knee, or hip pain from standing too long with poor posture. The evidence supports alternating between sitting and standing, with movement breaks, rather than treating standing as the complete solution.

Can massage therapy help with lower back pain from desk work?

Yes, particularly for reducing muscle tension in the paraspinal muscles, quadratus lumborum, and hip flexor group, which are commonly overloaded in desk workers. Massage is most effective as part of a broader treatment plan that includes exercise and postural strategies. Used in isolation, the relief is temporary. Combined with targeted rehabilitation, it supports the tissue changes that make recovery durable. Alexandria Physiotherapy offers remedial massage therapy as an integrated part of back pain treatment programs.

What exercises should I avoid if I have lower back pain at a desk job?

Avoid heavy loaded spinal flexion exercises, such as traditional sit-ups and weighted forward bends, during an acute flare-up. These increase intradiscal pressure and can aggravate already sensitised structures. Also avoid exercises that require significant spinal rotation under load until your deep stabilisers are functioning adequately. Your physiotherapist will guide you through what is appropriate at each stage of your recovery, which changes as your capacity improves.

If you have experienced desk-related back pain and found a particular approach that worked for you, or if you are currently working through your recovery and have questions, we would love to hear your experience in the comments or via our contact page.

References

Evidence-Based Physiotherapy Sydney: Why It Matters

Wed, 23 Sep 2026 00:00:00 GMT

Evidence-based Physiotherapy

Most people choose a physiotherapist based on location or word of mouth. Few stop to ask whether the treatment they are receiving is actually supported by current research. That question matters more than most patients realise, because physiotherapy delivered without an evidence base is not simply less effective. It can actively delay recovery, reinforce unhelpful movement patterns, and leave the root cause of an injury untreated. Evidence-based physiotherapy Sydney clinics offer a fundamentally different standard of care, one where every clinical decision is grounded in the best available research, combined with genuine clinical expertise and a clear understanding of what you as a patient actually need.

What Is Evidence-Based Physiotherapy?

The formal definition comes from the World Confederation for Physical Therapy, which describes evidence-based practice as "a commitment to use the best available evidence to inform decision-making about the care of individuals" , integrating individual professional judgement with evidence gained through systematic research. A widely cited refinement of this adds that clinical decisions should also incorporate patient values, ethical principles, and the physiotherapist's own expertise.

In plain terms, evidence-based physiotherapy means your treatment plan is not built on habit, tradition, or a single practitioner's preferred technique. It is built on what the research actually shows works for your specific condition, filtered through the real-world clinical experience of a skilled practitioner, and shaped around your goals, circumstances, and values.

This is not a minor distinction. The PEDro database (Physiotherapy Evidence Database, maintained by Neuroscience Research Australia) indexes more than 70,000 randomised controlled trials, systematic reviews, and clinical guidelines specifically evaluating physiotherapy interventions. That body of evidence exists to be used. Clinics that do not draw on it are, by definition, operating without the full picture.

The Three Pillars That Define Best Practice

The American Physical Therapy Association and leading physiotherapy bodies worldwide agree on a three-part model. All three elements carry equal weight. Focusing exclusively on any one of them produces inferior outcomes.

Pillar One: Best Available Research Evidence

This means drawing on peer-reviewed studies, systematic reviews, and clinical guidelines rather than anecdote or assumption. For a condition like ACL rehabilitation, for example, the research literature has produced clear, consensus-based protocols for load progression, return-to-sport criteria, and strength benchmarks. A physiotherapist practising at a high standard knows this literature and applies it directly.

Pillar Two: Clinical Expertise

Research evidence does not override clinical skill. It informs it. An experienced physiotherapist applies research findings through the lens of thousands of real patient encounters, pattern recognition developed over years, and the ability to adapt a protocol when the textbook presentation differs from what is actually in front of them. This is what separates a good physio from someone who simply reads studies.

Pillar Three: Patient Values and Circumstances

A recovery plan that ignores what a patient actually needs is a plan that will not be followed. Whether someone is a competitive athlete wanting to return to a specific sport, a tradesperson who cannot afford extended time off, or a professional managing a chronic condition alongside demanding work hours, the treatment approach must reflect their reality. Evidence-based practice makes patient values a non-negotiable input, not an afterthought.

Why It Matters for Your Recovery

The gap between evidence-based and non-evidence-based physiotherapy becomes most visible when recovery stalls. A patient who has been treated for eight weeks without measurable improvement should ask whether the intervention being applied has demonstrated efficacy for their specific condition. In many cases, the honest answer is that it has not.

Faster, More Predictable Timelines

When treatment protocols are grounded in research, the expected recovery timeline is not a guess. It is a projection based on what outcomes the evidence has shown. That clarity allows the physiotherapist to identify early when a patient is not progressing as expected and to adjust the approach, rather than continuing indefinitely with something that is not working.

Lower Risk of Re-injury

One of the most consistent findings across physiotherapy research is that incomplete rehabilitation, particularly for lower limb injuries, dramatically increases re-injury risk. Evidence-based return-to-sport protocols include objective strength and movement benchmarks that must be met before full activity is resumed. Skipping or shortening this process because a patient feels better is a common cause of repeat injury.

Treatments That Actually Address the Cause

A non-evidence-based approach tends to treat symptoms. Evidence-based physiotherapy treats causes. For a runner with recurring knee pain, that means assessing hip strength, running mechanics, training load, and footwear, not just applying modalities to the painful site. The distinction between symptom management and genuine rehabilitation determines whether a problem resolves or simply cycles between flare-ups.

Pro tip: Ask your physiotherapist directly: "What does the research say about the best approach for my condition?" A practitioner working at a high standard will have a clear, specific answer. Vague or defensive responses are a signal to look elsewhere.

Evidence-Based vs. Other Approaches: A Direct Comparison

Not all physiotherapy is delivered to the same standard. The table below compares evidence-based practice with two other common modes of delivery that patients encounter.

The comparison above is not meant to suggest that techniques like dry needling or manual therapy have no place in good clinical care. They do, but only when applied within an evidence-informed framework as part of a broader rehabilitation plan, not as a substitute for one.

Sports Injury, Performance, and the Evidence Advantage

For athletes and people who train regularly, the stakes around physiotherapy quality are higher. A recreational runner, a competitive team sport player, or a CrossFit athlete asking for physio Alexandria inner city services is not just seeking pain relief. They want to return to full performance quickly, safely, and with confidence that the same problem will not reappear six weeks later.

Return-to-Sport Criteria: Where Evidence Makes the Biggest Difference

The question of when an athlete is genuinely ready to return to full training and competition is one of the most researched areas in sports physiotherapy. Evidence-based clinicians use validated assessment tools and strength ratios, specific to each sport and injury type, rather than simply waiting until pain has resolved. Pain resolution is a necessary but entirely insufficient marker of readiness. An athlete who returns based on subjective symptom improvement alone faces a substantially elevated risk of re-injury, particularly for hamstring strains, ACL reconstructions, and shoulder instability.

Load Management and Injury Prevention

Sports physiotherapy research has produced strong evidence around training load and injury risk. Acute to chronic workload ratio monitoring, for example, is now a well-supported concept in managing injury risk in team and individual sports. An evidence-based physiotherapist working with athletes does not just treat injuries after they occur. They help athletes and coaches understand load parameters, identify early warning signs of overload, and modify training to reduce injury risk before a problem develops.

This approach is a direct reflection of the environment that shapes clinical practice at Alexandria Physiotherapy and Sports Injury. Working at the highest levels of professional rugby league, including with the NSW Blues under Eddie Farah, demands exactly this kind of rigorous, research-grounded thinking applied to high-stakes athletic performance.

Pro tip: If you are managing a sports injury, ask your physiotherapist for specific, measurable return-to-sport criteria before you begin treatment. Having clear benchmarks from day one keeps both you and your practitioner accountable, and removes the ambiguity that leads to premature returns.

What to Expect at an Evidence-Based Clinic in Alexandria

Choosing physio Alexandria inner city means you have access to a practice that was built around elite sporting standards from the ground up. Alexandria Physiotherapy and Sports Injury was founded by Eddie Farah and Steve Velovski, physiotherapists with more than 15 years of experience leading the South Sydney Rabbitohs in the NRL and working at the highest levels of professional sport. That background is not incidental. It directly shapes how every patient, athlete or otherwise, is assessed and treated.

What a First Appointment Should Include

An evidence-based first appointment goes well beyond a brief movement screen and a list of exercises. You should expect a thorough subjective history that captures not just what hurts but how it affects your function, what your goals are, and what you have already tried. The physical assessment should be systematic, test-driven, and aimed at arriving at a specific clinical diagnosis rather than a vague category label like "back pain" or "knee problem".

Ongoing Measurement and Adjustment

One of the clearest markers of best physiotherapy practice is the use of objective outcome measures throughout your treatment, not just at the start. Whether that is a validated questionnaire, a movement quality score, or a specific strength benchmark, your physiotherapist should be able to show you, in concrete terms, how you are progressing. If a particular intervention is not producing the expected results within a reasonable timeframe, an evidence-based practitioner will identify this and modify the plan. Continuing the same approach indefinitely in the absence of measurable progress is not evidence-based care.

Communication That Respects Your Intelligence

Patients make better decisions when they understand what is happening in their body, why a particular treatment is being used, and what the research actually says about their condition. A practitioner working at a high standard explains the rationale behind every element of your plan in terms you can engage with. This is not just good communication. It is a core component of evidence-based practice, because your informed engagement with your own rehabilitation is one of the strongest predictors of a good outcome.

Frequently Asked Questions

What makes evidence-based physiotherapy different from regular physiotherapy?

Evidence-based physiotherapy means clinical decisions are grounded in the best available research, combined with practitioner expertise and your individual values and goals. The key difference is that treatments are selected because the evidence supports their effectiveness for your specific condition, not simply because they are familiar or traditional. This approach produces more predictable outcomes and reduces the risk of prolonged or ineffective treatment.

Is evidence-based physiotherapy only relevant for serious injuries or professional athletes?

Not at all. The evidence-based approach applies equally to office workers with persistent neck pain, new mothers managing postpartum pelvic floor issues, older adults working through knee osteoarthritis, and elite athletes managing sports injuries. The research literature covers the full spectrum of conditions physiotherapists treat. What changes between patients is how the evidence is applied, not whether it is relevant.

How do I know if my physiotherapist is genuinely practising evidence-based care?

Ask questions. A practitioner working to a high standard should be able to explain, in plain language, why they have chosen a particular treatment approach for your condition and what the research shows about its effectiveness. They should use measurable outcome benchmarks throughout your care and be willing to modify your plan if expected progress is not occurring. Look also at the clinical environment: does the practitioner engage in continuing professional development, use standardised assessment tools, and keep up with current clinical guidelines?

How does evidence-based physiotherapy handle conditions where the research is limited?

Honest practitioners acknowledge the limits of the current evidence base. For conditions where high-quality research is sparse, an evidence-based approach uses the best available evidence at the appropriate level, whether that is expert consensus, clinical guidelines, or well-designed observational studies, while being transparent with you about the certainty of the recommendations. This is more honest and ultimately more useful than projecting false confidence.

Does evidence-based care mean the same treatment for every patient with the same diagnosis?

No. This is one of the most common misconceptions about evidence-based practice. Research findings provide a framework and a starting point, but individual factors including age, fitness level, activity demands, tissue quality, and personal goals shape how a protocol is applied. Two people with the same ACL reconstruction will not necessarily follow an identical program. The evidence informs the approach; clinical expertise and patient values determine how it is tailored.

How does physiotherapy at Alexandria compare to generic high-volume clinics?

The fundamental difference is clinical depth. High-volume clinics often rely on brief appointments managed largely by support staff, with the treating physiotherapist spending limited time on actual hands-on assessment and treatment. At Alexandria Physiotherapy and Sports Injury, the model is built around extended one-on-one time with an experienced practitioner, outcome-focused planning, and a standard of care derived from years of work at the elite sporting level. You are not receiving adapted professional sports medicine. You are receiving the real thing.

Can I access evidence-based physiotherapy for chronic conditions, not just acute injuries?

Chronic pain and long-standing conditions are areas where evidence-based physiotherapy has made some of its most significant contributions. The research on persistent pain has shifted considerably over the past decade, with strong evidence now supporting graded exercise, pain neuroscience education, and active rehabilitation over passive treatment. An evidence-based physiotherapist treating a chronic condition should be familiar with this literature and applying it, rather than defaulting to older models of pain management that the evidence no longer supports.

Have you experienced the difference between evidence-based and non-evidence-based physiotherapy care? Share what you noticed in the comments below.

References

5 Sports Injury Recovery Mistakes to Avoid

Tue, 22 Sep 2026 00:00:00 GMT

5 Sports Injury Recovery Mistakes

Most sports injuries do not fail to heal because the body lacks the ability to repair tissue. They fail to heal properly because of decisions made in the days, weeks, and months after the initial injury. Sports injury recovery mistakes are incredibly common, and the frustrating part is that most of them feel like the right call at the time. Pushing through pain feels tough. Skipping a physiotherapy appointment when you feel better feels sensible. Returning to training the moment the swelling drops feels like progress. Every one of those decisions can set your recovery back by weeks or cause a repeat injury that is far worse than the original. This guide breaks down the five most damaging mistakes, why they happen, and exactly how to correct them.

Quick Takeaways

Mistake 1: Returning to Sport Before You Are Actually Ready

This is the most damaging mistake on the list, and it is the most common one seen in a clinical setting. An athlete feels good, training is missed, and the competitive instinct overrides caution. The result is a repeat injury that is usually worse than the first, with a longer, harder recovery the second time around.

A research study published in the Journal of Orthopaedic and Sports Physical Therapy found that young athletes who returned to sport before nine months after ACL reconstruction had a rate of new injury seven times higher than those who delayed their return. That is not a marginal risk increase. It is a category-defining number that should inform how every post-surgical athlete thinks about their timeline.

What "Ready" Actually Means

Return-to-activity readiness is assessed through objective functional criteria, not pain scores alone. These typically include achieving specific strength thresholds in the injured limb relative to the uninjured side, demonstrating adequate proprioception and neuromuscular control under progressive loading, and completing sport-specific movement patterns at appropriate intensity without compensatory mechanics.

At a clinic like Alexandria Physiotherapy and Sports Injury , return-to-sport assessments are structured and data-driven, not based on how an athlete feels on a particular morning. Your physiotherapist should be tracking measurable benchmarks at every stage, not just asking whether the pain has settled.

Pro tip:

Pro tip: Ask your physiotherapist specifically what functional tests you need to pass before returning to full training. If the answer is vague, push for specific numbers, such as limb symmetry index targets on hop testing or strength ratios between injured and uninjured sides.

Mistake 2: Treating Pain Disappearance as the Finish Line

Pain is the most visible signal the body has, so it is understandable that most people use it as their primary guide for how recovery is progressing. The problem is that pain typically resolves before structural tissue repair is complete. Pain returns because the tissue has become quieter, but not stronger. The ligament, tendon, or muscle that no longer aches is not necessarily a ligament, tendon, or muscle that has been restored to full capacity.

This mistake is particularly common with soft tissue injuries. An ankle sprain may stop hurting after a few days of reduced loading. A hamstring strain may feel fine on the walk to training. A shoulder rotator cuff issue may settle enough to allow overhead movement without noticeable pain. None of these scenarios mean the tissue is ready to absorb sport-specific loads.

The Biology Behind the Misconception

Tissue healing occurs in phases: an inflammatory phase, a proliferative (repair) phase, and a remodelling phase. Pain typically diminishes during the proliferative phase, but the remodelling phase, during which new tissue develops the tensile strength and organisation needed to handle load, continues for weeks or months after symptoms resolve. Resuming heavy loading during remodelling is exactly how partial tears become full ones.

The absence of pain does not mean the body is ready to return to competition or normal training. Before resuming activity, several criteria must be met for each patient: full mobility, similar strength to the uninjured side, safety in sports movements, and absence of pain. Pain-free is one criterion, not the only one.

Mistake 3: Relying on Rest Alone and Skipping Active Rehabilitation

Rest has a legitimate role in the very early acute phase of most injuries. Beyond that, it is one of the most counterproductive things you can do. The standard advice of "ice it, rest it, and see how it goes in a week" delays tissue repair and accelerates muscle loss in ways that compound throughout recovery.

Complete rest is out, smart movement is in. Studies show that gentle motion, introduced early, helps clear swelling and gets tissues rebuilding. For ankle sprains, athletes who started controlled exercises within the first week bounced back quicker than those who stuck with full rest.

The Problem With the Old RICE Model

The RICE protocol (Rest, Ice, Compression, Elevation) was the standard recommendation for soft tissue injuries for decades. More recently, updated frameworks in sports medicine have shifted toward guided early movement. There has been some recent debate about the RICE method for musculoskeletal injuries. Healthcare providers still recommend it for the acute phase, but with caveats, and newer protocols suggest introducing gentle movement and progressive exercise as healing progresses.

Skipping physiotherapy entirely, or attending only one or two sessions before deciding you can manage alone, leaves major gaps. Physical therapy is not just for severe injuries. Skipping therapy often leaves the injured area weak and unstable. The risk is not just local weakness at the injury site. It is the development of compensatory movement patterns that load other structures asymmetrically and create secondary injuries down the line.

Pro tip: If you are tempted to stop attending rehabilitation sessions because you feel better, discuss a discharge plan with your physiotherapist first. A structured home program and clear re-engagement criteria give you autonomy while protecting the work you have already done.

Mistake 4: Focusing Only on the Injured Site

The human body does not function in isolated parts, and injuries do not affect only the tissue at the point of pain. Every significant musculoskeletal injury produces systemic effects that extend well beyond the primary site, and any rehabilitation program that ignores those effects is setting the person up for ongoing problems.

Injury management that focuses exclusively on the primary site of injury misses the systemic effects that every significant injury produces. Muscle inhibition around an injured joint begins within 24 hours of injury onset. Compensatory movement patterns develop almost immediately as the body redistributes load away from the painful area. Proprioceptive function is disrupted at and around the injury site.

Common Kinetic Chain Failures

Focusing solely on the injured area is a common mistake. The body functions as a chain. When one part is weak, it impacts the rest. If you have injured your knee, you will also need to strengthen your hips and ankles to provide support and reduce the chances of overloading the knee again.

In practice, this means a lateral ankle sprain program needs to include hip strengthening and single-leg balance work, not just range-of-motion exercises for the ankle itself. A rotator cuff tear program needs to address scapular stability and thoracic mobility alongside shoulder-specific strengthening. A hamstring strain program needs to address hip flexor length, lumbar control, and running mechanics, not just hamstring loading.

This is one area where individual physiotherapy assessment adds the most value over generic programs. A physiotherapist evaluates your overall posture, identifies muscle imbalances elsewhere in the kinetic chain, tests the quality of your functional movements, and identifies risk factors for recurrence. This systemic approach explains why your knee pain might actually stem from hip weakness. The sports injury team at Alexandria Physio applies exactly this whole-body lens to every rehabilitation assessment.

Mistake 5: Self-Treating Based on Generic Online Advice

Access to health information has never been easier, and that is both a benefit and a problem. For every useful explanation of how to manage an Achilles tendinopathy or a Grade 1 hamstring strain, there are dozens of generic exercise programs that were built for a broad, unspecified audience and are not appropriate for your specific injury, your tissue quality, your biomechanical history, or your sport.

Generic programs ignore your biomechanics, history, and patterns. Cases report aggravated injuries following non-personalized advice. Working only the painful muscle without its antagonists creates imbalances. Using the same exercises for eight weeks without progression leads to stagnation, because tissues adapt and require a gradual increase in demand.

When Online Resources Help Versus When They Harm

General educational content about injury types, healing timelines, and rehabilitation principles can help you understand your injury and have better conversations with your clinician. Where things go wrong is when people substitute online content for clinical assessment and use a program designed for a general audience as their actual rehabilitation protocol.

Athletes who attempt self-treatment or rely on internet advice instead of professional guidance risk aggravating their injuries. A complete rehabilitation program should address the entire kinetic chain. Recovery does not end when the pain disappears. Preventive measures are essential to avoid recurrence.

The value of physiotherapy is not simply the exercise prescription. It is the ongoing assessment of how your body is responding, the adjustment of load and progression based on real-time feedback, and the identification of contributing factors that you would never find in a search result. For athletes and active professionals in Sydney's inner south, Alexandria Physiotherapy and Sports Injury provides exactly that level of individually tailored care, combining clinical experience with data-driven programming to get people back to training and competition safely.

Recovery Approach Comparison

Not all approaches to managing a sports injury deliver the same outcomes. The table below compares three common paths athletes take, using what typically happens with a moderate soft tissue injury such as a Grade 2 ankle sprain or a hamstring strain.

Frequently Asked Questions

How long should I wait before seeing a physiotherapist after a sports injury?

The short answer is: as soon as possible. Early assessment does not mean early loading. A physiotherapist can advise on appropriate management from day one, including what to do and what to avoid during the acute phase. The earlier you are assessed, the more options are available to influence the recovery trajectory. Waiting several weeks until pain persists is one of the most common ways people lose time.

Is it okay to exercise through pain during rehabilitation?

Mild discomfort during rehabilitation exercise is often acceptable and sometimes expected, particularly in the later stages of tendon or muscle rehabilitation. Increasing, sharp, or joint-based pain is not. The clinical rule of thumb used in structured rehabilitation is that exercise-related soreness should resolve within 24 hours. If it does not, the load was too high. Pain that intensifies during an exercise session is a clear signal to stop and reassess with your physiotherapist.

Why do I keep re-injuring the same area?

Repeat injuries to the same site almost always point to incomplete rehabilitation the first time around. The most common reasons include returning to sport before hitting objective strength and neuromuscular benchmarks, failing to address the kinetic chain contributors to the original injury, and stopping rehabilitation once symptoms resolved rather than completing the full program. A thorough movement assessment can identify the specific deficits driving the recurrence pattern.

What is the difference between physiotherapy and massage for sports injury recovery?

Remedial massage and physiotherapy serve different but complementary roles in sports injury recovery. Massage therapy is effective for managing soft tissue tension, reducing muscle guarding, improving circulation, and supporting recovery between training sessions. Physiotherapy involves clinical assessment, diagnosis, and the prescription of a structured rehabilitation program targeting the underlying cause of the injury. Many athletes benefit from both, particularly during high-load training phases. Alexandria Physio offers both services under one roof, which allows for coordinated care.

How do I know when I am genuinely ready to return to sport after an injury?

Readiness should be determined by a set of objective criteria established by your physiotherapist at the start of your rehabilitation, not by how you feel on a given day or by a calendar date. These criteria typically include achieving a specific percentage of limb symmetry on strength and hop tests, completing sport-specific movement patterns without compensatory mechanics, and passing a graduated return-to-training protocol without symptom recurrence. If your current program does not include measurable return-to-sport benchmarks, ask your clinician to put them in place.

Does nutrition affect sports injury recovery?

Yes, significantly. Tissue repair is a biological process that depends on adequate protein intake for collagen synthesis, sufficient caloric intake to support healing, and micronutrients including vitamin C, zinc, and omega-3 fatty acids that play direct roles in the inflammatory and repair phases. Undereating during recovery, which is common in athletes who are not training, slows tissue healing measurably. Sleep quality has a similar effect. These factors are worth raising directly with your physiotherapist or sports medicine practitioner.

Have you made any of these mistakes during your own recovery, and what helped you get back on track? Share your experience below.

References

Hamstring Injury Rehabilitation Sydney: The Runner's Guide

Mon, 21 Sep 2026 00:00:00 GMT

Hamstring Injury Rehabilitation

Hamstring injuries are the most frequently recurring soft-tissue injuries in sport. Research tracking athletes across full seasons has found recurrence rates ranging from roughly 14% to over 60%, with the highest risk concentrated in the first two weeks after returning to running. For Sydney-based runners, that number is not a statistic to skim past. It means that if your hamstring has gone once and you returned to training on timeline alone rather than on demonstrated strength and capacity, the odds are seriously stacked against you. Expert hamstring injury rehabilitation in Sydney is not just about resting until the pain fades. It is about systematically rebuilding the tissue so it can tolerate the demands of sprinting, long runs, and everything in between.

Quick Takeaways

Understanding Hamstring Anatomy and Why Runners Get Hurt

The hamstring group consists of three muscles: the biceps femoris (long and short heads), the semitendinosus, and the semimembranosus. All three originate from the ischial tuberosity (sit bone) at the pelvis and cross both the hip and knee joints. This dual-joint crossing is exactly what makes them vulnerable during running, where they must simultaneously control hip flexion and manage knee extension at high speeds.

During sprinting, the hamstrings are most heavily loaded in the late swing phase, when the hip is flexed and the knee is extending rapidly. At this moment, the muscle is active and lengthening at the same time. This is called an eccentric contraction, and it is where most running-related hamstring injuries occur. The biceps femoris long head is the most commonly injured structure, particularly at the proximal musculotendinous junction near the ischial tuberosity.

For distance runners, the mechanism shifts slightly. Rather than a single high-velocity sprinting event, hamstring injuries in long-distance runners often develop from repeated loading over many kilometres, cumulative fatigue, poor pelvic control, or a combination. A runner who overrides their training load, neglects hip and gluteal strength, or runs with significant anterior pelvic tilt is stacking risk factors on top of one another with every kilometre logged.

Pro tip: If you are a runner experiencing a gradual onset of deep posterior thigh or sit-bone pain that worsens when sitting for long periods, do not assume it is a simple hamstring strain. Proximal hamstring tendinopathy requires a different loading approach than a muscle belly tear, and a physio assessment is the only way to distinguish them accurately.

Grading Hamstring Injuries: What Your Diagnosis Actually Means

Hamstring strains are clinically graded on a three-tier scale that reflects the degree of muscle fibre and tendon damage. Understanding your grade is the single most important factor in setting realistic expectations for return to running.

Grade I: Mild Strain

A Grade I injury involves minimal fibre disruption. The runner typically experiences a sudden onset of tightness or ache in the posterior thigh during running, but is often able to continue at a reduced pace. Tenderness on palpation is localised and mild. With appropriate management, most Grade I injuries resolve within one to two weeks.

Grade II: Moderate Partial Tear

Grade II injuries involve a partial tear of the muscle fibres. There is a more sudden and sharp pain during the inciting activity, often with visible or palpable swelling in the posterior thigh within the first 24 hours. Strength deficits are present and measurable. Return to full running typically takes three to six weeks, though this can extend considerably if the injury is at the proximal musculotendinous junction.

Grade III: Complete Rupture

A Grade III hamstring rupture is a full-thickness tear. There is immediate, severe pain, marked swelling, and significant loss of knee flexion strength. Surgical consultation may be required for proximal tendon avulsion injuries. Recovery measured in months, not weeks, is the realistic expectation. Research confirms that injuries extending into the tendon are significantly more prone to both reinjury and prolonged return-to-play timelines.

Acute Management: The First 72 Hours Matter More Than You Think

The immediate response to a hamstring injury shapes the quality and speed of the entire rehabilitation. The old RICE protocol (Rest, Ice, Compression, Elevation) has been largely replaced in evidence-based practice with a more active, graduated approach. Current best practice follows the PEACE and LOVE framework, which emphasises protecting the tissue from further damage initially, then progressively introducing load as the tissue heals.

What to Do in the First 72 Hours

Avoid aggressive stretching of the injured area. Pulling hard on an acutely torn muscle does not help it heal faster. Compression around the posterior thigh reduces early swelling. Elevation is appropriate when resting. Ice can help with pain management but does not accelerate tissue repair. Avoid anti-inflammatory medications in the first few days unless directed by a clinician, as the early inflammatory response is part of the natural healing process.

What Not to Do

Do not continue running through the pain hoping it will loosen up. Do not apply aggressive deep massage to the acute injury site. And do not decide your rehabilitation is complete when the acute pain resolves. Pain resolution and tissue healing are not the same event. A hamstring can feel painless long before it has recovered adequate tensile strength.

Pro tip: See a physiotherapist within 48 to 72 hours of the injury. Early clinical assessment allows for accurate grading, a realistic return-to-run timeline, and a rehabilitation plan that begins from day one rather than after weeks of unguided rest.

The Four Phases of Evidence-Based Hamstring Rehabilitation

Effective hamstring rehabilitation follows a phased progression built on objective criteria rather than calendar dates. Each phase has specific goals and measurable benchmarks for advancement. Rushing through phases because a runner "feels fine" is how Grade II injuries become recurrent Grade II injuries.

Phase 1: Pain and Tissue Protection (Days 1 to 5)

The goal here is to protect the healing tissue while preventing the deconditioning that comes with complete rest. Gentle range-of-motion work within a pain-free arc, isometric hamstring contractions, and walking at a comfortable pace are appropriate. No aggressive stretching, no loaded knee flexion. The physio will also assess the lumbopelvic region and kinetic chain at this stage, since deficits in gluteal or calf function often contribute to hamstring overload.

Phase 2: Strength Building in Short Range (Days 5 to 14)

As acute tenderness reduces, submaximal loading through a short range of motion begins. Prone leg curls, ball bridges, and early hip-hinge patterns are introduced. The focus is on re-establishing muscle activation patterns rather than achieving maximum load. The runner should be able to tolerate low-intensity walking and basic gym movements without pain provocation.

Phase 3: Progressive Eccentric Loading and Running Preparation (Weeks 2 to 6)

This is the most clinically significant phase for runners. Exercises that load the hamstring eccentrically through longer muscle lengths are introduced progressively. Romanian deadlifts, single-leg deadlifts, Nordic hamstring curl regressions, and hip thrusts at longer ranges are central to this phase. High-speed running cannot be safely reintroduced until the hamstring can tolerate significant eccentric load , because sprinting imposes eccentric forces that low-intensity running never matches. Progressive straight-line jogging is introduced here, starting at low speeds and building incrementally.

Phase 4: Sport-Specific Loading and Return to Full Training (Weeks 4 to 12+)

The final phase bridges from controlled gym-based loading to the unpredictable demands of sport and high-speed running. Sprint progressions, agility work, change-of-direction drills, and maximal-effort sprints are reintroduced in a structured sequence. Return-to-sport sign-off requires objective strength testing, typically aiming for greater than 90% limb symmetry on hamstring strength assessments. For distance runners, this phase also incorporates full long-run capacity without any posterior thigh symptoms.

Nordic Hamstring Curls and Prevention: The Research Is Clear

No single exercise has as strong an evidence base for hamstring injury prevention as the Nordic hamstring curl. Systematic reviews and meta-analyses covering thousands of athletes have consistently found that including Nordic hamstring curls in training programs reduces hamstring injury incidence by more than 50%. That is a substantial effect for a single exercise, and it holds across football codes, athletics, and team sports.

The mechanism is well understood. The Nordic curl loads the hamstring eccentrically at long muscle lengths, which is the position of greatest vulnerability during high-speed running. Regular training in this position increases both the eccentric strength of the hamstring and the length of the muscle fascicles, making the tissue more resilient to the demands of sprinting.

How to Implement Nordic Curls Without Getting Injured Doing Them

The Nordic curl is an advanced exercise that needs to be progressed carefully, particularly for runners who have not trained eccentrically before. Beginning with a supported or banded regression is appropriate. Common errors include excessive lumbar extension during the lowering phase, which shifts load off the hamstring, and lowering too quickly without muscular control. The goal is a slow, controlled descent under full muscular tension. Three to four sets of four to six repetitions, two to three times per week during a training block, is a reasonable starting volume for injury prevention.

Prevention Beyond a Single Exercise

Nordic curls are powerful but insufficient alone. A complete prevention program for runners should also include regular hip extension strengthening (Romanian deadlifts, hip thrusts), targeted gluteal work, and periodic running technique assessment to identify overstriding patterns or pelvic instability. Training load management, specifically avoiding rapid week-to-week volume spikes, remains a modifiable risk factor that no amount of strength training fully compensates for.

Return to Running: Criteria, Not Calendars

The most dangerous moment in hamstring rehabilitation is the return to sport. Research consistently shows that a third or more of hamstring injuries recur, with the highest risk in the first two weeks after return. The primary cause is premature return, driven by symptom resolution rather than objective capacity assessment.

Clinically, a runner should meet specific benchmarks before advancing to unrestricted running. These include the ability to perform a single-leg bridge and single-leg Romanian deadlift without pain or compensation, greater than 80% limb symmetry on manual or dynamometer-based hamstring strength testing, pain-free jogging at progressive speeds across multiple sessions, and no posterior thigh symptoms during or after eccentric loading exercises.

High-speed running deserves its own attention. A runner who has progressed to 70% effort pain-free has not demonstrated readiness for maximal-sprint efforts. A staged sprint progression, beginning with submaximal acceleration runs and building to full-effort sprints over one to two weeks, is the minimum standard before declaring rehabilitation complete.

Pro tip: Keep a symptom log during your return-to-run phase. Record any tightness, fatigue, or discomfort during and for 24 hours after each session. A pattern of next-day posterior thigh soreness after higher-intensity runs is an early warning sign that the tissue is not yet ready for that load level, even if the session itself felt manageable.

Comparing Rehabilitation Approaches

Running Injury Treatment in Alexandria: What to Expect at a Specialist Clinic

Not all physiotherapy clinics are built for the demands of athletic rehabilitation. Running injury treatment in Alexandria at a specialist clinic like Alexandria Physio means your assessment goes well beyond the site of pain. A comprehensive hamstring injury consultation will include a full lower limb and lumbopelvic screen, strength testing, assessment of running mechanics if appropriate, and a rehabilitation program built around your specific training goals rather than a generic recovery template.

The clinical team at Alexandria Physio has worked with athletes at the highest levels of professional sport, including providing physiotherapy services to elite rugby league and other professional sporting organisations. This is not background detail. It means the rehabilitation principles applied in the clinic are the same ones used to manage hamstring injuries in athletes whose livelihoods depend on safe, complete recovery. Those same principles, applied to a recreational runner or a corporate athlete trying to complete their first marathon, produce the same quality of outcome.

What the Assessment Covers

On your first visit, the physio will establish the injury grade through clinical testing, assess active knee extension and hip flexion range of motion, palpate the hamstring musculotendinous chain to identify the exact injury site, and evaluate gluteal and hip flexor strength to identify contributing factors. If there is clinical uncertainty about injury grade or if the injury involves the proximal tendon, imaging referral will be recommended.

What a Realistic Rehabilitation Program Looks Like

You will receive a home exercise program that begins within days of the injury, a clear timeline with phase-progression criteria, and regular re-assessment appointments to track objective strength recovery. Massage therapy and manual techniques may be used to manage muscle tension and support tissue recovery, but they are adjuncts to loading, not replacements for it. The goal is to return you to running with a lower injury risk than you had before the hamstring went, not simply to return you to the same baseline that produced the injury in the first place.

Frequently Asked Questions

How long does hamstring rehabilitation take for a runner?

It depends on the grade of the injury. A Grade I strain in a well-conditioned runner with no previous hamstring history may resolve within one to two weeks. A Grade II injury typically requires three to six weeks of structured rehabilitation before return to full running. Grade III injuries, including proximal tendon avulsions, can require three to six months. These timelines assume progressive loading begins promptly and criteria-based progression is followed. Passive rest extends timelines rather than shortening them.

Can I run through a hamstring strain?

A mild Grade I strain may allow reduced-intensity jogging after a short period of relative rest, under guidance. Running through a Grade II or Grade III injury is not advisable. Continuing to run on a partial or complete tear significantly increases the risk of worsening the injury and extends the total rehabilitation period. The two to four weeks you might save by pushing through an early session is not worth the additional two to three months a re-tear can add to your recovery.

Is stretching helpful for hamstring injury recovery?

In the acute phase (first 72 hours), aggressive stretching should be avoided entirely. As the injury moves into the subacute phase, gentle range-of-motion work becomes appropriate. However, passive stretching is one of the least effective tools in hamstring rehabilitation. Loading the hamstring eccentrically through progressive strength exercises does far more to restore tissue capacity and reduce reinjury risk than a stretching routine. Runners who rely on stretching as their primary hamstring management strategy are consistently underserving their own recovery.

What is the difference between a hamstring strain and proximal hamstring tendinopathy?

A hamstring strain is an acute injury involving tearing of muscle fibres or the musculotendinous junction, typically caused by a sudden high-force event like a sprint. Proximal hamstring tendinopathy is a load-related tendon condition affecting the attachment of the hamstrings at the ischial tuberosity. It develops gradually, is aggravated by sitting for prolonged periods, running uphill, and speed work, and requires a very different rehabilitation approach. Tendinopathy management prioritises progressive tendon loading rather than rest, and stretching the proximal tendon in the early stages can actually aggravate the condition.

Should I get an MRI for my hamstring injury?

MRI is not required for most hamstring strains. An experienced physiotherapist can clinically grade the vast majority of hamstring injuries accurately through examination. MRI becomes useful when the injury site is unclear, when proximal tendon avulsion is suspected, or when the runner is not progressing as expected despite appropriate rehabilitation. Research has found that MRI findings such as the extent of myofascial damage and tendon involvement provide useful information about reinjury risk and expected return-to-sport timelines in higher-grade injuries.

How do I know if my hamstring is ready to return to full sprint training?

You are ready to return to maximal sprint work when you can perform full eccentric loading exercises (including Nordic curls and single-leg Romanian deadlifts) without posterior thigh symptoms, when you demonstrate greater than 90% limb symmetry on hamstring strength testing, and when you have completed a graded sprint progression at 70%, 80%, and 90% effort without any next-day symptoms. Pain-free jogging is not sufficient. Sprint demands are categorically different from easy running, and the hamstring must be specifically prepared for them.

What role does gluteal strength play in hamstring injury prevention?

A significant role. The gluteus maximus is the primary hip extensor during running. When gluteal function is reduced, the hamstrings compensate by working harder than their capacity allows. Runners with weak or inhibited glutes are at higher risk of hamstring overload, particularly during higher-speed or longer-duration efforts. Incorporating targeted hip extension and gluteal strengthening into your training is one of the most effective structural changes you can make to reduce long-term hamstring injury risk.

Have you dealt with a recurring hamstring injury as a runner? Share your experience or any questions in the comments below, we would love to hear what has or has not worked for you.

References

Active Recovery Physiotherapy vs. Rest: Stop Passive Recovery

Sun, 20 Sep 2026 00:00:00 GMT

Active Recovery vs. Rest: Stop Passive Recovery

You train hard, something hurts, and someone tells you to rest. You comply. Two weeks later you return to sport, feel stiff, undercooked, and somehow more injury-prone than before. This is not a coincidence. The instinct to stop moving when the body is under stress is deeply human, but the science of active recovery physiotherapy is unambiguous: prolonged passive rest slows tissue repair, deconditions the neuromuscular system, and puts athletes at a measurably higher risk of reinjury when they return. If you are an athlete or an active professional in Sydney who wants to perform at the highest level, the choice between passive rest and guided active recovery is not a minor tactical question. It defines the ceiling of your performance.

Quick Takeaways

Why Passive Recovery Fails Athletes

The traditional model is seductive in its simplicity: train hard, then do nothing and let the body fix itself. The problem is that this model was built on a misunderstanding of how the cardiovascular and neuromuscular systems actually adapt and repair. Passive rest removes pain signals in the short term, but it does not address the cascade of physiological events that follow tissue stress or injury.

When an athlete stops moving entirely, several things happen simultaneously. Muscle strength in the structures surrounding the injury begins to decline within days. Joint position sense, the proprioceptive feedback that tells the brain where a limb is in space, degrades quickly without the mechanical stimulation that movement provides. Circulation in already poorly-vascularised tissues like ligaments and cartilage slows, reducing the delivery of oxygen and nutrients that drive tissue repair.

Scar tissue formation is perhaps the most underappreciated problem with passive recovery. When the body heals without mechanical guidance, the collagen fibres deposited at an injury site are laid down in a disorganised pattern. This produces scar tissue that is structurally weaker, less flexible, and less functional than the original tissue. The practical result is that an athlete who rests passively through a hamstring strain or a shoulder impingement often returns to training with reduced range of motion, altered mechanics, and a tissue structure that is primed for a repeat injury.

There is also a psychological cost to passive rest that is rarely discussed. Prolonged inactivity in competitive athletes correlates with increased anxiety, reduced confidence, and a heightened fear of movement. These psychological states directly affect how an athlete returns to sport, often producing the hesitation and guarded movement patterns that paradoxically increase the chance of a second injury.

What Active Recovery Physiotherapy Actually Means

Active recovery is not simply "doing some light stretching." In a clinical physiotherapy context, it refers to a structured, criterion-based program of controlled movement prescribed and progressed by a physiotherapist according to the athlete's current tissue capacity, injury stage, sport demands, and training load.

The Spectrum of Active Recovery Interventions

At the lighter end of the spectrum, active recovery might mean a 30-minute session on a stationary bike at low resistance, maintaining heart rate in a zone that drives blood flow without creating additional tissue stress. For a runner recovering from a calf injury, this might mean pool walking while the calf is off-loaded, preserving cardiovascular fitness and limb circulation while the tissue heals.

Further along the spectrum, active recovery includes targeted strengthening of the muscles that support the injured structure, proprioceptive re-training drills, movement pattern correction, and gradual loading of the injured tissue itself using principles of progressive overload. This is where the clinical skill of a physiotherapist becomes essential: knowing exactly how much load a healing tendon can tolerate on day 10 versus day 21, and how to progress that load without tipping into re-injury territory.

Mobilising Adjacent Areas During Unavoidable Rest

For injuries requiring genuine immobilisation, such as certain post-surgical protocols, active recovery physio still has a role . Working the joints and muscles proximal and distal to the injury site preserves overall conditioning, prevents compensatory movement patterns from taking hold, and keeps the nervous system engaged in the rehabilitation process. This is standard practice in evidence-based physiotherapy and one of the reasons athletes under expert care consistently outperform those who manage recovery on their own.

Pro tip: If you are told to "rest" after an injury, always ask what specifically should stay still and what can keep moving. In most soft-tissue injuries, the answer is that the injury site needs protection, not the entire limb or the entire body.

The Biology Behind Active Recovery

Understanding why active recovery works requires a basic grasp of three biological processes: lactate clearance, tissue perfusion, and mechanotransduction.

Lactate Clearance and Performance Restoration

After high-intensity training or competition, metabolic byproducts accumulate in the muscles. Low-intensity movement is one of the most effective ways to clear these byproducts because it increases blood flow without generating additional metabolic waste. Research published in peer-reviewed sports science literature confirms that active recovery through low-intensity exercise is more effective than total rest for performance restoration, with the mechanism being the maintenance of elevated circulation that delivers nutrients to repair damaged tissue while removing what no longer belongs there.

Tissue Perfusion in Low-Vascular Structures

Tendons, ligaments, and cartilage are notoriously poor at receiving blood supply compared to muscle. This is why injuries to these structures take longer to heal and why the quality of that healing matters so much. Controlled movement drives synovial fluid circulation in joints and creates the intermittent compression and decompression that pushes nutrients into cartilage. Without this mechanical stimulus, these structures receive a fraction of the inputs they need to repair effectively.

Mechanotransduction: Load as a Signal for Tissue Repair

Mechanotransduction is the process by which cells detect and respond to mechanical forces. When a tendon is loaded appropriately during recovery, the tenocytes within it receive a signal to produce collagen and organise that collagen along functional lines of stress. When a tendon is left completely unloaded during passive rest, this signal is absent and the resulting repair is architecturally inferior. This is not a fringe theory. It is the foundation of evidence-based tendon rehabilitation programs used by physiotherapists working with elite athletes at every level of sport.

Pro tip: Zone 2 cardiovascular training, where you maintain a heart rate in the 60-70% of maximum range, is one of the most reliable active recovery tools for athletes. The key marker is that you should feel better at the end of the session than when you started. If fatigue accumulates, intensity is too high.

Active vs. Passive Recovery: A Direct Comparison

The differences between these approaches are not subtle. Across every measurable outcome that matters to an athlete, structured active recovery outperforms passive rest when prescribed correctly by a qualified physiotherapist. The table below summarises the core distinctions.

How Sports Performance Physio in Sydney Applies These Principles

The gap between knowing that active recovery is superior and actually executing it correctly is where most athletes fall down. Effective active recovery is highly specific. The program for a rugby forward with a grade 2 ankle sprain is fundamentally different from the program for a swimmer with rotator cuff tendinopathy, even if both athletes are at the same stage of healing.

Individual Load Management

At Alexandria Physio , load management is built into every rehabilitation program from the first assessment. The physiotherapist identifies not just what tissue is injured but how much load it can currently tolerate, what direction of load is beneficial versus harmful, and how that tolerance is expected to change over time. This is then matched to the athlete's competition calendar, training demands, and individual recovery capacity.

Sport-Specific Movement Re-Education

One of the most frequently missed steps in passive recovery is that athletes return to sport having rested through their injury, but they never corrected the underlying movement fault that created vulnerability in the first place. Evidence-based physiotherapy in Alexandria specifically targets these root causes: whether that is hip control affecting knee load in a runner, thoracic stiffness driving shoulder overuse in a swimmer, or poor landing mechanics contributing to ankle reinjury in a court sport athlete.

Progressive Return-to-Sport Criteria

A structured return-to-sport program uses objective criteria, not a symptom-free time period, to determine when an athlete is ready to resume full training. Criteria might include achieving a specific percentage of limb symmetry on a strength test, completing a sport-specific agility task without pain or compensation, or reaching a defined cardiovascular fitness benchmark. This criterion-based approach is one of the clearest differentiators between sports performance physio in Sydney delivered at a high standard and generic rehabilitation that sends athletes back "when the pain is gone."

The clinical team at Alexandria Physio, led by practitioners with deep roots in elite sport including professional rugby league and state representative programs, applies exactly this standard of care to every athlete on the treatment table, regardless of whether they play professionally or compete on weekends.

When Rest Is Genuinely Appropriate

Advocating for active recovery does not mean dismissing rest entirely. There are specific clinical situations where rest or relative rest is the correct short-term intervention, and conflating "active recovery is better than passive rest" with "you should never rest" is a misreading of the evidence.

In the first 24 to 72 hours of an acute moderate-to-severe injury, relative rest, meaning protection of the injured structure combined with movement of everything else, is appropriate. Acute fractures, post-surgical presentations, and certain tendon ruptures require periods of protected immobilisation before loading begins. The skill is in knowing when that protection phase ends and when loading must begin to drive optimal healing.

Systemic fatigue, where the entire nervous system is overloaded from cumulative training stress, is another context where passive rest has a role. But this is distinct from soft-tissue injury management and is typically a short-term reset, measured in days rather than weeks, within a broader periodised recovery plan.

The core principle holds: rest is a tool, not a default. Using it by default, because no one has taken the time to prescribe a proper active recovery program, is where athletes consistently lose weeks of productive rehabilitation time and compound their injury risk on return to sport.

Frequently Asked Questions

How soon after an injury should I start active recovery?

For most soft-tissue injuries, some form of active recovery can begin within 24 to 72 hours of the initial injury, once acute bleeding and significant swelling have been controlled. The exact timing depends on the injury type, severity, and affected structure. A physiotherapist can assess your specific presentation and prescribe the appropriate type and volume of movement for your injury stage. Starting earlier, under proper guidance, consistently produces better outcomes than waiting until pain resolves.

Is active recovery physiotherapy different from just doing light exercise?

Yes, significantly. Light exercise on its own addresses general blood flow but does not target the specific deficits that follow an injury: the strength asymmetries, proprioceptive loss, movement pattern faults, and tissue loading requirements unique to your injury. Active recovery physiotherapy is a clinically prescribed program that addresses all of these simultaneously, progressed according to your individual tissue response and functional objectives. The difference in outcomes between generic light exercise and structured active recovery physio is substantial.

Can I do active recovery if my injury is still painful?

Pain during active recovery does not automatically mean you are causing harm, but it requires careful interpretation. The goal is to find movement that is within your current tissue tolerance, which may mean working at intensities or in movement directions that are pain-free or at the low end of discomfort. A physiotherapist will help you distinguish between the expected discomfort of loaded healing tissue and pain signals that indicate genuine overload. Self-managing this distinction without clinical guidance is one of the most common sources of setbacks in injury recovery.

Does massage therapy count as active recovery?

Massage therapy is a valuable adjunct to rehabilitation and has good evidence for reducing muscle soreness and improving tissue perfusion, but it is technically a passive intervention. It works best as a complement to active recovery physiotherapy, not a replacement for it. At Alexandria Physio, massage therapy is integrated into rehabilitation programs where it serves a specific clinical purpose: reducing tension that restricts movement, supporting nervous system recovery, or addressing myofascial restrictions that are limiting functional movement patterns.

How does active recovery differ between elite athletes and recreational athletes?

The physiological principles are the same. The prescription differs in volume, intensity, and complexity. An elite athlete may have a more demanding return-to-sport criteria, a tighter competition timeline, and a higher baseline of fitness that changes how quickly progressive loading can occur. A recreational athlete may need more attention to basic movement quality and load tolerance before sport-specific conditioning can begin. What matters in both cases is that the program is individualised and evidence-based, not generic. An athlete at any level benefits from professional assessment and a structured active recovery program over passive rest.

What makes evidence-based physiotherapy in Alexandria different from managing recovery at home?

Home-managed recovery lacks the clinical assessment needed to identify exactly what is injured, how severely, what structures are compensating, and what the appropriate loading progression looks like. Athletes managing recovery independently tend to either under-load, staying too cautious too long and losing fitness and tissue quality, or over-load, returning too quickly and reinjuring themselves. Evidence-based physiotherapy provides the clinical reasoning, hands-on treatment, and structured progression that bridges the gap between injury and full performance. It also identifies and corrects the movement faults that created the injury in the first place, which is the step that home recovery almost always skips.

Have you experienced the difference between passive rest and structured active recovery? Share what worked and what did not in your recovery journey, because every story adds to the collective understanding of what high-performance rehabilitation actually looks like in practice.

References

Guide to active recovery for athletes during physical therapy: how structured low-intensity movement outperforms passive rest
Frontiers in Physiology: exercise-mediated lactate clearance, blood flow, and recovery mechanisms in athletes
Randomised controlled trial comparing active and passive recovery strategies on pain, mobility, and rehabilitation duration in athletes with lower limb injuries
ScienceDirect: active recovery, lactic acid clearance, and the role of movement in restoring physical performance between training sessions

Rotator Cuff Injury Physio Sydney: Causes & Treatment

Sat, 19 Sep 2026 00:00:00 GMT

Rotator Cuff Injury

Shoulder pain that wakes you at 3am, a throwing arm that loses power mid-season, or a swimmer who can no longer finish a set without grinding discomfort, these are the realities of a rotator cuff injury left unmanaged. Research confirms that initial diagnosis and treatment of rotator cuff disorders frequently do not follow evidence-based recommendations, which means athletes and active individuals often spend months cycling through unhelpful advice before getting the right care. If you are searching for rotator cuff injury physio Sydney , the stakes are high: the choices made in the first weeks after injury have a direct bearing on whether you return to full function or develop a chronic shoulder problem. This article lays out exactly what the evidence says about causes, diagnosis, and treatment, written from clinical practice, not from a textbook summary.

What Is the Rotator Cuff and Why Do Athletes Injure It?

The rotator cuff is a group of four muscles and their tendons that surround the glenohumeral joint: the supraspinatus, infraspinatus, teres minor, and subscapularis. Together they compress the humeral head into the glenoid socket, control fine rotation, and generate the explosive forces required in throwing, swimming, serving, and lifting. The supraspinatus is the most commonly injured tendon, but full-thickness tears can involve any of the four.

The shoulder is the most mobile joint in the body, and that mobility comes at the cost of inherent instability. Athletes who repeatedly demand high loads from this joint, particularly in positions of elevation and rotation, are placing enormous stress on tendons that have a relatively poor blood supply in their distal zones. That combination of mechanical load, reduced vascularity, and repetitive motion is the biological recipe for tendon breakdown.

Quick Takeaways

Understanding these principles before you walk into any clinic will help you ask better questions and make better decisions about your shoulder care. The details behind each of these insights matter enormously for athletes who need their shoulders to perform, not just function at a basic level.

Common Causes of Rotator Cuff Injuries in Athletes

Rotator cuff injuries in athletes do not come from a single mechanism. Clinical literature identifies five distinct failure modes: primary compressive disease, secondary compressive disease, primary tensile overload, secondary tensile overload, and macrotraumatic injury. In practice, most athletes present with overlap between these mechanisms, which is why a one-size-fits-all treatment protocol consistently underperforms.

Repetitive Overhead Loading

Swimming, water polo, tennis, cricket, and volleyball require thousands of overhead arm cycles per training week. Research tracking shoulder injury prevalence across these sports has found that subacromial impingement syndrome is particularly concentrated among swimmers (around 44%) and water polo players (around 43%), with rotator cuff partial tears most frequent in water polo and swimming populations. The posterior cuff, specifically the infraspinatus and posterior supraspinatus, absorbs enormous eccentric deceleration forces during the follow-through phase of any throwing motion.

Internal (posterosuperior) impingement is a distinct mechanism frequently seen in overhead throwing athletes in extreme abduction and external rotation. In this position, the posterior supraspinatus and infraspinatus are pinched between the greater tuberosity and the posterior glenoid rim, producing partial articular-side tears that are notoriously difficult to identify without high-quality imaging and a skilled clinical assessment.

Contact Sport Trauma

In contact and collision sports, rotator cuff injuries typically present as acute macrotraumatic events rather than the gradual attrition seen in overhead athletes. A direct blow to the shoulder, a fall onto an outstretched arm, or a tackle that forces the shoulder into extreme range can produce contusions, partial tears, or full-thickness tears depending on the force involved. These athletes require rapid triage to determine whether conservative management or early surgical intervention is appropriate.

Training Load Errors

A common mistake in clinical practice is underestimating the role of training load spikes in producing rotator cuff injuries. Athletes who dramatically increase training volume, intensity, or technique demands without adequate recovery periods expose their tendons to cumulative stress that exceeds the tissue's adaptive capacity. The tendon does not fail catastrophically overnight; it degrades progressively until a threshold is crossed.

Pro tip: Keep a simple training load diary tracking weekly shoulder-dominant volume. A spike of more than 10% in a single week is a well-recognised risk factor for tendon overload injuries across multiple body regions, and the rotator cuff is no exception.

Accurate Diagnosis: What Actually Works

The most consistent finding in the clinical literature is that diagnosis of rotator cuff disorders is frequently done poorly. Over-reliance on imaging, particularly early MRI, drives unnecessary cost, delays active treatment, and often creates nocebo effects where athletes become fearful of findings that may have been present for years without causing symptoms.

Clinical Examination First

A thorough physical examination remains the foundation of rotator cuff diagnosis. Specific orthopaedic tests assess the individual tendons: Hawkins-Kennedy and Neer signs for impingement; the Empty Can and Full Can tests for supraspinatus integrity; the Lift-Off test and belly press for subscapularis; the external rotation lag sign for infraspinatus and teres minor. No single test is definitive in isolation, but a cluster of positive findings combined with a detailed history creates a reliable clinical picture.

Symptoms that demand prompt assessment include pain worsening at night, weakness in resisted external rotation or abduction, and the inability to lie on the affected shoulder. Sudden, sharp pain following a specific incident, combined with immediate weakness, raises the clinical suspicion of an acute full-thickness tear and warrants urgent review.

When Imaging Is Warranted

Imaging becomes appropriate when the clinical examination is inconclusive, when symptoms fail to respond to six weeks of well-structured physiotherapy, or when surgical planning is required. MRI remains the preferred modality for rotator cuff assessment, providing detailed information on tear size, depth, tendon retraction, and the condition of the muscle belly. Ultrasound is a useful adjunct: it allows dynamic real-time assessment and direct comparison of the symptomatic and asymptomatic shoulder, and it can be performed cost-effectively in a well-resourced physiotherapy clinic.

One underappreciated diagnostic consideration is glenohumeral internal rotation deficit (GIRD), particularly in throwing athletes. A measurable side-to-side difference in internal rotation range, combined with posterior shoulder tightness, is a recognised risk factor for rotator cuff pathology and should be systematically screened in overhead sport populations.

Evidence-Based Treatment Options

The 2025 Clinical Practice Guideline for rotator cuff tendinopathy, supported by leading physical therapy associations, positions exercise therapy as the cornerstone of recovery. It explicitly discourages early imaging and passive modalities as primary interventions, and supports objective strength and range of motion measurement to guide clinical decision-making. This aligns with what practitioners at high-performance clinics have observed for years: athletes who get moving under proper guidance recover faster than those who rest and wait.

Progressive Exercise Therapy

Progressive, load-based exercise is the most evidence-supported intervention for rotator cuff tendinopathy and partial tears. This is not generic gym work. A well-structured program moves through distinct phases: isometric loading in the acute pain phase to maintain neuromuscular control without provoking symptoms; isotonic strengthening as pain settles; and sport-specific, high-load eccentric and plyometric work in the later stages of rehabilitation.

Scapular stabiliser training is not optional. The serratus anterior, lower and middle trapezius, and rhomboids directly influence how the scapula rotates and tilts during arm elevation, which controls the subacromial space available for the rotator cuff tendons. Weakness in any of these muscles shifts compressive load onto the cuff. Every rotator cuff rehabilitation program at a serious clinic incorporates scapular control from day one.

Manual Therapy as an Adjunct

Joint mobilisation, soft tissue techniques, and targeted massage therapy can meaningfully reduce pain and restore range of motion in the early stages of rehabilitation, creating a window where therapeutic exercise becomes more tolerable. The key word is adjunct. Manual therapy used in isolation, without progressive loading, does not produce lasting tendon adaptation. It is a facilitator, not a cure. Our massage therapy services are always integrated within a broader rehabilitation framework, not delivered as standalone treatment.

Corticosteroid Injections

Corticosteroid injections can provide meaningful short-term pain relief for athletes whose symptoms are severe enough to prevent participation in exercise therapy. The evidence supports their use as a temporising measure, not as a primary treatment. Repeated injections carry risks to tendon integrity, and any athlete receiving an injection should move directly into structured rehabilitation to capitalise on the pain-free window the injection creates.

Surgical Decision-Making

Surgery for degenerative rotator cuff tears warrants careful consideration. Meta-analyses comparing surgical repair to conservative physiotherapy management have found that while surgery may produce marginally better short-term scores on pain and functional measures, the difference frequently does not meet the threshold for minimal clinically important difference. For acute, full-thickness traumatic tears in competitive contact athletes, prompt surgical referral is more clearly indicated, and return-to-sport rates following repair in this population are considerably higher than in recreational overhead athletes with the same injury. Our team works closely with orthopaedic specialists in Sydney to ensure athletes receive the right recommendation for their specific tear type, sport demands, and career stage.

Pro tip: Before agreeing to surgery for a degenerative rotator cuff tear, ask your clinician specifically whether you have completed a minimum of twelve weeks of supervised, progressive physiotherapy. Most guidelines recommend this as a prerequisite, and the evidence suggests a meaningful proportion of athletes will achieve satisfactory outcomes without an operation.

Treatment Approach Comparison

Return to Sport: What the Evidence Says

One of the most poorly managed aspects of rotator cuff rehabilitation is the return-to-sport phase. Athletes are either cleared too early based on pain resolution alone, or kept out too long based on over-cautious timelines that do not account for functional recovery. Neither approach serves the athlete.

The current evidence-based position is that return-to-sport decisions should be driven by objective criteria: demonstrable strength symmetry between sides (commonly assessed as a percentage of the unaffected limb), restored pain-free range of motion through the full arc required by the sport, and successful completion of sport-specific loading tasks without symptom provocation. Pain resolution is necessary but not sufficient on its own.

For overhead athletes, additional criteria specific to their sport mechanics matter. A cricket fast bowler, for example, needs to demonstrate symptom-free performance through a graduated return-to-bowling program, not just pain-free resisted external rotation in a clinical setting. The gap between clinical assessment conditions and the actual demands of sport is where re-injuries happen.

The 2025 Clinical Practice Guideline specifically highlights the importance of gradual, load-based return-to-sport programming for both elite and recreational athletes with rotator cuff disorders. This aligns with the approach taken at our Alexandria clinic, where athletes progress through sport-specific milestones under direct physiotherapist supervision before receiving full clearance to compete.

Shoulder Injury Treatment in Alexandria, Sydney

Athletes seeking shoulder injury treatment and shoulder physiotherapy in Alexandria have access to one of Sydney's most experienced clinical teams. Alexandria Physio is led by Eddie Farah, Head Physiotherapist for the NSW Blues, with a clinical team that has accumulated over 20 years of experience working with professional sporting organisations. This is not a general practice that sees shoulder injuries occasionally. It is a specialist environment where rotator cuff pathology is assessed and managed daily, across a spectrum from weekend warriors to state-level professional athletes.

Our state-of-the-art facility combines evidence-based clinical assessment with targeted rehabilitation programming. We do not rely on passive modalities as a substitute for active rehabilitation. Every athlete who walks through our doors receives a thorough clinical examination before any treatment decision is made, because accurate diagnosis is where effective treatment begins.

If you are an overhead athlete dealing with recurring shoulder pain, a contact sport player who sustained a shoulder injury during a match, or a professional whose shoulder is affecting work performance, the right place to start is a thorough assessment with a physiotherapist who understands the demands of your specific activity. Early intervention consistently produces better outcomes than waiting until the injury becomes chronic.

We also support athletes through the full return-to-sport continuum, including sports physiotherapy programs tailored to individual sport demands and performance goals, not just pain management. Whether you are preparing for a season, recovering from a competition injury, or managing a long-standing shoulder condition that has never been properly addressed, the approach here is built around what the evidence actually supports.

Frequently Asked Questions

How do I know if I have a rotator cuff tear or just tendinopathy?

The distinction requires a clinical assessment and, in many cases, imaging. Tendinopathy typically presents as a dull, aching pain that worsens with activity and settles with rest, without significant weakness. A tear, particularly a full-thickness one, is more likely to involve measurable weakness in resisted movements such as external rotation or shoulder abduction. Acute tears following trauma often cause immediate, sharp pain and noticeable loss of strength. A physiotherapist can usually differentiate the two with a structured physical examination before deciding whether imaging is necessary.

Can a rotator cuff injury heal without surgery?

Many rotator cuff injuries, including partial tears and tendinopathy, respond well to structured conservative management without surgery. Even some full-thickness degenerative tears can achieve functional recovery through progressive exercise rehabilitation. The evidence comparing surgery to physiotherapy for degenerative tears does not consistently show that surgery produces outcomes that are meaningfully superior when quality rehabilitation is provided. Traumatic full-thickness tears in competitive athletes, particularly contact sport athletes, are more likely to require surgical consideration, but this should always be assessed on an individual basis by an experienced clinician.

How long does rotator cuff rehabilitation take?

Timelines vary considerably depending on injury severity, the athlete's baseline strength and conditioning, the sport they are returning to, and how consistently they complete their rehabilitation program. Tendinopathy typically responds within eight to twelve weeks of progressive loading. Partial tears may require twelve to twenty weeks. Full-thickness tear repairs, where surgery is undertaken, often involve six months or more before return to full competitive sport, particularly for overhead athletes. These are general guides, not fixed timelines, because individual response to loading drives the actual pace of recovery.

Is it safe to keep training with a rotator cuff injury?

It depends entirely on the injury type, severity, and what training involves. Continuing to train through a rotator cuff injury without proper assessment and guidance is a common mistake that converts manageable conditions into chronic ones. Many athletes can maintain significant training volume with modifications that offload the symptomatic structures while the cuff recovers. Others need a period of relative rest before loading is reintroduced. The critical point is that training decisions should be guided by a physiotherapist who understands both the injury and the sport, not by pain tolerance alone.

What exercises should I avoid with a rotator cuff injury?

In the acute phase, exercises that load the shoulder in the provocative range should be avoided or significantly modified. This typically includes heavy overhead pressing, behind-the-neck movements, wide-grip pull-downs, and any exercise that reproduces the characteristic pain pattern. The specific restrictions depend on which tendon is involved and in what arc the pain occurs. A common mistake is applying the same restrictions to all shoulder injuries regardless of which structure is affected. Subscapularis injuries behave very differently from supraspinatus injuries, and the exercise modifications should reflect that difference.

What makes shoulder physiotherapy at a sports clinic different from a general practice?

A sports-focused physiotherapy clinic brings together clinical expertise in shoulder anatomy and biomechanics, experience with sport-specific demands, and access to technology and rehabilitation tools that a general practice may not have. More importantly, the clinical reasoning behind diagnosis and treatment is shaped by working with athletes regularly, which produces a different level of nuance in how load, timing, and return-to-sport criteria are managed. For competitive athletes, this difference in clinical experience has a direct effect on recovery speed and the likelihood of returning to pre-injury performance levels rather than simply becoming pain-free.

Have you been managing a shoulder injury for longer than it should take to resolve? Share your experience or questions in the comments, because your situation may help other athletes in the same position.

References

Remedial Massage Alexandria Sydney: Sports Recovery Guide

Fri, 18 Sep 2026 00:00:00 GMT

Remedial Massage

Most athletes who come to us at Alexandria Physiotherapy are not asking whether remedial massage works. They are asking why they still feel wrecked four days after a hard training block, or why the same muscle keeps pulling up tight no matter how much stretching they do. The answer, almost always, involves how they are managing recovery, not just how hard they are training. Remedial massage in Alexandria, Sydney is one of the most consistently underused tools in an athlete's recovery plan, and when it is applied correctly by a trained therapist who understands the body under load, it changes what is possible in the weeks that follow. This is not about relaxation. It is about tissue management, neurological recovery, and getting back on the field faster.

Quick Takeaways

What Remedial Massage Actually Is (and Is Not)

Remedial massage is a clinically applied, assessment-driven manual therapy . The therapist begins with a postural and functional assessment, identifies the tissues that are overloaded, restricted, or dysfunctional, and then applies specific techniques to address those findings. It is not a head-to-toe Swedish massage with a health fund rebate attached to it.

For athletes, this distinction is not semantic. A runner presenting with recurring calf tightness needs a therapist who can assess whether the issue originates in the calf itself, the plantar fascia, the Achilles insertion, or a hip extension deficit loading the posterior chain differently. Applying deep tissue work to the calf alone without that context produces temporary relief and repeating problems.

What remedial massage is genuinely good at is addressing the accumulated soft tissue dysfunction that builds up over a training block. Every hard session creates micro-damage, fluid shifts, fascial tension, and neuromuscular guarding. A single session will not fix a torn ligament. But consistent, well-timed remedial massage keeps the baseline tissue quality high enough that the body can handle progressive training loads without breaking down.

Pro tip: Always tell your remedial massage therapist exactly what you trained in the last 48 to 72 hours. The session should be adjusted based on your actual tissue state, not a fixed protocol. A therapist who does not ask about recent training is working blind.

The Physiological Mechanisms Behind Sports Recovery

Understanding why remedial massage works requires a brief detour into what actually happens to muscle tissue after high-intensity exercise. The mechanical stress of training creates micro-tears in muscle fibres, triggers a local inflammatory cascade, and increases interstitial fluid. The body's response is appropriate, but it is not always efficient.

Circulatory and Lymphatic Effects

One of the most consistently cited mechanisms is the effect on local circulation and lymphatic drainage. Techniques like effleurage and petrissage are thought to enhance blood flow to working tissues and assist the clearance of metabolic by-products including lactate and creatine kinase from the blood. Improving local circulation means oxygen and nutrients arrive to repairing tissues more readily, and waste products clear more quickly.

Neurological and Fascial Effects

Beyond circulation, remedial massage has a significant neurological component. Sustained pressure on hypertonic (overactive) muscle tissue triggers the Golgi tendon organ response, reducing motor neuron firing rates and lowering resting muscle tone. This is why athletes often notice not just reduced tightness but improved movement quality after a session. The fascial system , which wraps every muscle and connects structures across the body, responds to manual tension with a viscoelastic change that improves extensibility.

Inflammatory Modulation

Research published in peer-reviewed journals has examined how massage affects systemic inflammatory markers after high-intensity intermittent exercise. The picture is complex. Direct suppression of inflammation is not the primary mechanism. Rather, massage appears to influence the body's inflammatory signalling environment in a way that supports tissue repair without the excessive stiffness and pain that slows athletes down. The goal is always modulation, not suppression.

Remedial Massage and DOMS: What the Evidence Says

Delayed onset muscle soreness peaks between 24 and 72 hours after unaccustomed or high-intensity exercise. For athletes training multiple times per week, DOMS is not an occasional inconvenience. It is a recurring factor that, if poorly managed, leads to altered movement patterns, reduced training quality, and increased injury risk.

The research on massage and DOMS is one of the more settled areas in sports recovery science. A systematic review and meta-analysis published in Frontiers in Physiology examined the effects of massage on alleviating DOMS and muscle performance after strenuous exercise. The evidence supports massage as an effective intervention for reducing DOMS severity. A separate meta-analysis available on PubMed confirmed that sports massage can improve both flexibility and DOMS, even where direct improvements in peak athletic performance are harder to quantify.

The practical implication is straightforward. If a rugby player trains hard on Tuesday and has a game on Saturday, the difference between a DOMS-managed Tuesday-to-Saturday recovery and an unmanaged one can be the difference between playing at 90% and playing at 70%. Sports recovery massage is not a luxury at that point. It is a performance variable.

Pro tip: The optimal window for post-exercise remedial massage is typically within two to six hours of completing a session, or within the first 24 hours. Waiting until you are already severely sore on day two or three is less effective. Build the massage into your recovery schedule proactively, not reactively.

Techniques Used in a Sports Recovery Session

A well-constructed remedial massage session for an athlete draws from several distinct technique categories, each with a different tissue target and therapeutic goal.

Effleurage and Petrissage

These are the foundational strokes. Effleurage uses long, flowing pressure strokes to stimulate circulation, warm tissue, and prepare the area for deeper work. Petrissage involves kneading and compression that targets deeper muscle layers, helps mobilise interstitial fluid, and begins addressing areas of localised tension.

Deep Tissue and Trigger Point Therapy

Deep tissue work applies slow, sustained pressure into the deeper layers of muscle and connective tissue. It is not simply "hard massage." The pressure is controlled, directional, and specific. Trigger point therapy targets discrete hyperirritable spots within a muscle that refer pain to other areas. Athletes who report persistent tightness in a muscle that is not responding to stretching often have active trigger points driving that sensation.

Myofascial Release

Myofascial release involves sustained, gentle traction on the fascial envelope surrounding muscles. It is slower and less forceful than deep tissue work, but its effects on tissue extensibility and movement quality are significant. This technique is particularly valuable for athletes with recurring injury patterns in the same region, where fascial restriction is contributing to mechanical load.

PNF Stretching

Proprioceptive Neuromuscular Facilitation stretching, when incorporated into a remedial massage session, uses contract-relax cycles to achieve greater range of motion gains than passive stretching alone. For athletes with chronic hip flexor, hamstring, or shoulder tightness, this approach produces durable improvements when applied consistently.

Comparing Recovery Approaches: Which One Does What

The key point this table illustrates is that these approaches are not competing. They target different mechanisms. An athlete managing a hamstring strain, for example, needs physiotherapy to correct the load pattern and rehabilitate the tissue. They also need remedial massage to manage the surrounding tissue tightness that develops as the body protects the injured area. Using only one approach leaves a gap.

When to Book a Remedial Massage: Timing Within Your Training Cycle

One of the most common mistakes athletes make with massage therapy for athletes is treating it as something they do when something hurts, rather than as a scheduled component of their training programme. By the time pain is the prompt, tissue quality has already degraded significantly.

During a Heavy Training Block

When training volume and intensity are high, weekly or fortnightly remedial massage sessions help maintain tissue quality, manage accumulated fatigue, and catch problems before they become injuries. A therapist working regularly with an athlete develops a baseline understanding of their tissue state, which means deviations from normal are identified early.

In the Week Before Competition

Pre-event massage serves a different purpose than post-training massage. The session should be lighter, focused on activating circulation and reducing resting tension rather than deep tissue work that leaves muscles sore. Avoid heavy remedial work within 48 hours of a key performance event. A lighter, shorter session two to three days out is appropriate for most athletes.

During Injury Recovery

Remedial massage plays a specific role in injury rehabilitation beyond the injury site itself. When a shoulder is injured, the surrounding rotator cuff muscles, the thoracic paraspinals, and often the neck and upper trap develop compensatory tension. Addressing that compensatory tissue load with massage, alongside the targeted physiotherapy for the primary injury, speeds up the overall recovery arc.

In the Off-Season

The off-season is the optimal time to address chronic restrictions that accumulate during a season. Old scar tissue, fascial thickening from repeated strains, and habitual movement asymmetries are all best treated when the athlete is not under performance pressure. Monthly sessions during the off-season produce a measurably better tissue baseline heading into pre-season.

How Remedial Massage Fits Into a Physiotherapy-Led Plan

At Alexandria Physiotherapy, remedial massage is not offered as a standalone product detached from clinical reasoning. It sits within a broader assessment and management framework led by experienced physiotherapists. This matters more than most athletes realise.

When Eddie Farah and the team assess an athlete, the decision about whether remedial massage is appropriate, which techniques to use, and how it integrates with any existing rehabilitation programme is a clinical decision, not an administrative one. A massage applied to an area of active inflammation in the wrong phase of healing can delay recovery. A massage applied to the correct tissue at the right time in the right way accelerates it. The difference is clinical judgment.

The broader evidence base confirms this position. Research consistently shows that massage is most valuable not as a direct performance enhancer but as an indirect performance tool, reducing the barriers to training, managing fatigue, and keeping athletes physically and psychologically ready to absorb the next session. When that effect is coordinated within a physiotherapy-led performance programme , the outcomes are greater than the sum of the parts.

Athletes based in the Inner West and South Sydney corridor have access to exactly this kind of integrated care at our Alexandria clinic. If you are curious about whether your current recovery approach is as effective as it could be, the starting point is always a proper clinical assessment rather than booking a session and hoping for the best.

Frequently Asked Questions

What is the difference between remedial massage and sports massage?

Remedial massage is a broader clinical discipline that involves assessment and targeted treatment of specific soft tissue dysfunctions. Sports massage is a subset that is specifically applied in the context of athletic training and competition. In practice, a well-trained remedial massage therapist working with athletes will use sports massage techniques as part of their toolkit, but the remedial framework gives them a more comprehensive clinical basis for deciding what to treat and how.

How often should an athlete get remedial massage during a competitive season?

The honest answer depends on training load, the athlete's injury history, and what the massage is being used to address. A general guide for athletes in moderate to high training volume is every one to two weeks during the season. Athletes recovering from injury or in a particularly heavy training block may benefit from more frequent sessions. Your physiotherapist is better placed than any general guideline to advise on the right frequency for your specific situation.

Will remedial massage make me sore the next day?

It can, particularly after a first session or after deep tissue work on a very restricted area. This post-massage soreness typically peaks within 24 hours and resolves within 48 hours. It is not damage. It is a normal tissue response to mechanical stimulus and the early stages of the inflammatory repair process. Communicating your pressure preferences to the therapist and staying well hydrated post-session both help manage this response.

Can remedial massage help prevent injuries, or is it only useful for recovery?

Both. Remedial massage as a preventive tool works by maintaining tissue quality, identifying areas of excessive tension or restriction before they progress to injury, and improving the range of motion available for athletic movement. Consistent massage through a training season gives a therapist with clinical knowledge the opportunity to flag tissue changes early, well before they become structural problems. Many of the injuries we see could have been avoided with earlier soft tissue management.

Is it better to see a physiotherapist or a remedial massage therapist for sports recovery?

The most effective answer is both, within a coordinated plan. A physiotherapist brings diagnostic capability, exercise prescription, and a structural understanding of injury and movement dysfunction. A remedial massage therapist brings hands-on soft tissue management skills. The two are complementary. At Alexandria Physiotherapy, our practitioners work within an integrated model precisely because athletes get better outcomes when their manual therapy and their exercise rehabilitation are informed by the same clinical picture.

Does remedial massage actually reduce inflammation, or is that a myth?

The relationship between massage and inflammation is more nuanced than a simple yes or no. Research suggests that massage does not directly suppress the inflammatory response in a way that compromises tissue repair. Rather, it appears to modulate the inflammatory environment, contributing to reduced pain perception, reduced muscle soreness, and faster functional recovery. The goal is not to shut down inflammation. It is to keep it proportionate and efficient.

If you have used remedial massage as part of your sports recovery or rehabilitation, we would genuinely like to hear what worked for you and what did not - share your experience in the comments below.

References

ACL Rehabilitation Sydney: The Complete Recovery Guide

Thu, 17 Sep 2026 00:00:00 GMT

The Complete Recovery Guide

An ACL tear does not end a sporting career. But a poorly managed rehabilitation program very often does. Whether you tore your ACL on the football field, the basketball court, or simply landing awkwardly at the gym, the path back to full function is long, specific, and unforgiving of shortcuts. ACL rehabilitation in Sydney is not a one-size-fits-all process, and the difference between returning to sport in nine months versus being stuck at eighteen months almost always comes down to the quality of your rehabilitation program and the expertise guiding it. This guide covers every phase, every key exercise, and every decision point you need to understand before you begin.

What Actually Happens to Your ACL

The anterior cruciate ligament is one of four primary stabilising ligaments of the knee. It prevents the tibia from sliding forward relative to the femur and controls rotational forces during cutting and pivoting movements. When it ruptures, you typically hear a "pop," experience immediate instability, and develop significant swelling within the first few hours.

A complete ACL rupture does not heal on its own with meaningful structural integrity. Unlike muscle tissue, ligaments have poor blood supply and the repaired tissue does not replicate the mechanical properties of the original. This is why treatment, whether surgical or conservative, requires a structured, expert-led rehabilitation program, not rest alone.

Quick Takeaways

The Five Phases of ACL Rehabilitation

ACL rehabilitation is best understood as five distinct phases, each with specific biological realities, measurable goals, and exercises calibrated to where the graft or injured tissue actually is in its healing process. Rushing any phase does not build resilience. It builds the conditions for re-rupture.

Phase 1: Acute Management (Days 0 to 14)

The immediate priority after ACL reconstruction is swelling control, pain management, and restoring knee extension. In the first 72 hours, patients are typically non-weight bearing, using crutches, with ice, compression, and elevation applied consistently. Neuromuscular electrical stimulation (NMES) is commonly used by experienced physiotherapists to begin reactivating the quadriceps muscle, which shuts down rapidly in response to joint effusion.

The graft is at its weakest point during this entire window. It undergoes a process called ligamentization, where the transplanted tendon begins transforming into a functional ligament. Aggressive loading at this stage risks graft damage before it has established adequate blood supply. The work here is deliberate and low-load: passive range of motion, quad sets, straight-leg raises, and heel slides.

Pro tip: If your knee does not reach full extension by the end of week two, flag it with your physiotherapist immediately. Extension loss that is allowed to persist becomes exponentially harder to correct and is one of the most common causes of chronic post-surgical dysfunction.

Phase 2: Early Strengthening (Weeks 2 to 6)

By weeks two to three, weight bearing progresses to full and crutches are discarded. Physiotherapy intensity increases significantly. The focus shifts to restoring normal gait mechanics, rebuilding quadriceps and hip strength, and achieving roughly 90 to 120 degrees of pain-free knee flexion. Exercises in this phase include calf raises, hip abduction strengthening, step-ups, mini squats, and gait re-education drills. Low-impact cardiovascular activity such as stationary cycling and walking is reintroduced to maintain fitness without loading the graft excessively.

Phase 3: Progressive Loading (Weeks 6 to 16)

This is where the real strength work begins. The graft is still maturing but can now tolerate progressively higher loads. Closed-chain exercises dominate: goblet squats, split squats, Bulgarian split squats, Romanian deadlifts, leg press through increasing range, hamstring curls, and hip abduction work with resistance. The goal is to rebuild symmetrical strength between the operated and non-operated limbs, targeting the specific deficits associated with the graft type used.

A common mistake in this phase is over-focusing on quadriceps while neglecting posterior chain strength. Hamstring co-contraction is a primary dynamic stabiliser of the ACL. Underdeveloped hamstrings in a post-surgical knee are a genuine re-injury risk factor, particularly during deceleration and change-of-direction tasks.

Phase 4: Neuromuscular Control and Running Return (Months 4 to 6)

Return to running is not a reward for good behaviour. It is a clinical decision based on strength symmetry, single-leg stability, and quality of movement patterns. Running is progressively reintroduced in a straight-line format, with distance and intensity controlled carefully. Neuromuscular control work, including single-leg balance, reactive drills, and perturbation training, becomes the central focus. The athlete must demonstrate clean landing mechanics before any multidirectional movement is added.

Phase 5: Sport-Specific Preparation and Return to Play (Months 6 to 12+)

Cutting, pivoting, jump-landing, and contact scenarios are reintroduced under controlled and then progressive loading. Psychological readiness is formally assessed here, as fear of re-injury is a well-recognised barrier to full return to performance even when physical criteria are met. Return to competitive sport is not cleared until objective testing confirms the athlete has met all defined benchmarks.

Surgery or No Surgery: Making the Right Call

Not every ACL tear requires surgical reconstruction. The decision depends on the degree of injury, the individual's age, activity demands, the presence of concurrent injuries such as meniscal or cartilage damage, and their expectations for return to high-level pivoting sport. Surgical reconstruction is typically recommended for younger athletes, those competing in high-demand pivot sports, and individuals with combined ligamentous or meniscal injuries causing functional instability.

Conservative, non-surgical rehabilitation has produced strong outcomes for many individuals, particularly those with lower activity demands, older patients, and those with partial ACL tears. A skilled physiotherapy program for non-surgical management focuses on restoring range of motion, building compensatory strength in the surrounding musculature, proprioceptive retraining, and returning to function within appropriate movement parameters. The decision about the right approach should never be made in the first week of injury when pain and swelling are at their peak. Allow the acute phase to settle, get a thorough assessment, and then make an informed call.

ACL Graft Types and What They Mean for Your Rehab

The graft chosen for ACL reconstruction has direct implications for how rehabilitation is programmed. The three most commonly used autograft options are the bone-patellar tendon-bone (BPTB) graft, the hamstring tendon (HT) graft, and the increasingly used quadriceps tendon (QT) graft.

With a patellar tendon graft , research identifies low-velocity concentric extensor deficits, particularly through mid-range flexion. Rehabilitation needs to address quadriceps strength through a specific range and velocity profile to correct this. Anterior knee pain at the donor site is also a consideration in programming, particularly with kneeling and squatting patterns early in recovery.

With a hamstring tendon graft , the primary strength deficit tends to be high-velocity, eccentric flexor weakness. This has direct implications for deceleration and landing tasks. Eccentric hamstring loading must be deliberately programmed and progressed carefully, given that the donor site muscles are also the primary dynamic knee stabilisers.

Understanding which graft was used is not academic knowledge. It directly shapes which exercises your physiotherapist should be prescribing and at what stage of recovery. If your physio program looks the same regardless of graft type, that is a problem worth raising.

Key Exercises by Phase

The exercises listed here represent the categories used in evidence-based ACL rehabilitation. Specific sets, reps, and load parameters must be individualised by a physiotherapist based on your graft type, surgical findings, and weekly progress assessments.

Phase 1 Exercises (Weeks 1 to 2)

Quad sets (isometric quadriceps activation)
Heel slides for flexion ROM
Prone knee hangs to restore full extension
Straight-leg raises
Ankle pumps for circulation
NMES-assisted quadriceps activation where indicated

Phase 2 Exercises (Weeks 2 to 6)

Stationary cycling (low resistance)
Calf raises (double-leg progressing to single-leg)
Hip abduction and extension strengthening
Mini squats (0 to 45 degrees)
Step-ups (progressing height gradually)
Gait re-education drills
Terminal knee extensions

Phase 3 Exercises (Weeks 6 to 16)

Goblet squats and progressing squat variations
Split squats and Bulgarian split squats
Romanian deadlifts
Leg press through progressive range
Hamstring curls (concentric and progressing to eccentric)
Hip abduction and external rotation with resistance
Single-leg press

Phase 4 to 5 Exercises (Months 4 to 12+)

Straight-line running progression
Single-leg balance and reactive perturbation training
Lateral shuffles and change-of-direction drills
Jump-landing mechanics (box drops, bilateral to unilateral progression)
Sport-specific movement patterns under controlled conditions
Plyometric progressions calibrated to sport demands

Pro tip: Plyometric training should not be introduced until you can demonstrate greater than 80% limb symmetry on single-leg strength testing and clean, controlled landing mechanics on single-leg squats. Introducing jumping and cutting movements before this threshold is a well-recognised driver of re-rupture, particularly in the six to nine month post-operative window.

Return to Sport Criteria: Not Just a Calendar

The biggest error in ACL rehabilitation is treating return to sport as a date on a calendar rather than a set of measurable benchmarks. Evidence consistently supports the use of the Limb Symmetry Index (LSI) as the primary objective measure for return-to-sport clearance. A score greater than 90% LSI on isokinetic quadriceps and hamstring strength testing, combined with passing scores on a battery of functional hop tests, represents the current evidence-based minimum standard before returning to competitive sport.

Alongside physical testing, psychological readiness must be assessed. Athletes who pass all physical criteria but report high fear of re-injury demonstrate elevated re-injury rates. The ACL Return to Sport after Injury (ACL-RSI) scale is one validated tool for measuring this dimension of readiness.

In practice, athletes who attempt return to high-demand pivoting sport before meeting these criteria carry a significantly elevated risk of re-rupture, particularly in the first two years post-surgery. The evidence here is clear: meeting the criteria matters more than the specific number of months post-operation.

Approach Comparison: Criteria-Based vs. Time-Based vs. Pain-Guided

Common Mistakes That Extend Recovery

ACL rehabilitation is long enough without adding avoidable setbacks. These are the patterns that consistently extend timelines and increase re-injury risk.

Skipping the First Two Weeks

The assumption that early post-surgical rehabilitation means rest is wrong and costly. Patients who do not begin active physiotherapy within the first 24 to 48 hours post-surgery, particularly quad activation and passive extension work, frequently pay for it with months of additional recovery. This is not a phase for watching and waiting. It is a phase for precision, low-load work that sets the structural foundations for everything that follows.

Advancing Based on Absence of Pain

Pain reduction is not the same as readiness to progress. The graft undergoes its most significant biological remodelling between months two and six, a period during which the knee often feels deceptively comfortable. Athletes who interpret this comfort as clearance to run, jump, or return to training are operating on exactly the wrong signal.

Neglecting Hip and Posterior Chain Strength

Knee-focused rehabilitation that ignores the hip is incomplete. Gluteal weakness, particularly in abduction and external rotation, is a direct driver of poor knee alignment during landing and cutting tasks. Building a strong, reactive hip is not supplementary work. It is central to rebuilding a stable, sport-ready knee.

Returning to Sport Before Passing Objective Testing

The temptation to return for a season-defining game, a major race, or because it "feels fine" is understandable. The consequences, however, are not. Re-rupture rates in athletes who return to sport before meeting LSI criteria are substantially higher than those who complete the full testing battery. No single game is worth another twelve months of rehabilitation.

ACL Rehabilitation at Alexandria Physio

Alexandria Physiotherapy and Sports Injury Clinic is built around the same evidence-based standards that govern elite sport. The clinic was founded by Eddie Farah and Steve Velovski, physiotherapists who spent over fifteen years working at the highest levels of the NRL with the South Sydney Rabbitohs. Eddie Farah continues in his role as Head Physiotherapist for the NSW Blues, bringing that level of elite clinical thinking directly into the management of every patient who walks through the clinic's doors.

The clinic's team brings backgrounds in Australian Rugby, the NSW Waratahs, and Olympic athlete management to their everyday practice. This is not background noise. It means that when you are navigating a complex ACL rehabilitation program, your physiotherapist has managed the same injury profile in athletes with professional careers on the line. The standards applied to your program are the same standards applied in elite environments, adapted for your individual goals, timeline, and lifestyle.

For athletes and community members in Alexandria, Sydney, and the surrounding inner-south suburbs, this level of evidence-based, performance-oriented knee injury treatment is available without travelling to a specialist hospital setting. If you are in the early stages of an ACL injury or post-surgical recovery and you want a rehabilitation program that actually matches the standard of your goals, the team at Alexandria Physio is the right starting point. You can book an assessment directly through the online booking page or explore the full range of physiotherapy and sports injury services available at the clinic.

Frequently Asked Questions

How long does ACL rehabilitation take in Sydney?

The timeline for ACL rehabilitation following surgical reconstruction generally ranges from 9 to 18 months before return to competitive sport. Professional athletes with daily access to elite rehabilitation and sports medicine support can return in as little as 9 months. For most people, the realistic timeline is 12 months or longer. Non-surgical rehabilitation for partial tears or lower-demand individuals can follow a shorter timeline depending on goals.

Do I need surgery for an ACL tear?

Not necessarily. Surgical reconstruction is typically recommended for complete tears in younger, active individuals who participate in pivoting sports, or when the ACL tear is accompanied by meniscal or other ligamentous damage. Older adults, lower-demand individuals, and those with partial tears can achieve excellent outcomes through structured non-surgical rehabilitation. The decision should be made after the acute swelling has settled, following a thorough clinical assessment and often with the input of an orthopaedic surgeon.

What is the Limb Symmetry Index and why does it matter?

The Limb Symmetry Index (LSI) compares the strength or performance of your operated leg to your non-operated leg, expressed as a percentage. A score of 90% or greater on quadriceps and hamstring strength testing, combined with passing scores on functional hop tests, is the current evidence-based standard for return-to-sport clearance after ACL reconstruction. Athletes who return to sport before achieving this threshold carry a significantly elevated risk of re-rupture.

What is the difference between a hamstring graft and a patellar tendon graft?

Both are autograft options where tissue is taken from your own body to reconstruct the ACL. The patellar tendon graft (bone-patellar tendon-bone or BPTB) tends to produce low-velocity concentric extensor deficits and can cause anterior knee pain at the donor site. The hamstring tendon graft tends to produce high-velocity eccentric flexor deficits and affects the muscles that also act as dynamic knee stabilisers. Each graft type requires different rehabilitation emphasis to correct the specific strength deficits it creates.

When can I return to running after ACL surgery?

Return to running is a clinical decision, not a milestone automatically reached at a particular week. Before running is reintroduced, you need to demonstrate adequate single-leg strength and stability, full pain-free range of motion, and clean movement mechanics on single-leg tasks. In most criteria-based programs, straight-line running begins somewhere between months three and five post-surgery, with pace and distance controlled carefully from the outset.

Can ACL rehabilitation be done without surgery if I play competitive sport?

This depends heavily on the demands of the sport and the degree of instability present. Some individuals with complete ACL tears do return to low-level recreational sport without surgery through a targeted strengthening program. However, for athletes competing in high-demand pivoting sports at a meaningful competitive level, non-surgical management carries a higher risk of ongoing instability and further joint damage, particularly to the meniscus. This is a conversation to have in detail with both an orthopaedic specialist and an experienced physiotherapist.

What should I look for in an ACL physiotherapist in Sydney?

Look for a physiotherapist with direct experience in sports injury rehabilitation and, ideally, elite sport environments. They should use a criteria-based progression model, not a time-based calendar. They should understand graft-specific rehabilitation protocols and be able to administer and interpret objective return-to-sport testing. In Sydney, this standard of ACL recovery physio is exactly what the team at Alexandria Physiotherapy and Sports Injury Clinic is built around.

If you are currently working through an ACL recovery or have recently been diagnosed, we would genuinely like to hear what questions or challenges you are facing, drop them in the comments or get in touch directly and we will do our best to help you navigate the next step.

References

Week-by-week ACL surgery recovery timeline covering early post-operative care through return to sport
Evidence-based ACL rehabilitation exercise progressions across all five phases of recovery
Research on Limb Symmetry Index criteria and return-to-sport decision making after ACL reconstruction
Peer-reviewed analysis of graft type selection and its implications for ACL rehabilitation programming
Clinical overview of ACL rehabilitation phases, goals, and exercise selection by phase

7 Signs Your Sports Injury Needs Physio, Not Rest

Wed, 16 Sep 2026 00:00:00 GMT

Injury Recovery Mistakes

Most athletes have been there: you roll an ankle, tweak a shoulder, or feel a sharp pull in your hamstring, and the instinct is to ice it, rest for a few days, and hope it sorts itself out. Sometimes that works. Often it does not. The real problem is that rest alone addresses pain as a symptom, not the underlying structural damage, muscle weakness, or movement fault driving it. If you are searching for sports injury physiotherapy Sydney because something does not feel right, you probably already sense that rest is not enough. This article gives you seven clear, specific signs that it is time to stop waiting and get a professional assessment at a sports injury clinic in Alexandria built for exactly this kind of work.

Quick Takeaways

Sign 1: Pain That Persists Beyond 72 Hours

Minor muscle soreness from training, known as delayed onset muscle soreness (DOMS), typically peaks within 24 to 48 hours and then fades. Injury pain behaves differently. If your pain is still present, unchanged, or worsening after three days of appropriate rest and basic care, that is not soreness. That is a signal your body cannot resolve the problem on its own.

Sharp pain during movement, pain at rest, or pain that intensifies with activity rather than easing off are all specific red flags. These patterns suggest tissue damage that requires active treatment: hands-on physiotherapy, load management, and targeted rehabilitation, not another week on the couch.

Pro tip: Track your pain on a simple 0 to 10 scale every morning for three days after an injury. If the number is not dropping, or if it spikes when you try to return to activity, book in with a physiotherapist rather than extending your rest period.

Sign 2: Swelling That Is Significant or Slow to Resolve

Some swelling after a sports injury is a normal inflammatory response. What is not normal is swelling that is severe, that spreads well beyond the injured site, or that refuses to go down after several days of rest, ice, and compression. Prolonged or significant swelling can indicate ligament tears, tendon damage, or nerve involvement, any of which carries serious consequences if left unaddressed.

Swelling that lingers also actively damages the muscles surrounding the injured area. The joint becomes inhibited, meaning the muscles protecting it switch off, and this sets up a cycle of weakness and vulnerability that passive rest does nothing to break. A physiotherapist can assess whether the swelling is disproportionate to the apparent injury and initiate treatments that address the underlying cause rather than just the symptom.

What significant swelling might actually indicate

Visible bruising alongside swelling is a sign that blood vessels have been damaged beneath the skin, often from torn muscle fibres or ruptured capillaries. Large-scale bruising, particularly if it appears in an area away from the initial impact site, warrants immediate professional attention. It can indicate a more severe structural injury than the surface presentation suggests.

Sign 3: Numbness, Tingling, or Burning Sensations

If you feel numbness, tingling, or a burning sensation in or around an injured area, treat it as urgent. These sensations are signs of nerve involvement, whether from compression, stretching, or direct nerve damage. Nerve injuries that are not properly managed carry a real risk of permanent deficit, which is why this sign sits near the top of the priority list.

Common examples seen in sport include a stinger or burner in the neck and shoulder from a tackle, radiating leg pain from a lower back injury, or tingling into the fingers after a shoulder impact. In every case, a physiotherapist needs to assess the injury to determine the type and degree of nerve involvement before any further activity is resumed.

Pro tip: Never return to contact sport, heavy lifting, or overhead activity when you still have numbness or tingling. These sensations mean the nervous system has not cleared the injury, and loading the structure before it has is how minor nerve injuries become serious ones.

Sign 4: Joint Instability or the "Giving Way" Feeling

A joint that feels like it is about to give way, or that actually buckles under normal load, is not something to manage through rest alone. Joint instability occurs when the muscles, tendons, and ligaments surrounding a joint can no longer hold the bones in proper alignment. This is a structural problem, not a pain problem, and rest without rehabilitation does not restore that structural integrity.

Knee, ankle, and shoulder joints are the most common sites where athletes experience this. An ankle that has been sprained multiple times without proper rehabilitation often develops chronic ligament laxity, where the joint repeatedly gives way on uneven ground or during direction changes. Each subsequent episode increases the risk of further damage and extends the total recovery timeline significantly.

Why instability demands active rehabilitation

Restoring joint stability requires a graded program of proprioception training, strength work, and neuromuscular re-education. These are not things that happen passively. At a dedicated sports injury clinic , your physio will assess which structures are involved and build a program that progressively reloads the joint in a controlled way, rebuilding the stability the injury took away.

Sign 5: Loss of Range of Motion

Difficulty moving a joint through its normal range, whether from pain, stiffness, or a physical block, is one of the clearest signs that physiotherapy is needed. Loss of range of motion after a sports injury means the surrounding tissues, whether muscle, tendon, ligament, or joint capsule, are not behaving normally. Left untreated, this restriction becomes harder to resolve and often leads to compensatory movement patterns that create new problems elsewhere.

A common mistake is to assume that stiffness will just "loosen up" over time with gentle stretching. Sometimes it does. More often, stiffness after injury reflects scar tissue formation, joint swelling compressing the capsule, or protective muscle guarding, all of which require specific manual therapy and targeted exercise to resolve properly.

The functional test that matters

The relevant question is not just whether you can move the joint, but whether you can move it well enough to perform the specific demands of your sport or activity. A footballer needs full hip rotation and knee extension under load. A swimmer needs full shoulder overhead range with scapular control. Your physio assesses functional range, not just passive range, which is a meaningfully different and more useful standard.

Sign 6: The Injury Keeps Coming Back

Recurring injuries are the clearest evidence that rest alone is never a sufficient treatment. If you have had the same calf strain flare three times this season, if your Achilles always flares after a long run, or if your hamstring consistently tightens after training, you are not dealing with bad luck. You are dealing with an injury that was never properly rehabilitated the first time.

Recurring pain often points to one of three root causes: the original injury did not fully heal before you returned to load, a movement or technique fault is repeatedly stressing the same structure, or a strength or flexibility deficit is placing that tissue under more load than it can handle. A physiotherapist will assess all three and build a rehabilitation plan that targets the actual cause rather than just the symptoms.

At Alexandria Physiotherapy and Sports Injury Clinic, this is exactly the kind of problem the clinical team excels at. With a background treating elite NRL and rugby athletes, including longstanding roles with the South Sydney Rabbitohs, the team understands how to identify the biomechanical and loading factors driving recurring injuries and how to address them without unnecessarily keeping athletes out of their sport.

Sign 7: You Have Changed How You Move to Protect the Injury

This sign is easy to overlook because it does not feel like a symptom. If you are limping slightly, protecting one shoulder during overhead activity, or changing your running gait to avoid reproducing a pain, you have already developed a compensatory movement pattern. These adaptations feel protective in the short term. Over weeks and months, they systematically overload structures that were not designed to carry that extra demand.

A common clinical scenario: an athlete sprains an ankle, rests until the pain reduces, returns to sport, and six weeks later develops knee or hip pain on the same side. The ankle was not fully rehabilitated, the movement pattern changed to protect it, and the altered mechanics transferred stress upward. The knee or hip becomes the presenting complaint, but the ankle is the origin.

Catching compensatory patterns early is one of the most high-value things a physiotherapy assessment provides. You get a professional eye on how you are actually moving, not just whether you are still in pain.

Rest vs. Physiotherapy: Knowing Which One Actually Fixes the Problem

Rest is not useless. For genuinely minor soft tissue injuries, a short period of relative rest combined with load management is entirely appropriate. The problem is that most athletes either rest too long without addressing the underlying issue, or they return too early because the pain has gone and they assume the injury has resolved. Neither approach works reliably.

Here is a direct comparison of what rest and physiotherapy each deliver, and where each falls short on its own:

The athletes who recover fastest and re-injure least are not the ones who rested most. They are the ones who got an accurate assessment early, followed a structured rehabilitation program, and did not return to full training until objective functional criteria, not just pain levels, cleared them to do so.

Alexandria Physiotherapy and Sports Injury Clinic operates on exactly this model. Clinic owner and Head Physiotherapist for the NSW Blues, Eddie Farah, has shaped the clinic's approach around the same clinical standards applied to professional athletes. Every client receives a customised assessment and rehabilitation plan, not a generic rest-and-review protocol.

Pro tip: If you are in Sydney and have been managing an injury for more than a week without clear improvement, the most efficient thing you can do is book a 45 to 60 minute initial assessment at a dedicated sports injury clinic in Alexandria. A single session of accurate diagnosis and a clear plan is worth more than three more weeks of uncertain rest.

Frequently Asked Questions

How long should I rest a sports injury before seeing a physiotherapist?

For any injury where you have severe pain, cannot bear weight, notice significant swelling or bruising, or feel numbness or tingling, do not wait. Seek professional assessment within 48 hours. For injuries that seem minor but are still symptomatic after three days of basic care, that is the point to book in with a physiotherapist rather than continuing to wait and see.

Can physiotherapy make a sports injury worse?

When delivered by a qualified physiotherapist following a proper assessment, physiotherapy does not worsen injuries. The risk runs in the other direction: delaying assessment and continuing to train through an injury without understanding its nature is what causes minor injuries to become serious ones. A good physio will also advise when an injury is outside the scope of physiotherapy alone and requires medical imaging or specialist referral.

What happens at a first physiotherapy appointment for a sports injury?

At your first appointment, the physiotherapist will take a detailed history of the injury, including mechanism, onset, and what has made it better or worse. They will then perform a physical assessment covering range of motion, strength, joint stability, and movement quality. From that, they build a diagnosis and an initial treatment and rehabilitation plan specific to your injury, your sport, and your goals.

Is it worth seeing a physio for a recurring sports injury if the pain is manageable?

Yes, and this is one of the most important times to seek assessment. Manageable pain from a recurring injury masks the fact that the underlying fault has not been fixed. Each recurrence typically causes a little more cumulative damage and increases the risk of a more serious episode. Addressing it when it is manageable is far better than waiting until it becomes a significant structural problem that requires a longer recovery.

What is the difference between a general physio and a sports injury physiotherapist?

A sports physiotherapist has additional training and practical experience in sports-related injuries, athletic performance, and return-to-sport rehabilitation. They understand the specific demands of different sports, the mechanics of athletic movement, and how to rebuild function to competition-level standards, not just everyday function. If your goal is to return to training or competition at the level you were at before injury, a sports-specific physio is the appropriate choice.

Should I stop training completely when I have a sports injury?

Not necessarily, and often that is the wrong call. The goal is appropriate load management, not complete rest. A physiotherapist will identify which activities are safe to continue, which need to be modified, and which need to be temporarily avoided. Many injured athletes can maintain significant training volume in unaffected areas while their injury is treated. Blanket rest often leads to deconditioning that prolongs the overall return-to-sport timeline.

If you are dealing with a sports injury that has not responded to rest, or if you recognise any of the seven signs above, we would like to hear about your experience. Drop a comment below about what has worked for you, or what finally made you decide to see a physio.

References

What Causes Bone Stress Injuries? Risk Factors Explained by Sports Physios

Wed, 01 Oct 2025 05:59:01 GMT

What Causes Bone Stress Injuries?

Bone stress injuries (BSIs), often referred to as stress fractures, occur when repetitive loading on a bone exceeds its ability to remodel and recover. These injuries are common among runners, athletes, military recruits, and active individuals who rapidly increase training loads.

At Alexandria Physiotherapy and Sports Injury, we regularly treat athletes and everyday runners with BSIs. Understanding the risk factors behind bone stress injuries is essential for prevention, early diagnosis, and effective rehabilitation.

What is a Bone Stress Injury?

A bone stress injury develops when tiny amounts of microdamage accumulate in the bone faster than the body can repair them. If not managed, this can progress to a stress fracture, a visible crack in the bone that requires longer recovery.

These injuries most often affect weight-bearing bones, including the tibia, fibula, metatarsals, femur, and pelvis.

Intrinsic Risk Factors (Within the Body)

Intrinsic factors are linked to an individual’s biology and biomechanics.

1. Bone Health and Density

Low bone mineral density (BMD) and osteoporosis increase susceptibility.
Conditions such as Relative Energy Deficiency in Sport (RED-S) or the female athlete triad (low energy intake, menstrual dysfunction, low BMD) are major contributors.
A 2023 review found athletes with RED-S had up to 3x greater risk of developing BSIs.

2. Sex and Hormonal Status

Females have a higher incidence, particularly in endurance sports.
Menstrual irregularities and low oestrogen levels reduce bone repair capacity.
Oestrogen plays a crucial role in bone metabolism and remodelling.

3. Anatomical and Biomechanical Factors

Foot arch morphology: both flat feet (pes planus) and high arches (pes cavus) alter force distribution.
Leg length discrepancies or alignment issues (e.g., knock knees, hypermobility).
Muscle weakness, especially in hip stabilisers and calves, can create compensatory loading.

4. Previous Injury

Athletes with a history of BSIs or lower-limb injuries are more likely to experience recurrence due to lingering biomechanical deficits.

Extrinsic Risk Factors (Training & Environment)

Extrinsic factors relate to the external stresses placed on the body.

1. Training Load and Intensity

Rapid increases in training volume, frequency, or intensity are the leading cause of BSIs.
A 2022 meta-analysis found runners who increased weekly mileage by >10% were 2.5x more likely to develop BSIs.
Physiotherapist-guided load management plans can reduce this risk.

2. Training Surfaces and Footwear

Hard or uneven surfaces increase impact.
Worn-out or unsupportive shoes raise loading stress.
Sports physios can provide running gait assessments and footwear recommendations.

3. Nutrition and Recovery

Inadequate calcium, vitamin D, and protein intake negatively impacts bone health.
Vitamin D deficiency has been linked with higher BSI risk in military populations.
At Alexandria Physio, clients are also able to book in with our dietitian at our sister clinic in Redfern, who can provide tailored nutrition strategies to support bone strength, energy availability, and recovery.
Poor sleep and insufficient recovery time further impair repair processes.

4. Environmental and Psychological Stressors

Psychological stress and elevated cortisol interfere with bone turnover.
High-altitude or cold-weather training may also increase susceptibility.

How Risk Factors Interact

Bone stress injuries rarely result from a single cause. Instead, it’s usually a combination of intrinsic and extrinsic factors. For example:

A female runner with irregular periods (intrinsic) who rapidly ramps up her mileage (extrinsic) has compounded risk.
Poor biomechanics plus inappropriate footwear amplifies strain, often leading to shin pain, stress fractures, or long-term rehab needs.

How Physiotherapy and Nutrition Help Manage and Prevent BSIs

At Alexandria Physio, our multidisciplinary team offers:

Early diagnosis of BSIs using clinical assessment and imaging referrals.
Load management plans to gradually build training volume.
Strength programs targeting hips, calves, and core for better load distribution.
Nutritional support with our in-house dietitian, focusing on calcium, vitamin D, protein, and fuelling strategies to prevent RED-S.
Footwear and running assessments to correct biomechanical issues.

Key Takeaway

Bone stress injuries result from the interplay of biological vulnerabilities and training errors. Recognising modifiable risk factors like training load, footwear, nutrition, and recovery can dramatically reduce risk.

If you’re experiencing persistent bone pain or preparing for events like the Hoka Half Marathon, early intervention is essential.

Book a consultation with our sports physio team and dietitian in Alexandria today to prevent injury, improve performance, and recover stronger.

The Best Ways to Reduce the Risk of Developing Bone Stress Injuries

Wed, 01 Oct 2025 05:58:58 GMT

Best Ways to Reduce the Risk of Developing Bone Stress Injuries

Bone stress injuries (BSIs), or stress fractures, are common overuse injuries that pose a significant challenge to athletes and active individuals. Preventing these injuries is paramount to maintaining performance and long-term musculoskeletal health. This blog post synthesises the latest high-quality evidence and systematic reviews to provide practical, evidence-based strategies to reduce the risk of BSIs.

Our sports physios , massage therapists and dietitians see first-hand how bone stress injuries impact athletes at all levels. By combining careful load management, nutritional guidance, and strength training, an experienced physio can help reduce risk and keep athletes performing at their best.

Understanding Bone Stress Injury Risk

Before prevention, it’s important to remember that BSIs develop when repetitive mechanical loading outpaces the bone’s ability to repair and remodel.

Effective prevention targets both intrinsic and extrinsic risk factors. Many patients benefit from working with a sports physiotherapist who can identify these risks and tailor an injury prevention program.

1. Gradual and Structured Training Load Progression

One of the strongest modifiable risk factors is a rapid increase in training volume, intensity, or frequency.

Evidence: Multiple cohort studies and meta-analyses confirm that increasing weekly mileage or training load by more than 10% substantially raises BSI risk.
Practical approach: Employ the “10% rule” - do not increase running or training load by more than 10% per week.
Periodisation: Incorporate rest weeks and taper phases to allow bone remodelling.
Monitoring: Use wearable devices or training logs to track load and detect risky spikes.

Physiotherapists often guide training load progression to help athletes avoid overload while still improving fitness.

2. Optimise Nutrition and Energy Availability

Adequate nutrition is fundamental to bone health and injury prevention.

Calcium and Vitamin D: Both are critical for bone mineralisation. Systematic reviews link vitamin D insufficiency to increased stress fracture rates.
Energy availability: Maintaining sufficient caloric intake relative to expenditure prevents RED-S and supports hormonal balance.
Protein: Adequate protein intake supports tissue repair and bone remodelling.
Practical tips: Encourage balanced diets rich in dairy or fortified alternatives, leafy greens, and consider supplementation if deficiencies are identified.

At Alexandria Physio, our dietitian works alongside physiotherapists to ensure athletes fuel correctly for performance, recovery, and long-term bone health.

3. Correct Biomechanical and Anatomical Issues

Addressing biomechanical risk factors reduces localised bone stress.

Gait analysis: Identifies abnormal loading patterns such as overpronation or excessive impact forces.
Footwear: Select appropriate shoes based on foot type and activity demands. Replace worn-out footwear regularly.
Orthotics: Custom or prefabricated orthoses can improve load distribution, especially in those with structural abnormalities.
Strength training: Target hip abductors, calf muscles, and foot intrinsic muscles to improve shock absorption and movement mechanics.

An experienced physiotherapist can assess movement patterns, provide tailored strengthening, and recommend orthotics where needed to reduce BSI risk

4. Incorporate Strength and Conditioning Programs

Beyond endurance and sport-specific training, strength conditioning plays a protective role.

Muscle strength: Stronger muscles absorb impact forces, reducing bone loading.
Balance and proprioception: Enhances neuromuscular control and reduces injury risk.
Evidence: Recent RCTs show strength programs reduce stress injury incidence by improving movement quality.
Program design: Include weight-bearing resistance exercises, plyometrics, and neuromuscular training progressively.

Athlete physiotherapy programs often combine strength training with mobility work to build resilience against bone stress injuries.

5. Ensure Adequate Recovery and Sleep

Bone remodelling occurs during rest periods; inadequate recovery delays repair.

Sleep: Poor sleep quality or duration is associated with increased injury risk.
Rest days: Schedule regular rest or low-impact activity days.
Cross-training: Utilise low-impact activities like swimming or cycling to maintain fitness while reducing bone stress.

Recovery strategies are often guided by physiotherapy programs tailored to an athlete’s workload , ensuring balance between training and rest.

6. Manage Hormonal Health and Screening

Hormonal health is particularly important for female athletes, but relevant for all.

Menstrual health: Monitor for irregularities; early intervention for amenorrhea is critical.
Bone density testing: Consider in athletes with risk factors or recurrent BSIs.
Referral: Collaborate with dietitians or medical professionals for RED-S or osteoporosis.

Our clinic offers both sports physio and dietetic support (from our sister clinic in Redfern) , helping athletes address underlying risk factors that influence bone health.

7. Environmental and Equipment Considerations

External factors also contribute to injury risk.

Train on softer surfaces when possible, especially during high-intensity phases.
Use shock-absorbing insoles or surface modifications for hard or uneven terrain.
Be mindful of environmental factors such as temperature and altitude.

Preventing bone stress injuries requires a multifaceted approach targeting training practices, nutrition, biomechanics, and recovery.

At Alexandria Physio, our team of sports physiotherapists and dietitian from our sister clinic in Redfern, work together to provide evidence-based prevention and rehabilitation strategies. Through careful load management, nutritional optimisation, strength conditioning, and proactive screening, athletes can reduce their risk of injury and improve long-term performance.

Whether preparing for a marathon, returning from an overuse injury, or looking to prevent conditions such as Achilles heel pain or groin injuries, working with an expert physio ensures you can keep training, competing, and moving well.

The Latest Physiotherapy Evidence for Knee Osteoarthritis

Wed, 17 Sep 2025 06:31:03 GMT

The Latest Physiotherapy Evidence

for Knee Osteoarthritis

Knee osteoarthritis (OA) is a highly prevalent musculoskeletal condition and a leading cause of pain and disability among adults over 50. It involves progressive degeneration of the articular cartilage, changes in subchondral bone, and inflammation of the synovial membrane. Symptoms typically include joint pain, stiffness, swelling, and reduced mobility.

Traditionally managed with pharmacological and surgical approaches, there has been a growing emphasis on physiotherapy-led interventions grounded in high-quality evidence. Let’s explore the most effective physiotherapy strategies based on the latest systematic reviews and clinical guidelines used by elite physiotherapists and exercise physiologists.

1. Exercise Therapy

Exercise remains the cornerstone of OA management, supported by nearly every major guideline globally (NICE, EULAR, ACR, RACGP). Its benefits extend beyond symptom relief—exercise improves joint function, promotes cartilage health through mechanotransduction, reduces inflammation, and supports weight management.

Types of beneficial exercises:

Aerobic exercise (e.g., walking, cycling, swimming): improves general conditioning and joint lubrication.
Strength training: especially targeting the quadriceps and gluteal muscles to support knee alignment and reduce joint load.
Neuromuscular training: enhances joint proprioception and dynamic stability.
Flexibility and range of motion (ROM) exercises: counteract stiffness and maintain functional mobility.

Evidence: A 2022 Cochrane review concluded that land-based therapeutic exercise provides moderate improvements in pain and function. Meta-analyses have shown strength training to be particularly effective, especially when supervised.

Practical advice: Start with low-impact aerobic work and isolated strength training.

Progress to functional, closed kinetic chain exercises (e.g., sit-to-stands, step-ups).

Aim for 3+ sessions per week, sustained over at least 12 weeks.

2. Weight Loss and Load Management

Obesity is a well-established modifiable risk factor for both the onset and progression of knee OA. Weight loss reduces the mechanical load on the joint—every 1 kg of weight loss equates to ~4kg of load reduction per step on the knee joint.

Combined intervention: The IDEA trial (2013) demonstrated that combining weight loss with exercise improved pain and function more than either alone. Patients who lost ≥10% of body weight showed the greatest symptom relief.

Key load management strategies:

Limit deep squats and high-impact activity initially.
Encourage cycling or hydrotherapy for cardiovascular fitness without joint strain.
Assess footwear and consider cushioned or rocker-bottom soles.

Many patients seek advice from Move Physiotherapy or exercise physiology programs to support safe weight loss alongside rehab.

3. Manual Therapy: Adjunct, Not a Standalone

Manual therapy techniques, such as joint mobilisation and soft tissue remedial massage, may provide short-term pain relief and reduce stiffness. They can enhance patient comfort and facilitate movement, especially early in rehabilitation.

Evidence: A systematic review in JOSPT (2021) found manual therapy to be more effective when combined with exercise. However, the benefits are modest and short-lived if used in isolation.

Best practice involves using manual therapy, such as remedial massage services offered in the Marrickville, Alexandria, and Redfern clinics, to enable participation in more active treatments.

4. Bracing, Taping, and Assistive Devices

Unloader knee braces and kinesiology taping can help redistribute joint forces and improve alignment. Walking aids, like canes or trekking poles, can offload the affected limb and increase confidence.

Taping: McConnell taping can help align the patella and reduce pain, though evidence is mixed.
Bracing: More effective in unicompartmental OA, especially medial knee OA.
Assistive devices: Should be individually prescribed and introduced with proper instruction.

5. Patient Education and Self-Management

Empowering patients with knowledge is essential. Misbeliefs—such as the idea that walking worsens joint wear or that OA inevitably leads to surgery—can drive fear-avoidance and inactivity.

Educational topics should include:

The benefits and safety of exercise.
Pain neuroscience and flare-up management.
Weight control and nutrition.
Joint protection strategies.

Digital tools: Mobile apps, online exercise videos from physio Pilates or exercise physiologists, and self-monitoring platforms can increase adherence and autonomy.

6. Electrotherapy and Other Modalities

TENS (Transcutaneous Electrical Nerve Stimulation): May provide temporary pain relief.
Ultrasound: Lacks strong evidence and is not routinely recommended.
Cryotherapy or heat: Can assist in symptom management before or after activity.

Their use should not replace exercise but can support engagement in active rehab.

7. Group Programs and Multidisciplinary Models

Programs such as GLA:D (Good Life with osteoArthritis: Denmark) have shown significant benefits by combining education and neuromuscular exercise in a group setting.

Results: Large reductions in pain, improved function, and delayed surgical consideration.
Structure: Typically includes 12 exercise sessions and 2 education classes over 6–8 weeks.

Participation in group-based rehab run by exercise physiologists, physios, and remedial massage providers, fosters social support, accountability, and motivation—key components of long-term success.

8. When to Refer for Surgery?

Surgery (e.g., total knee replacement) may be considered when:

Pain significantly limits daily activities despite conservative management.
Functional decline persists beyond 6 months.
Radiological findings align with symptoms (though X-ray alone should not drive decision-making).

Even when surgery is likely, prehabilitation with sports physiotherapy services improves postoperative outcomes.

Conclusion

Physiotherapy plays a central, evidence-backed role in the management of knee OA. The combination of therapeutic exercise, education, load management, and behavioural support can significantly improve patient outcomes. Tailoring the program to each individual—considering their goals, comorbidities, and preferences—is essential. With the right approach, many patients can delay or avoid surgery and lead a more active, pain-free life.

The Latest in ACL Rehabilitation

Wed, 17 Sep 2025 06:13:57 GMT

The Cross Bracing Protocol Explained:

The Latest in ACL Rehabilitation

Anterior cruciate ligament (ACL) injuries are among the most common and impactful injuries in sports medicine. Traditionally, ACL ruptures—especially complete ones—were considered irreparable and almost always managed surgically in active individuals. However, recent developments in bracing protocols have reopened the door to non-operative management, particularly for proximal ACL tears. The Cross Bracing Protocol (CBP) is one such innovation drawing attention in physiotherapy and orthopaedics.

This post explores the rationale behind the CBP, the evidence supporting it, how it works in practice, and key considerations for physiotherapists involved in early to mid-stage rehabilitation.

What is the Cross Bracing Protocol?

The Cross Bracing Protocol is a non-surgical approach developed primarily to treat proximal ACL tears—those close to the femoral attachment of the ligament. The protocol uses immobilisation in knee flexion (usually between 60–90 degrees) for a defined period, aiming to bring the torn ends of the ACL into close proximity to facilitate natural healing.

It challenges the long-held assumption that a ruptured ACL cannot heal and must be reconstructed. Instead, CBP posits that under the right mechanical conditions (reduced tension and improved ligament contact), biological healing is possible—similar to how MCL injuries often heal without surgery.

The Science Behind Ligament Healing

The idea that ACLs cannot heal stems from early studies that didn’t control for limb positioning or stability post-injury. However, we now understand that:

Proximal ACL tears have better vascularity and cellular potential to heal.
Immobilisation in flexion reduces tension across the ACL, preventing retraction of the torn stump.
Mechanical stability (e.g., from bracing) is critical to allow bridging tissue to form.

A 2022 study by Murray et al. in The American Journal of Sports Medicine found that spontaneous healing of the ACL is possible in selected cases, particularly with bracing and early rehab supervision. From an exercise physiologist or sports physio.

Evidence Supporting the Cross Bracing Protocol

Several key studies and case series have explored the efficacy of CBP:

Blachut et al. (2021, AJSM): In a case series of 80 patients with proximal ACL ruptures, over 70% showed MRI-confirmed healing at 12 weeks with CBP, and many returned to pre-injury levels of sport within 6–9 months.
Burgi et al. (2023): Found that the healing ligament, although slightly different structurally from the native ACL, had sufficient continuity and functional stability for high-level sport participation.
Systematic review (2024, Sports Med): Concluded that CBP is promising for selected patients and may reduce unnecessary surgeries in well-screened populations.

While the sample sizes remain modest and follow-up periods limited in some cases, the preliminary outcomes are compelling for those working with athlete physiotherapy services and sports rehabilitation centres such as Sports Lab Alexandria.

Who is Suitable for Cross Bracing?

Ideal candidates meet the following criteria:

Acute, proximal ACL rupture, confirmed on MRI
Minimal or no concomitant meniscal damage requiring repair
No significant instability on initial manual testing when knee is braced
Strong patient adherence and motivation

CBP is not suited to mid-substance or distal ACL tears, or to individuals with significant rotational instability. It also requires access to imaging and specialist review for ongoing monitoring – typically guided by an exercise physiologist or experienced physiotherapists in clinics like Marrickville Physio or Erko Physio.

Phases of the Cross Bracing Protocol

The protocol typically unfolds over 12–14 weeks and consists of the following phases:

Phase 1: Immobilisation in Flexion (Weeks 0–4)

Position: Knee is braced at 90° flexion
Goals: Promote ACL stump approximation and biological healing
Intervention: Isometric quadriceps, hamstring co-contractions, hip strength maintenance, ankle pumps

Phase 2: Controlled Extension (Weeks 4–8)

Gradual extension (10–15° per week) introduced via adjustable brace
Continued quadriceps and hamstring activation
Partial weight-bearing may begin by week 6
MRI at week 6 often used to assess healing

Phase 3: Full Range and Load Reintroduction (Weeks 8–12)

Brace removed around week 10–12 if healing is confirmed
Focus on normalising gait, increasing strength, and proprioceptive training
Begin cycling, bodyweight exercises, and balance drills

Phase 4: Return to Sport Prep (Weeks 12–24+)

Progressive return to cutting, jumping, and sport-specific tasks
Formal hop testing, Y-balance, and isokinetic testing to confirm readiness

Physiotherapist’s Role in CBP

The role of the physiotherapist is central throughout the CBP:

Monitoring adherence: Bracing must be consistent. Poor compliance can disrupt healing.
Progressive loading: The transition from isometric to dynamic exercise must be based on both clinical progress and imaging.
Neuromuscular retraining: Emphasise hamstring and hip strength to reduce anterior tibial translation forces.
Gait correction: Monitor for compensations during reintroduction of walking and jogging.

This is where collaboration between elite physiotherapists, remedial massage practitioners, and exercise physiologists becomes invaluable. Many patients also complement their program with remedial massage services, such as those located in Marrickville, Redfern Sydney, or Alexandria to assist with pain relief, flexibility, and circulation during rehab.

Limitations and Controversies

Despite its promise, CBP is not without criticism:

Limited long-term data: Most studies report outcomes up to 12–24 months; re-tear rates long-term remain unknown.
Lack of randomised trials: Most evidence is observational or from case series.
Risk of stiffness: Especially if knee is immobilised in flexion too long without adequate rehab.

Some sports physicians argue that delaying surgery in non-responders may increase meniscal or chondral damage, especially in high-risk sports. This is why close collaboration with sports physiotherapists or massage and physiotherapy services is critical to ongoing management.

Conclusion

The Cross Bracing Protocol represents a shift in how we view ACL management. For select patients, particularly those with proximal tears—it offers a chance to heal without surgery, potentially reducing downtime, costs, and surgical risk. However, it demands careful patient selection, close monitoring, and a highly engaged rehab process

As the evidence base grows, physiotherapists, exercise physiologists, and sports physios are in a pivotal position to guide patients through this novel approach with a combination of structured rehabilitation, progressive loading, and functional testing.

Five Methods to Manage Plantar Fasciitis

Wed, 17 Sep 2025 05:47:26 GMT

Five Methods to Manage Plantar Fasciitis

BASED ON LATEST EVIDENCE

Plantar fasciitis (PF) is one of the most common causes of heel pain, particularly in runners, people who are overweight, and those whose jobs require prolonged standing. It is characterised by degeneration and microtears in the plantar fascia, a thick band of connective tissue that supports the arch of the foot. Patients typically report sharp, stabbing pain near the heel, often worse in the morning or after prolonged periods of inactivity.

This blog explores five gold-star management strategies based on recent systematic reviews and randomised controlled trials (RCTs), providing an evidence-based approach for exercise physiologists, physiotherapists and patients alike.

1. Calf and Plantar Fascia Stretching

Stretching remains one of the first-line treatments for PF, and recent literature continues to support its efficacy. A Cochrane review (2021) and several individual RCTs confirm that both calf muscle and plantar fascia-specific stretching improve pain and functional outcomes.

Stretching helps relieve tension on the fascia and improve dorsiflexion range of motion, which may reduce tissue stress during gait.

Best Practice: Stretch the plantar fascia by pulling the toes back while seated (3 times/day, 3 reps of 30 seconds). Calf stretches against a wall should also be incorporated.
Evidence: DiGiovanni et al. demonstrated superior outcomes with specific plantar fascia stretches over Achilles tendon stretching in patients with chronic PF.

A long-term stretching program (min 8 weeks) is more likely to yield sustained relief. Combining static and dynamic stretches into a morning routine can also improve first-step pain.

2. Foot Orthoses

Foot orthoses, whether prefabricated or custom, are effective in redistributing plantar pressures and reducing strain on the fascia. They are particularly useful for patients with flat feet or overpronation.

Short-Term Benefits : Prefabricated orthoses have shown significant short-term relief in pain over 6–12 weeks, according to a 2022 meta-analysis in the Journal of Foot and Ankle Research .
Long-Term Use : Orthotics should be used as part of a broader management strategy and not as a standalone solution.

A 2023 review indicated that although custom orthoses may offer slightly better long-term outcomes, they are not significantly superior to high-quality prefabricated options, making the latter a cost-effective choice. Many patients also benefit from combining orthotics with remedial massage or sports physiotherapy.

3. Shockwave Therapy (ESWT)

Extracorporeal Shockwave Therapy (ESWT) is increasingly used for chronic cases (symptoms >6 months) that have not responded to conservative treatment. It works by delivering mechanical energy to the affected area, promoting neovascularisation and stimulating tissue repair.

Effectiveness: A 2020 systematic review found ESWT significantly improved both pain and function compared to placebo, especially when used alongside exercise therapy.
Types: Radial and focused ESWT both have evidence, though focused shockwaves may penetrate deeper.
Caveat: Multiple sessions are usually needed, and results may take several weeks to become noticeable.

Clinicians need to ensure appropriate patient selection - those with recalcitrant PF and failed conservative care are the best candidates.

4. Low-Dye Taping and Kinesiology Taping

Taping techniques, particularly Low-Dye taping, are effective short-term interventions to reduce load on the plantar fascia and alleviate pain. Kinesiology taping is less rigid but still provides some support and proprioceptive feedback.

Application: Taping is most beneficial during high-load periods (e.g., work shifts, sports participation).
Research: A 2021 systematic review confirmed temporary improvements in pain scores with taping lasting up to 7 days.

Taping can also act as a diagnostic tool - if patients improve significantly, it indicates load reduction strategies will be effective.

Many patients combine taping with massage or physiotherapy services such as those available in Marrickville, Surry Hills, or Redfern to support plantar fasciitis recovery.

5. Foot Intrinsic Muscle Strengthening

The role of the foot's intrinsic muscles in maintaining arch integrity is increasingly recognised. Strengthening these muscles reduces overload on the fascia and improves dynamic foot control.

Exercises: Include towel scrunches, marble pickups, toe spreads, and short-foot exercises.
Evidence: A 2023 RCT found that intrinsic foot strengthening improved arch height and pain scores when added to traditional treatment.

Progression from isometric holds to dynamic balance challenges (e.g., single-leg stance with perturbation) can further enhance outcomes. Many sports physios combine this with Pilates-based physiotherapy or tailored exercise programs.

Integrative Treatment Planning

The most effective treatment plans combine several of the above strategies and adapt based on symptom chronicity, patient activity levels, and comorbidities (e.g., diabetes, obesity).

Here's a suggested 8–12 week plan:

Weeks 1–4: Emphasise stretching, taping, & education on load management.
Weeks 4–8: Introduce strengthening and orthoses. Consider ESWT if pain persists.
Weeks 8–12: Progress strengthening, reduce reliance on passive supports.

Rehabilitation should also address proximal control. Weakness in the glutes or poor single- leg mechanics can perpetuate excessive pronation. Physiotherapists and exercise physiologists can assist in assessing these movement patterns.covery.

Additional Considerations

Load Management: Gradually return to high-impact activities. Use pain as a guide.
Footwear: Supportive shoes with arch support and cushioning are essential.
Manual Therapy: Soft tissue release of the plantar fascia and calf muscles can complement active therapy. Massage services in areas such as Marrickville, Redfern, or Alexandria are often used in conjunction with physiotherapy.
Education: Address beliefs about pain—fear avoidance and catastrophizing are associated with worse outcomes.

While no single treatment works universally, a tailored plan incorporating stretching, orthoses, strengthening, and possibly shockwave therapy can significantly reduce symptoms and restore function. Early intervention, patient education, and combined care from physiotherapists and exercise physiologists are key to preventing chronicity and recurrence.

Special Considerations for Hamstring Injuries

Thu, 03 Aug 2023 06:38:21 GMT

Hamstring Injuries

Hamstring injuries are a common injury among athletes, particularly those involved in sports that require sudden changes of direction, explosive acceleration, and high-speed running. Rehabilitation after a hamstring injury can be a challenging process, and it is essential to understand the special considerations involved in the rehabilitation process to ensure optimal outcomes.

The latest evidence has shown hamstring injuries require assessment and treatment of multiple areas of the body such as lumbopelvic control, posterior chain strength and stability and hamstring strength in a fatigued state. Due to the complex nature of hamstring injuries and their relationship with the aforementioned areas, they have a high recurrence rate.

In this blog, we will discuss the special considerations for hamstring rehabilitation.

The Importance of Early Intervention

One of the most critical special considerations for hamstring rehabilitation is the importance of early intervention. Delaying rehabilitation can prolong the recovery time and increase the risk of re-injury. Therefore, it is essential to initiate rehabilitation as soon as possible after the injury.

Gradual Progression

Another important consideration for hamstring rehabilitation is the need for gradual progression. It is crucial to progress rehabilitation exercises slowly and steadily, focusing on regaining strength, flexibility, and mobility while avoiding overloading the hamstring muscles.

Eccentric Exercises

Eccentric exercises are particularly effective for hamstring rehabilitation. These exercises involve lengthening the muscle while it is under tension, which helps to promote muscle fibre remodelling and healing. Eccentric exercises can also help to improve muscle strength and reduce the likelihood of recurrence.

Sports-Specific Rehabilitation

Rehabilitation exercises should be tailored to the specific requirements of the athlete's sport. For example, athletes involved in sports that require high-speed running may benefit from incorporating high-speed running drills into their rehabilitation program. This approach can help to improve neuromuscular control, endurance, and power.

How Can High-Speed Running Help with Hamstring Rehabilitation?

The use of high-speed running as a rehabilitation strategy for hamstring injuries is based on the principle of progressive loading. High-speed running involves significant eccentric loading of the hamstring muscles, which can help to stimulate muscle fibre remodelling and improve muscle strength and endurance.

Evidence for High-Speed Running for Hamstring Rehabilitation

Several studies have explored the use of high-speed running as a rehabilitation strategy for hamstring injuries, with promising results. A systematic review published in the British Journal of Sports Medicine evaluated the effectiveness of high-speed running in the rehabilitation of hamstring injuries. The review analysed seven studies with a total of 301 participants.

The review found that high-speed running was effective in improving hamstring strength, running performance, and reducing the risk of re-injury. The review also found that high-speed running did not increase pain or re-injury risk compared to traditional rehabilitation programs.

Another study published in the Journal of Orthopaedic and Sports Physical Therapy evaluated the effectiveness of high-speed running in the rehabilitation of elite soccer players with hamstring injuries. The study found that high-speed running was effective in reducing the time to return to play, improving hamstring strength, and reducing the risk of re-injury.

The Role of Manual Therapy

Manual therapy can also be beneficial for hamstring rehabilitation. Soft tissue mobilisation techniques, such as soft tissue release, can help to improve blood flow, reduce muscle tension, and promote tissue healing. Joint mobilisation techniques around the lumbar spine and pelvis can also help to improve joint mobility, reducing the risk of further injury. This is integral as we work on ensuring the lumbopelvic region is working efficiently to allow the hamstrings to rehabilitate to their full potential.

Psychological Considerations

Recovering from a hamstring injury can be a frustrating and challenging process, and psychological consider a tions should also be taken into account during rehabilitation. It is common for people to experience the highs and lows of rehab & may benefit from working with a sports psychologist to help them cope with the emotional and psychological challenges of rehabilitation and stay motivated throughout the process. This is also integral for return to sport considerations as it can be a daunting experience after injury. Concerns of re-injury or not being able to perform at their pre-injury level is often felt and thus it is important for people to feel confident and mentally prepared to return to sport following a hamstring injury.

Conclusion

Hamstring rehabilitation requires special considerations to ensure optimal outcomes. Early intervention, gradual progression, eccentric exercises, sports-specific rehabilitation, manual therapy, and psychological considerations are all essential elements of an effective rehabilitation program. It is essential to work with a physiotherapist to develop a personalised rehabilitation program tailored to the athletes specific needs and goals.

Blood Flow Restriction (BFR) Training

Tue, 11 Jul 2023 04:11:58 GMT

Application and benefits during rehab.

Blood flow restriction (BFR) training involves restricting the blood flow to working muscles during exercise, resulting in hypoxia in the muscle tissue. It can be applied to both resistance and aerobic exercise; however, the purpose of this blog is to have a look at the potential benefits of using BFR during resistance-based exercise in rehab.

BFR resistance training has been shown to help increase muscle size and strength in young, old and load compromised populations (including post ACL replacement surgery and people suffering from OA). The greatest benefits of BFR training have been shown to occur during low-load resistance exercise, with some studies showing that muscle hypertrophy and strength adaptions using BFR are significantly greater than those achieved with low load resistance exercise alone.

Benefits of BFR during rehab

After sustaining an injury or having surgery, people will often struggle tolerating heavy loads through the affected area, which can cause an increase in pain during activity, reduce function and impact rehab and recovery timeframes.

During rehab for any type of injury, it is important to load and strengthen the muscles around the injured or painful structure, however pain (and injury) can often prevent a person from being able to perform the required exercises (or tolerate the required load during exercise) to actually achieve this increase in strength, which can often lead to slow progression during rehab.

This is where BFR training can be beneficial. BFR training can be used to get the most out of low-load resistance training for load compromised people who can’t tolerate heavy-load training during the early stages of rehab.

Applying BFR training to rehab

As mentioned above, BFR training can be a useful tool when trying to maximise the impact of low-load exercise during rehab. This can often be beneficial when pain/injury is impacting the ability to appropriately load the injured area in order to elicit a change in symptoms. A good example of this presentation in the clinic is during rehab following a patella dislocation or subluxation.

The sensitivity and reduced capacity to load the patellofemoral joint after this type of injury can make it hard to perform quadriceps strengthening exercises with adequate load to elicit a meaningful change in strength, which can lead to the development of compensatory strategies and slow progression during rehab. BFR can be used to help overcome this hurdle. Have a look at our Instagram here to see an example of a rehab session using BFR for a client who suffered a patella dislocation.

There are many other types of pain/injury that could benefit from the use of BFR at certain stages of rehab, such as managing OA pain and when recovering from ACL replacement surgery.

Overall, BFR can be a useful tool to use during certain stages of rehab; but just like all aspects of rehab there is no ‘one size fits all’ approach, so get in contact in you would like to discuss if BFR could be useful for you.

Reference for information

Hughes L, Paton B, Rosenblatt B, Gissane C, Patterson SD. Blood flow restriction training in clinical musculoskeletal rehabilitation: a systematic review and meta-analysis. Br J Sports Med. 2017 Jul;51(13):1003-1011. doi: 10.1136/bjsports-2016-097071. Epub 2017 Mar 4. PMID: 28259850.

The High Ankle Sprain. Syndesmosis Injuries.

Sun, 04 Jun 2023 08:00:23 GMT

The ‘High Ankle Sprain’ - Syndesmosis Injuries

Syndesmosis injuries, also known as high ankle sprains, are a type of injury that occurs in the ankle joint. Unlike traditional ankle sprains, which affect the ligaments on the outside of the ankle, syndesmosis injuries involve the ligaments that connect the tibia and fibula bones in the lower leg. These ligaments are known as the syndesmotic ligaments, and they help to stabilise the ankle joint during movement.

Symptoms of syndesmosis injuries can include pain, swelling, and tenderness on the front of the ankle. The pain is often located above the ankle joint and can be severe, especially during weight-bearing activities. In more severe cases, the individual may experience difficulty bearing weight on the affected leg and may have limited mobility in the ankle joint.

Syndesmosis injuries are often caused by a twisting or rolling motion of the ankle, which can occur during sports or other physical activities. They can also be caused by a fall or other trauma to the ankle joint. Individuals who participate in sports that involve jumping, cutting, or pivoting movements are at higher risk for syndesmosis injuries.

Diagnosis of syndesmosis injuries usually involves a physical examination of the ankle joint, as well as imaging tests such as X-rays or MRI scans.

The following is an example of a sports rehab program for an individual recovering from a syndesmosis injury:

Phase 1: Acute Phase (1-2 weeks)

Rest, ice, compression, and elevation to manage pain and swelling
Non-weight bearing with the use of crutches
Gentle range of motion exercises such as ankle circles and ankle pumps
Isometric exercises for ankle strengthening

Phase 2: Sub-Acute Phase (2-4 weeks)

Weight-bearing as tolerated
Active range of motion exercises such as calf loading and calf raises
Strengthening exercises such as calf raises, single leg balance exercises and posterior chain loading
Manual therapy techniques such as soft tissue massage and joint mobilisation
Sport-specific training

Phase 3: Functional Phase (4-6 weeks)

Plyometric exercises to improve power and agility
Sport-specific drills to improve coordination and balance
Proprioception and balance training
Advanced strengthening exercises such as squats, lunges, and lateral movements
Return to sport or activity with gradual progression and careful monitoring

It is important to note that every individual's rehab program will be different and will depend on the severity of their injury, as well as their overall health and fitness level. It is recommended to work closely with a qualified physiotherapist to ensure a safe and effective rehab program that is tailored to your specific needs and goals.

A systematic review published in the British Journal of Sports Medicine in 2019 found that early functional rehabilitation, which includes range of motion, strength, and proprioception exercises, can lead to better outcomes and faster return to sport for individuals with syndesmosis injuries compared to immobilization or surgery alone.

Another study published in the Journal of Orthopaedic Surgery and Research in 2019 found that a structured rehabilitation program that included progressive weight-bearing, range of motion, and strength exercises resulted in significant improvements in pain, function, and ankle range of motion for individuals with syndesmosis injuries.

In summary, syndesmosis injuries are a type of ankle injury that can be caused by a variety of factors. Prompt diagnosis and treatment are important for a successful recovery, and rehabilitation programs can help individuals return to their normal activities safely and effectively. By taking steps to prevent ankle injuries in general, individuals can reduce their risk of experiencing a syndesmosis injury and maintain good overall ankle health.

ACL Prehab

Fri, 17 Feb 2023 07:13:09 GMT

ACL Prehab

Injuring your ACL can be overwhelming, often you will be deliberating whether or not to get surgery while coming to terms with the long rehab process ahead. This blog will shed a bit of light on something that everyone should be doing after sustaining an ACL injury; Prehab.

What is ACL Prehab?

ACL Prehab is what is done between tearing your ACL and having surgery/performing rehab. It is the term used for the exercises and training that needs to be performed after sustaining an ACL injury and should be performed even if you are considering not having surgery.

What does ACL Prehab involve?

Prehab involves a block of supervised exercise sessions with a focus on lower body strengthening (particularly the quadriceps and hamstrings), knee mobility and stability/motor control. The timeframes and specific types of exercise will vary between different people, but the goal of prehab remains the same; maximise the chance of returning to your pre-injury level of activity and staying there.

Why is Prehab so important?

Performing a 5-week block of prehab training has been shown to increase the chance of returning to your pre-injury level of sport following an ACL replacement, it has also been shown to significantly improve knee function after ACL injury, regardless of whether you decide to have surgery or not (Eitzen et al, 2010).

Prehab also provides a great opportunity to perform some strength and hop testing, which will be used later in rehab. This testing will provide a good comparison for leg strength and function prior to returning to sport, doing this has been shown to help reduce the risk of reinjury by up to 75% (Capin et al, 2019).

The take home message.

A short block of Prehab has been shown to have a great impact on knee function after ACL injury and will increase the chances of having a good recovery and returning to your chosen sport or activity, regardless of whether or not you require surgery. Everyone who suffers an ACL injury should perform some amount of Prehab; if you have recently injured your ACL and would like to have a chat about Prehab, then get in touch.

Can the ACL Heal?

Thu, 09 Feb 2023 03:43:23 GMT

Torn ACL

The Anterior Cruciate Ligament (ACL) is the most important stabilising structure within the knee joint, most commonly injured through either a contact (eg being tackle) or non-contact (change of direction) mechanism. The classic symptoms are often reported to be hearing/feeling a pop in the knee joint, immediate swelling, and pain as well as feelings of instability.

Typically, hands on clinical assessments are very good at diagnosing an ACL rupture, however, imaging such as MRI is often used to assess whether there are any secondary injuries to other structures within the knee which may impact management.

We are so used to hearing about ACL injuries being season ending events reported within most sports media outlets, with many athletes going on to have around a 9–12-month rehabilitation before returning to sport.

It was widely accepted at one time that there are only 2 options for rehabilitation when someone has torn their ACL, either to have surgical reconstruction of the ACL ligament, using either a hamstring or patella tendon graft, or conservatively managing without an intact ligament through strengthening the muscles around the knee to provide stability.

However, there have been recent studies which have shown some spontaneous healing of ACLs on MRI imaging in patients who have undertaken conservative rehabilitation (Costa-Paz et al. 2012, Filbay et al. 2022)

So, it begs the question, surgical or conservative management? Well, what if there was a 3rd option?

The Cross Bracing Protocol

Exciting new findings were presented by Dr Tom Cross, a local Sydney Sports Physician, during a lecture held by the Australian Physiotherapy Association exploring the utilisation of a novel bracing protocol to promote natural healing of the ACL. The protocol is described as 4 weeks in a Range of Motion brace locked at 90 degrees of knee bend, with the next 8 weeks the brace slowly being let out to full knee extension. The reason for this is that by placing the knee in that position, it allows for the greatest chance for the two torn ends of the ACL to be aligned as closely as possible and hopefully lead to healing.

Dr Cross’ preliminary work has shown that by following this protocol, 82 out of 84 patients demonstrated a healed ACL at 6 months post injury.

Whilst there are many factors that go into which patients are offered the protocol and which have the greatest chance of healing, this case series demonstrates that there is an ability for the ACL to be able to heal on its own. This would allow for patients to be able to avoid possible risks of surgery, such as infection, whilst also having an intact ACL which would arguably allow them to return to sport in a quicker time frame.

If you currently have an ACL injury or any knee injury which requires rehabilitation, you can book online via the website or chat to our friendly staff on 9194 1800 to book a detailed initial assessment and management plan to get you back to doing the things you love!

References:

Costa-Paz, Ayerza, M. A., Tanoira, I., Astoul, J., & Muscolo, D. L. (2011). Spontaneous Healing in Complete ACL Ruptures: A Clinical and MRI Study. Clinical Orthopaedics and Related Research, 470(4), 979–985. https://doi.org/10.1007/s11999-011-1933-8

Filbay, Roemer, F., Lohmander, S., Turkiewicz, A., Roos, E. M., Frobell, R., & Englund, M. (2022). 32 Spontaneous healing of the ruptured anterior cruciate ligament: observations from the KANON trial. BMJ Open Sport & Exercise Medicine, 8(Suppl 1), A3–A3. https://doi.org/10.1136/bmjsem-2022-sportskongres.

Elite Physiotherapists and Sports Injury Experts Near Rosebery

Tue, 18 Oct 2022 14:21:20 GMT

Alexandria Physiotherapy & Sports Injury

If you're looking for expert physiotherapy and top-tier injury management near Rosebery, Alexandria Physio is your trusted choice! As Rosebery physio experts, our team of elite physiotherapists has been helping a diverse range of individuals from all over Sydney, including the nearby areas of Zetland, Mascot, Alexandria, and Green Square, achieve their health and fitness goals for years.

At Alexandria Physio, we pride ourselves on creating a welcoming, supportive, and inclusive environment. We understand and respect the diverse backgrounds, values, and cultures of our clients, ensuring that everyone feels comfortable and heard during their physiotherapy journey. Our compassionate team is dedicated to providing personalised care that aligns with your unique needs and lifestyle.

Our clinic, located just a short drive from Rosebery, is renowned for providing exceptional sports injury treatment, rehabilitation, athletic screening, and recovery & wellness services. Whether you’re recovering from a sports-related injury or looking for preventative care to avoid future injuries, we’re here to help you get back on your feet stronger than ever.

Why Choose Alexandria Physio—Rosebery Physio Experts for Injury Recovery?

Our clinic’s approach blends advanced techniques, hands-on care, and personalised programs, making us the go-to experts for sports injuries, musculoskeletal pain, and post-op rehabilitation. From muscle strains and tendonitis to more complex issues like neck and back pain, we use targeted treatments that restore mobility and prevent long-term injury, making us Rosebery’s best physios for pain relief and recovery.

Convenient Location Just Minutes from Rosebery

Situated on Fountain Street in Alexandria, we’re easily accessible for those in Rosebery and surrounding suburbs like Zetland, Mascot, and Green Square. Our location is just a few minutes’ drive from key areas like Gardeners Road, The Cannery precinct, and Eastlakes Shopping Centre, making it convenient for students, professionals, and families looking for physio experts near Rosebery.

Comprehensive Physiotherapy Services by Rosebery Physio Specialists

At Alexandria Physio, we offer a wide range of services designed to treat your specific needs. Whether you're dealing with a recent injury or managing a long-term condition, our team of physiotherapists is equipped to help you achieve optimal health:

Sports Injuries: Whether it’s a sudden injury or an overuse issue, our experts will develop a detailed and data-driven sports-specific program to restore strength and mobility.
Neck and Back Pain: Our therapists are experienced in treating common neck and back issues that hinder daily activities and quality of life.
Post-Op Rehabilitation: We offer structured rehab programs post-surgery to ensure smooth and effective recovery, no matter the procedure.
Dry Needling: For relief from chronic pain, our dry needling techniques target trigger points in muscles to restore normal function.

We also offer specialised services such as ergonomic assessments and onsite physiotherapy for businesses, as well as injury prevention and performance enhancement programs via our partner company, InTouch Physiotherapy.

Book an Appointment with Leading Rosebery Physiotherapists

Looking for the best physiotherapy and sports injury treatment in Rosebery? Book your appointment today with leading Rosebery physio experts and take the first step toward recovery.

FAQs about Physiotherapy near Rosebery

What conditions do your physiotherapists treat? We specialise in treating sports injuries, post-surgical rehabilitation, chronic pain, and musculoskeletal conditions.
How do I book an appointment at Alexandria Physio? You can book online or call us at 02 9194 1800.
Do you offer physiotherapy for workplace injuries? Yes, we provide ergonomic assessments, injury prevention programs, CTP and WorkCover-approved treatment plans.

No matter where you're coming from, our dedicated team is here to support your journey to better health. You don’t have to travel far to receive the best physiotherapy and sports injury care – book your appointment online today or contact us to learn more about how we can help you recover and thrive.

Don’t Ignore the Niggle!

Sat, 15 Oct 2022 04:32:46 GMT

Don’t Ignore the Niggle!

With the start of the sporting season upon us, it’s not surprising to see more people out and about, going for a jog around Sydney Park or beginning their community sporting endeavours with the local soccer or footy club.

Unlike professional sports stars however, much of the general population who like to play organised sport don’t have the luxury of having a preseason and an ability to reintroduce the body to the loads that they will be experiencing during the season. Due to this, many people may begin to experience niggling injuries in the hamstrings and calves, knees, ankles and groins when they begin their training. If ignored, these may turn into a more serious or chronic injury during the season and prevent you from playing the sport you love!

Can niggles prevent me playing my chosen sport?

To demonstrate this point further, a recent study published in 2020, which looked at whether injuries that do not result in time away from sport (i.e. niggles) increase the risk of someone suffering a time-loss injury where they are unable to complete their sport for a period of time.

The study looked at 218 semi-professional football players in NSW, all participating in at least 3 football-based sessions per week (for example 2 trainings and 1 game). They completed screening questionnaires at every training session and game day over a 35-week period, which was designed to pick up on time-loss and non-time loss injuries respectively.

So, what did they find?

Over the 35-week observation period, the researchers found that within the test subjects, time-loss injury risk was 3-6x higher when a non-time loss injury (niggle) was reported in the past 7 days. As well as this, 33% of participants reported some kind of injury, whether it was a time-loss or non-time loss injury, each week.

What does this mean?

The most important message from this study is to listen to your body! Think of a niggle as an early warning sign from the body telling you that you are potentially at risk of having a bigger injury.

Our advice – Nip it in the bud!

What should I do if I get a “niggle”?

Come and see us! Our friendly team at Alexandria Physiotherapy and Sports Injury are here to help! Our physiotherapists will listen to your story as well as perform a comprehensive physical assessment to diagnose your injury. Following this, we will work with you to design a tailored rehabilitation program to get you back to doing what you love better than ever!

Reference:

Matthew Whalan, Ric Lovell & John A Sampson (2020) Do Niggles Matter? – Increased injury risk following physical complaints in football (soccer), Science and Medicine in Football, 4:3, 216-224, DOI: 10.1080/24733938.2019.1705996

Five Things We Want You to Know After 18 Months of Lockdown

Sat, 15 Oct 2022 04:31:46 GMT

1. Back and neck pain is more present than ever

As Physiotherapists, we often see clients who present with back and neck complaints, however in the last 18 months it has been rife. Most Physiotherapists would agree that neck and back issues have been the common trend during the pandemic, with many clients attributing their symptoms to changes to their working environment.

Most of these complaints are musculoskeletal in nature and we’ve learnt that there is several variables that are attributing to such increases. You’ve been working in an office job for several years without issues and are now experiencing more pain than ever – why is that? Is it because you are working from home without an ergonomic office chair or sit-stand desk, or is it more complicated than that?

My take away message – keep reading!

2. Your posture may not be the main cause

Have you been spending more time working from the couch or the kitchen bench and noticing that you’re slumping more than ever? Is this the reason for your pain?

What if I told you that it isn’t about the posture, but more about the fact that you’re spending too long in that static position. The longer you spend in that posture, the less time you’re moving.

I’ve never been and will never be a Physio to promote the ‘perfect posture’ of sitting up tall with your shoulders and neck back. What I do promote however is an ‘ever-changing posture’ – one that promotes lots of breaks, differences in movement patterns and avoiding long static positions.

If I sat for 8+ hours a day hunched over my desk and didn’t change my position, of course I’d have aches and pain. However, if I sat for 8+ hours, upright and my shoulders and neck back in the ‘perfect posture’ and didn’t change my position, I’d still have aches and pains.

My take away message – it is fine to have ‘poor posture’ just as much as it is to have ‘perfect posture’, but as long as you aren’t spending too long in either position.

3. A lack of incidental exercise is the main problem

With our exercise routines taking a shake up in the last 18 months, we’ve had to come up with new ways to keep active. All you have to do is look at your local park or walking track to see more people running, walking their dogs or performing 1 on 1 PT sessions. Despite this, the incidental exercise that we’d normally complete in our day to day lives have been greatly impacted.

The walk or ride to the train station, the walk to get your local café or browsing shops in your lunch break – all of which have become a distant memory for most throughout lockdown. It is this type of movement that increases your daily exercise volume and promotes constant movement.

My take away message – movement is medicine & this is the best way to prevent a several aches and pains!

4. Slow and steady wins the race

With the closure of gyms, a lot of us have taken up running. But for many, running is a new form of exercise that we don’t have much experience doing. We’ve seen a large proportion of clients go from running very little to running high weekly volumes in a short period of time. Four to six weeks later, I’m seeing the presentation of lots of knee and heel pain and people are wondering why?

Similar to an increases in neck and back pain, tendon overload issues (i.e. tendinopathies) have also increased. This is an overuse injury that occurs when the load placed on the tendon exceeds the capacity it can withstand. In short – you haven’t prepared your muscle to be able to cope with the amount of running volume in such a short period of time.

My take away message – don’t listen to Drake and go “ 0 to 100 real quick”.

5. It’s a different world we live in!

We are living in an unprecedented situation and going forward, the world will be a very different place. We must adapt, learn and move forward as better versions of ourselves. Never under-estimate the impact that mental health has on our physical health. The last 18 months have been a challenging time psychologically and many have experienced immense amounts of pressure and grief.

My take away message – remember to check in on the wellbeing of family and friends and we will get through this together!

What is Causing My Groin Pain?

Sat, 15 Oct 2022 04:31:39 GMT

Groin pain.

The hip adductors, commonly referred to as your Groin muscles, are a group of muscles which lie on the inside of your femur (leg bone) and move your leg inwards across your body. They originate from your pubic bone then migrate along the inside of your leg inserting at various point along your inner thigh and leg.

There can be numerous causes of groin pain from musculotendinous neurological and internal bony and cartilage structures in the pelvic region. This can make differentiating between diagnoses extremely difficult due to the overlapping nature of various pathologies. Groin pain pathologies can include adductor tendinopathies, osteitis pubis (pelvic overload syndrome), sports or inguinal hernia, iliopsoas bursitis, stress fracture, avulsion fracture, nerve compression, snapping hip syndrome, and others.

What is known however, is that adductor related pain or injuries are one of the most common cause of injury in team sports such as football, with one of the main risk factors being low strength levels of the associated musculature. Muscle synergy and balance around the pelvic region is also extremely important as evidenced by one study which found athletes were 17 times more likely to sustain an adductor muscle strain if their adductor strength was less than 80% of their abductor (gluteus medius, gluteus minimus, and tensor fasciae latae) strength.

TENDINOPATHY:

One of the common adductor pathologies that is prevalent in athletes and weekend warriors alike is adductor tendinopathy. As with any other tendinopathy, it is non-inflammatory damage to a muscle tendon resulting from a failure to adapt to loading – primarily due to a rapid increase in intensity, frequency or duration of training with insufficient time to recover. This leads to a reduction in the load bearing capacity of the tendon and result in pain and weakness with movements around the hip. Due to the diverse nature of intrinsic, extrinsic and environmental factors that can lead to a tendinopathy of the adductors, different treatment interventions are required that take into account the specific mechanisms of injury.

PHYSIOTHERAPY MANAGEMENT

With Adductor Tendinopathies, passive treatments such as stretching, massage, mobilisations and cryotherapy may alleviate symptoms in the short term, but they do little to rectify the problem or safeguard against further damage or degeneration. The focus of treatment should be on load management, strengthening and behaviour management. Recovery can vary greatly between individuals depending on the level or stage of degeneration in the tendon.

In recent years, glute exercises have been given all the attention when it comes to athletic development and rehabilitation. Little attention however is paid to the adductors beyond the old “stretch your groin” advice. Adductor strengthening is an essential component of athletic performance and developing single leg control/ stability. The added benefit of adductor exercises is injury prevention for the groin, especially when the sport involves sprinting, cutting or changing direction quickly. A Copenhagen Side Plank like the one below can help reduce the risk of groin strains.

The aim of rehabilitation should be to restore muscle and tendon properties. Strength training is proven to be beneficial to the tendon matrix structure, muscle properties and limb biomechanics. There is some disagreement on the most appropriate type of strength training in rehabilitation with respect to isometric, eccentric and isotonic loadings. Previously, evidence has suggested that an eccentric (loading whilst lengthening the muscle) based exercise programme is the most effective exercise for improving both pain and function in the tendon. More recently however, heavy isometrics (resisting load, but without movement) are showing to be more effective in the early stages of degeneration or in the acute injury stage. What is certain however, is that tailoring the type of exercise to the athlete’s specific sport and training load based on their relative pain tolerance is extremely effective in the rehabilitation of tendinopathies.

IMPORTANT POINTS TO NOTE:

Complete rest may alleviate symptoms but will not rectify the tendon issue. Relative rest in the form of load management is the most appropriate intervention with a guide of no more than 3/10 pain for activity which is achieved through altering speed, distance, intensity and frequency of training.

Strengthening abdominal core muscles is also recommended to support the adductors during activity as well as hip flexor exercises.

In acute cases, a return to a normal function can be within in a few weeks, but in more chronic cases, rehabilitation can take a number of months before returning to normal, pain free, activities.

To prevent the development of adductor tendinopathy, an athlete should ideally engage in a strength and conditioning programme to work on the factors mentioned, such as improving strength and coordination of the muscles, but allowing sufficient periods of recovery and adaptation in between training sessions, i.e. not too much training too soon.

When all else fails, and despite your best attempts to rehabilitate the injury, surgery may be the appropriate course of action if symptoms persist or deteriorate, and for those for those who are prone to recurrent tears. Keep your eye out for our upcoming blog on surgery and rehabilitation for chronic adductor tendinopathy.

I Have Knee Pain. Should I Get A Scan?

Sat, 15 Oct 2022 04:31:38 GMT

I Have Knee Pain – Should I Get A Scan?

A question we are often asked is whether you should get a scan on your knee. Despite there being numerous times where a knee scan can be beneficial to assist with further investigation – is it always required?

An interesting article was published in 2020 which looked at identifying how common it is to display abnormalities in individuals without knee pain. The results are interesting and can help provide some great insight into how/why a scan does not always correlate to pain.

In the study, 230 knees of 115 uninjured and asymptomatic sedentary adults were scanned using a high powered MRI machine. Of this cohort, there were 51 males and 64 females, with a median age of 44 years. All participants had both knees scanned. Two senior musculoskeletal radiologists assessed the scans and graded all intraarticular knee structures using validated scoring systems.

The Results

97% of the knees scanned displayed abnormalities!! (227 of the 230 knees)

This was broken down into the following abnormalities:

33% – Meniscal Tears (Horizontal 23%, Complex 3%, Vertical 2% & Bucket Handle 1%)

57% – Cartilage abnormalities at the patellofemoral joint

48% – Bone Marrow Abnormalities at the patellofemoral joint

19% – Moderate Cartilage lesions and bone marrow oedema

31% – Severe Cartilage lesions and bone marrow oedema

21% – Tendon Lesions (Patella Tendonitis accounted for 11%)

3% – Partial Ligament Tears (ACL Partial Tears accounted for 2%)

So, what does this mean?

You are not your scan! A scan does not always correlate to the pain you are experiencing, and the results have been mirrored in other parts of the body across numerous other research articles. As Physiotherapists, we always aim to listen to your story and your history, assess your biomechanics and functional assessment before we look at your scans.

And even though you will likely have some changes on your scan, this doesn’t mean that you can’t return to full, pain-free function.

If you are unsure of your scan findings, have knee pain or need some further advice – be sure to get in contact with our team at Alexandria Physiotherapy.

Reference:

Horga, L. M., Hirschmann, A. C., Henckel, J., Fotiadou, A., Di Laura, A., Torlasco, C., D’Silva, A., Sharma, S., Moon, J. C., & Hart, A. J. (2020). Prevalence of abnormal findings in 230 knees of asymptomatic adults using 3.0 T MRI. Skeletal radiology, 49(7), 1099–1107.

Immediate Management of Soft Tissue Injuries

Sat, 15 Oct 2022 04:31:35 GMT

Immediate Management of Soft Tissue Injuries- PEACE and LOVE

Common and well-known principles of soft tissue injury management include principles such as RICE and Police, but there is so much more complexity to the management and rehabilitation of soft tissue injuries. These well-known methods focus on the acute management of soft tissue injuries and do not really provide any information on the sub-acute and chronic stages of soft tissue healing.

However, the British Journal of Sports Medicine has spent much time studying the literature and they now suggest the use of these two new acronyms to optimise recovery.

P.E.A.C.E. for initial injury management and L.O.V.E. for subsequent management.

PEACE

PROTECT

Unload or restrict movement in the area for 1 to 3 days. This may require the use of crutches for a leg injury, or a sling for the arm.

this reduces bleeding
minimises further damage
reduces risk of aggravating injury

Let pain guide removal of protection and gradual reloading

ELEVATE

Elevate the injured area above the level of your heart to reduce swelling.

this promotes fluid flow out of the injured tissue
although poor evidence for it – it still is recommended as there is a low risk-benefit ratio

AVOID ANTI INFLAMMATORIES

During the acute phase anti-inflammatories can inhibit tissue repair. Simple analgesics like paracetamol can be used for pain relief.

Optimal soft tissue regeneration is supported by the various phases of the inflammatory process. Making use of medications to inhibit the inflammatory process could impair the healing process

AVOID ICE

use of ice is mostly analgesic
although it is widely accepted as an intervention there is very little high quality evidence that supports
the use of ice in the treatment of soft tissue injuries

COMPRESS

External mechanical compression with a brace, bandage or taping can reduce local swelling and prevent further bleeding within the injured tissues.

EDUCATION

Speak with your physical therapist about the injury and get a guideline for recovery and a therapy plan. Set goals about recovery times and expectations. Understand that restrictions for loading the injured area is only a temporary protective measure for the first 2 to 3 days.

There are many benefits of an active approach to recovery instead of a passive approach
Patients need to have a better understanding of their condition. This is achieved through consultation with your physiotherapist to set realistic expectations and recovery times

LOVE

“After the first days have passed, soft tissues need LOVE”

LOAD

An active approach, with movement and exercise, benefits most injuries. Loading or stressing the joint or muscle (essentially making it work) within the limits of pain early on, actually promotes healing and stimulates tissue repair.

Optimal loading without increasing pain

promotes repair and remodelling
builds tissue tolerance and capacity of tendons, muscles and ligaments

OPTIMISM

The brain plays a significant part in rehabilitation interventions. Science has shown that depression, fear and catastrophising about an injury and the recovery, can actually result in worse outcomes and a worse prognosis. Stay realistic but optimistic to improve the chances of optimal recovery.

VASCULARISATION

This is a fancy word for improved blood supply to an area. Better blood flow means more oxygen and nutrients to the injured tissue which ensures good healing. Moving and working the joint or muscle and exercising the tissues around the area will increase blood flow to the injured site

Pain free cardiovascular activity is a motivation booster and it increases blood flow to injured structures
Benefits of early mobilisation and aerobic exercise in people with musculoskeletal disorders include:
improvement in function
improvement in work status
reduces the need for pain medication

EXERCISE

Controlled exercise, within pain limits, is key from the beginning of your recovery. Restoring mobility and building strength will speed up your recovery and help prevent a recurrent injury

Evidence supports the use of exercise therapy in the treatment of ankle sprains and it reduces the risk of a recurring injury
Benefits of exercise:
restores mobility
restores strength
restores proprioception, early after an injury
Avoid pain to promote optimal repair in the subacute phase
Use pain as a guide to progress exercises gradually to increased levels of difficulty

The management of soft tissue injuries , whether it is a hamstring strain or an ankle sprain, should not just focus on short-term damage control. Rehabilitation should also focus on long-term outcomes and management.

Understanding the Low FODMAP Diet

Fri, 12 Aug 2022 01:04:39 GMT

Low FODMAP Diet

If you suffer from IBS (Irritable Bowel Syndrome), there’s a high chance that you have heard of the low FODMAP diet – you may have even started one and feel better! The low FODMAP diet is broken down into three phases: elimination, reintroduction and personalisation. Understanding these three stages and working through them with a dietitian is key to getting the most out of the diet and controlling your symptoms long-term.

What is IBS?

IBS is a collection of unpleasant symptoms such as abdominal cramping, pain, bloating, diarrhoea and/or constipation. Unfortunately, it affects around one in five Australians at some point. Its cause is often unknown but, in some cases, it can be triggered by gastro or food poisoning. Psychological stress and genetics have also been implicated in the development of IBS.

FODMAPs explained

The low FODMAP diet was a breakthrough for IBS suffers. FODMAPs, stand for Fermentable, Oligosaccharides, Disaccharides, Monosaccharides and Polyols. FODMAPs are a type of carbohydrate found in certain foods that are poorly absorbed in those with IBS. They then act as a food source to bacteria and ferment in the gut causing all those troubling IBS symptoms mentioned.

The 3 Phase of a Low FODMAP Diet

The low FODMAP diet should not be a lifelong diet. Rather it is an investigative tool to work out your IBS triggers so you can make better informed food choices to help you live more comfortably.

Phase 1: Elimination

To be commenced under the supervision of a dietitian, this phase involves eliminating all high FODMAP foods from the diet for a period of 2-6 weeks. Many begin to feel better as early as a few days into the elimination phase, but for some, it can take a few weeks. So, don’t be discouraged! The better you stick to this phase the more accurate the results. Your dietitian will help determine how long you spend in this phase, but it should never be long-term, no matter have great you feel.

Phase 2: Reintroductions (or challenge steps)

This phase involves reintroducing high FODMAP foods back into the diet in a methodical way to determine which trigger symptoms and which do not. It is the most informative phase of the diet and can often produce surprising results! As each FODMAP is reintroduced it is important that your background diet remains low in FODMAPs to ensure an accurate result. A dietitian is crucial during this phase to help interpret your responses. This phase can take 6-8 weeks to complete.

Phase 3: Personalisation

The last phase of the low FODMAP diet involves establishing your longer-term, personalised FODMAP diet. Initially this will involve reintroducing FODMAPs that were well tolerated and avoiding those that triggered your symptoms. Determining your thresholds of those FODMAPs that did trigger symptoms is the final step and important to expand the variety of your diet and allow as much food freedom as possible. Thresholds can change over time too, so if there are FODMAPs you didn’t tolerate well during the challenge steps, try again in a few months and see if anything has changed.

As you can see, the low FODMAP diet is an involved multiphase diet. The end goal is to eat as freely as possible without triggering IBS symptoms.

If you are suffering from IBS, or have started a low FOMDAP diet but are not sure what is next, you can book an appointment with our dietitian Fiona here .

Help! I’ve Got a Grumpy Shoulder

Mon, 04 Jul 2022 03:10:19 GMT

I’ve got a grumpy shoulder

Last year, I injured my shoulder in COVID-19 lockdown whilst completing a bench press at the gym. Having an injured shoulder caused me to be frustrated and anxious as I was unable to continue with my training program. Being on the ‘other side of the fence’ dealing with an injury highlighted some aspects of recovery which I feel are worth reminding you about!

Shoulder injuries are very common and often are incorrectly prescribed with “rest” and other passive management tools such as cortisone injection to treat the pain and inflammation. However, the root cause of the shoulder pain is often not assessed and treated appropriately, and this predisposes you to getting persistent shoulder pain or a GRUMPY shoulder!

Do any of these common shoulder complaints relate to you?

I get pain in my shoulder:

when I reach out into awkward rotated positions behind me. ‘I have difficulty putting on shirts/clothes overhead or grabbing the seat belt in the car.’
after completing a task (cleaning/gardening/painting) for over an hour (or even less). ‘I avoid doing these tasks because of the pain.’
during certain exercises in the gym. ‘I am frustrated as this stops me working out/ going to the gym and building strength.’
when sleeping on my side through the night. ‘I’ve tried sleeping on my back, but I can’t fall asleep and wake when I roll onto that side.’

My best advice is that you need to listen to your shoulder. Ignoring the pain can lead to persistent symptoms, further weakness and breakdown of tissue, and therefore chronic pain. Many of our clients we see at Redfern Physio have a Grumpy Shoulder for several weeks or months before they present to our practice.

This chronic overload of the shoulder usually causes pain which we labelled as “rotator cuff related shoulder pain”. This incorporates the following:

Rotator cuff tendinopathy or tendinitis
Partial / Full thickness tears of the rotator cuff muscles
Subacromial bursitis
Subacromial or rotator cuff impingement syndrome

Often it is not “just the shoulder” causing pain, but an overload in the muscles around the shoulder blade, mid-back and neck. A thorough physiotherapy assessment will aim to assess the compensatory movement patterns that have caused pain into the shoulder.

What’s our message here? If you experience pain in your shoulder whilst gardening, don’t expect it to improve if you continue to ‘push through’. If you hurt your shoulder at the gym, you will need a minimum of period of reduced intensity of that activity as well as a period of physiotherapy and rehab to get you back to lifting at your best. You must pace yourself back to your normal activities over a period of time, usually several weeks.

I had the most benefit after a physio assessment, which gave me a clear diagnosis with a physiotherapy management plan to work with me on my weakness and reduce my fear of reinjury. I am now able to train without any pain. Next time you come into the clinic, make sure you ask about my story with my shoulder injury!

For detailed advice and an individual management program contact our team at Redfern Physio on (02) 9194 1800, or book now by clicking Book an appointment

Muscle Tightness. To Stretch or To Strengthen.

Mon, 04 Jul 2022 03:05:00 GMT

Feeling Tightness: To Stretch or Strengthen?

Feeling “tight” is something we have all gone through in life at some stage. Whether that is after sitting at our work-desks for hours on end and getting a gripping discomfort in our neck or after a hard day training session and feeling like we can’t move our legs properly. You’ve clicked on this blog to find out how to deal with it. But before we do that, we need to take a bit of a dive into what tightness is.

What is Tightness?

Contrary to common belief, tightness is not mechanical but a feeling. It is not the same thing as physical stiffness in a joint or shortness in a muscle causing a decrease in range of movement.

Often, we may see someone come through the door complaining of tightness in their hamstrings after increasing their running; but on physical assessment they are able to touch the floor. And on the flip side of that, there are people who can barely reach past their knees and don’t complain of any feeling of restriction, discomfort or tightness in their hamstrings.

A study by Stanton et al. 2017 hypothesises that back “stiffness” is a “perceptual protective construct” rather than biomechanics. Those who feel stiff, are self-protective; over-estimating forces applied to their spine but also more acute at detecting small changes in force. This perception can be altered with audio input without changing actual stiffness.

This study is much in line with recent Pain Science pioneered by Professor Lorimer Moseley; providing evidence for the fact that pain can exist in the complete absence of physical tissue damage.

Using this study, we can reason similarly that tightness is a protective construct and that when we feel tight, it is our body trying to protect us against the stresses we are placing on it; whether that is sitting for excessively long periods or pushing a Couch to 5 km running program a bit too enthusiastically.

Why Am I Feeling Tight?

The precipitating factors that would have led to your specific individual tightness can only be accurately assessed by a thorough history and objective examination.

However, in a nutshell, feelings of muscle tightness are usually a sign that the loads we are placing on our tissue are exceeding their capacity.

For example, dramatically increasing your running load over a few weeks to prepare for a Marathon or heading back into your first few training sessions after the Off-Season, may cause tightness in certain muscles of the legs. This is a sign that we are doing a little too much and placing ourselves at a much greater risk of injury if you were to continue or increase that work-rate.

On the other hand, you may feel tight after long days sitting at the desk. This is likely due to a lack of endurance in the muscle, inadequate blood flow to them and a build-up of metabolic stress. The feeling of tightness is literally urging you to get moving.

How do I fix tightness?

Given that tightness is a subjective sensation and not reflective of joint stiffness or muscle shortening; all the stretching in the world will not be of much use unless there was in fact a biomechanical restriction.

Resistance Training on the other hand, has been shown to create local adaptations in muscle to improve their endurance and reduce the likelihood of metabolic distress and feelings of tightness.

Furthermore, Resistance Training will increase the load capacity of tissue and minimise the risk of actual injury.

Research has also shown that exercise has an analgesic effect and can reduce Central Nervous System sensitivity.

Next time you are feeling tightness in your upper traps after sitting for too long, try some Shrugs rather than Stretching it out and see how you feel?

“You Can’t Go Wrong, Getting Strong”

For a more comprehensive assessment of all the Contributing Sport, Work and Lifestyle Factors that may be contributing to your tightness; book in with one of our Physiotherapists for a Consultation to identify and address the underlying issues before it turns into Pain.

How To Help Your Shin Splints

Mon, 04 Jul 2022 02:59:57 GMT

What Are Shin Splints?

Shin splints are a common overuse injury characterised by pain along the front of your lower leg near your shin bone. This pain is due to irritation from the overloaded tendons and muscles along the tibia or ‘shin bone’ constantly creating friction and inflammation at their attachment onto the bone.

Shin splints are common among:

Runners
Dancers
Athletes in sports that require a lot of running on hard surfaces (like tennis), or with unsupportive shoes like rugby/football boots

What Causes Shin Splints?

extended periods of running on hard surfaces
overexertion of your lower leg muscles
not stretching adequately
stiff and/or weak calf muscles
poorly fitted or worn out footwear
increasing your training loads suddenly
flat feet or high arch feet
weak gluteal muscles, weak foot/ankle stabilising muscles

If you experience pain in your shin area during exercise, we advise that you do not continue as the pain will only be exacerbated, causing it to prolong symptoms and recovery.

A few tips to help you prevent shin splints include:

Wearing shoes that fit adequately and comfortably
Invest in shoe inserts (orthotics) if you have flat feet or high arches
Consulting your physiotherapist to perfect your running stride
Replace your shoes often
Gradual build up in your training level to prevent injury
Embrace cross-training to avoid overusing the muscles in your lower legs
Be sure to always maintain a good stretching program
Have an adequate dynamic warm-up before any exercise
Strengthen your hips, ankles, and core muscles

How Can My Physio Help Shin Splints?

Getting assessed by a physio will help you understand the condition so that you can better learn how to manage it. During your physio sessions for shin splints, you will likely be treated with:

Lower leg soft tissue releases
Strapping or taping
Strengthening exercises for weak ankles, hips, or core muscles tailored to your individual needs
Self-release techniques and stretches for tight muscles
You will also be given specific advice, tips, and suggestions to help manage the pain and get you on the path to recovery.

While you’re being treated for shin splints by a physio, it is advised you are taking relative rest by reducing or completely stopping the aggravating activity – pushing through the pain will only make things worse!

Shin splints can be very frustrating if you ignore it and fail to get the appropriate treatment. For detailed advice and an individual management program contact our team at Redfern Physio on (02) 9194 1800, or book now by clicking Book an appointment

Five Healthy Lunch Ideas for Work

Mon, 04 Jul 2022 02:53:12 GMT

5 Healthy Lunch Ideas for Work

Have you found yourself returning to work and slipping straight back into the same boring lunch routine as last year? Or maybe you’ve started relying on takeaway often because you’re lacking inspiration in the kitchen. It can take a while to get back on track with meal prep after a break, so here are 5 delicious and easy lunch ideas for work to help get you started:

The classic sandwich

Sandwiches are often overlooked when it comes to healthy lunches, but the fact is, they can be one of the quickest and easiest, balanced meals around. There are plenty of healthy breads to choose from when making a sandwich – wholegrain, sourdough, rye and spelt are all wholegrain options high in fibre and packed with nutrients. As for what goes between the bread, the options are endless! Aim to include the following for a satisfying and nutritious sandwich:

Protein: chicken, canned fish, lean meat, tofu
Vegetables: grated carrot, beetroot, cucumber, tomato, roasted capsicum, baby spinach, shredded cabbage
Healthy spread: nut butter, hummus, cottage cheese, avocado

Healthy burrito bowl

Burrito bowls are versatile, tasty and require minimal prep time, making them an ideal work lunch. Using precooked brown rice and canned legumes helps this nutritious meal come together in no more than 5 minutes. Simply add brown rice to a bowl (or multiple containers if meal prepping for the week ahead). Add drained and rinsed legumes, and a variety chopped salad vegetables. Top with some chopped avocado and some grated cheese. Simple as that!

The ultimate salad

It is a common misconception that salads are boring, but they don’t have to be! Preparing a salad that is healthy and tasty is possible, and a great option for work lunches during the warmer months. Here are 4 elements to include:

Protein – to keep you feeling nice and full. Choose from chicken, fish, eggs, legumes, tofu or lean red meats and aim to fill ½ of your salad bowl.
Carbohydrates – to boost your intake of fibre and micronutrients and to give you energy too! Opt for whole grains such as brown rice, quinoa, barley, whole grain bread.
Vegetables (and fruit) – get creative and colourful to keep it interesting. Spinach, mixed leaves, rocket, grated beetroot, snow peas, mushrooms, shredded cabbage, roasted capsicums, mushrooms, grated apple or even blueberries work wonderfully in salads.
Flavour – think nuts, seeds, hummus, guacamole, olives, sun-dried tomatoes, crumbled feta, fresh herbs and pesto. These are the ingredients to jazz up your salads. Drizzle salads with homemade dressing made with extra-virgin olive oil to avoid added salt and sugar in store-bought varieties.

Rice Paper Rolls

Rice paper rolls are quick and easy to make, and are a great change for the lunchbox, especially when the weather is warm! You can fill them with a huge variety of ingredients. By adding some protein such as shredded chicken breast, prawns, tofu or tempeh they will make a substantial and satisfying lunch. Aim to add plenty of colourful vegetables, and fresh herbs as well as cooked vermicelli rice noodles. A dipping sauce of equal parts fish sauce, sesame oil and soy sauce plus some lime juice and chopped cashew nuts is a delicious addition!

Simple veggie frittata

Frittatas are a great way to use up all the leftover vegetables in your fridge at the end of the week and are ideal for work lunches. They can be eaten warm or cold, and are loaded with veg, protein and healthy fats, so are super healthy for you! Simply transfer any cooked and cooled vegetables of your choice into a mixture of whisked eggs and milk. If you have time, roast the vegetables for extra flavour! Pour into a greased pan and bake in the oven until set through. Serve with a slice of wholegrain bread and side salad. Easy and so nutritious.

Food & Mood

Fri, 26 Nov 2021 01:17:00 GMT

Food & Mood

Depression and anxiety are the most prevalent mental health conditions worldwide affecting a large portion of the population. Many aspects of lifestyle are important factors in keeping healthy, both physically and mentally. The relationship between food and mood has gained particular interest recently.

A number of studies have already demonstrated that a good quality diet is important in reducing the risk of mental health disorders. However, the idea of food having the ability to improve mood and clinical outcomes for those with existing depression and anxiety is a relatively new and exciting area of research.

A randomised control trial called the SMILES trial asked this exact question, ‘if I improve my diet, will my mood improve?’ The trial recruited participates experiencing depression symptoms and split them into two groups, a control group and a dietary intervention group. The dietary intervention group were encouraged to follow a Modified Mediterranean Diet, a dietary pattern focused on fruit, vegetables, wholegrains, legumes, nuts, extra virgin olive oil, and fish but including slightly higher intake of red meat than traditional Mediterranean diets. The results showed that those in the dietary intervention group had much greater reduction in depression symptoms than the control group over a 3-month period. A higher percentage also met remission for depression. Put simply, those who improved the quality of their diet experienced the greatest reduction to their depression.

While acknowledging the complex nature of mental health conditions, the SMILES trial, shows how certain foods and dietary patterns could indeed affect mental health in a positive way.

So how might you move towards a more Mediterranean-style diet to look after your mental health? Below are some ideas:

Cook with extra virgin olive oil Drizzle it on cooked dishes and use in mashed potato instead of butter.
Eat more fish . Twice a week to start and choose salmon or sardines, all rich in omega-3 fatty acids.
Switch to wholegrains. Brown rice, wholegrain bread, quinoa, barley and oats are all great choices.
Snack on nuts and seeds or add to salads.
Use avocado as a spread instead of butter or margarine or try in a smoothie.
Limit red meat and poultry . Add small amounts or replace with plant proteins such as legumes and tofu.
Enjoy fruit for dessert or snack.
Limit heavily processed food and sugar-sweetened drinks.

This post first appeared on Redfern Physiotherapy & Sports Medicine Health Blog.

St Peters Physiotherapy Experts for Sports Injuries and Rehabilitation

Wed, 10 Nov 2021 14:17:49 GMT

Why Choose Alexandria Physio—St Peters Physio Experts for Injury Recovery?

If you're looking for expert physiotherapy and top-tier injury management near St Peters, Alexandria Physio is your trusted choice! As St Peters physio experts, our team of elite physiotherapists has been helping a diverse range of individuals from all over Sydney, including the nearby areas of Newtown, Erskineville, Alexandria, and Marrickville, achieve their health and fitness goals for years.

Our clinic, located just a short drive from St Peters, is renowned for providing exceptional sports injury treatment, rehabilitation, athletic screening, and recovery & wellness services. Whether you’re recovering from a sports-related injury or looking for preventative care to avoid future injuries, we’re here to help you get back on your feet stronger than ever.

Our clinic’s approach blends advanced techniques, hands-on care, and personalised programs, making us the go-to experts for sports injuries, musculoskeletal pain, and post-op rehabilitation. From muscle strains and tendonitis to more complex issues like neck and back pain, we use targeted treatments that restore mobility and prevent long-term injury, making us St Peters’ best physios for pain relief and recovery.

Convenient Location Just Minutes from St Peters

Situated on Fountain Street in Alexandria, we’re easily accessible for those in St Peters and surrounding suburbs like Newtown, Erskineville, and Marrickville. Our location is just a few minutes’ drive from key areas like Princes Highway and St Peters Station, making it convenient for students, professionals, and families looking for St Peters’ physio experts.

Comprehensive Physiotherapy Services by St Peters Physio Specialists

Sports Injuries: Whether it’s a sudden injury or an overuse issue, our experts will develop a detailed and data-driven sports-specific program to restore strength and mobility.
Neck and Back Pain: Our therapists are experienced in treating common neck and back issues that hinder daily activities and quality of life.
Post-Op Rehabilitation: We offer structured rehab programs post-surgery to ensure smooth and effective recovery, no matter the procedure.
Dry Needling: For relief from chronic pain, our dry needling techniques target trigger points in muscles to restore normal function.

Book an Appointment with Leading St Peters Physiotherapists

Looking for the best physiotherapy and sports injury treatment in St Peters? Book your appointment today with leading St Peters Physio experts and take the first step toward recovery.

FAQs about Physiotherapy near St Peters

What conditions do your physiotherapists treat? We specialise in treating sports injuries, post-surgical rehabilitation, chronic pain, and musculoskeletal conditions.
How do I book an appointment at Alexandria Physio? You can book online or call us at 02 9194 1800.
Do you offer physiotherapy for workplace injuries? Yes, we provide ergonomic assessments, injury prevention programs, CTP and WorkCover-approved treatment plans.

All About Ankles: Syndesmosis

Wed, 22 Sep 2021 00:26:00 GMT

All About Ankles

Have you ever been watching sport, particularly Rugby League, AFL or Football, and seen a player go down injured with what looks like some kind of ankle injury, only to hear the announcer use the term ‘syndesmosis’? ‘Oh, that looks like a syndesmosis injury’, ‘That must be their syndesmosis’, ‘I’m not too sure what it is but I’m going to say syndesmosis.

Now, I’m not having a dig at the announcers in anyway. Maybe they are a former player (which is common) that has experienced something similar. But, for most people, the term syndesmosis sounds like a buzz word some announcers use to sound clever, whilst your sitting there having no idea what they’re talking about.

You may even think, ‘it just looks like a normal ankle sprain’. And here is where things change. Syndesmosis injuries, or ‘high ankle sprains’ are more complex in comparison to injuries affecting the lateral ligaments and can (if managed poorly) lead to greater disability and poorer outcomes in regards to long term pain.

Everyone I seem to talk to or see in the clinic has had some kind of old ankle injury that ‘was just a sprain’ and didn’t think much more of it. This is until they develop progressively worsening symptoms in their ankle or feel as if their ankle rolls ‘all the time’. In that manner, sometimes a sprain isn’t just a sprain.

So, to make things easier to understand, and for the next time an announcer drops the term ‘syndesmosis’, I’m going to go through what the term syndesmosis means, and how we go about management of this condition.

Syndesmosis Injuries – High Ankle Sprains

Put simply, the syndesmosis is an area between your Tibia and Fibula (lower leg bones) where ligaments in the ankle act to secure the distal aspect of the lower leg, above the ankle joint. Hence, they are commonly referred to as high ankle sprains (refer to photo below).

When the syndesmosis gets injured, it will involve at least one, if not all of the structures that secure the joint. In the majority of cases, for this injury to occur requires significant force to the ankle (such as a tackle or an opposition player falling onto the ankle).

This mechanism is where the foot is forced into external rotation (turning out) and the ankle into dorsi flexion (pointing upwards). When a player is injured, they usually describe the sensation of the ankle and foot being twisted outwards under force followed by sharp pain at high in the ankle. This force places increased stress on the syndesmosis joint, forcing the tibia and fibula apart, causing ligaments to either strain, or in worst cases, rupture.

Like most injuries, syndesmosis issues are graded in severity with Grade 1 being minor strains through to Grade 4 injuries which are substantial and may require surgery to stabilise the joint. Thankfully, most Grade 1 and Grade 2 injuries can be managed non-surgically with great results. Grade 3 injuries can also be managed conservatively but may require a surgical opinion with an orthopaedic specialist. This can depend on a number of reasons such as which ligaments of the syndesmosis have been injured, the sport you play, type of work you participate in and lifestyle habits.

As for management, let’s look at an example case. And by example case, I mean my own personal experience. I suffered a Grade 2 injury to my syndesmosis after I was tackled from the side during a game of Rugby League. The below outlines the week by week processes I went through to manage and eventually return to sport.

Week 1 – 2

Placed into CAM boot but allowed to walk as tolerated. I would remain in boot for the first 2 weeks. For the first 72 hours, the injury was allowed to settle using the PRICE (protection, rest, ice, compression, and elevation) regularly. The boot was also able to be removed to complete basic ankle range of motion exercises, only to neutral or plantar grade. In the second week, I began balance exercises in the boot and commenced non-weight bearing exercises for the other lower limb muscle groups.

Week 3 – 4

Boot was removed and I was able to commence double leg strength exercises in weight bearing positions. I could also commence exercise bike for conditioning. I also attend a local pool to begin hydrotherapy exercises such as water running, single leg strengthening and water jumps. The water allows you to complete these exercises at a reduced level of body weight without the chance of aggravation. All exercises were progressed with the physiotherapist and regular testing was undertaken to determine progression.

Week 5

Passed all Return to Running criteria and began to run with ankle strapped in straight lines. This was progressed during the week to increase intensity and slight directional changes. Exercises and strengthening continued to progress with plyometric and single leg strengthening.

Week 6

Running drills for change of direction were introduced. This progressed from simple drills with focus on technique to game simulated drills in chaos with an emphasis on maintaining technique. Re-introduced to light game-based skill drills such as passing and non-contact ball work.

Week 7-8

Progressed through all return to sport criteria during weeks 7-8 which was guided by a physiotherapist based on specific testing criteria. This criterion involved knee to wall differences between injured and non-injured side, symmetrical lower limb strength, various hopping tests, balance tests and questionnaires.

Overall, if managed well under the guidance of a physiotherapist , athletes and individuals can make a full recovery and return to their sport or activities without problems. It is important to note, as mentioned earlier, if your failure to complete guided rehab exercises and implement appropriate loading strategies, long term problems can occur.

If you have an ankle injury or have previously sustained a syndesmosis injury which continues to limit your function and activity levels, we can perform a detailed initial assessment and prescribe you a tailored exercise program to manage your symptoms and get you back on the field or track.

The post appeared first on Redfern Physiotherapy & Sports Medicine .

Dietitians, the Missing Part of the Injury Recovery Puzzle.

Mon, 16 Aug 2021 23:58:00 GMT

Dietitians - part of the injury recovery puzzle.

Has your physiotherapist ever referred you to a dietitian before? Because they probably should have!

Imagine if you could win the race by having a 50m head start. This kind of edge is the power of combining both physiotherapy and dietitian guidance in your injury journey.

Here are a few examples of how adding a consult with a dietitian can help your injury process and give you that head start.

Injury Prevention:

Physiotherapists don’t just work towards returning you to sport or helping decrease your injury pain. They continue the process assisting to decrease your chance of secondary injuries. This can include long term strengthening programs and ongoing load monitoring adjustments, to ensure you have the best chance of decreasing any secondary injury. So what role does seeing a dietitian have in injury prevention? Fuelling your activity adequately can assist with energy levels and fatigue prevention, in turn reducing the risk of overtraining and injury.

Seeking individual advice from a dietitian can assist you to make food choices that ensure you are getting energy delivered at the right times for your chosen sport or activity to prevent fatigue and injury.

Did you know that Johnston ., et el 2013 found that athletes who don’t have adequate time to recover between training, fatigue will accumulate compromise performance and result in an increase risk of injury and illness.

Joint Pain:

Joint pain and osteoarthritis are one of the most commonly seen injuries in the clinic. Physiotherapists can assist to manage daily pain levels, by restoring your joint range of movement and increase your overall strength levels. Increasing your strength can decrease the loads going through your joints. A long term strength program can also decre ase your joint pain and allow you to participate in more sport and activity.

How can a consult with a dietitian assist your joint pain? It is well researched that diet and lifestyle changes can decrease your joint pain. Messier ., et el 2005 found that each kg of weight reduction, decreased the compressive force within the knee joint. So every kg of weight lost was shown to have a 4 fold reduction of load going through the knee. Some studies have reported up to 50% decrease in knee pain with a 10% body weight loss.

The Mediterranean Diet has also been shown to reduce inflammation and pain in those with joint pain and osteoarthritis . The Mediterranean Diet is a way of eating that is high in anti-inflammatory and anti-oxidant nutrients including plenty of fruit, vegetables, legumes, wholegrains, nuts, seeds, herbs, spices and olive oil.

Improving Performance:

How can physiotherapy and dietetics help to improve your sports performance? As mentioned before, physiotherapist’s don’t just return you to sport. They can help take you to a higher level, faster and stronger post injury. Throughout your rehabilitation stages there will be a time where you transition into some form of training. This means added training sessions and rehab sessions. To maximize your return, working closely with a dietitian can assist you achieve your return to sport goals.

Sports performance can largely be influenced by the correct fuelling of macronutrients prior to sport and more importantly the right dosage after activity to help your recovery. Training under fuelled can result in poor performance and feeling like you are lacking energy and unable to perform at your best, it also increases your risk of injury and illness. Dietitians can also discuss the use of supplements to help you achieve the best performance you can. If supplements are right for you and your sport, a dietitian can help prescribe how best to incorporate these into your diet.

These are just a few examples of how combining the power of physiotherapy and dietitian guidance can give you that 50m head start in winning your injury race. Every injury is different and every case if different from the next, therefore it is important to get tailored guidance that is individualised for you. At Redfern Physiotherapy & Sports Medicine we believe incorporating the whole team can give you the best outcome in your journey. If you are looking for that cutting edge in your injury journey, speak to your physiotherapist about booking a dietitian consult now.

Hoffa’s Fat Pad Impingement. Is It Causing Your Knee Pain?

Sun, 25 Jul 2021 10:40:00 GMT

Hoffa’s Fat Pad Impingement

I f you’re suffering from a pain at the front of your knee, then it may be coming from your fat pad! We aren’t saying you have a weight problem – we all have a pad made of fatty soft tissue just behind the bottom of our knee cap.

There are three fat pads at the front of the knee however, the Infrapatellar Fat Pad, sometimes called Hoffa’s Fat Pad, is one of the more common causes of pain.

How does Fat Pad Impingement present?

Pain in the front of your knee exacerbated by extension or prolonged flexion – prolonged standing will be provocative, sometimes even a straight leg raise will hurt. Prolonged sitting may also irritate the pain.
The fat pad is tender to touch – this will be just below the kneecap
A puffy anterior knee - the fat pad is a bit like a sponge and when inflamed will become engorged
Pain may be worse when barefoot or wearing flat shoes compared with a heeled shoe

Treatment: Acute vs Chronic

The main difference between treating acute or chronic infrapatellar fat pad pain is screening for and correcting causative factors. When acute trauma is identified as the reason for inflammation, then focus is concerned primarily on offloading the fat pad and allowing it to settle. When the pain is a persistent issue that has developed over time, it’s likely there is an underlying reason that needs to be resolved.

This process can be described in two stages:

Stage 1: Reduction of Inflammation

Activity Modification – reduce aggravating activities which may mean reducing walking or running time/distance, reducing prolonged standing and anything else provocative
Wearing heeled shoes (no we don’t mean high heels but anything with a good heel lift and support) – avoiding barefoot or flat shoes especially if it is painful
Ice Massage over the tender area
Offload Taping – lifting the inferior patella away from the fat pad with a ‘V-Tape’ technique. This may be applied 24/7 until symptom free. Our experienced team of physios will be able to teach you the appropriate taping technique.

Stage 2: Recondition the limb / Fix the cause

Progressive loading exercise: with a strong focus on the quadriceps and also considering glutes and hip external rotation exercises for control of the knee.
Isometric Knee Exercise: may be useful in the early stages, working within a safe zone of 20-40° of knee flexion can be manageable if the pain is irritable.
Stretching: of the quadriceps and hip flexors may be beneficial.

Things your physiotherapist will assess:

Knee Hyperextension – if the patient has poor control over inner range quadriceps or stands often in a hyperextended position then this may irritate the fat pad. Quads control exercises may be prescribed to correct this.
Patellar Hypermobility – the patella may have a large amount of movement which can impinge the fat pad. Dynamic quad exercises can be prescribed to treat this.
Patella position – tight structures on the lateral aspect of the knee may cause a lateral pull or malt racking. Treatment and focussed stretches can help to manage this.

Beaconsfield Physiotherapy Experts for Sports Injuries and Rehabilitation

Tue, 11 May 2021 14:15:16 GMT

Why Choose Alexandria Physio—Beaconsfield Physio Experts for Injury Recovery?

If you're looking for expert physiotherapy and top-tier injury management near Beaconsfield, Alexandria Physio is your trusted choice! As Beaconsfield’s physio experts, our team of elite physiotherapists has been helping a diverse range of individuals from all over Sydney, including the nearby areas of Alexandria, Rosebery, Zetland, and Waterloo, achieve their health and fitness goals for years.

Our clinic, located just a short drive from Beaconsfield, is renowned for providing exceptional sports injury treatment, rehabilitation, athletic screening, and recovery & wellness services. Whether you’re recovering from a sports-related injury or looking for preventative care to avoid future injuries, we’re here to help you get back on your feet stronger than ever.

Our clinic’s approach blends advanced techniques, hands-on care, and personalised programs, making us the go-to experts for sports injuries, musculoskeletal pain, and post-op rehabilitation. From muscle strains and tendonitis to more complex issues like neck and back pain, we use targeted treatments that restore mobility and prevent long-term injury, making us Beaconsfield’s best physios for pain relief and recovery.

Convenient Location Just Minutes from Beaconsfield

Situated on Fountain Street in Alexandria, we’re easily accessible for those in Beaconsfield and surrounding suburbs like Rosebery, Zetland, and Waterloo. Our location is just a few minutes’ drive from key areas like Botany Road and Green Square, making it convenient for students, professionals, and families looking for Beaconsfield’s physio experts.

Comprehensive Physiotherapy Services by Beaconsfield’s Physio Specialists

Sports Injuries: Whether it’s a sudden injury or an overuse issue, our experts will develop a detailed and data-driven sports-specific program to restore strength and mobility.
Neck and Back Pain: Our therapists are experienced in treating common neck and back issues that hinder daily activities and quality of life.
Post-Op Rehabilitation: We offer structured rehab programs post-surgery to ensure smooth and effective recovery, no matter the procedure.
Dry Needling: For relief from chronic pain, our dry needling techniques target trigger points in muscles to restore normal function.

Book an Appointment with Leading Beaconsfield Physiotherapists

Looking for the best physiotherapy and sports injury treatment in Beaconsfield? Book your appointment today with leading Beaconsfield physio experts and take the first step toward recovery.

FAQs about Physiotherapy near Beaconsfield

What conditions do your physiotherapists treat? We specialise in treating sports injuries, post-surgical rehabilitation, chronic pain, and musculoskeletal conditions.
How do I book an appointment at Alexandria Physio? You can book online or call us at 02 9194 1800.
Do you offer physiotherapy for workplace injuries? Yes, we provide ergonomic assessments, injury prevention programs, CTP and WorkCover-approved treatment plans.

Elite Physiotherapists and Sports Injury Experts Near Green Square

Tue, 13 Apr 2021 14:10:37 GMT

Green Square Elite Physiotherapy and Sports Injury Experts

If you're searching for expert physiotherapy and injury management services near Green Square, look no further than Green Square Physiotherapy and Sports Injury Experts! Our team of elite physiotherapists has been helping a diverse range of individuals from all over Sydney, including the nearby areas of Zetland, Waterloo, Rosebery, and Kensington, achieve their health and fitness goals for years.

Our clinic, located just a short drive from Green Square, is renowned for providing exceptional sports injury treatment, rehabilitation, athletic screening, and recovery & wellness services. Whether you’re recovering from a sports-related injury or looking for preventative care to avoid future injuries, we’re here to help you get back on your feet stronger than ever.

Why Choose Alexandria Physio for Your Sports Injury Recovery?

Convenient Location Just Minutes from Green Square

Situated on Fountain Street in Alexandria, we’re easily accessible for those in Green Square and surrounding suburbs like Zetland, Waterloo, and Kensington. Our location is just a 5 minute drive from key areas like Green Square Train Station, making it convenient for students, professionals, and families looking for trusted physio experts near Green Square.

Comprehensive Physiotherapy Services

Sports Injuries: Whether it’s a sudden injury or an overuse issue, our experts will develop a detailed and data-driven sports-specific program to restore strength and mobility.

Neck and Back Pain: Our therapists are experienced in treating common neck and back issues that hinder daily activities and quality of life.

Post-Op Rehabilitation: We offer structured rehab programs post-surgery to ensure smooth and effective recovery, no matter the procedure.

Dry Needling: For relief from chronic pain, our dry needling techniques target trigger points in muscles to restore normal function.

Get in Touch With Trusted Green Square Physio Experts

Planning to Eat a Plant-based Diet in 2021?

Wed, 07 Apr 2021 23:14:00 GMT

Eat a plant-based diet

The popularity of plant-based diets has been on the rise for some time and there is evidence to suggest that this trend is here to stay. The shift to plant – based diets has been predominately driven by concern surrounding health, animal welfare and the environment. So, what is a plant-based diet? Exactly as it suggests, a diet that is based on plants.

Plant foods include fruit and vegetables, wholegrains, nuts and seeds, lentils and legumes and healthy fats such as olive oil.

A vegetarian diet is an example of a plant-based diet with some flexibility. While it doesn’t include any meat, poultry or seafood, it does allow animal-derived products such as dairy, eggs and honey.

A vegan diet on the other hand, strictly excludes all animal and animal derived products (dairy eggs and honey included).

Other variations of plant based have also immerged in recent years, such as a pescatarian diet (vegetarian diet plus seafood) and a flexitarian diet (vegetarian diet with occasional consumption of meat, poultry or seafood).

Health benefits of going plant-based

The health benefits of plant-based diets are numerous. Plant foods are nutrient dense, packed with vitamins, minerals, antioxidants and fibre. It is therefore not all that surprising that plant-based diets have been associated with lower levels of chronic diseases such as type 2 diabetes, cardiovascular disease and certain cancers. Diets high in fibre and resistant starch, found in plant foods, have also been associated with improved gut health now linked to mental health and other positive health outcomes.

You don’t necessarily need to go vegetarian or vegan to get the health benefits associated with plants foods. A moderate change to your diet such as replacing one serve of animal food with plant food a day can have a great impact on your health.

Despite all these potential health benefits it is worth noting that not all plant-based diets are created equal. A plant-based diet focused primarily on processed or packaged foods will not necessarily be any healthier than its animal-containing alternative. A wholefood diet approach is always best to minimise saturated fat, salt and added sugar.

Plant-based diet downfalls

Following a strict plant-based diet (i.e., vegan), or even vegetarian diet, requires some planning to ensure nutritional adequacy. While most nutrients we require are abundant in plant foods, there are a key few vitamins and minerals that are only found in animal foods or are better absorbed when they come from animal sources. Strict plant-based diets can also make it harder for those with particularly demanding energy requirements to meet their energy needs (e.g., adolescents or athletes).

Key nutrients for consideration in plant-based diets:

Iron

Iron is found in both animal and plant foods, however, the type found in plants (non-haem iron) is less readily absorbed making requirements harder to meet.

Vitamin B12

Only found in animal foods, and essential for healthy blood cells and neurological function, Vitamin B12 must be added by consuming fortified foods (e.g., breakfast cereals, dairy milk alternatives) or supplementation.

Protein

A key macronutrient in meat, poultry, seafood and animal derived foods. While there are plenty of plant-based proteins too, think tofu, lentils, legumes and quinoa, they can often be overlooked when transitioning to a plant-based way of eating.

Calcium

Essential for muscle function and bone health, the highest amounts of calcium are found in dairy products. Adequate calcium intake may not be a big issue for less strict plant-based diets; however, vegan diets require considered planning to ensure calcium intake is adequate.

Omega-3 fatty acids

Found in the highest quantities in fish, and extremely beneficial for health, omega-3 supplementation may be required.

As you can see while the health benefits of going plant-based are plentiful, so are the nutritional considerations. The consequences of nutrition deficiencies can be greatly detrimental, so it is highly recommended that you seek individualised nutrition advice from your doctor and a dietitian when following a strict plant-based diets. Please don’t just rely on social media, websites on the internet and advice from family and friends.

Nutrition in Managing Osteoarthritis

Mon, 08 Mar 2021 23:14:00 GMT

The Role of Nutrition in Managing Osteoarthritis

Osteoarthritis (OA) is the most prevalent form of arthritis, affecting a rising number of people worldwide.

The pain associated with OA is one of the key barriers to maintaining physical activity in those with the condition, which in turn can greatly impact quality of life. Those affected would benefit from ways to self-manage their condition and this is where nutrition can play an important role.

Is there a diet to cure OA?

Is there a diet to cure OA? Short answer, no. However, while there is no miracle diet that can cure OA, we do know that maintaining a healthy body weight and ensuring nutrient needs are met can help symptom management and improve quality of life.

Maintaining a healthy body weight is one of the important ways diets can assist with OA management. OA occurs when the protective cartilage that cushions joints wear down over time, so reducing unnecessary impact on these joints is an effective management strategy. Excess body weight can cause increased wear and tear as well as joint inflammation and pain for those with OA. Research suggests that a reduction of as low as 5% in body weight can improve pain felt in affected joints. Everyone has different energy requirements and understanding what this is for you can be difficult. Seeking individualised nutrition advice from a dietitian can help make sure you are mastering nutritious, balanced meals and getting your portion sizes right.

What should I eat?

What should I eat? Research suggests that the Mediterranean Diet could help reduce inflammation and pain in those with OA. The Mediterranean Diet has been thought to assist with OA management due to the anti-inflammatory and antioxidant nutrients abundant in this way of eating. It includes plenty of fruit, vegetables, legumes, wholegrains, nuts, seeds, herbs, spices and olive oil, a moderate number of fish, seafood, poultry, eggs and dairy, and small amounts of red meat and sweets. It also emphasises enjoying food socially, in moderation, and has been seen to be beneficial in maintaining a healthy weight.

Nutrition research in the area of OA is constantly evolving, and while there is currently limited evidence to suggest any one particular nutrient can prevent or delay OA, certain nutrients have been deemed to be important for symptom control. For example, adequate protein intake is important for those with OA to ensure adequate muscle mass and strength is maintained as low muscle strength has been linked with increased pain. Research has also shown that vitamin E may have an anti-inflammatory role that may reduce the progression of OA, and higher intakes of vitamin D has been implicated in less progression of cartilage damage. Future research is sure to shed more light on the importance of specific nutrients.

Eccentric Training. Why do We Use It?

Wed, 23 Dec 2020 04:03:00 GMT

Eccentric Training

I f you have ever been to the Physio, chances are that you been asked to perform some eccentric exercises – but what exactly does this mean?

‘Eccentric movement’ refers to a muscle contracting whilst it is lengthening. On the contrary, ‘concentric movement’ is when a muscle is contracting whilst shortening.

The simplest example to explain this is performing a bicep curl.

The upwards part of the movement (hand to shoulder) is when the bicep is shortening under load, thus contracting “concentrically”.
The downwards part of the movement (hand lowering down) is when the bicep is lengthening under load, thus contracting “eccentrically”.

Without knowing it, you work several muscles eccentrically every day!

Every time you take a step – The tibialis anterior muscle in the front of your shin bone helps to flex the foot upwards when you run or walk but then works “eccentrically” to help lower the toes to the floor. Without this control, your feet would slap the ground every time.
Every time you go down the stairs – The quadriceps muscles contract “eccentrically” to prevent the knee from collapsing too fast or too far forward.

Notice that these two examples often correspond to body parts that tend to be sore after exercising. This is because eccentric contractions are deemed a more efficient way to exercise the muscles compared to concentric contractions given, they are able to work the muscle harder with less energy expenditure.

It is for this reason that the phenomenon of delayed-onset muscle soreness (DOMS) is greatest when a muscle has been placed under a greater eccentric load. This i explains why your shins are sore after running on a firm surface and why your quadriceps is sorer after running downhill.

But why are eccentric contractions so important for rehab?

Eccentric training is commonly used to treat tendinopathies, hamstring strains and for preventative purposes in a wide array of sports.

Research has suggested that the implementation of eccentric exercises for the treatment of common injuries such as Achilles and Patella tendinopathies can help to significantly decrease pain levels, improve function and increase tendon strength. It is suggested that this is achieved by increasing the muscle strength at longer lengths by exposing the tendon to a greater load, and therefore progressively being able to withstand loads that could have caused the initial damage.

This is further evident in a study by Mafi et al, 2001, which found that when comparing eccentric and concentric exercises in the treatment of mid-portion Achilles tendinopathy, patients performing eccentric contractions had greater improvements compared to those performing concentric contractions. The results found that 82% of the eccentric exercise group were able to return to their baseline function and activity compared to only 36% of the patients who performed the concentric exercise regime.

Hamstring strains are another common injury seen in various sports and also has a high recurrence rate. As a result, eccentric training has been well researched and has formed part of the gold standard rehabilitation process for these types of injuries. The Nordic Curl is a popular and highly effective eccentric hamstring exercise for the prevention of hamstring strains.

A study by Mjølsnes et al, 2004 found that eccentric hamstring training resulted in an 11% increase in eccentric hamstring strength and a 65% reduction in hamstring strains in football teams that implemented the Nordic Curl exercise compared with those that do not.

All our rehab programs at Redfern Physio are tailored to your specific needs and these may include eccentric exercises. Now, the next time you’re asked to perform these as part of your rehabilitation plan, we hope you have a little more understanding into the reasons why.

Running Into Trouble

Fri, 16 Oct 2020 06:01:00 GMT

Running Into Trouble

With the weather warming up, and many of us finding ourselves with more time to exercise as we work from home, people are taking to running in order to maintain health and fitness. Whilst this means everyone is getting up off the couch, eating better and getting fit, it is also leading to a wide range of overuse and training related injuries.

With all chronic overload injuries, load management should be the cornerstone of any rehabilitation program. An initial reduction of 30% intensity and volume of training is recommended. If this does not result in pain free activity, a further 10% reduction should be applied every week until training does not result in pain. Load should then be progressed gradually (approximately 10% per week) until pre-injury levels are reached.

Other treatment options that will aid in the reduction of intensity and occurrence of lower limb injuries from running include:

Gait and footwear analysis: to identify abnormalities such as excessive pronation, coordination issues and excessive shock or strain. This may involve retraining the walking/running pattern, increasing the cushioning of shoes or inserting orthotics.
Range of motion exercises for the hip, knee, ankle and foot to improve blood circulation, reduce inflammation and relieve pain.
Strengthening of the muscles through eccentric exercises as well as developing core stability via training of the abdominal, gluteal and hip muscles to improve running mechanics.
Proprioceptive balance training which is crucial in neuromuscular education and will increase the efficiency of joint and postural stabilisation muscles which in turn help the body to react to changes in surface whilst running.

Here are 3 very common conditions related to running and how to manage them:

Achilles Tendinopathy

The Achilles tendon is the largest tendon in the body, attaching the calf muscles onto the heel bone. This band of connective tissue, mostly made up of collagen fibres, can become painful when subject to repetitive and sudden changes in load. Achilles tendinopathy is the term used to describe an overuse injury to this tissue. Tendons that are inflexible and stiff are at a greater risk of injury.

Often those suffering from an Achilles tendinopathy will feel stiffness and pain into the heel/calf in the morning. Symptoms can ease with movement however, the tendon often reaches a threshold point with activity and can become symptomatic again. Swelling or thickening of the tendon may or may not be seen at the site of pain.

Typically, tendons do not have a good blood supply in comparison to other tissues in the body; subsequently any healing takes place on a much slower timeframe. Research has shown the most effective way to rehabilitate a tendon and enable it to tolerate load again is through eccentric strengthening exercises. This program will be put together by your physiotherapist following a detailed assessment and will be tailored to your specific needs.

Self-massage and stretching will also be beneficial in the rehabilitation of the Achilles tendon and these will also be demonstrated by your treating physiotherapist to form part of your program. By releasing the calf muscles, the load on the Achilles tendon can be reduced leading to a reduction in pain.

Medial Tibial Stress Syndrome - MTSS or Shin Splints

Medial Tibial Stress Syndrome (MTSS), commonly referred to as Shin Splints, is an exercise induced condition that is characterised by pain and discomfort of the lower leg along the inside border of the tibia. Shin Splints are the result of a training error (poor technique) or overload (intensity, duration and repetition) occurring primarily in running and jumping athletes. Tightness and weakness of the calf muscles along with other supporting muscles in the lower leg are the most common cause of MTSS.

Muscle tightness and weakness leads to fatigue and ultimately altered running or jumping patterns. This can place excessive strain on the Tibia causing chronic inflammation of the attachments and bony changes, all leading to pain. Typically, this pain will be experienced at the start of the workout and dissipate once warm, before returning after cooling down. However as the condition worsens it may be experienced throughout the activity leading to being unable to continue.

MTSS is the most prevalent lower leg condition and accounts for 13% to 17% of all running-related injuries. Dancers have been shown to have injury rates of 22% whilst younger population runners and athletics are 13%. Risk factors for developing shin splints include cold weather exercise, poorly trained people, overweight runners, excessive pronation at the foot and excessively tight calf muscles. Symptoms can include:

dull pain and mild oedema along the second third of the posteromedial tibia
pain that develops either side of shin during exercise
swelling, heat and redness of the shin region
numbness or weakness in the feet
associated muscle pain of the legs

Ceasing the provocative activity is the most effective treatment for MTSS along with ice to relive pain and inflammation. Symptoms will return upon resumption of exercise unless preventative treatment and rehabilitation program is applied in consultation with you physiotherapist.

Acute phase: involves mainly rest for a period of 2-6 weeks depending on severity. Pain relief is generally through the use of anti-inflammatory medications (in consultation with your doctor) and ice immediately after exercise for 20 minutes. Manual therapy can include dry needling and soft tissue mobilisation such as massage, trigger point therapy and stretching.

Subacute phase: should be focussed on behaviour and training modification such as decreased distance, intensity and frequency by as much as 50%. Uneven surfaces should be avoided and cross training with minimal impact (x-trainer, stationary bike) should be utilised during rehabilitation to compensate for the drop in training load. A stretching/ strengthening (eccentric loading) regime for the calf muscles will prevent muscle fatigue and further exacerbation of symptoms upon return to normal running loads.

Gluteus Medius/Minimus Tendinopathy

A Gluteal Tendinopathy (GT) is a non-inflammatory tendinopathy of the Gluteus Medius and/or Minimus muscles. It is due to excessive hip adduction (hip drop) in combination with other muscle or bone factors and results in moderate to severe disabling pain in the lateral hip region (Greater Trochanter). The gluteus medius and minimus muscles are two muscles found in the posterior aspect of the pelvis. Their places of origin and insertion are very close to one another, which means they act synergistically.

Traditionally a GT was diagnosed as Trochanteric Bursitis due to the similar presentations and focal point of pain. Recent research has shown however that GT is the most common source of hip pain with the condition affecting primarily runners and less active people. Women are 2-4 times more likely than men to develop a GT and as many as 1 in 4 females over 50 are likely to be affected by a Gluteal Tendinopathy. Research has shown that as much as 35% of those with low back pain (LBP) develop a GT with increased duration of LBP resulting in an increased risk of developing a tendinopathy.

A GT is a result of repeated and excessive loading of the tendon due to factors mentioned above. Some symptoms may include:

Pain is often described as a constant ache or bruising on the side of the hip
Increased pain and stiffness during the night or first thing upon waking
The area is tender, warm, red or swollen
A crunch sensation during weight bearing
Pain when you run, walk up and down stairs, or balance on one leg
Discomfort at night or trouble finding a comfortable sleeping or sitting position

Physiotherapy has been shown to be the best treatment option for managing GT. Initial management involves rest, avoiding the aggravating activity and ice for pain relief (20min every hour for first 72hrs). Gentle range of motion exercises and stretching are important to prevent stiffness, as well as specific treatment modalities applied by your therapist. Other management options that will aid in the recovery from a gluteal tendinopathy include:

Gait analysis: to identify abnormalities such as excessive foot pronation, coordination issues and hip control issues. This may involve retraining the gait pattern or inserting orthotics.
Strengthening of the hip, abdominal and core muscles including eccentric exercises for the glute muscles to provide stability and improve tissue tolerance to load.
Retrain hip and core control

See your physiotherapist at Alexandria Physio for a detailed assessment and tailored rehab plan to manage any of your injuries arising from your running program.

My Disc Has Slipped

Wed, 09 Sep 2020 23:05:00 GMT

My disc has slipped

That is a phrase I hear way too often as a physiotherapist, and it can lead to a poor attitude and approach to how people understand and manage their back injury.

I want to explain the usual timeline that occurs with back pain. Most people will often visit the GP to get some pain medication to help make functional movements bearable. Of course, this is only a band-aid solution for the injury and your pain often persists or worsens. It can become so debilitating that you’re sent off for an X-ray, CT scan or MRI to provide some clarification of what is actually going on beneath the surface. And wallah! It is a ‘slipped disc’. Now you’re probably walking around like the tin man of the Wizard of Oz because you fear any movement that involves the back.

Luckily for you, I’m here to tell you that discs don’t “Slip”. This is a complete misnomer and should never be used to describe a back injury. This term is actually referring to a bulging or a herniation of the disc. These injuries are far more common than you think and, furthermore, these bulges and herniations can exist even in the absence of pain or dysfunction!!

What is a disc?

I want you to picture a jam donut. Like the donut, discs are composed of two parts; a tough outer portion and a soft inner core. The outer layer is designed to withstand large compressive forces and has cartilaginous end plates that firmly attach the disc to the vertebrae above and below.

Together with the inner structure, the discs are designed to act as shock absorbers for the spine. Each vertebral joint in the spine has a disc that sits between each bone and these are surrounded by many spinal ligaments.

What is a disc bulge/herniation?

Discs are incredibly strong. But they do get damaged by excessive compressive or torsional forces. So it’s not a good idea to lift heavy items off the floor with an extremely flexed spine or with a jerking twisting motion. They can also be damaged and deteriorate over time from bad posture, poor movement patterns and simple wear and tear. As the cartilage deteriorates (Think of the outer shell of the donut), the gelatinous nucleus (The inside of the jam donut) starts to push out against and distend the disc. Hence the name, bulging disc. If the nucleus breaks through the outside of the disc, that is then a disc herniation.

Herniations come in two varieties, extrusions or sequestrations. Put simply, extrusions are when the disc material has come out of the disc but is still intact with the remainder of the nucleus. Whereas sequestrations are when a portion of the disc material has come away from the rest and now resides in the layers of the annulus or possibly into the spinal canal. Pressure on the spinal cord or spinal nerve roots can cause serious problems so a correct diagnosis is vital.

What signs are seen with a disc herniation?

For a lumbar (lower back) herniation, you might be experiencing any of the following:

Back pain and spasms
Muscle weakness in either or both legs
Numbness in either or legs
‘Pins and needles’ or Tingling
Pain down the back of either legs
Loss of lower-body motor function.

Is treatment necessary?

Herniated discs DO often heal on their own. However, they don’t necessarily heal well. As mentioned above, the discs play an important role in the mobility of your spine in addition to shock absorption. If incorrectly healed or rehabilitated, the affected segment will have reduced mobility and therefore place additional strain on the segments above and below. Over time, they can become unstable and develop their own bulge and this can become a never-ending problem.

Pain and damage to the spinal structures, including the discs, will lead to reflex wasting of the spinal muscles and persistent weakness. Symptoms may often resolve on their own but this does not mean that the underlying cause of the injury have been addressed, or that the supporting muscles have been completely rehabilitated. Our advice is always to be proactive with your injuries, not reactive.

Can you fix a bulging disc?

The majority of symptoms can be relieved by working with your physiotherapist and getting the right exercise program for you! Yes, you read that correctly. Rest isn’t best. Movement is key! So, your first step with treatment should involve having a thorough assessment by a physiotherapist to determine all the contributing factors to your pain. Scans are rarely recommended for the typical back pain as they are often misleading and not useful for all care. There will be some rare cases that require injections or even surgery, but the majority of symptoms can be relieved by working closely with your physiotherapist.

Your treatment options after your initial assessment will include:

Postural advice and retraining movement patterns
Education and advice surrounding safe lifting techniques
Following a home exercise program working on your posture & core control
Conditioning and rehabilitation exercises
Manual therapy

Experiencing back pain that hasn’t gone away for some time now? Ceased exercise or sports because you have been told it could make your ‘slipped disc’ worse? Then call us on (02) 9194 1800 so we can help take care of your spine.

Meal Prep Your Way Through Winter

Mon, 27 Jul 2020 22:41:00 GMT

Meal Prep

When it comes to healthy eating , there is one strategy that works time and time again –meal prepping. Why? Because making healthy food choices is the hardest when we are busy, tired and stressed. By planning ahead and having plenty of prepped ingredients in your fridge, all it takes is a little last-minute assembling to create healthy and varied meals during the week.

Putting aside just 1-2 hours for meal prep every weekend is usually enough and can save you countless hours in the kitchen during the week. Not only will meal prepping mean one less thing to worry about during the week, it will save you money by limiting ingredient wastage and the temptation to order-in when you come home to an empty fridge.

Winter is an ideal time to meal prep entire meals. Soups, curries and slow cooker meals are all perfect to cook in big batches and store in the fridge or freezer in individual serve containers for reheating during the week.

Meal prepping ingredients over full meals is another great way to meal prep and avoid eating the same reheated meal over-and-over again during the week. This will take a little longer than just popping a meal in the microwave but if you have all the components of the meal ready to go it should only take you 5 or so minutes.

How to ingredient prep

There are so many ways you can meal prep but changing up the ingredients you use weekly is important to ensure nutrient variety. Choosing 1-2 ingredients from each of the categories below is a great start. Remember, the goal is to have enough prepped ingredients to make assembling meals quick and easy.

Protein

Baked salmon fillet
Poached and shredded chicken breast
Marinated tofu
Boiled eggs
Black bean burgers
Turkey or lean beef mince meatballs
Cooked legumes (e.g. chickpeas, cannellini, borlotti beans)

Carbohydrates

Overnight oats or homemade muesli
Roasted sweet potato
Cooked brown rice, quinoa or barley
Baked polenta
Cooked legumes (e.g. chickpeas, cannellini, borlotti beans)

Vegetables

Washed and pre-chopped vegetables to use in stir-fries
Roasted and pre-cooked vegetables for re-heating
Spiralled vegetables for pasta sauces
Washed and pre-sliced salad vegetables for sandwiches

Snacks

Washed and sliced fruit
Mixed nuts and dried fruit
Pre-chopped vegetable sticks
Hummus or Tzatziki dip
Roasted chickpeas
Homemade raw nut and date balls

In addition to the ingredients you prep, make sure you have a few staples ready to help flavour your meals – extra-virgin olive oil, avocados, lemons, fresh or dried herbs, nuts and seeds, hummus dip, olives and feta cheese are flavours that work well with virtually any meal.

If you’d like some more meal-prep ideas or help with any of your nutrition needs our dietitians are available for both in-clinic and telehealth appointments.

Running Related Injuries

Mon, 15 Jun 2020 01:59:00 GMT

Running Related Injuries Series – Part One

With the difficulties we have faced over the past 3 months due to COVID-19 restrictions, we have seen a huge percentage of people rediscovering the importance of their health and fitness. Many of us have utilised this extra time we have to eat healthier and get fit. And with many also returning to team sports very soon we are seeing a huge spike in running related overuse injuries.

This is the first part of a series dealing with running related injuries and how to manage them:

ITB friction Syndrome

Iliotibial Band (ITB) friction syndrome is a very common overuse injury resulting in pain and tenderness in the outside of the knee. It is commonly seen in runners, accounting for up to 22% of all lower limb injuries, however it can also be seen in any active population.

The ITB is a thick band of connective tissue which runs down the outside of your thigh. At the top of your thigh it attaches to your Tensor Fascia Latae muscle and your Gluteus Maximus muscle, and at the knee it attaches to the top of your tibia (shin bone) as well as the end of your femur (thigh bone).

When the knee is bent, the ITB slides across the outside of the knee with the maximal compression occurring between 20-30° of knee bend. ITB friction syndrome occurs when excessive tightness or biomechanical issues cause increased compression at the knee leading to an increase in friction. This increased friction combined with high repetition involved with running causes the tissue to break down and become inflamed.

ITB friction syndrome presents with pain localised to the outside of the knee however can occasionally refer pain up the leg. You will find that the pain gets worse with activity with the majority of cases being pain free at rest or walking unless the syndrome progresses to an extreme level. You will likely experience that downhill running is more aggravating than flat ground as it places more stress on the muscles around the knee. Quite often, the onset of pain can be attributed to recent and sudden change in training load, type of activity (eg. more hill running) or equipment (eg. change of footwear).

Conservative treatment is very successful in most people suffering from this condition and it is recommended that you see your physio immediately for a detailed assessment and management plan. Management of this condition usually involves relative rest (never complete rest) to allow for tissue healing, massage to release tight muscles , stretching and strengthening of the muscles around the hip and knee, and correction of any contributing biomechanical issues. Relative rest refers to modifications to running load or the type of training which allows you to maintain strength and fitness without aggravating the inflamed tissue.

‘Hands-on’ treatment is ideal in the acute phase, when pain and inflammation at the insertion is felt. The use of a foam roller on tight muscles is also highly beneficial and our therapists can demonstrate the most effective technique for this, allowing you to treat yourself at home. Exercises to strengthen muscles that stabilise the hip such as band resisted side walking, glute clamshells, hip hikes and thrusters should form the main part of any rehab program . All sound a bit confusing? Our experienced team of physiotherapists will talk you through all of these exercises and send you home with a detailed and specific program tailored to your individual needs.

Finally, load management is an integral part of managing and rehabilitation with a recommended reduction initially of 30% intensity and volume of training. If this doesn’t result in pain free activity a further 10% reduction should be applied until training doesn’t result in pain. Load should then be progressed gradually (approximately 10% per week) until pre-injury levels are reached. While these are very rough guidelines, and need to be varied for every individual, it highlights the importance of managing training loads in an overuse injury.

Workstation Ergonomics – The Ultimate Guide

Tue, 05 May 2020 02:58:00 GMT

Workstation Setup – The Ultimate Guide

Posture related pain and musculoskeletal problems are becoming more prevalent in the digital age as we spend increasing amounts of time at work, as well as glued to our mobile phones. With developments in technology and an understanding of how the human body interacts with these environments, comes better knowledge on how to combat these problems. Gone are the days of being expected to sit perfectly upright, sit on a balance ball, or any number of one size fits all generic approaches. While there is no one correct way to sit at a workstation, seating should support postures that can be changed frequently within a comfortable range throughout the day. It should accommodate the work being done, the visual demands and the workers’ individual differences. This will reduce fatigue and strain on the neck, shoulders, back and legs.

The two most important items in any office setup for appropriate ergonomics are the chair and work desk. An appropriate workstation should be designed to allow adequate height, depth and work surface for your body dimensions, the type of work you do and the equipment that is required for use. The workstation should have the following features:

a flat smooth surface for the keyboard and mouse
space to position all the equipment so that posture or vision is not compromised
a suitable height between 68 and 72cm from the top of the desk to the floor
adequate clearance for legs under the desktop
sufficient space under the desk to comfortably stretch legs

Most ergonomic chairs these days have all the adjustments required to ensure that it is the right fit for you. Typically, office chairs are classified as ergonomic when they have an adjustable seat height, seat depth and lumbar support. In addition, they should ideally have:

An adjustable headrest
Adjustable arm width and height
Adjustable tilt tension and lock

Height adjustable workstations

Height adjustability is another highly desirable workstation feature and all height adjustable

Workstations need to be to easily adjustable. Sit to stand workstations allow the desktop to be used in either the seated or standing position and should have similar dimension to a standard workstation as well as being able to be raised to at least 110cm without disruption to equipment or items. Height adjustable workstations are important for highly sedentary work or where work requires sitting or standing positions for long periods. They are also extremely useful for very tall or short people as they can adjust the workstation to suit their needs.

The introduction of standing desks can improve physical ( chronic disease prevention or management ) and psychological (worker productivity, well-being) outcomes with workers. Because sitting for prolonged periods is harmful to physical health and incorporates large health costs, employers should consider standing desks as an alternative to sitting desks that could improve workplace health and the general well being of their staff. Recent research has shown that prolonged standing can also come with its own physical costs which brings us back to our main goal that aims for work stations which support postures that can be changed frequently within a comfortable range throughout the day.

Adopting some of the above changes to your work set up can significantly help with postural related workplace injuries. However, the most important factors that can prevent issues are how you interact with your environment, your posture and general muscle strength and flexibility.

To Stretch or Not to Stretch? That is the Question!

Thu, 16 Apr 2020 06:14:00 GMT

To stretch or not to stretch?

There are multiple scientific studies to both prove and dispute the benefits of stretching. From personal experience, with years spent working with both elite athletes and the general public, we will all benefit from stretching on a daily basis. So why is stretching good for you?

Stretching keeps the muscles flexible, strong, and healthy, and we need that flexibility to maintain a range of motion in our joints. Without range of motion, our muscles are prone to becoming tight and therefore shorten. Then, as we start to train and work the muscles, they will be weaker as they are not working in their optimal range. If you continue to train, then you are putting yourself at risk of muscle damage, strains and joint pain.

If the majority of your day is spent in a slumped position, relaxing or commuting to work then you may start to notice a muscle imbalance within the body. For example, sitting in a chair all day results in tight hamstrings in the back of the thigh. This can make it harder for you to extend your leg or straighten your knee all the way, which inhibits optimal walking mechanics.

Likewise, when tight muscles are suddenly called on for a strenuous activity that loads them as they stretch, such as playing touch footy or tennis, they may become damaged from suddenly being overloaded. In addition, tight or injured muscles may not be strong enough to support the joints, which can lead to joint injury.

What type of stretching should you do?

Dynamic stretching involves active movements where you will move the arms or legs through a full range of motion. Usually performed before starting a workout to help you warm up the muscles. This stretching routine should go for 6-12 minutes. We avoid static stretching prior to any workout as this has been shown to impair your performance.

Static stretching involves you holding in place for a set period of time without movement, between 20-60 seconds usually. This is usually done at the end of a workout once the muscles are warmed up but also beginning to relax. We recommend taking a minimum of 10 minutes for a post-workout cool down stretch.

Most people skip static stretching and it is difficult to understand to why? Stretching will help improve your flexibility and help you to stay injury free. Stretching takes 10 minutes out of your day, but an injury can significantly affect your health and lifestyle for 6 months or more! It’s a no brainer.

Try these quick stretches to help with everyday tightness from sitting or decreased activity during your day.

Seated Piriformis (Buttock) stretch

Start in a seated position.
Keeping your right foot flat on the floor, lift your left leg and place your left ankle on your right knee.
Apply gentle downwards pressure to the knee as you lean forward, increasing the depth of the stretch.
Hold this position, you should feel a comfortable tension with no pain in the bottom region of the leg that is not making contact with the ground.
Repeat every hour with each leg for 20-60 seconds.

Chest Openers

Sit up straight on a chair.
Place your hands behind your head and extend your upper back over the top of the chair.
Hold this position for 2 seconds.
Repeat 1 set of 10 repetitions each hour you are seated at work.

Cat – Cow stretch

Start on your hands and knees, with your knees directly underneath your hips and your hands underneath your shoulders and your back in a neutral position.
Place your hands flat on the floor and contract your abdominal muscles, making sure that your spine is well aligned with your back straight as a tabletop.
Inhale, and arch your spine away from the floor, pulling your belly up like a cat.
When it comes time to exhale, round your spine in the opposite direction, lowering your belly towards the floor and lifting your head.
Hold the end of each position for 2 seconds, repeat 3 times with 10 repetitions in each direction. Alternate sets with the following exercise.

Lumbar Rolls

Lie on your back with your knees bent and your feet flat on the floor.
Keeping your shoulders flat on the ground, roll both knees out to one side.
Hold this position.
You may feel the stretch in your hips, as well as your lower back.
Bring your knees back to the middle before repeating the same movement on the other side.
Complete 3 sets of 10 repetitions each side, morning and evening

If you are unsure about how to stretch safely, or even what you should be stretching, you can ask our experienced team of physiotherapists to show you how. We will assess your muscle flexibility and tailor a stretching program to fit your needs. Book a session now and you will never feel the same again!

COVID-19 Nutrition. Stocking a Healthy Pantry.

Thu, 16 Apr 2020 06:04:00 GMT

COVID-19 Nutrition – Stocking a Healthy Pantry

With the evolving impact of the COVID-19 pandemic, many are planning to stay at home for extended periods and access to nutritious food has become top of mind. While being prepared is important, unnecessary stockpiling of food puts strain on the most vulnerable members of our community . Below are some tips for sensibly stocking a healthy pantry while considering others.

Check out what you already have in the pantry, fridge and freezer – there is no point doubling up unnecessarily. Throw out any food that is out of date food to free up storage space.

Write a list before heading to the supermarket but be prepared to do the best you can with what you can get. Some foods may be difficult to find, or too expensive, so being flexible is important. Include a variety of fresh, canned, dried and frozen produce from the major food groups below and focus on foods that you will enjoy, therefore avoiding future food waste.

Foods to consider:

Protein

Canned fish such as tuna, salmon or sardines
Canned or dried legumes – drain and rinse canned legumes before use
Fresh meat and poultry – freeze in individual portions for future use
Nuts, seeds and nut butters – store them in the fridge to last longer
Long life dairy milk – UHT or powdered or non-dairy alternatives such as soymilk, almond milk or oat milk

Fruit and vegetables

choose those that last longer such as celery, broccoli, cauliflower, Brussel sprouts, carrots, pumpkin, cabbage, onions, sweet potatoes, oranges and apples
Frozen and canned fruit and vegetables – drain and rinse canned vegetables and choose canned fruit in natural juice where possible

Grains

Stock up on a variety of dried wholegrains – barley, rice (brown, red, wild), pasta, quinoa, rolled oats and cereals
Consider freezing a loaf of wholegrain bread or rolls to extend their shelf-life

Flavouring staples

Extra-virgin olive oil
Balsamic vinegar, lemon juice (frozen in ice-cubes)
Dried herbs and spices
Garlic and onion

Comfort foods

Whatever these are for you – coffee, chocolate, wine – don’t forget these!
Seeking foods that provide a source of comfort is not only understandable during a time of such uncertainty but also encouraged as they can be beneficial to your mental health.

While some of us are enjoying the extra time at home to experiment with new recipes – it is low on the priority list for others. Juggling child-care, full-time work and other competing responsibilities is the reality for many, and for some, unemployment and reduced income are making mealtimes particularly challenging. Focus on easy recipes with simple ingredients and adapt as necessary. Meals that can be made in batches and frozen for future use can help provide meal variety and while reducing cost and wastage.

For recipe ideas and individualised nutrition advice during this challenging time our dietitians are available for telehealth appointments. To make an appointment call us on (02) 9194 1800 or book online by clicking here

Probiotics and Prebiotics. What You Need to Know.

Fri, 31 Jan 2020 01:19:00 GMT

Probiotics and Prebiotics

Lately, it seems like everyone is talking about gut health – and with good reason.

A healthy gut is important for effective digestion, a strong immune system, cognitive function and mood – it is even thought to be effective at preventing and managing chronic diseases.

The best way to promote a healthy gut is to eat a diet rich in fibre with plenty of prebiotic and probiotic foods. Getting enough probiotics and prebiotics in your diet ensures a healthy balance of the good and bad bacteria in your gut – impacting much more than just your digestion.

Probiotics are live bacterial cultures, which when consumed with a healthy diet can help restore and support a healthy gut. They are particularly beneficial if gut health has been compromised. Although people often choose to consume probiotics in the form of a supplement, they occur naturally in foods too.

Some of the best probiotic foods include:

Yoghurt: Not all yoghurt on the supermarket shelves contain probiotics so if you’re looking to improve your gut health, make sure you check the label. Avoid sweetened varieties as we know refined sugar can destroy the good gut bacteria

Sauerkraut: AKA fermented cabbage, is arguably the healthiest food there is for your gut. Choose those in the refrigerated section to ensure more live probiotics

Tempeh: A plant-based protein food made from fermented soybeans is jam packed with good bacteria. This probiotic food doubles as a great source of protein, iron, magnesium and calcium

Miso: A popular flavouring made from fermented soybean paste used in Japanese and Chinese cuisine . As well as being packed with millions of beneficial bacteria for your gut miso is a rich source of protein, essential minerals and vitamins. Avoid boiling to maximise its gut health benefits

Kombucha: A mildly fizzy, flavoured drink taking over shelves at cafes and health food stores is made by fermenting brewed tea. A great alternative to soft-drinks and sweetened fruit juices however more research is needed to show whether the number of probiotics produced translates to a gut health benefit

As there is no way to know the exact quantities of these probiotic rich foods to include in your diet – adding a variety daily is recommended.

You may choose to take probiotics in supplement form when therapeutic doses are required and particular strains may have a beneficial effect on conditions such as irritable bowel syndrome, diarrhoea, allergies, colds and more.

What about prebiotics?

Probiotics and prebiotics work together and while they sound similar, they play very different roles in gut health.

Prebiotics are fermentable fibres found in plant foods that end up the food source for the growth of good bacteria in our gut – they feed probiotics. The health-promoting benefits of probiotics are transient unless you keep feeding them.

Some of the best prebiotic foods to include in your diet are:

Oats: A versatile wholegrain with prebiotic benefits. Oats contain large amounts of beta-glucan fibre, as well as some resistant starch and are particularly suited to breakfast – porridge, muesli or added to smoothies

Onion: Nutrient-dense and rich in prebiotics and antioxidants, onions aid digestion and strengthen gut health. To boost their prebiotic benefits, eat onions raw and avoid over peeling them as most of the flavonoids are contained in the outermost layers

Garlic: Loaded with nutrients including manganese, Vitamin B6, Vitamin C and selenium as well as containing almost 20% fibre by weight, garlic is a versatile prebiotic food. There are several healthy ways to add garlic to your diet – stir-fries, pasta sauces, curries and dips

Bananas: High in fibre, vitamins, and minerals – slightly unripe bananas have particularly powerful prebiotic effects

Chicory Root: Available in supplement form and commonly used as a coffee replacement, chicory root is one of the best prebiotics around. You may have even eaten it without knowing as it is commonly used as a food additive

Legumes: Beans, peas, lentils and soybeans – legumes contain the prebiotic galacto-oligosaccharides (GOS) and resistant starch. Cooking legumes with spices such as fennel, ginger and cumin can help minimise flatulence and bloating

Jerusalem artichoke: Rich in potassium, thiamine and fibre, Jerusalem artichoke they can be prepared similarly to a potato – boiled, sautéed or roasted. Despite its name, the Jerusalem artichoke is unrelated to the globe artichoke

Every meal you eat can make a difference – research has shown that within days of eating a diet rich in probiotics and prebiotic foods our gut bacteria transforms, becoming more balanced and diverse.

Plantar Fasciopathy. This one simple exercise can help heel it!

Mon, 18 Nov 2019 20:48:00 GMT

Plantar Fasciopathy

Do you wake up every morning and dread taking that first step when getting out of bed? It may feel like you are walking on a continuous line of thumbtacks, and this quickly starts your day on the wrong foot (pun intended).

You notice that the first few steps are always the worst but then it slowly improves with activity as it warms up. The pain will start under the heel in your foot or in the arch after you have rested the feet all night. The lifetime prevalence of obtaining this injury is as high as 10% – That is a quite a large number of people who will be affected by this at some point.

Where does the pain come from?

A thick fibrous band of connective tissue called your plantar fascia (PF). It originates on the medial (the middle) aspect of your calcaneus (heel bone) and extends along the sole of the foot before inserting at the base of the toes. It supports the arch of your foot to prevent flattening. When your PF develops micro tears or becomes inflamed, this is known as plantar fasciitis.

What are the causes?

Unfortunately, no one really knows the answer to this question. There have been numerous studies performed over the years, but the findings remain inconclusive. All we do know is that Plantar Fasciitis is thought to be a traction and overuse injury where the PF has been repeatedly overstretched.

This can be due to weak foot stabiliser muscles (the intrinsic foot muscles) and poor foot biomechanics, which causes overpronation. If the muscles in your feet are weakened, then an excessive force is transmitted to other tissues such as your PF. The pain will then arise if the tolerance of your PF is exceeded.

Could my running technique be causing me the pain?

It is a common assumption that the repetitive impact caused by landing on your heel when running is what causes Plantar Fasciitis. However, one study has shown that the high impact forces that occur when you overstride (poor running technique) can be a contributing factor in developing the condition.

From our experience with athletes, we have found that landing on your forefoot with your foot in front of your body is a likely technique-related cause for Plantar Fasciitis. Often runners make the mistake of intentionally trying to land on their forefoot or midfoot when they are running. This causes dropping of the forefoot but a stiffening of the foot, which quickly overloads the plantar fascia, calf muscle and Achilles tendon.

Research suggest that ideal landing is when your foot lands close under your body/hips and for your foot to be relaxed when it lands. However, if you run in cushioned, well supported shoes then you are more likely to contact the ground heel first (heel-striking). As long as your foot is under your body, then the impact and stress on the PF is significantly reduced compared to landing with the foot in front of the body. Now we know the cause, let’s investigate the question you really want to know….

How do you fix it!

You might have tried a combination of orthotics, massage, new shoes, plantar specific stretching, complete rest from exercising or several other popular recommendations found on Doctor Google. These interventions will provide some relief but there are a high percentage of you that will still have symptoms for up to 2 years after your initial diagnosis. If those approaches haven’t worked, then it’s time to try something different:

Progressive loading

Recent evidence suggests that high load strength training has been placed superior to that of PF stretching in improving heel pain. Progressive loading strengthens the PF, connective tissue and foot muscles. Book an appointment with your physiotherapist to begin loading at an optimal range for you (every case is different, and you might delay recovery if you load too heavy too soon). A usual starting point will begin with heel raises.

Toe Elevated Heel Raises

Place a rolled-up towel under the toes to stretch the PF, especially at the top of the heel raise. Start the exercise with both feet and then progress to one if that’s too easy. To decrease the risk of symptoms flaring, start loading with 12 repetitions for 3 sets and gradually work down to 8 repetitions for 5 sets.

Each heel raise should consist of a three-second concentric phase (going up) and a three second eccentric phase (coming down) with a 2 second isometric phase (pause at the top of the exercise). They need to be performed slowly and completed every day. To progress the load, you can wear a backpack with books which will then involve decreasing the number of reps but increasing the sets.

It is common to experience mild pain when completing this exercise. However, pain should be no higher than 3 on a 10 scale (10 being the worst pain imaginable). If you have a flare up in pain don’t stress, you may have over worked it. Next time adjust your reps, sets or weight.

Some individuals are lucky enough to continue running whilst rehabbing their PF, but others may need to cease training for a short while. Check in with your physiotherapist today to see what will work best for you in giving you the quickest reduction in pain.

Carbohydrates, Friend or Foe?

Fri, 01 Nov 2019 03:55:00 GMT

Carbohydrates – Friend or Foe?

In case you haven’t noticed, low-carb diets are all the rage these days. Popular diets such as Paleo and Keto have heightened the misconception that all carbohydrates are bad and should be avoided at all costs. But are carbohydrates really the enemy, or could excluding them from your diet be detrimental to your long-term health?

Carbohydrates = Fuel

Carbohydrates are the most important energy source for your body and the reality is your body needs them to function optimally.

Carbohydrates in the food that we eat are broken down into smaller sugars (glucose) and used as fuel – even the simple task of breathing relies on this fuel source. Any unused glucose is then stored in the muscle in the form of glycogen for future use. Our body recruits this stored carbohydrate during exercise or whenever glucose levels in the blood are low.

It is therefore no surprise that a low carbohydrate diet can result in low energy levels as well as fatigue and delayed recovery from exercise. In addition, the brain depends solely on carbohydrates – it is unable to used stored energy. As a result, low-carbohydrate diets may also adversely impact cognitive function and mood.

Fibre

Carbohydrates are a major source of dietary fibre and as a population we are far from meeting the recommended intake of 30g per day. Fibre is essential for our digestive health. It helps you feel fuller for longer, can improve cholesterol and blood sugar levels, and can assist in preventing a number of diseases. Considering its importance, avoiding carbohydrate foods rich in dietary fibre is not a good idea.

All carbs are not created equal

Not all carbohydrates are equal when it comes to nutrition. Eating the right type of carbohydrates, in appropriate amounts for your individual requirements, is definitely worth incorporating in your diet.

Complex carbohydrates such as those found in whole-grains, legumes, fruit and vegetables are digested slowly and released into the bloodstream gradually. They are also packed with dietary fibre and have important vitamins and minerals adding to their value. Including a serve of these carbohydrates in main meals is advisable.

Some examples include:

Oats
Legumes
Whole-grain bread
Quinoa
Barley
Brown rice
Starchy vegetables such as sweet potato
Fruit

Simple carbohydrates on the other hand are often refined and stripped of fibre. They are digested quickly and can cause a rapid spike and then drop in your blood sugar levels. While all foods can have a place in a healthy diet, limiting simple carbohydrates is recommended.

Simple carbohydrates can be found in:

Refined breakfast cereals
White bread
Brown or white sugar
Fruit juices – particularly concentrate
White rice
Flavoured yoghurt
Confectionary
Soft drinks

Getting portions right

Carbohydrate requirements vary considerably and some individuals do indeed eat too much. A good starting point is to include a fist sized portion or ½ cup cooked complex carbohydrate with your main meals. Remember, this portion will need to be increased significantly for some – particularly those exercising regularly.

While there is no best diet for everyone, a restrictive way of eating is usually not the right path for most. Low- carb diets such as Paleo and Keto – that promise fast weight loss – can seem attractive but their effectiveness and safety long term is unknown.

Our dieticians can help you find a carbohydrate balance and plan that will work best for your individual needs. To make an appointment call us on 8068 5158 or book online

Strapping Basics. Notes from our Level 1 Course.

Tue, 22 Oct 2019 09:28:00 GMT

Level 1 Strapping Course

Strapping tape and Supportive taping is commonly used by physiotherapists and trainers to:

relieve your pain
improve joint stability
enhance athlete confidence
reduce injury recurrence
prevent injury

Types of Strapping Tape

Rigid strapping tape commonly used in taping or strapping is often referred to as “sports tape” or “athletic tape” and is most often a rigid style of strapping tape.
Elastic strapping tape can also be used when less rigidity or support is required, or as an overwrap to provide added support.
Kinesiology tape (or K-Tape) is an improved version of elastic sports tape that acts to dynamically assist your muscle function.
Underwrap tape is used to protect any sensitive areas.

One of the main functions of tape is restriction of movement

Elastic tape DELAYS the movement
Rigid tape LIMITS the range of movement by up to 25-50%
Use of underwrap – loss of 30-50% of effectiveness

Other main function of tape is stimulation of our proprioceptive system!

Serves as a ‘Reminder’.

Preparation and Protection of the skin:

Check that the person to be taped is not allergic to adhesive tape. They may not know this if they have not been taped before but it is best to ask. Also, make sure there is no broken skin or existing rashes.

You may ask the patient to shave to remove hair from the area to be taped (generally only for patient comfort upon removal only). For best results this should be done 12 hours before application of tape to reduce skin irritation.

Clean and prepare the skin. Before taping the area and skin should be clean and free of any oils or creams, as they will reduce the effectiveness of the tape’s adhesive. If the athlete has particularly oily skin or you want increased adhesion you may opt for a pre-tape adhesive spray

Pad any sensitive areas or cuts with underwrap. We utilise Leukofoam Lite or Elastowrap (or other hypo-allergenic underlays) on areas where ‘tape cuts’ are more common (e.g ‘heels’ or ‘laces’ for ankle taping).

Rules of tape application:

Place limb or joint in position that offers most stability and comfort to athlete. Joints are normally strapped in the ‘neutral’ or functional resting position. Positioning is one of the most important things to consider when strapping!! Need to ask yourself – “What are we trying to achieve?” As sports physiotherapists and trainers we need to identify the positions in which the joint/ligaments is most at risk, and therefore should tape the joint in a position of protection. For example, an anterior shoulder dislocation taping is performed with the athletes shoulder in internal rotation, to protect the shoulder from the ‘at-risk’ position of external rotation and abduction.
Choose an appropriate thickness of tape for the part to be strapped. Take into consideration the size and musculature of the person you are tapping.
Follow natural anatomical boundaries for tape application. Due to the conical shape of the limbs (e.g. the calf muscle) applying the tape perpendicularly leads to uneven pressures at the top and bottom portions of the tape.
With musculature, allow for contraction/expansion.
Hold the roll in one hand and pull off the roll with the other, then apply to the body part. Alternatively cut or tear lengths of tape to fit the part, then apply.
Each layer of tape should overlap the previous layer by approximately a third to half the width of the tape.
Smooth and mould tape as it is laid on skin. The strapper should be acutely aware of the ‘line of pull’ of the tape which they apply. Novice strappers often just lay down the tape in pre-learned directions without thought about what they are trying to achieve.
The tape should mould to the anatomy of the region and follow the line of the ligaments to be supported. Allow tape to fit natural contours of skin/body part.
Always start taping with anchor pieces and finish with closing pieces (lock-off).
Where maximum support is required tape directly on skin (use minimal underwrap).
Tape should be applied firmly to the skin but not so firmly as to cut off the blood supply.
Use an amount of tape sufficient to support the joint. Too much will restrict the joint and too little will offer poor support.
With practice you will get better at applying and judging the amount required. Like any other skill – it takes years of practice to master!
When finished tape application, check tape job for support, tidiness and flaws

Caution

Always check once you have completed the taping to see if it is too tight and loosen or reapply if necessary.

Check circulation distal to tape. This is more of an issue with wrists, thumbs and fingers.

Removal of tape:

Tape should be removed immediately if the circulation appears to be affected or the person taped complains of itching or develops a rash.
Under normal circumstances, it should be removed once the activity it was put on for has finished.
Use either bandage scissors (which have a rounded end so as not to cut the person) or take the tape off in individual pieces.
With the scissors slip them between the tape and the skin in a muscular part of the body, not against the bone. Slide and cut at the same time.

Common flaws of tape application:

skin not prepared properly (too oily)
wrinkles/rolling of tape
tape applied to tight
tape applied too loose
‘windows’ in tape job
natural anatomical boundaries ignored
failure to apply proper anchors
failure to use sound biomechanical principles

New Concepts in ACL Injury Management

Sun, 20 Oct 2019 22:29:00 GMT

Anterior Cruciate Ligament Injury

Most people wanting to return to sports after an anterior cruciate ligament (ACL) injury are commonly recommended anterior cruciate ligament reconstruction (ACLR). Consequently, the annual incidence of ACLR continues to rise, particularly for younger patients and those seeking revision surgery. Unfortunately, only 65% of patients return to their pre-injury level of sports participation following ACLR, and of those who do, nearly one in four experience a subsequent ACL injury

It is important to understand that neither surgical nor conservative management will guarantee an uncomplicated return to sport, but there is now strong evidence that conservative management of ACL injuries does not result in inferior outcomes compared to surgery.

The rehabilitation process following an ACL injury is very similar whether you have opted for the surgical or non-surgical path. however timeframes for non-surgical management are usually faster, given there is no need to recover from surgery, or graft to monitor.

The initial consultation

Development of a comprehensive, long-term structured rehabilitation program for any patient with an ACL injury begins at the initial consultation. It is common thought that surgery is a ‘quick-fix.’ A key part of a physiotherapist’s role is to help the patient understand that irrespective of their end goal, they need to commit to a purposeful rehabilitation program, as this is a key factor in the determinant of successful outcome (Ericsson et al 2013, Eitzen et al 2010)

As a priority, our physiotherapists to use the subjective exam/interview to get a feel for the patient’s beliefs, expectations and goals around the injury, with the best research showing it is these elements that determine whether a patient chooses surgery, or not (Thorstensson et al. 2009). Here are some simple questions we commonly use to help us understand your goals, understanding of injury and potential barriers to recovery:

‘What do you understand the best research-evidence says about the management of ACL tears?’
‘Would you be pleased to know that for many patients, physiotherapy and exercise actually becomes their treatment?’
‘How long do you think it will take to get back to your desired level of activity?’
‘Are you worried about using your knee again?’
‘Do you believe that if you feel pain you are causing damage?’
‘If you feel an increase in your knee pain during an activity, do you stop or carry-on? Why/why not?’
‘How fearful are you of re-injuring your knee?’

Having identified a series of functional limitations in the patient interview during the initial consultation, Our physiotherapist’s then like to attempt to show a patient that often their pain can quickly be modified. This can be as simple as supporting the painful site.

Many patients who have injured their ACL, can be pleasantly surprised at how quickly their resting pain and pain with functional tasks can be considerably abolished with simple strategies like this, which diminishes a reductionist focus on the ligament as being the sole cause of their pain.

At the first session, we like to conclude by recorrecting any aberrant functional movement patterns and then use these as the initial building blocks of an exercise program. They might include repetition and practice at home of a relaxed sit-to-stand, two-legged squats or ‘baby lunge’ tasks within pain tolerable limits.

Controlled, high-quality, supervised rehabilitation over time

Generally, by the end of the first or second consultation, We like to talk about prognosis in terms of time frames with patients. Clinical guidelines and the best trials of non-surgical management for this injury recommend three to six months for returning to pre-injury activity for non surgical management and nine to twelve months for surgical management. Time frames can be quicker or longer than this (Rooney 2018, Frobell et al 2010). For non surgical management, we generally outline to patients verbally three key, fluid phases, with approximate timeframes and key focuses of management, which may include:

Weeks 0-4, symptom relief: Manual therapy techniques , active range of motion exercises, balance/proprioception exercises, restoring normal functional movement patterns, 2- and 1-legged exercises as able, cycling and normal gait with graded walking programs
Weeks 5-13, a progression of functional exercises and strengthening: Advancing 2- and 1-legged functional exercises, then stationary plyometrics, jogging/running/sprinting
Weeks 14-28 and beyond, return to sports progressions and assessments: Dynamic plyometrics, cutting/agility drills, sports-specific drills, psychological readiness, prevention/performance-enhancing exercises.

What to Expect From Seeing a Dietitian

Mon, 22 Jul 2019 06:09:00 GMT

What to Expect When Seeing a Dietitian

Prior to your first appointment

Before we even see you, our reception staff will send you a form to fill in. This is to help us get to know you better before the first consultation. The form includes questions about your medical history, food history and lifestyle habits, along with what you are hoping to achieve from working with us.

At your first appointment

At your initial consultation we spend time going over the initial questionnaire to ensure we have clarified any information, gain more insight and information into any medical symptoms, training program or lifestyle habits that may be impacting you, and then put together initial strategies to help you work towards achieving your goal. This may be some specific changes to your current food intake, or education around a certain aspect of nutrition that will be the most effective first step towards best health.

How long is an appointment?

Your first appointment is scheduled for 45 minutes. Follow ups are scheduled for 30 minutes. If you require a longer appointment, this can be discussed with our reception team at time of booking.

How many times, and how often will we see you?

This really depends on your personal needs, and the reason you have to come to see us. Regular reviews with your dietitian have been shown to improve compliance and achieve better health outcomes compared with going it alone. Follow up appointments are essential to provide you with all the relevant information and practical advice you need to achieve your health goals. In your follow up sessions, we build on the information you are already familiar with and adjust the content to target your priorities. We will always discuss your treatment pathway with you as well, to ensure you understand why and when we want to see you.

The Heated Topic About Cold Therapy

Mon, 22 Jul 2019 00:51:00 GMT

Heated Topic About Cold Therapy

I want you to think back to the last injury you had. Did you have an initial impulse to put an ice pack on it? Or did you prepare a heat pack in the microwave? Well, different types of injuries require different types of management.

We all know that both cold and hot therapy can help treat many injuries. They are both quick, drug-free, inexpensive and easy self-treatment options. But do you know when it’s appropriate to use a cold or hot pack to treat a problem? Here I will explain when you should use hot or cold treatments.

Firstly, how does it work?

In the initial stages following an injury the immune system responds with an inflammatory response which sees an increase of blood flow to the area. This causes a rush of white blood cells, antibodies, proteins and other fluids to the injury site. This increase in swelling and inflammation causes the pain. Too much swelling will slow down the healing, be uncomfortable and also limit joint range of motion.
Ice reduces tissue temperature by slowing down metabolic activity around the injured area and as a result, decreases tissue damage. This will also lessen the pain by numbing the nerve endings involved.
Heat increases the surfaces temperature of the skin, which stimulates your sensory receptors and as a result, blocks the pain signals being sent to the brain. Heat also makes your muscle tissue more elastic, which releases tension and increases blood flow. Therefore providing oxygen and more nutrients to the painful area to aid in the healing process and restore range of movement.

How do you know which one to choose?

Cold Therapy:

Think ‘acute’ sports injuries. These include sprained ankles, torn muscles/ligaments and bruises. When an acute injury occurs they become red, swollen and hot due to damaged muscle tissues.
Get it on fast! Ice is most effective immediately following an injury and loses its affect significantly after approximately 48hours. The sooner you get it on; there is a greater chance of reducing swelling and minimising inflammation.
What form of ice? Ice therapy includes raw ice, gel packs (used with a towel to reduce intensity), ice baths or the trusty bag of peas. The most effective method is the use of crushed ice in a bag applied to the injury site.
You can purchase gel packs that turn into ice in your freezer or, to make things quick and easy on the sideline of a game, use instant ice packs, which are designed to turn cold instantly with a simple squeeze.
A commercial device such as a Game Ready is commonly used in an outpatient setting. It provides intermittent compression whilst delivering cryotherapy (cold therapy) to the injury site. This is the best way to deliver cold and compression therapy to an injured site and is used commonly by the world’s best athletes. Redfern Physiotherapy is equipped with its very own Game Ready machine to help manage your acute injuries!
Did you know? Ice has been shown to be more effective than gels (a common item in a sports parents freezer) at reducing skin surface temperature. It has the ability to absorb more heat as it goes through a state of physical change – melting from ice to water.

Hot Therapy:

Think ‘chronic’ sports injuries. Is best used for consistent pain (pain lasting from weeks to months), stiffness, muscle spasms, whiplash, arthritis and to loosen and relax tired muscles. However, it should not be used directly after exercise.
No Exceptions! Refrain from using heat for at least 48-72 hours after a new injury has occurred. If swelling or redness to the skin occurs following an injury then do not apply heat.
Signs of a chronic injury include a dull ache when at rest or pain when performing an activity.
Ways to heat it up? Heat therapy includes wheat packs, hot water bottles, a sauna or hot bath. Deep Heat and Tiger Balm are often used to provide a neurological distraction due to their warming sensation on the skin only.
Did you know? The continuous application of low-level heat eased low back pain better than two common over the counter painkillers.

Friendly reminders:

How long? Whether hot or cold, be sure to keep exposure to 20 minutes per session. You should wait at least 1 hour between treatments (starting when you take off the ice until you reapply the ice).
Protect your skin from burns by wrapping packs in a towel or cloth before applying.
What a mess! A Ziploc bag is a great solution for keeping ice therapy mess-free! No bag or cloth to use? Perform an ice massage by constantly moving the ice around the area of discomfort.
The Price is right! A common acronym to remember what steps to take in the initial stages of an acute injury is

Protect = Protection from further damage
Rest = rest to avoid prolonged irritation
Ice = To control pain, bleeding and edema (swelling)
Compression = For support and to control edema
Elevation = Place the injury site above the heart to drain fluid away from the area.

As a general rule of thumb, you should use heat on stiff, aching and chronic injuries and ice on acute or new injuries that occur suddenly. Remember! Ice and heat provide symptom relief but are not going to treat the underlying issue. To find out how to recover from your acute or chronic injury, book an appointment with our team of physiotherapists to help you follow a customized rehabilitation management plan.

Food Packaging Label Reading Made Simple

Mon, 10 Jun 2019 07:22:00 GMT

Food Packaging Made Simple

Label Reading

Food labels are meant to be helpful – a quick scan and you should be able to compare products and make a healthy choice. But all too often, they cause more confusion than clarity, and add to the hassle of supermarket shopping. Does this breakfast cereal have too much sugar? How important is sodium? Should I even worry about total fat? It can be difficult to know what to look for!

Below are some simple tips to help you take the stress out of label reading and choose products with the right balance of ingredients.

Start with the ingredient list

All ingredients must be listed on a product in order of the most to least by weight. Therefore, if a source of fat, salt or sugar is listed as one of the first few ingredients, this product may not be a healthy choice. My advice; choose products with a short ingredient list. If you pick up a product with numerous ingredients you’ve never heard of before, or lots of numbers, it is generally a good idea to put it back on the shelf. Familiarising yourself with the alternate names for sugar, salt and fat can also be helpful. Did you know that corn syrup, dextrose, glucose and rice malt are all just other names for sugar?

Check serving sizes

Always use the per 100g column on food labels to assess and compare products. Use the per serve column when looking at energy (kJ) content or sugar per serve. Remember there are often multiple servings in one package. Therefore, if a bag of potato chips contains three servings and you eat the whole bag, you’re going to need to multiple the kJs per serve by three.

Take energy into account

Everybody’s energy needs are different, so providing a kJ recommendation for food products is tricky. Some manufactures choose to include information about percentage (%) daily intake, which can be used as a guide, but remember this has been calculated on the needs of an ‘average adult’. Aim for 600 kJ or less per serve for a snack.

Watch out for added sugar

You’ll find sugar where you least expect it so always check this one. Stick to products that contain less than 10g per 100g and no more than 5g per serve. The exception to this rule is if the product contains fruit (as one of the first three ingredients), 20g per 100g is acceptable in this case.

Keep an eye on fat

While it’s a good idea to keep an eye on total fat, the others are more important!

Saturated fat and trans fat should be as low as possible, as these are the fats associated with disease risk. Look for products with less than 2g of saturated fat and no more than 1g trans fat per 100g. Monosaturated and polyunsaturated fats are an essential part of our diet and important for good health. Consume fish, avocado, nuts, seeds, extra virgin olive oil in small amounts. Less than 10g per 100g is ideal.

Check the sodium content

Sodium is used to enhance flavour, and even ‘non-salty foods’, can contain high amounts. Less than 120mg per 100g is considered low and anything greater than 400mg per 100g high. Compare products like bread, crackers and canned produce and choose ‘no added salt’ where possible.

Fill up on fibre

Particularly important when looking at products like bread, breakfast cereals and crackers. Products made with wholegrains will generally be high in fibre and do a better job of filling you up. Aim for 7.5g of fibre per 100g.

Be mindful of nutrition claims

Nutrition claims are statements made by food businesses and can often be misleading. Example, ‘baked not fried’ does not mean the product is lower in fat or energy, it may still be baked in oil. This is where knowing a few simple label reading tips can be helpful.

Our dietitians Chloe and Fiona, are available for individualised advice on reading food labels and help meeting any nutritional needs you may have.

5 Office Exercises for Relieving Neck Pain

Wed, 29 May 2019 02:07:00 GMT

Five Office Exercises for Neck Pain

You wouldn’t go running, bench press or sit in a car for 8 hours continuously without a break or two to move around, would you? So why do we find it perfectly normal to sit, hunched over, with muscles in constant contraction, straining our eyes as we stare into a fluorescent screen all day? It’s absolute madness.

Never fear however as help is at hand for relieving those aches and pain as well as tight neck muscles that leave you feeling sore, tired, heavy and at quite possibly with a splitting headache. Fortunately, we have some easy to do, take anywhere, anytime exercises that will get you loose as a goose and ready to face the afternoon slog.

Active Neck Rotation

This is a great one for general mobility of the neck when it feels tight. Starting incorrect posture (which is sitting tall, shoulders slightly back and down, chin tucked in and head facing forward) slowly rotate the head to the left keeping the line of sight parallel to the ground (not looking up or down). When you reach a position where the neck is slightly uncomfortable with the stretch pause for 1 second and then turn the head back through centre and to the right. Repeat this in a slow controlled motion for one minute, take a short 30-second break and repeat.

Levator Scapulae Stretch

If this muscle could be renamed it would surely be the gremlin muscle. When your neck and shoulders get tired you can trust good old Levator Scapulae to take over and try to hold things up but it comes at the cost of a tight neck, sore shoulders and even headaches. To stretch it out place one arm by your side (or even tucked behind your back) and rotate your head to look the opposite way, gently look down and with your free arm reach over the head and apply moderate pressure for 30 seconds then repeat on the opposite side. Stretch both sides a total of three times applying slightly more pressure each repetition.

Chin Retractions

Ever wondered why your neck gets tired and sore? Does it feel like you head weighs 100kilos by the end of the day? Chances are you’re spending your day with your head tilted forward and your chin poking out, which places huge amounts of strain on your neck. To counteract this, the chin retraction exercise is our favourite.

Start by standing up tall and looking straight ahead. Raise one arm and shape your thumb, pointer and middle finger into a tripod. Place the thumb and middle finger on each collar bone and the pointer finger on your chin. This should cause you to retract your chin and engage to muscles as the upper back of your neck (where it connects to the skull). Hold this posture for 10-20 seconds and rest 5 seconds. Repeat 10 times.

Neck Stretches

Now it’s time to stretch out all those tight muscles, particularly the Upper Traps that spend all day working overtime and also your neck extensors which are under strain from crooning your neck forward to peer at the screen or look at the keyboard. Flex your head to one side, reach over with same side hand and apply a moderate amount of pressure to increase the flex to the desired side. Hold for 20 seconds and then repeat on the opposite side. Stretch both sides twice before moving on to the back of the neck. Looking down, place both hands on the back of your head and lightly apply pressure in a forward motion and hold for 20 seconds (repeat this twice more). Your neck should feel nice and loose now so let’s move on to posture

2 sets of 30 sec each

Isometric Neck Strength

Finally, it’s time to make our neck resilient and robust. The idea is to apply only a moderate amount of force and match it in the opposite direction with your hand so that the head remains in the same place. Looking straight ahead, place either your right or left hand onto the side of your head and push into the hand meeting the resistance. Hold this for 5 seconds and relax (Repeat 10 times). Now swap to the opposite side and repeat. Finally, placing your hands behind your head similar to the neck stretch, push back into your hands and hold for 5 seconds (repeat 10 times).

1 set of 10 reps (5sec hold) for each

Neck Pain is common but most cases are not caused by serious problems. These exercises, if done correctly and regularly, should help keep you pain-free and moving well.

May is Crohn's and Colitis Awareness Month

Fri, 17 May 2019 04:37:00 GMT

Crohn's and Colitis Awareness Month

The month of May is Crohn’s and Colitis awareness month. So what better time to share part of my personal story, to help us explore the impact that inflammatory bowel disease (IBD) can have on physical and emotional wellbeing.

10 days after my 20 th birthday I was diagnosed with Crohn’s disease. I’d never heard of this disease before and to be honest, I thought that Crohn’s was an “old person’s” disease. But I was wrong – Crohn’s Disease & ulcerative colitis are lifelong, and affect many lives, starting from young children, right through to adulthood. Australia has one of the highest incidence in the world with more than 80,000 Australians living with these conditions, and numbers expected to increase to more than 100,000 by 2022.

https://www.crohnsandcolitis.com.au

For those that don’t know

IBD is an autoimmune disorder

This occurs when a person’s immune system mistakenly attacks their own body tissues. In many ways IBD has more in common with other autoimmune disorders – such as rheumatoid arthritis (which affects the joints), psoriasis (which affects the skin) and lupus (which affects the connective tissue) – than irritable bowel syndrome (IBS).

Unlike IBD, IBS does not cause inflammation, ulcers or other damage to the bowel. The digestive system looks normal but doesn’t work as it should. Irritations include stress, infection and some foods can aggravate the condition.

A small percentage of people with IBD may also experience problems outside the gastrointestinal tract including joint pain, skin conditions, eye inflammation, liver disorders, and thinning of the bones (osteoporosis).

Crohn’s disease may not have a cure, and there is no replacement for regular consultations with your Doctor, dietician, or other medical professionals (physiotherapy). But with the right advice and management, you can ensure a happy & healthy life is possible!

Being diagnosed with a lifelong disease has not stopped me or slowed me down. This has been largely in thanks to the support of my Dad. He has showed me that a good life is possible despite suffering from ankylosing spondylitis (a bad form of Rheumatoid Arthritis) by combining a few different therapies over the years. To this day we are both living our lives to the fullest!

Massage has saved me many times through the tough days of fatigue, muscle pain, body aches, depression and stress. Though it may seem to be a somewhat unconventional remedy, massage actually has many benefits. Massage therapy can help relieve stress. And by lowering stress levels, you can help reduce inflammation and other symptoms.

General strengthening of muscles surrounding peripheral joints provides additional joint stability, reducing stress placed on the joint itself.

Postural and stretching exercises are beneficial for improving symptoms of axial arthritis.

This is where a physiotherapist can complete a thorough assessment and provide individual exercises tailored to suit your symptoms and requirements.

https://www.painmanagement.org.au

Whilst making dietary changes will not cure Crohn’s or ulcerative colitis, it can significantly help with symptom management and ensure overall good nutrition is achieved and maintained.

Each and every person with IBD, has an individual experience with nutrition. Foods that cause problems for one person, may not impact another at all.

For example, some people find that a bland, low-fibre diet is easier to tolerate than one that contains high-fibre or spicy foods when experiencing a flare-up. Others have found that adopting a low FODMAP diet helps manage their symptoms.

As well as managing symptoms, attaining adequate nutrition can also be challenging for individuals with IBD due to symptoms, disease complications and medications. Adjusting the diet with guidance to avoid nutritional deficiencies is often necessary.

One of the best ways to understand how diet affects your condition is to start recording a food and symptom diary and to see an Accredited Practising Dietitian for tailored management and a diet plan. Consultation with an experienced dietitian is strongly recommended and the therapists at RPSM are ready to help guide you through this journey.

I hope this has helped you find a few answers, especially if you have been newly diagnosed or never had someone in the family go through the emotions and hidden pain you deal with on a daily basis. As lucky as I have been over the last 17years managing Crohn's disease, there are definitely some days that are better than others. So be smart in your management and seek the right advice. Try understand your body and listen to what it needs or doesn’t want. But also know with a positive attitude & good support, the good days will outweigh the bad.

Now get out there and enjoy every possible adventure!

by Hayley Rawson – Massage Therapist at Redfern Physiotherapy and Sports Medicine

Effective Treatment Of Osteoarthritis

Wed, 27 Mar 2019 22:53:00 GMT

Osteoarthritis

A recently published report from the Australian Commission on Safety and Quality in Healthcare (ACSQHC) reported that knee osteoarthritis (OA) treatment in Australia is falling well short of what is considered ‘best practice’. The report found in particular that knee arthroscopy surgery can cause more harm than good, providing no long-term benefits. This finding is supported by research which demonstrates that knee arthroscopies are no more beneficial than placebo procedures for knee OA (McAlindon et al 2014) . Conservative treatment (i.e physiotherapy) combined with a focus on promoting weight loss and becoming more active is best practice for managing hip and knee osteoarthritis. Joint replacements should only be considered as a last resort when other treatment options no longer provide adequate relief or progress.

Suffering from OA?

People suffering from OA often believe that their joint has worn out, (like the sole of a shoe), and avoid physical activity as it will only lead to further deterioration of the joint. The research evidence is conclusive in demonstrating that loading of a joint through exercise stimulates and promotes tissue regeneration, and is essential for joint health. Exercise based management has been proven to provide the following benefits for individuals suffering from symptoms of OA;

Reduce overall pain levels,
aid joint lubrication and nourishment
ease your joint pain and stiffness
improve flexibility
build muscular strength
improve your balance
help you sleep better
improve posture
improve or maintain the density of your bones
improve overall health and fitness
lower stress levels
improve your mood
help you maintain a healthy body weight

Despite the clear evidence in favour of exercise as the best treatment of OA, the majority of Australians with knee OA do not participate in any form of exercise. Exercise also has additional benefits for those suffering from OA, beyond reducing pain and increasing function in an arthritic joint. Two in three people with OA have other comorbidities, such as diabetes and cardiovascular disease. Exercise has been demonstrated to be the optimal treatment for a number of such chronic diseases due to its anti-inflammatory effects. Although exercise may not be considered the “easy” option, it has the strongest evidence for treating OA and is associated with many other health benefits (Skou et al. 2018).

Our highly skilled physiotherapists at Redfern Physiotherapy and Sports Medicine are committed to helping all of our clients in pain. So, If you think you may have knee or hip OA, our Physiotherapists are able to provide you with an individualised exercise program targeted to your needs and preferences., as we understand that not all knee injuries are the same. We are able to supervise you doing your exercises to promote self-efficacy and confidence in managing your OA in the future.

Newtown Physiotherapy Experts for Sports Injuries and Rehabilitation

Wed, 03 Oct 2018 03:34:00 GMT

Why Choose Alexandria Physio—Newtown Physio Experts for Injury Recovery?

If you're looking for expert physiotherapy and top-tier injury management near Newtown, Alexandria Physio is your trusted choice! As Newtown’s physio experts, our team of elite physiotherapists has been helping a diverse range of individuals from all over Sydney, including the nearby areas of Erskineville, St Peters, Marrickville, and Enmore, achieve their health and fitness goals for years.

Our clinic, located just a short drive from Newtown, is renowned for providing exceptional sports injury treatment, rehabilitation, athletic screening, and recovery & wellness services. Whether you’re recovering from a sports-related injury or looking for preventative care to avoid future injuries, we’re here to help you get back on your feet stronger than ever.

Our clinic’s approach blends advanced techniques, hands-on care, and personalised programs, making us the go-to experts for sports injuries, musculoskeletal pain, and post-op rehabilitation. From muscle strains and tendonitis to more complex issues like neck and back pain, we use targeted treatments that restore mobility and prevent long-term injury, making us Newtown’s best physios for pain relief and recovery.

Convenient Location Just Minutes from Newtown

Situated on Fountain Street in Alexandria, we’re easily accessible for those in Newtown and surrounding suburbs like Erskineville, St Peters, and Marrickville. Our location is just a few minutes’ drive from key areas like King Street and Sydney University, making it convenient for students, professionals, and families looking for Newtown physio experts.

Comprehensive Physiotherapy Services by Newtown’s Physio Specialists

Sports Injuries: Whether it’s a sudden injury or an overuse issue, our experts will develop a detailed and data-driven sports-specific program to restore strength and mobility.
Neck and Back Pain: Our therapists are experienced in treating common neck and back issues that hinder daily activities and quality of life.
Post-Op Rehabilitation: We offer structured rehab programs post-surgery to ensure smooth and effective recovery, no matter the procedure.
Dry Needling: For relief from chronic pain, our dry needling techniques target trigger points in muscles to restore normal function.

Book an Appointment with Leading Newtown Physiotherapists

Looking for the best physiotherapy and sports injury treatment in Newtown? Book your appointment today with leading Newtown physio experts and take the first step toward recovery.

FAQs about Physiotherapy near Newtown

What conditions do your physiotherapists treat? We specialise in treating sports injuries, post-surgical rehabilitation, chronic pain, and musculoskeletal conditions.
How do I book an appointment at Alexandria Physio? You can book online or call us at 02 9194 1800.
Do you offer physiotherapy for workplace injuries? Yes, we provide ergonomic assessments, injury prevention programs, CTP and WorkCover-approved treatment plans.

Elite Physiotherapists and Sports Injury Experts in Erskineville

Thu, 03 Oct 2013 04:28:00 GMT

Why Choose Alexandria Physio—Erskineville Physio Experts for Injury Recovery?

If you're looking for expert physiotherapy and top-tier injury management near Erskineville, Alexandria Physiotherapy and Sports Injury is your trusted choice! As Erskineville physio experts, our team of elite physiotherapists has been helping a diverse range of individuals from all over Sydney, including the nearby areas of Newtown, St Peters, Alexandria, and Redfern, achieve their health and fitness goals for years.

Our clinic, located just a short drive from Erskineville, is renowned for providing exceptional sports injury treatment, rehabilitation, athletic screening, and recovery & wellness services. As proud supporters of the South Sydney Rabbitohs and the NSW Blues, we have extensive experience treating athletes at all levels, from local club players to elite professionals. Whether you’re recovering from a sports-related injury or looking for preventative care to avoid future injuries, we’re here to help you get back on your feet stronger than ever.

Our clinic’s approach blends advanced techniques, hands-on care, and personalised programs, making us Erko’s go-to experts for sports injuries, musculoskeletal pain, and post-op rehabilitation. From muscle strains and tendonitis to more complex issues like neck and back pain, we use targeted treatments that restore mobility and prevent long-term injury, making us the best Erskineville Physio for pain relief and recovery.

Convenient Location Just Minutes from Erskineville

Situated on Fountain Street in Alexandria, we’re easily accessible for those in Erskineville and surrounding suburbs like Newtown, St Peters, and Redfern. Our location is just a few minutes’ drive from key areas like Erskineville Train Station, making it convenient for students, professionals, and families looking for Erskineville physio experts.

Comprehensive Physiotherapy Services by Erko Physio Specialists

Sports Injuries: Whether it’s a sudden injury or an overuse issue, our experts will develop a detailed and data-driven sports-specific program to restore strength and mobility.
Neck and Back Pain: Our therapists are experienced in treating common neck and back issues that hinder daily activities and quality of life.
Post-Op Rehabilitation: We offer structured rehab programs post-surgery to ensure smooth and effective recovery, no matter the procedure.
Dry Needling: For relief from chronic pain, our dry needling techniques target trigger points in muscles to restore normal function.

As Erskineville Physiotherapy experts with strong ties to Sydney’s sporting community, we proudly support the South Sydney Rabbitohs and NSW Blues, offering treatment strategies tailored to the demands of high-performance athletes.

Get in Touch With Trusted Erskineville Physio Experts

Elite Physiotherapists and Sports Injury Experts Near Kensington

Thu, 03 Oct 2013 04:11:00 GMT

Why Choose Alexandria Physio for Your Sports Injury Recovery?

If you're searching for expert physiotherapy and injury management services near Kensington, look no further than Alexandria Physio! Our team of experienced Physiotherapists has been helping a diverse range of individuals from all over Sydney, including the nearby areas of Zetland, St. Peter’s, Newtown, Erskineville, and beyond, achieve their health and fitness goals for years.

Our clinic, located just a short drive from Kensington, is renowned for providing exceptional sports injury treatment, rehabilitation, athletic screening, and recovery & wellness services. Whether you’re recovering from a sports-related injury or looking for preventative care to avoid future injuries, we’re here to help you get back on your feet stronger than ever.

Our clinic’s approach blends advanced techniques, hands-on care, and personalised programs, making us the go-to sports injury experts in Kensington. From muscle strains and tendonitis to more complex issues like neck and back pain, our trusted Kensington physios use targeted treatments that restore mobility and prevent long-term injury. This makes us the premier physios for Kensington when it comes to treating musculoskeletal pain and post-op rehabilitation.

Convenient Location Just Minutes from Kensington

Situated on Fountain Street in Alexandria, we’re easily accessible for those in Kensington and surrounding suburbs like Rosebery, Mascot, and Moore Park. Our location is just a few minutes’ drive from key areas like Anzac Parade and the University of New South Wales (UNSW), making it convenient for students, professionals, and families looking for trusted Kensington physio experts.

Comprehensive Physiotherapy Services

At Alexandria Physio, we offer a wide range of services designed to treat your specific needs. Whether you're dealing with a recent injury or managing a long-term condition, our team of elite Kensington physiotherapists is equipped to help you achieve optimal health:

Sports Injuries: Whether it’s a sudden injury or an overuse issue, our Kensington sports injury experts will develop a detailed and data-driven sports-specific program to restore strength and mobility.

Neck and Back Pain: Our therapists are experienced in treating common neck and back issues that hinder daily activities and quality of life.

Post-Op Rehabilitation: We offer structured rehab programs post-surgery to ensure smooth and effective recovery, no matter the procedure.

Dry Needling: For relief from chronic pain, our dry needling techniques target trigger points in muscles to restore normal function.

Get in Touch With Trusted Kensington Physiotherapy Experts

No matter where you're coming from, our dedicated team is here to support your journey to better health. You don’t have to travel far to receive the best physiotherapy and sports injury care from elite Kensington physiotherapists – book your appointment online today or contact us to learn more about how we can help you recover and thrive.

Elite Physiotherapists and Sports Injury Experts Near Zetland

Thu, 03 Oct 2013 03:51:00 GMT

Why Choose Alexandria Physio for Your Sports Injury Recovery?

If you're searching for expert physiotherapy and injury management services near Zetland, look no further than Alexandria Physio! Our team of elite Zetland Physiotherapists has been helping a diverse range of individuals from all over Sydney, including the nearby areas of Green Square, Waterloo, Rosebery, and Kensington, achieve their health and fitness goals for years.

Our clinic, located just a short drive from Zetland, is renowned for providing exceptional sports injury treatment, rehabilitation, athletic screening, and recovery & wellness services. Whether you’re recovering from a sports-related injury or looking for preventative care to avoid future injuries, we’re here to help you get back on your feet stronger than ever.

Our clinic’s approach blends advanced techniques, hands-on care, and personalised programs, making us the go-to experts for sports injuries in Zetland. From muscle strains and tendonitis to more complex issues like neck and back pain, our Zetland trusted physios use targeted treatments that restore mobility and prevent long-term injury. This makes us the premier physios for Zetland when it comes to treating musculoskeletal pain and post-op rehabilitation.

Convenient Location Just Minutes from Zetland

Situated on Fountain Street in Alexandria, we’re easily accessible for those in Zetland and surrounding suburbs like Green Square, Waterloo, and Kensington. Our location is just a few minutes’ drive from key areas like East Village Shopping Centre, making it convenient for students, professionals, and families looking for trusted physio experts near Zetland.

Comprehensive Physiotherapy Services

At Alexandria Physio, we offer a wide range of services designed to treat your specific needs. Whether you're dealing with a recent injury or managing a long-term condition, our team of Zetland Physiotherapists is equipped to help you achieve optimal health.

Sports Injuries: Whether it’s a sudden injury or an overuse issue, our Zetland sports injury experts will develop a detailed and data-driven sports-specific program to restore strength and mobility.
Neck and Back Pain: Our therapists are experienced in treating common neck and back issues that hinder daily activities and quality of life.
Post-Op Rehabilitation: We offer structured rehab programs post-surgery to ensure smooth and effective recovery, no matter the procedure.
Dry Needling: For relief from chronic pain, our dry needling techniques target trigger points in muscles to restore normal function.

Get in Touch With Trusted Zetland Physiotherapy Experts

Alexandria Physiotherapy Experts for Sports Injuries and Rehabilitation

Thu, 03 Oct 2013 03:43:00 GMT

Why Choose Alexandria Physio—Alexandria Physio Experts for Injury Recovery?

If you're looking for expert physiotherapy and top-tier injury management near Alexandria, Alexandria Physio is your trusted choice! As Alexandria physio experts, our team of elite physiotherapists has been helping a diverse range of individuals from all over Sydney, including the nearby areas of Zetland, Mascot, Alexandria, and Green Square, achieve their health and fitness goals for years.

Our clinic is renowned for providing exceptional sports injury treatment, rehabilitation, athletic screening, and recovery & wellness services. Whether you’re recovering from a sports-related injury or looking for preventative care to avoid future injuries, we’re here to help you get back on your feet stronger than ever.

Convenient Location in the Heart of Alexandria

Comprehensive Physiotherapy Services by Alexandria Physio Specialists

Sports Injuries: Whether it’s a sudden injury or an overuse issue, our experts will develop a detailed and data-driven sports-specific program to restore strength and mobility.
Neck and Back Pain: Our therapists are experienced in treating common neck and back issues that hinder daily activities and quality of life.
Post-Op Rehabilitation: We offer structured rehab programs post-surgery to ensure smooth and effective recovery, no matter the procedure.
Dry Needling: For relief from chronic pain, our dry needling techniques target trigger points in muscles to restore normal function.

Book an Appointment with Leading Alexandria's Physiotherapists

Looking for the best physiotherapy and sports injury treatment in Rosebery? Book your appointment today with leading Alexandria physio experts and take the first step toward recovery.

FAQs about Physiotherapy near Alexandria

What conditions do your physiotherapists treat? We specialise in treating sports injuries, post-surgical rehabilitation, chronic pain, and musculoskeletal conditions.
How do I book an appointment at Alexandria Physio? You can book online or call us at 02 9194 1800.
Do you offer physiotherapy for workplace injuries? Yes, we provide ergonomic assessments, injury prevention programs, CTP and WorkCover-approved treatment plans.

Waterloo Physiotherapy Experts for Sports Injuries and Rehabilitation

Thu, 03 Oct 2013 03:19:00 GMT

Why Choose Alexandria Physio—Waterloo Physio Experts for Injury Recovery

If you're looking for expert physiotherapy and top-tier injury management near Waterloo, Alexandria Physio is your trusted choice! As Waterloo physio experts, our team of elite physiotherapists has been helping a diverse range of individuals from all over Sydney, including the nearby areas of Zetland, Redfern, Alexandria, and Green Square, achieve their health and fitness goals for years.

Our clinic, located just a short drive from Waterloo, is renowned for providing exceptional sports injury treatment, rehabilitation, athletic screening, and recovery & wellness services. Whether you’re recovering from a sports-related injury or looking for preventative care to avoid future injuries, we’re here to help you get back on your feet stronger than ever.

Our clinic’s approach blends advanced techniques, hands-on care, and personalised programs, making us the go-to experts for sports injuries, musculoskeletal pain, and post-op rehabilitation. From muscle strains and tendonitis to more complex issues like neck and back pain, we use targeted treatments that restore mobility and prevent long-term injury, making us Waterloo’s best physios for pain relief and recovery.

Convenient Location Just Minutes from Waterloo

Situated on Fountain Street in Alexandria, we’re easily accessible for those in Waterloo and surrounding suburbs like Zetland, Redfern, and Green Square. Our location is just a few minutes’ drive from key areas like Danks Street and Moore Park, making it convenient for students, professionals, and families looking for Waterloo’s physio experts.

Comprehensive Physiotherapy Services by Waterloo Physiotherapy Specialists

Sports Injuries: Whether it’s a sudden injury or an overuse issue, our experts will develop a detailed and data-driven sports-specific program to restore strength and mobility.
Neck and Back Pain: Our therapists are experienced in treating common neck and back issues that hinder daily activities and quality of life.
Post-Op Rehabilitation: We offer structured rehab programs post-surgery to ensure smooth and effective recovery, no matter the procedure.
Dry Needling: For relief from chronic pain, our dry needling techniques target trigger points in muscles to restore normal function.

Book an Appointment with Leading Waterloo Physiotherapists

Looking for the best physiotherapy and sports injury treatment in Waterloo? Book your appointment today with leading Waterloo physio experts and take the first step toward recovery.

FAQs about Physiotherapy near Waterloo

What conditions do your physiotherapists treat? We specialise in treating sports injuries, post-surgical rehabilitation, chronic pain, and musculoskeletal conditions.
How do I book an appointment at Alexandria Physio? You can book online or call us at 02 9194 1800.
Do you offer physiotherapy for workplace injuries? Yes, we provide ergonomic assessments, injury prevention programs, CTP and WorkCover-approved treatment plans.

Redfern Physiotherapy & Sports Medicine

Exercise Rehabilitation Sydney: Injury to Peak Performance

Rehabilitation from Injury to Peak Performance

Table of Contents

Quick Takeaways

What Is Exercise Rehabilitation?

The Five Phases of Rehabilitation: Acute to Elite Performance

Phase 1: Acute Phase (Protection and Pain Control)

Phase 2: Subacute Phase (Restoring Mobility and Early Strength)

Phase 3: Strength and Functional Loading Phase

Phase 4: Sport-Specific and Conditioning Phase

Phase 5: Return to Performance Phase

Progressive Loading: The Engine of Recovery

Rehab Gym vs. Treatment Table: Why the Difference Matters

Return to Sport Criteria: What Actually Clears You to Play

Strength and Symmetry

Neuromuscular Control and Movement Quality

Sport-Specific Fitness

Psychological Readiness

Common Injuries Treated with Exercise Rehabilitation in Sydney

Performance Enhancement: What Happens After You Have Recovered

Frequently Asked Questions

How long does exercise rehabilitation take?

Can I do exercise rehabilitation if I am not a competitive athlete?

What is the difference between a physiotherapist-supervised gym program and a regular gym program?

What does an initial exercise rehabilitation assessment involve?

How do I know when I am ready to return to sport or full training?

Does Medicare or private health insurance cover exercise rehabilitation in Sydney?

I had the same injury before and it came back. What is different this time?

References

Ankle Sprain Physio Sydney: Elite Recovery Protocol

Ankle Sprain Recovery

Table of Contents

Quick Takeaways

Understanding Ankle Sprains: Grades, Ligaments, and Why Classification Matters

The PEACE and LOVE Protocol: Why RICE Alone Is Not Enough

Phase One: Acute Management (Days 1 to 5)

Protecting the Joint Without Immobilising It

What Your Physio Is Actually Assessing

Phase Two: Subacute Rehabilitation and Load Introduction (Days 5 to 21)

Range of Motion Restoration

Early Strength and Calf Loading

Phase Three: Functional Strength and Neuromuscular Control (Weeks 3 to 6)

Proprioception Training: The Non-Negotiable Element

Sport-Specific Loading and Running Mechanics

Phase Four: Return-to-Sport Criteria and Testing

Comparing Rehabilitation Approaches: What the Evidence Actually Supports

The Mistakes That Set Athletes Back by Weeks

Frequently Asked Questions

How long does it take to recover from an ankle sprain with physiotherapy?

What is the difference between ankle sprain physio in Sydney and simply resting at home?

Can I exercise with an ankle sprain, or does it need complete rest?

When should I see a physio after rolling my ankle rather than waiting to see if it gets better?

Why do ankle sprains keep recurring even after the pain has resolved?

Is bracing or taping necessary after an ankle sprain, and for how long?

References

Rugby Physiotherapy Sydney: Elite Principles for You

Physiotherapy for Rugby

Table of Contents

Quick Takeaways

What Makes Elite Rugby Physio Different

Load Management: The Principle Most Everyday Patients Ignore

What Load Management Looks Like in Practice

Neuromuscular Retraining: Beyond Just Resting the Injury

Why This Matters More Than Most People Realise

Soft Tissue Therapy and How It Fits Into a Structured Plan

Soft Tissue Therapy at Alexandria

Return-to-Activity Protocols: The Elite Standard

Applying This Standard Outside Professional Sport

Comparing Recovery Approaches

Frequently Asked Questions

Do I need to be a rugby player or an athlete to benefit from elite physiotherapy principles?

What is the difference between seeing a sports physiotherapist and a general physiotherapist?

How long does elite-standard injury rehabilitation typically take?

Is massage therapy enough on its own to recover from a sports injury?

What should I expect at my first appointment at Alexandria Physiotherapy?

Can elite physiotherapy principles help with chronic or recurring injuries, not just acute ones?

References

Lower Back Pain at Work: A Desk Worker's Guide

Lower Back Pain at Work