Osteitis Pubis

Osteitis pubis is the inflammation of the pubic symphysis and surrounding muscle insertions. It is an overuse syndrome caused by repeated trauma, rather than a one-time specific incident that results in groin pain and can become chronic in nature. 

The main cause is from instability of the hip bones, especially at the pubic symphysis, and poor movement control between the lower back and the pelvis. This could be from uneven loading through the pelvis during activities like running and kicking sports. It is not uncommon for athletes to have experienced groin strains or low back pain in the past as well.

Signs and symptoms

  • Ache in groin over time (one or both sides)
  • May be felt in lower abdominals or front of hip
  • Running, kicking, sit ups, change in direction can lead to pain onset
  • Stiffness in groin
  • Limping or a waddle type walk due to pain

Potential contributing factors to look out for

  • Poor posture (foot and back)
  • Inadequate training/warm up
  • Muscle imbalance, tightness or weakness in lower limbs
  • Inadequate rehab post previous adductor injury 
  • Poor pelvic and core control and stability
  • Changes in training routine (sudden increase or change in condition/surfaces)

Role of physiotherapy

Physiotherapy is able to give a full and proper assessment to determine what exactly is causing this condition, and to provide self-managing advice so that you can take control of your condition, especially controlling the inflammation prior to commencing a specialized exercise program that is suitable for you!

Rehabilitation with a tailored exercise program given by your physiotherapist is the best way of managing the symptoms and recovery. Physiotherapy is essential in not just fixing the acute issue, but also to prevent recurring injuries. A graduated specific program given by your physiotherapist for flexibility, core stability and strength is key in correcting movement technique and for safe and successful return to sports and daily activity without symptoms. 
If you have concerns about osteitis pubis or are already showing signs/symptoms regarding groin or inner thigh pain and want more information, come see us at Capital Physiotherapy for early management and rehab! We are conveniently located at South Yarra, Balwyn and Footscray. Contact us today via email info@capitalphysiotherap.com.au or call 0401 865 333.

Patella Dislocation

Patella dislocation refers to the displacement of the knee cap out from its normal alignment from the groove of the femur (thigh bone). Most commonly, the patella tends to dislocate laterally towards the outside of the knee. As muscles, ligaments and stabilizing structures run through the knee joint, a dislocation can therefore disrupt these structures and cause them to be overstretched and damaged.

What causes patella dislocation?

Dislocation of the kneecap is often caused by a traumatic type incident, such as a direct blow to the knee in a twisting motion. However, there are also factors that can increase the risk of patella dislocation, such as:

  • Previous history of patella dislocation or subluxation
  • Poor tracking of the patella
  • Shallow femoral groove
  • Weak inner quadriceps muscles
  • Tight lateral muscles/support, such as vastus lateralis (lateral part of the quadriceps), ITB, hip flexors and biceps femoris (lateral part of the hamstring)

Symptoms include:

  • Visible relocation of the kneecap to outside of the knee
  • Swelling and tenderness at the kneecap
  • Pain in weight bearing or straightening of the leg
  • Feeling of instability, like it is giving way
  • Feeling of weakness in the quadriceps muscles

This injury is usually seen in athletic teenagers participating in sports involving a lot of twisting and turning motions. Pivoting your femur (thigh bone) internally on a planted foot while knee is bent is the most common mechanism of injury (Greiwe et al., 2010).

Relocation of the patella will be needed, either by self or by health professional. X-rays, ultrasound or MRI may be used to confirm diagnosis. Damaged structures can also be identified on imaging, but this will also be assessed in the physiotherapy session.

What can physio do for patella dislocations?

The first step is to reduce the swelling and inflammation as well as providing some temporary support such as taping or bracing. Normalizing and improving the range in which your knee moves will be the major focus during this period. Once everything has settled, a rigorous rehab program focusing on strengthening muscles of the lower limbs begins. This type of training takes at least 8-12 weeks to 6 months of regular physio visits and adherence to the program for the best results to prevent future dislocations and for safe return to sports and daily activities.

Here at Capital Physiotherapy, we believe early management and rehabilitation is essential, so if this has happened to you or you notice you are experiencing some of the symptoms listed and need further advice, contact us today at info@capitalphysiotherapy.com.au or call 0401 865 333. We are located conveniently at South Yarra, Balwyn and Footscray.

Snapping Hip Syndrome

Affecting between 5-10% of the population, Snapping hip (also known as dancer’s hip) is a condition where hip joint movement causes a snapping sensation that is either felt or heard (Musick and Varacallo, 2019). The snapping can be either painful or pain free and is often caused by overuse. People who perform repetitive extreme hip movements such as ballet dancers and weight lifters are most at risk.

Diagnosis of snapping hip can be performed in clinic and a physiotherapist will determine the structure responsible for the snapping sensation. The iliotibial band and the iliopsoas muscle group are the most common sources of the condition. 

The majority of snapping hip cases are pain free and do not require imminent intervention, however the snapping sensation can cause discomfort and become painful over time. The preferred treatment for snapping hip is rest and a return to activity with physiotherapy input (Jenkins, 2010). 

Once the structure responsible for the snapping has been identified, treatment for snapping hip generally involves stretching of the tight structures (Byrd, 2005) and eccentric strengthening (Brosseau et al., 2009). Once the stretching and strengthening of the related structures has been completed, a graduated return to activity can begin with an effort to avoid activities and movements which trigger the snapping.

If you think you may be suffering from snapping hip our friendly team at capital physiotherapy can complete a comprehensive assessment of your hip and design a targeted treatment plan to help you return to doing what you love.  We are conveniently located at South Yarra, Footscray, and Balwyn. You may call 0401 865 333 or drop an email at info@capitalphysiotherapy.com.au.

Hamstring Strain

A hamstring strain is a tear in your hamstring muscle which runs down the back of your thigh. Often occurring during strenuous exercise or when the muscle is excessively lengthened, this is an injury which can take between 2 weeks to 6 months to recover from depending on the severity of the strain. 

The severity of the strain can be determined clinically by tenderness with contraction and palpation, often more a severe strain will also affect your ability to weight bear and walk with a normal gait. In some cases, an MRI or ultrasound may be used to better diagnose the severity of the strain.

Age, as well as having previously suffered a hamstring strain have been identified as risk factors for further hamstring strains (Freckleton and Pizzari, 2013).

Treatment for a Hamstring will often begin with managing the swelling and inflammation which will occur initially, before incorporating strengthening and stretching exercises and finally a graduated return to activity. The “L protocol” which involves three exercises with an emphasis on muscle loading while lengthening is one treatment approach which has shown to be effective. The protocol, which includes the “extender”, “glider” and “slider” was shown to allow athletes to return to sport in an average of 28 days compared to 51 days for those who completed a traditional hamstring rehabilitation (Askling, Tengvar and Thorstensson, 2013). 

If you think you may have suffered a hamstring strain, or would like to better prevent yourself from sustaining one in the future, our team at Capital Physiotherapy can design an effective treatment plan to keep you doing what you love. We are conveniently located at South Yarra, Footscray, and Balwyn. You may call 0401 865 333 or drop an email at info@capitalphysiotherapy.com.au.

Get Back to Exercise

Are you looking to get back to being active? Increasing your physical activity can be a great way to lose weight, build fitness and improve your overall health. However, returning to sport or physical activity after a long period of rest or trying out a new sport can come with its own risks. Both returning to sport after rest and performing a new can place you at an increased risk of injury (St Pierre and Sannes, 2001).  Typically sports involving eccentric, or lengthening, movements such as running or soccer (Falvo and Bloomer, 2005) are activities which may place you most at risk of injury.

In order to avoid injury or recover properly following an injury it is important to undertake an individualised and gradual strengthening program which will allow you to get fitter, get stronger and avoid injuries.

The type and intensity of the exercise you do is important and depends on what facilities you have access too. Running, walking, boxing, team sport, rock climbing, dancing or a combination of any of these are great ways to start getting back to getting active and each come with their own strength and fitness demands. 

At Capital Physiotherapy we offer both in room physio consultations to treat any injuries you may have as well as offering Pilates classes. Our Pilates classes are a great way to return to exercising with supervised and individualised exercise programs devised and supervised by our qualified physiotherapists. Pilates has been shown to improve both flexibility and muscular endurance (Kloubec, 2010) and can be targeted at meeting the demands of what you love to do.

If you’re looking to get back to exercise or have recently suffered an injury, be sure to get in contact with our team here at Capital Physiotherapy. We are conveniently located at South Yarra, Footscray, and Balwyn. You may call 0401 865 333 or drop an email at info@capitalphysiotherapy.com.au.

Exercise Over The Holiday Period

Exercise at all times is an essential part of maintaining a healthy body and mind. Over the festive season however it can be all too easy to find ourselves indulging in a third serving of Christmas Pud rather than our third set of burpees. Whilst relaxing over the holiday period is important, and the odd treat here and there is perfectly fine, when we allow the festive season to take hold from early December into January it can become a problem. 

Indeed, studies of the effect of the holiday period on weight gain have shown that we do indeed tend to put on weight (Hull, Hester & Fields, 2006; Helander, Wansink & Chieh, 2016). Now, whilst this makes sense, the good news is that it doesn’t mean that you shouldn’t enjoy yourself over the holiday period and nor does it mean that there isn’t something you can do the avoid weight gain.

Using the extra time off over the festive season to start up a new fitness regime is a great way to stay in shape over summer and start the new year or pre-season feeling great. A recent study by Mason, Pallan and Easter (2018) demonstrated that a program identifying the physical activity costs of foods over the Christmas period was effective at preventing weight gain and a new fitness program is a great way to meet these targets.

If you are looking to start a new fitness program or maybe need to overcome an injury first our friendly and highly qualified team at Capital Physiotherapy will complete a comprehensive assessment and treatment plan to get you on track for summer including Pilates. . We are conveniently located at South Yarra, Footscray, and Balwyn. You may call 0401 865 333 or drop an email at info@capitalphysiotherapy.com.au.

Medical Imaging

I’m experiencing pain, should I get a scan done?

Medical imaging can take many forms including X-Rays, MRI’s and CT scans. These tools allow both you and your healthcare professional to have a greater insight into you, your body and why you might be experiencing pain or dysfunction. Often confirmation of a diagnosis by using medical imaging is vital when considering treatment of many conditions including broken bones and some ligament tears.

It is important, however, that we take into consideration your pain and your condition in the context of you as an individual. Often medical imaging can show things which may not be causing pain at all and it is important to understand that a finding on an MRI does not mean something is necessarily wrong with you!

In people with absolutely no pain or disability. MRI or CT images have been shown to find:

  • osteoarthritic features in 19-43% of individuals over 40 years old
  • meniscal tears in 13-26% of individuals over 40 years old (Culvenor et al., 2019)
  • Spinal disc bulges in 30% of 20 year olds
  • Spinal disc bulges in 84% of 80 year olds (Brinjikji et al, 2015). 

It is always important to think holistically about why we may be experiencing pain and often an imaging diagnosis may be misleading. In order to start feeling better and getting back to doing what you love it’s necessary to consider all the possible sources for your pain. 

Here at Capital Physiotherapy our experienced and qualified physiotherapists will complete a full assessment and create an individualised treatment plan. We are conveniently located at South Yarra, Footscray, and Balwyn. You may call at 0401 865 333 or drop an email.

Femoroacetabular Impingement

photo courtesy of Mayo Clinic website

Femoroacetabular impingement- what a mouthful! Really, it’s just a fancy name for when your leg bone or your femur impacts with your hip bone or your acetabular. This occurs because the hip bone or femur is an irregular shape and not smooth causing the joint to impinge. 

Normally your hip bone is the socket and your femur is the ball, fitting perfecting together. However, in individuals with FAI, because of the irregular shape the joint is no longer a perfect fit, causing pain when moving the hip.

People can have FAI all their life and not be symptomatic, however sometimes due to overuse or muscle in balance, symptoms start appearing. These can include hip and groin pain on certain movements as well as clicking, pinching and restricted range of movement. 

FAI can be diagnosed by a physiotherapist in conjunction with MRI images to confirm the type of FAI present and thus determine how to manage it. Sometimes it can be conservatively managed through rest, avoiding aggravating factors and hip strengthening to help support the joint. However, in other cases, surgery is needed to alter the shape of the joint and prevent any further complications from constant impinging. After surgery, a strengthening program prescribed by a physiotherapist is essential to return to sport and everyday activities.

Early diagnosis and intervention is the key, so book an appointment today at Capital Physiotherapy and we can have you back to doing what you love in no time! You may make an online booking or email us at info@capitalphysiotherapy.com.au

Peroneal Retinaculum Tear

“POP”- went my ankle!

If this happened to you, could have a peroneal retinaculum tear. But what actually is it? 

Your peroneal muscles sit on the outside of your shin bone and run down to the outside of foot. They help stabilise the ankle when walking, running and jumping. Normally the tendons are kept in place alongside the outside of your ankle by a specialised structure called a retinaculum. But sometimes a forceful landing on a flexed foot or twisting action can cause these structures to tear and go “pop”. When these structures are no longer holding the tendons in place, they can move over the outside of your ankle when walking, pointing and flexing your foot. Not only can this be quite painful, but it can also be visible. 

Depending on the severity of tear, sometimes surgery is needed to repair the retinaculum.  After surgery, a cast or boot is used to help stabilise the ankle and allow the new tissue to heal successfully. Once the cast is off, a strengthening program is prescribed by a physiotherapist to help you return back to normal function.

In some cases, conservative treatment is used. This can also include a period of time in a boot or cast for approx. 4-6 weeks or the use of ankle strapping to help stabilise the ankle joint. Additionally, a physiotherapist will provide exercises to strengthen the calf and other foot muscles to in order to support the ankle in the long term and prevent any further complications. 

While it does sound like a scary injury, physiotherapists at Capitol Physiotherapy are here to help. We can help you manage and decide the best course of treatment suited to you and your situation and have back to normal in no time! If you’re near the area in any of our clinics, contact us via online booking or drop us an email at info@capitalphysiotherapy.com.au.

Posterior Ankle Impingement in Dancers

Posterior ankle impingement is a very common injury in dancers that can be managed and treated by physiotherapists. It is caused when the ankle joint is constantly forced into excessive plantarflexion or pointe, thus why its common in ballerinas who dance in pointe shoes. The bones at the back of the foot impinge and compress the tendons and muscles in this area causing pain and restriction when pointing the foot. The repetitive trauma created by the impingement can cause scar tissue to form, thickening the tendons in the area and restricting movement of the ankle further. In some rare cases, posterior ankle impingement is caused by an os trigonum, which is an extra piece of bone attached to the back of the ankle and is present at birth in some individuals. Most of the time people are unaware they have this extra piece of bone until it becomes an issue. 

Common signs and symptoms can include:

  • Localised pain at the back of the ankle during excessive ankle plantarflexion or pointing 
  • Tender to touch at the back of ankle
  • Restricted plantarflexion or pointing 

While this injury can be quite painful and sometimes a significant issue especially in ballerinas, it can be easily treated by a physiotherapist. Initially, some rest and avoidance of painful activities may be needed to reduce inflammation, however a rehabilitation program needs to be developed in order to reduce pain and improve function in the long term. This can include mobilising the joints of the ankle to create more space within the joint, strengthening and stretching the surrounding and deep muscles and improving balance and proprioception in the ankle. 

If you are experiencing similar ankle issues or have any concerns, contact us today at info@capitalphysiotherapy.com.au. At Capital Physiotherapy, we have a special interest in dance injuries so book an appointment today and we can have you back in pointe shoes in no time.