Patella Tendinopathy

A lot of people come into our rooms at Capital Physiotherapy with knee pains. Specifically, pain around the front of their knees. There are a few structures in this area of the knee, but we will be discussing about the patella tendon. The tendon is a part of the quadriceps muscle. The quads originates from the pelvis and inserts into the upper part of the patella. From here, the patella tendon starts and finishes at the ischial tuberosity, located in the tibia (lower leg).

The patella tendon is important as it is part of a pulley system for the quadriceps muscle. This adds leverage and consequently power to the quadriceps muscle. This will allow you to do intensive activities, such as jumping and sprinting. In saying this, you can imagine how much stress is placed on the tendon! In fact, the most common cause of patella tendinopathy are jumping and sprinting based sports.

This stress can cause issues in the tendon which will then lead to pain and subsequently, reduction in your activities! When stress is placed on a tendon, there are some micro tears, which heals when you look after the body. However, if you continually place the load on your tendon over a prolonged period of time, there is more aggravation than healing; resulting in pain. 

Usually, people will come in not knowing what’s causing the pain in their knees. This is because the pain would only come gradually. The pain would initially be described as an ache, but as physical activity continues, the pain becomes sharper, until finally you have to stop your sport.

Our physios at Capital Physiotherapy are well experienced with knee pains. While it’s important to get rid of the pain so that you can go back to your physical activity, what is equally important is finding the exact cause of the problem in the first place. During your consultation, our physio will spend their time 1-on-1 with you, to make sure they understand not just your body, but your training routine. They will develop a treatment plan that will not only get you pain-free, but also ensuring you do not have the same problem again.

So don’t hesitate, and get that knee looked after now. The sooner you get the knee looked after by our physios at Capital Physiotherapy, the better your prognosis and the quicker you’ll get back to your game!

PCL injury

We’ve talked about the ACL, now we come upon its equally important cousin, the Posterior Cruciate Ligament (PCL). Like the rest of the knee ligaments, the PCL works with them all to provide stability within the knee joint. It originates from the anterior (front) part of the femur and attaches to the posterior (back) part of the tibia. The ACL, as mentioned previously, originates form the posterior part of the femur and attaches to the anterior part of the tibia.

The PCL is important in ensuring stability within the joint by stopping the posterior movement of the tibia in respect of the femur.

Injury to the PCL is less common than an ACL injury. PCL tears are usually due to direct blows to a bent knee. This could be when you have an accident and your knee receives a direct blow from the dashboard. You may also be tackled in certain ball sports, while having your knees bent. Another common method is through extreme hyperextension.

Regardless of the cause, it is imperative that you get your injured knee looked at by a trusted physiotherapist. Prolonged sport activity is usually impossible due to pain as well as instability within the knee. Patients would normally report of a poorly localized posterior pain that is deep within the joint. Depending on the severity of the injury, your rehabilitation will differ. Conservative management is usually done before surgical intervention is advised. However, please talk to your physio before you make your next move.

Our physios at Capital Physiotherapy will ensure that you are looked after from the start. This means making sure we not only confirm a PCL tear, but also rule out other injuries. We will also provide a treatment plan that will include the goal of you going back to your chosen sport. This plan will include what we need to do, what exercises you require and many more important details to get you back to your best. By getting your injured knee early, you will have the best outcome quickly!

If you have any questions, please do not hesitate to contact us and we would love to be a part of your journey back living your life the way you want it to be!

Meniscus Injury

The knee joint is a relatively complex joint with multiple structures that works together to provide both stability and movement in the knee joint. A part of the knee that is quite commonly injured is the meniscus. This is an injury that Luke Hodge had back in May 2016.

The meniscus are 2 structures within the knee joint. As you can see from the picture, you have a Medial Meniscus and a Lateral Meniscus, both shaped in a circular fashion.

These structures has a few important functions within the knee joint. The most important function is they act as shock absorbers and load distributor. They are sponges that reduce the stress going through the bones; thereby reducing wear and tear in the joint.

The meniscus can be injured in several ways. Injury to the meniscus can be due to a gradual build of stress, which may occur with repeated or prolonged squatting/kneeling. An athlete may also injure their meniscus if they try to turn/pivot on their knees too quickly; this will result in a partial or a total tear.

Once a tear has occurred, it is important that the knee is assessed to find out how severe the injury is. Depending on the severity, a period of conservative management may be enough to get you back playing your sport. However, more serious injury such as the ‘bucket handle tear’, may require you to undergo an arthroscopy. In saying this, if you have a knee injury, come visit us at Capital Physiotherapy. Our physiotherapists have a lot of experience dealing with these types of injury. They will spend the time with you to make sure they get the right diagnosis as well as give you the correct treatment plan that you need to get better quickly!

So don’t hesitate, and get that knee looked after now. Capital Physiotherapy is ready to help you!

The Proper Squat Technique

Squats are one of the best exercises you can do in the gym (or at home!). This is because it is one of the few exercises that works multiple areas of your body. This makes it an efficient exercise to make you stronger quicker! However, when done incorrectly, squatting can cause a lot of issues to your knees. Improper technique results in imbalanced pressures around your knee cap, which will accelerate wear and tear.

Not only are squats great for your body, but they are easily done anywhere you’d like to exercise. While the gym is a great place, as you can use different bars with weights to challenge yourself. However, you can do squats at home or even at the park! The best exercises are the ones you can do anywhere. This means you won’t skip your exercise day and get the most out of it!

The most important factor while doing squats are to make sure your knees are positioned correctly throughout the movement. This means: 

1. Your knees do not move past your toes at the front 

2. Your knees do not move rotate inwards

By making sure you do not do the above, you reduce the chance of any wear and tear around your knee cap as well as reducing any issues that arise due to improper technique. By having your knees moving in the correct way, your knee caps are able to distribute the force much more evenly around its surface area; this reduces stress building up on only one area of the knee cap.

In addition, by doing the exercise correctly, you will gain the most out of your squat. Correct technique allows your muscles to function at its most effective; which means you can progress yourself and get stronger quicker!

Don’t hesitate to contact Capital Physiotherapy team if you have any questions and we’ll be able to help you!

Also, if you haven’t checked our previous article about Patellofemoral Pain Syndrome, please click here.

Patellofemoral Pain Syndrome

Patellofemoral Pain Syndrome, or PFPS, can be a very debilitating condition which can stop you from doing a lot of activities. At its worse, most patient will report of pain and inability to walk far.

PFPS is a term given to describe pain around the knee cap. This is usually due to repetitive damage around the knee cap as it contacts abnormally with the femur. Most patient will report of having a gradual build up of pain. Initially, the pain is niggling but does not stop a person from doing their exercises. Continued activity result in increasing pain which will in turn stop them from participating further. With rest, the pain would abate. However, returning to sport is usually short lived due to the returning pain.

There are multiple causes of PFPS. This include:

  • Foot and ankle misalignment
  • Poor hip control
  • Poor core strength
  • Leg length discrepancies
  • Poor training schedule (not enough rest, sudden increase in intensity)

Usually there are multiple factors that contribute to PFPS. It is important that you seek a trusted physiotherapist that can do a comprehensive assessment on your body. Taking the time with the assessment will result in identifying the causative factors, which means a better prognosis! You can trust our physiotherapists at Capital Physiotherapy to understand your body and get you back on track! Our initial appointments are industry-leading 1 hour. This gives our physiotherapists time to do full assessment, to make sure you are looked after!

Depending on what caused your PFPS, you may expect your physio at Capital Physiotherapy to:

  • Reduce any muscular tightness
  • Give exercises to improve muscle control
  • Suggest different types of footwear, or refer you onto our trusted network of podiatrists
  • Help plan an exercise program to make sure your body do not burn out

Our physiotherapists are trained at making sure all your concerns are listened to and provide you the best care you need.

If you have any questions, please do not hesitate to contact Capital Physiotherapy. Our physio clinics are located in Footscray, South Yarra, and Balwyn.

BULGING Disc? Herniated Disc?

One of a common reason for lower back pain is due to a bulging disc. But what exactly is a disc?

The disc is a gel like substance that sits in between our bones in the spine, the vertebrae). These discs acts to help with: shock absorption, spinal stability and allows a more efficient movement from the spine. The discs are made up of two parts: the more elastic outer shell, which keeps the shape of the disc together, and the gel like inside.


In normal movements, the disc will get compressed and extend in certain parts, depending on the movement. For example, bending forwards will result in the front part of the disc to be compressed, while the back part will be distended.

When you have a ‘disc bulge’, what happens is, instead of the outer elastic part keeping the disc’s shape, it has protruded out (this is called Bulged Disc). Depending on the severity of the injury, the gel like content can actually seep out as well! (This is called a Herniated Disc). 


Apart from pain, this bulging disc may be severe enough that it touches the nearby nerve root. When this occurs, you may also experience the following symptoms: pins and needles, numbness, burning, electrical shocks as well as loss of power in your legs. 





Diagnosis and Treatment

It is important that you seek a trusted physiotherapist that will be able to do a comprehensive assessment on you to get the correct diagnosis quickly. Without the right diagnosis, your treatment will be ineffective.

At Capital Physiotherapy, our initial appointment is 60 minutes, instead of the normal 20-30 minutes. This allows our physiotherapists the time to complete a full assessment so that the right treatment be implemented. The quicker your back is treated, the better your outcome is!

We are well equipped at providing you the best care to get you back on your feet. Treatments may include:

  • Mobilisation
  • Massage
  • Electrotherapy
  • Exercise prescription, including building core strength
  • Pilates equipment, including: reformers and Wunda Chair.

Anterior Cruciate Ligament Injury

The knee joint itself involves a multitude of structures to keep it stable and strong. The Anterior Cruciate Ligament (ACL) is one such structure that helps achieve these objectives. It originates from the posterior (back) part of the femur and attaches to the anterior (front) part of the tibia. The Posterior Cruciate Ligament (PCL) meanwhile, originates from the anterior part of the femur and attaches to the posterior part of the tibia. These two ligaments crosses in the middle and provide specific stabilities to the knee.

The ACL is important in securing the knee joint by preventing the forward movement and rotation of the tibia (lower leg bone) in respect of the femur (thigh bone).

There are many ways that a knee can be injured. On the one hand, there could be an obvious traumatic incident, where you were tackled while playing football. On the other hand, it could also be due to an inconspicuous activity, where you were simply running and trying to turn one way and injured yourself.

Most ACL injuries, in fact, are done via the later method. There may also have been a factor of jumping/landing prior to the injury.

A full tear of the ACL, may actually not cause significant amount of pain in some cases. In fact, some athletes would feel that they can continue their sporting commitments, only to find themselves unable to perform due to significant instability in the knee joint.

It is highly suggested that you stop your activities and seek diagnosis immediately. Our physios at Capital Physiotherapy are trained to ensure you get the correct diagnosis first and foremost. They will spend the time that is required to make you feel at ease and give you the correct advice that you need. Our appointments are 1-on-1 which ensures you get the most out of your physiotherapy sessions. A treatment plan will be drafted for you, so that you can go back to your best quickly! Capital Physiotherapy is also able to get you crutches as well as braces if required.

In the meantime, make sure you RICE; Rest, Ice, Compression and Elevation!

Know When to Change Your Shoes

Commonly, manufacturers have advised to change your runners after 500-800 km; this is an extremely rough guide. While this figure has some use, we’re going to let you know of other signs that will help you find out if your shoes are still good to run in.

But before we get to WHEN you should change your shoes, let’s talk about WHAT makes up a shoe.

Shoes Anatomy

Your shoe is made up of an: upper, midsole and outsole. The upper can be made from cloth (like Adidas’ Primeknit or a mesh material). The midsole of a shoe is usually made of EVA, which is basically a type of foam. The outsole of the shoe, meanwhile, is made of hard rubber which helps to protect the midsole from the ground.

So now that we know what makes up a shoe, let’s talk about WHEN and, more importantly, WHY you need to change your shoes!

Changing Your Shoes

Quite a lot of people that come into our rooms at Capital Physiotherapy, would say that their shoes are fine. They would show how the outsole is minimally worn out (especially if the shoe has good quality outsole like Continental), or they would show how there are no tears in the upper. While these are good indications the shoe may be ok, you must look at the midsole.

The function of the midsole is the most important part of the shoe. The EVA foam is there to ensure that when you land on your feet, it can absorb any impact forces (so that your bones and joints don’t have to!) EVA foam can be likened to a kitchen sponge. When you squeeze a fresh sponge, you can feel the springiness as it returns to its original form. But over time, the physical properties of the sponge degrades.

Similarly, as you pound the pavement or the treadmill, the midsole of your shoe degrades over time. Here are the signs of when you should change your shoes:

  • Visible and permanent horizontal creases along the midsole of your shoes.
  • The presence of compression marks from where the insoles are.
  • You would also see the outsole ‘digging’ into the midsole.

Basically the EVA foam has been compressed from the top and bottom! The result is, with each step you take in your run, the forces are not being absorbed by your midsoles anymore; but to the joints and muscles in your feet, knees and hips. So here’s another sign to look out for: if you start to feel more aches and pain than normal, it’s probably your shoe not giving the support you require anymore.

Continuing to wear your shoe could result in muscle and tendon injuries, including tears!

Hopefully that has helped you to find out when to change your running shoe. As much as we want to use the shoe until the upper is torn and your toes are showing, or the outsole is worn out completely, the truth of the matter is that your midsole will usually be the first to go.

Come into Capital Physiotherapy and our friendly and knowledgeable physiotherapists would be happy to help you!


Youtube Video for this blog

What are gluteal muscles?

The muscles of the gluteal region can be broadly divided into two groups:
• Superficial abductors and extenders – A group of large muscles that abduct and extend the femur. Includes the gluteus maximus, gluteus medius, gluteus minimus and tensor fascia lata.
• Deep lateral rotators – A group of smaller muscles that mainly act to laterally rotate the femur. Includes the quadratus femoris, piriformis, gemellus superior, gemellus inferior and obturator internus.

Why are gluteal muscles important?

You might be concerned about how to make your bottom looks toner to have a better fit for your jeans however, there’s so much more to glutes strength than the way your pants fit! This important group of muscles extends the hip (pulls the thigh behind you), abducts the hip (your lateral movement to the side), and does internal and external rotation of hip. In short, they’re incredibly important.

Unfortunately, in today’s society, they are often weak and under work.In this first work society, spending time in front of the desk becomes an inevitable task. Long hours sitting caused our glutes to “turn off” or stop firing. This in turned caused the muscles to weaken without us realising it.
Once our glutes stop firing, our hip flexors (the muscles that pull the thigh forward) get tight and can lead to injury. When you build a stronger booty, here are a few of the benefits you can expect.

Having a strong glutes can help:

Prevent back pain: Your glutes work to stabilize the pelvis and keep integrity of movement in the hip joint. When they’re strong, your lower back doesn’t bear the brunt of your motion.

Increase athletic performance: If you want to be a stronger athlete, it’s time to start working your glutes! Stronger glutes will improve your speed, agility, and jumping skills, and quick side-to-side movements will also become much easier.

Prevent knee pain: Strong glute keep the pelvis stable from swaying side to side. When your pelvis isn’t stable, it puts a lot of pressure on your knees and ankles to compensate. When your glutes are strong, it helps prevents this naturally, keeping you safe from injury.

Exercises to help gluteal muscles strengthening

There are many exercises that help strengthen our glutes. In our video, we demonstrate the 3 basic exercises that we normally start our client with, and progress to more sports specific gluteal exercise as required.

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Shoulder Blades Sticking Out? Is it Bad?- Ask a Physio

What is scapula winging?

Scapula winging is when the borders of the scapula (shoulder blade) stick out away from the ribcage. Normally the scapula is meant to lie flat against the rib-cage. Scapula winging usually results from muscle imbalances of the muscles attaching to the scapula. Imbalances commonly occur between the pectoralis minor, upper trapezius, lower trapezius and serratus anterior muscles.

Consequences of scapula winging:

Scapula winging can result in inefficient movement of the glenohumeral (shoulder) joint. The scapula and shoulder joint are connected. If the resting position and movements of the scapula are not in optimum position, it can lead to restricted movements of the shoulder joint. This in turn can lead to impingement of the rotator cuff tendons and associated pain and dysfunction.

Weakness of the cervicothoracic postural muscles and subsequent scapula winging can also lead cause increased tension and pain in the muscles between the shoulder blades and the muscles attaching from the scapula to the neck. This in turn can lead to joint stiffness and potentially tension-headaches in more severe cases.

How can Capital Physiotherapy help reduce scapula winging?

After thorough assessment to determine which muscles are contributing to the winging scapula, our physiotherapists may use a variety of different treatment to try and relieve symptoms associated with scapula winging and reduce the winging itself.

Treatment options include:

  • Postural education and correction
  • Postural taping
  • Massage to relieve tension of tight muscles
  • Dry needling to relieve muscle pain and tightness
  • Muscle strengthening and re-training to correct muscle-imbalances causing the winging
  • EMG activation prior to strengthening to help activate muscles that have difficulty firing due to altered neuromuscular activation patterns

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