Osteoporosis is a widespread condition characterized by low bone mass or density. It is primarily a metabolic disorder related to age and general health with a variety of risk factors and causes. The most common and well known consequence of osteoporosis is weakened bones that can break from small forces that would usually be harmless.
 
In osteoporosis, both the matrix of the bone (similar to scaffolding) and the density of the bone are affected. While bone seems like a static part of our body, it is continuously laid down and removed by our bodies. In osteoporosis, there is an imbalance between the growth and reduction in the bone so it becomes progressively weaker. As such, it is a progressive disorder that worsens with age. While the disease process might begin much earlier, symptoms are usually only noticed over the age of 50. 

What are the signs and symptoms?
 
Often called a silent disease, many people with osteoporosis will have no idea that they have it, as there are no visible symptoms. Sometimes the first sign that an individual has osteoporosis is when the first bone breaks. Unfortunately, these bones are also slower to heal than healthy bones which can lead to ongoing complications. Broken bones are not the only symptom of osteoporosis, as bones lose density and strength they can also become compressed and develop wedge fractures under the weight of the body. 
 
When the spine is affected by osteoporosis, people may develop a hunched or stooped posture, which can itself lead to respiratory issues and place pressure on the internal organs. Osteoporosis can severely impact a person's mobility and independence, which can have a distressing impact on their overall quality of life.
 
What causes it?
 
As a metabolic disorder, osteoporosis can be caused by any process that interferes with the body's ability to maintain bone density. This includes gastrointestinal conditions that prevent adequate absorption of calcium (which is required for bone growth); lack of dietary calcium or low levels of vitamin D, which are essential for the absorption of calcium. Some medications can contribute to bone loss as an unfortunate side effect, especially if they are taken for a long time or in high doses. An example is the long-term use of steroids which can be prescribed to reduce inflammation.
 
Inactivity can also predispose a person to osteoporosis as bones respond to force and weight bearing by building more bone. Having a sedentary lifestyle or choosing activities with low levels of impact can mean that without the weight bearing stimulus to make bone, bones are less dense over time. Osteoporosis can occur in elite cyclists and swimmers, who are more likely to develop the condition if they don't include weight-bearing activities such as jogging in their training program.
 
How can physiotherapy help?
 
Physiotherapy can help you to improve your overall bone health, and avoid or recover from fractures. Physiotherapy exercises can direct you to safely increase your weight-bearing, which can help build bone mass. Balance training is also an important factor as this can reduce your risk of falls. Your physiotherapist can also help you to adjust your lifestyle, at home or at work, to protect your bones and improve your posture, all of which are helpful in the overall management of osteoporosis.

Frozen shoulder is categorized as either primary or secondary. Primary frozen shoulder occurs for no clear reason, while secondary frozen shoulder develops following an injury or surgery around the shoulder. 

Frozen shoulder usually follows a typical pattern and can be separated into three stages, freezing, frozen and thawing. The pain begins in the freezing stage as an ache or twinge with movements. The pain gradually increases, and the shoulder begins to lose range of movement. Usually, shoulder movements away from the body or involving rotation  are the most painful and restricted. 
 
As the condition progresses, everyday activities can be significantly impacted, with activities such as dressing, grooming, reaching overhead and behind the back becoming difficult. Lifting heavy objects can be very painful, and the pain is often felt at night time, interrupting sleep. The three stages follow a typical pattern... 
 
Freezing – Pain is present at rest/night, increasing pain and stiffness with shoulder abduction and external rotation. 
 
Frozen- Pain starts to lessen, but the stiffness of the shoulder joint increases.
 
Thawing – Pain reduces to lower levels and movement begins to return.
 
Frozen shoulder will usually resolve on its own without any long-lasting stiffness. However, complete recovery does not always occur. 
 
Frozen shoulder most often affects people over the age of 40 and women are affected more often than men. While no definite cause has been identified, there are some factors that increase the risk of developing a frozen shoulder. These include diabetes, prolonged immobilization, trauma, stroke, thyroid dysfunction, heart disease and autoimmune disease.
 
The early stages of frozen shoulder can mimic other shoulder conditions, and these should first be ruled out by a thorough examination. While frozen shoulder is a self-limiting condition, meaning it will resolve on its own without treatment, this can take up to 2-3 years. Physiotherapy during this time focuses on reducing pain as much as possible and helping patients to cope and adapt to their symptoms during the freezing and frozen stages. 
 
As the condition moves into the thawing stage, physiotherapy aims to help restore strength, movement and control to the shoulder. The entire process can be distressing, so support and education from your physiotherapist as you move through the stages of the condition is an essential part of treatment. 
 
If you have any concerns about shoulder pain that is not resolving, come and have a chat with one of our physiotherapists to see how we might be able to help you. 

What is it?
​ 
Shoulder instability is a term used to describe a weakness in the structures of the shoulder that keep the joint stable, which can lead to dislocation. As one of the most mobile joints in the body, the shoulder maintains stability through a balance of support between the dynamic structures (muscles and tendons) and static structures (ligaments and joint shape).
 
Shoulder instability most often occurs in one of two directions, anterior (forward) or posterior (backwards). Anterior instability or dislocations are more common than posterior. 

​What are the symptoms?
 
The most noticeable symptom of shoulder instability is dislocation or subluxation of the joint. This is often accompanied by pain, clicking sensations, a feeling of instability and in some cases weakness, and pins and needles in the arm. Many patients report a feeling of apprehension or instability, as if ‘something is not quite right’. Posterior instability can also cause reduced range of movement and might mimic other common shoulder conditions, which need to be ruled out first. 
 
How does it happen?
 
Shoulder instability can be classified as traumatic, occurring after an injury or atraumatic, where the shoulder is exceptionally flexible and prone to dislocations from everyday forces. Instability can also occur from chronic overuse where the shoulder joint is damaged slowly over time.
 
Traumatic shoulder instability is the most common form. Often the joint is dislocated by a strong force and damaged, leaving it more unstable and vulnerable to future dislocations. Rugby and football players are commonly affected. However, dislocations can occur in the general public from something as simple as falling onto an outstretched hand. 
 
How can physiotherapy help?
 
Shoulder instability is a complex condition and each person will have a different combination of causes and structural deficiencies. Physiotherapists are trained to identify issues of coordination, control and strength that may be contributing to instability and provide an extensive rehabilitation program. For some patients, surgery is recommended to help restore some static stability to the joint. However, this is not the best pathway for everyone. If surgery is indicated, a full rehabilitation program is recommended post-operatively for the best possible outcome. 
 
Helping patients to understand and manage their condition is an essential part of recovery. Physiotherapy is usually recommended as the first line of treatment before surgery and can have excellent outcomes, with or without going under the knife. 

Chronic ankle instability, as the name implies, is a chronic condition of instability affecting the ankle and it’s surrounding structures. It usually develops after a severe ankle sprain. However, some people are born with less stable ankles and these individuals are generally extra flexible throughout their bodies. Approximately 20% of ankle sprains lead to chronic ankle instability due to the resulting changes in ligament support, strength, postural control, muscle reaction time and sensation. 

What are the symptoms?

As well as being more susceptible to ankle sprains, people with chronic ankle instability may notice they feel cautious during high-intensity activities, running on uneven surfaces or when changing directions quickly. They may experience a sense of weakness or frequent ‘giving way’ around their ankle.

What are the causes?

The primary causes of this condition are ligament laxity, decreased muscle strength of the muscles surrounding the ankle and reduced proprioception. 

Following an ankle sprain, ligaments can be stretched and slightly looser than they were. In severe cases, they may have torn altogether, leaving the ankle less structurally sound. Without full rehabilitation, the surrounding muscles also become weaker and studies have shown that balance and sensation of the ankle can also be reduced. This means that the ankle is more likely to be injured again, creating a cycle of recurrent injuries, leading to further instability.

How can physiotherapy help?

Physiotherapy treatment for chronic ankle instability focuses on improving strength, control and balance with a variety of techniques and exercises. This approach can significantly improve ankle stability and reduce the risk of future sprains. Physiotherapists can help patients to regain confidence and get back to their best performance. 

In some cases, braces for support can be used. However, this can lead to dependence and further loss of strength and control if used unnecessarily. In cases of extreme ligament laxity or if physiotherapy fails, surgery to repair the damaged ligaments is considered. This is usually combined with a full physiotherapy rehabilitation program for greatest success.

If you don’t feel 100% confident with your ankle, come and have a chat with one of our physiotherapists to see if we can help improve your ankle stability.

What is an ACL tear and how does it occur?
 
The ACL, or anterior cruciate ligament, is a strong piece of connective tissue which helps attach the thigh bone (femur) to your shin bone (tibia). The ACL provides stability to the knee joint as it prevents the tibia from sliding forward relative to the femur.
 
ACL tears are a common sporting injury, however they can also occur from everyday activities. The most typical mechanisms of injury are landing awkwardly from a jump, twisting the knee, or suddenly stopping while running. The ACL may also be injured during knee hyperextension, or getting hit on the outside of the knee. Often, other tissues surrounding the knee are also damaged, including the medial collateral ligament, meniscus, joint cartilage and bone surfaces. The ligament can be stretched, partially damaged or completely torn.

What are the signs and symptoms?
 
Many people report hearing a “pop” in the knee along with immediate pain and swelling. Decreased range of movement of the knee is common and the injured knee is typically unable to take full weight when standing or walking. The knee may also feel unstable, with a sensation of “giving way”. Poor balance and coordination may also be experienced. Smaller tears of the ligament may have only mild symptoms, however, more severe tears will have more significant pain, swelling and instability.
 
 Is surgery necessary?
 
Traditionally, surgery was thought to be necessary for all full-thickness ACL tears. A series of recent studies have shown however, that outcomes are often the same for people who chose surgery and those who didn’t, both in terms of recovery and future risk of osteoarthritis. Individual circumstances will impact this decision. Elite athletes and cases with additional meniscal tears may do better with surgery. Generally speaking however, with time and full rehabilitation, many people can return to their previous levels of activity without surgery. 
 
How can physiotherapy help?
 
For both surgical and non-surgical recovery from ACL tears, physiotherapy rehabilitation is essential for a full recovery. Your physiotherapist will assist you with improving your knee range of movement, lower limb strength, balance, stability and coordination. You will re-learn the tasks of walking, using stairs, and negotiating obstacles with retraining of your balance and control. 

Early in rehabilitation, the RICE protocol (rest, ice, compression, elevation) is used in conjunction with static resistance type exercises to improve muscle contraction in the leg and increase blood flow to the area.
 
Throughout your rehabilitation program, you will progress through a variety of strength and mobility exercises targeted towards your individual needs, with goals of returning to your favourite sport or hobby as soon and as safely as possible.

What is it?
 
The hip adductors are a group of five muscles located on the inside of the thigh that act to move the hip inwards or control hip movements outwards. These muscles also provide stability to the pelvis while standing, walking and running. The muscles attach to the pelvis via the adductor tendon, at the base of the pubic bone. Adductor tendinopathy is a condition affecting the adductor tendon and refers to a typical pattern of pain and stiffness in the groin and inner thigh that accompany this injury. 

What are the symptoms?
 
The hallmark of this condition is pain in the groin region with movements of the adductor muscles. There may be a feeling of stiffness or weakness and pain when pressing over the adductor tendon. The pain usually begins gradually and progresses over time. It may build up over a few months and may not go away on its own. In severe cases, the pain may impact day-to-day activities, with pain being present when walking or going up and down stairs. Tendon tears may occur suddenly, however tendinopathy is often already present when this happens.
 
What causes it?
 
Adductor tendinopathy usually occurs due to chronic overuse, particularly for runners and athletes whose sports involve regular changing of directions. Overstretching of the tendon or an increase in training intensity or type often precede the development of adductor tendinopathies. It is thought that excess forces over an extended period of time cause the tendon tissues to degenerate, becoming painful and more prone to tearing.
 
What is the treatment?

As many different conditions mimic adductor tendinopathy, accurate diagnosis by a health professional is essential. Certain conditions such as stress fractures of the hip, nerve entrapment or pathologies of the hip joint  should first be ruled out. 

Adductor tendinopathy is treated by first identifying factors that may have led to the development of the condition. Your physiotherapist may recommend a period of rest and suggest that you stop stretching. Common contributing factors are running technique, muscle tightness and/or weakness and training frequency.

Your physiotherapist is able to help you maintain your training program to the highest level without aggravating your symptoms and help support tendon healing. They are also able to provide support to unload the tendon along with manual therapy and an exercise program, particularly with eccentric exercises, which have been shown to stimulate tendon regeneration.

In most cases, conservative or non-surgical treatment is attempted as the first line of treatment. If this is unsuccessful, cortisone injections can be used to reduce symptoms. In severe cases where the pain persists despite all other attempts at treatment, other medical interventions can be attempted. Once the pain has subsided your physiotherapist is also able to help prevent any further recurrence. 

Osteoarthritis (OA) is a common degenerative joint disease that affects many of the joints of the body. The knees are some of the most commonly affected joints, with many people experiencing at least a small degree of osteoarthritis over the age of 40. The disease is characterized by degradation of the cartilage that lines the surfaces of the joint, growth of osteophytes or bony spurs, pain, stiffness and swelling. 

What are the symptoms?
 
Stiffness in the morning, pain with movement, clicking, crepitus, swelling and a generalized reduction in joint range of motion are all common symptoms of osteoarthritis. As OA is a progressive disease, the condition is categorized into stages to help describe symptoms and guide treatment. Early stages of OA may have only mild symptoms, however as the disease progresses or in more severe case, a joint replacement may be required.
 
What causes it?
 
While ageing is the most significant risk factor for the development of OA, it’s not an inevitable consequence of growing older. Other factors that may predict the development of OA are obesity, family history, previous joint injury, high impact sporting activities and peripheral neuropathy. It is thought that abnormal wear and tear or stress on the joint is the primary cause of OA. It is also important to note that many people will have changes on X-Ray that show OA, but will have no symptoms – which indicates that simply having OA is not a guarantee of persistent pain.
 
What is the treatment?

Your physiotherapist is first able to help diagnosis and differentiate OA from other conditions that may have similar symptoms. An X-Ray can confirm the diagnosis and can be helpful in determining the best course of treatment to follow.

While OA is a progressive disorder, there is often a significant improvement that can be made simply by addressing lifestyle factors and any biomechanical factors that may be contributing to pain.

How can physio help?

Your physiotherapist is able to guide you with strengthening exercises to support the joints, advice for adapting your exercise routine and can even help you to lose weight, all of which have been shown to have a positive impact on the symptoms of OA.
 
If surgery becomes the right course for you, your physiotherapist is able to guide you through this treatment pathway, helping you to prepare and recover from surgery to get the best outcome possible.