What is spinal stenosis?
 
The spinal cord, nerves and arteries are housed by the spine, which acts as a hard casing to support and protect these vulnerable structures. The spine has a hollow column that allows the spinal cord to run from the brain to the rest of the body. At each spinal segment, nerves exit the spine and supply the tissues of the body. There is also an intricate network of small veins and arteries that provide blood to the spinal cord and vertebrae, providing them with the nutrients needed to operate.
 
Spinal stenosis is characterized by a narrowing of the spaces that house the spinal cord, nerves and blood supply. A variety of factors can cause spinal stenosis, however overwhelmingly it is caused by degenerative changes to the spine as we age. Many people over the age of 60 will have a degree of spinal stenosis, however not all will have pain. Clinically, spinal stenosis is often used to describe the painful symptoms of this condition rather than just the narrowing itself.

What are the symptoms?

Pain with walking or standing that radiates into the hips, thighs and even as far as the feet is the hallmark of spinal stenosis. Usually, this pain will be reduced with rest and forward movements of the spine. Spinal stenosis is a progressive condition and symptoms will gradually increase over time. The pain is often described as a deep ache and can be associated with fatigue, heaviness, weakness and numbness. It can affect just one leg, but often will be felt in both legs.  There will often be associated back pain, however leg pain is usually the most severe complaint.

How can physiotherapy help?

There are many conditions that need to be excluded before a diagnosis can be made. Your physiotherapist is able to conduct a thorough examination and accurately diagnose this condition. In some cases, imaging may be requested. As mentioned earlier, many people have stenotic spinal changes without symptoms. Surgery to decompress the restricted nerves and stabilize the spine can be used in very severe cases. 

For mild to moderate cases of spinal stenosis, physiotherapy can be extremely beneficial.  Your physiotherapist can help you manage your pain through hands-on techniques and by providing a targeted exercise program based on biomechanical assessment. They are also able to help you to understand and manage your day in a way that helps to reduce flare-ups and maintain muscle strength.

Occasionally surgery is the right choice for you, then your physiotherapist is able to guide you through this treatment pathway, helping you to prepare and recover from surgery to get the best overall outcome possible. 

What is it?
Bursae are small sacs of fluid found throughout the body. These bursae produce synovial fluid and act to reduce friction between muscles, tendons, ligaments and bones as they move over each other. Bursae are located at strategic points, typically where there are higher points of stress. If a bursa is injured or irritated, it can become inflamed, painful, red and swollen. This condition is referred to as bursitis.
 
One bursa that is commonly affected is the olecranon bursa, which sits just over the hard bony process at the back of the elbow. Olecranon bursitis refers to inflammation of the bursa at this point and is a common condition, particularly in men between the ages of 30-60.

What causes it?
Olecranon bursitis has a few different causes including trauma, overuse and infection. A sharp blow to the elbow, through a fall or hit, might damage the bursa leading to bursitis. In other cases, the bursa can be infected by bacteria, which enter the body through a small skin tear.
 
Bursitis can also develop slowly through friction of the nearby muscles that cause the bursa to become irritated and inflamed.
 
What are the symptoms?
The hallmark of this condition is a painful, red, swollen elbow. Typically pain is worst when resting on the tip of the elbow and/or with elbow movements, particularly when bending or straightening the elbow fully. The pain often lasts a few months and may not go away on its own. The pain may build up gradually, or come on suddenly, depending on the cause. Bursitis caused by infection (septic bursitis) may also be associated with general feelings of illness such as fatigue, fever and body aches.
 
What is the treatment?
As there are many different causes of this condition, accurate diagnosis is essential. Your physiotherapist is able to distinguish between olecranon bursitis and similar conditions such as rheumatoid arthritis or fibromyalgia. Septic bursitis will need to be treated by a medical professional who will determine the best course of action.

All types of bursitis can be managed initially with a RICE protocol to reduce pain and swelling (Rest, ice, compression and elevation).  Mechanical causes of bursitis can require more in-depth identification of the factors that may have led to the development of this condition.

Common contributing factors are throwing technique, muscle tightness and/or weakness and training frequency. Your physiotherapist is able to address these factors and possibly provide taping support to unload the bursa,  along with manual therapy and an exercise program.

In most cases, conservative or non-surgical treatment is attempted as the first line of treatment. If this is unsuccessful, corticosteroid injections can be used to reduce pain and inflammation. In severe cases where the pain persists despite all other attempts at treatment, the bursa can be surgically removed in a procedure called a bursectomy. Once the pain has subsided your physiotherapist is also able to help prevent any further recurrence. 

Why are ankles particularly vulnerable to injuries related to poor balance?
 
Our ankles have to support our entire body weight when standing on one foot. To provide us with agility as well as stability, our ankles have the ability to move from side to side as well as backwards and forwards. There is a complicated process constantly operating to keep your foot in the correct position while supporting all this weight, particularly with quick changes of direction, activities done on tiptoes, jumping and landing.
 
If the ankle rolls excessively inwards, the ligaments on the outside of the ankle can be damaged and torn. Balance is an important part of keeping the ankle in the correct alignment and not twisting too far to either side during challenging activities.
 
A study of high school basketball players  by Timothy McGuine et al. in 2010 showed that students with poor balance were up to seven times more likely to sprain their ankle than students with good balance. Other studies have shown that balance training is an effective way of preventing falls in elderly populations.
 
Balance can vary from one leg to the other.
 
Most of us tend to favour one side of our body for all activities. This is more obvious in the upper body, with most of us identifying as either left or right handed. The same is also true for our lower body, with each of us favouring one leg over the other for balance activities. This can mean that one leg has better balance and strength than the other, leaving one leg more vulnerable to injury.
 
Reduced balance can mean your body has to work harder to perform activities, with muscles activating in a less coordinated way. Improving your balance can also improve your body’s efficiency of movement, which can, in turn, improve your overall performance without actually improving your muscle strength.
  
Balance can be trained rapidly.
 
Balance is one of the most overlooked dimensions of physical health however, the good news is that it can be improved relatively quickly. Do a quick check to see if you can stand on each leg for two minutes with your eyes closed. If this is difficult you might find that improving your balance is a great next step in your training program.
 
Your physiotherapist is able to identify any deficits in your balance is and is able to develop a training program for you to improve it. Come and see us for an appointment to see how we can help.​

What is it?
Fibromyalgia is a chronic condition characterised by widespread pain throughout the body along with fatigue, memory problems, sleep and mood disorders. Sufferers of fibromyalgia often spend years trying to find a diagnosis that fits their symptoms and fluctuate between periods of having high energy and ‘crashes’ of fatigue and pain. In severe cases, fibromyalgia can cause significant lifestyle disruptions, including reduced activity, unemployment and depression.
 
The underlying mechanism that creates the symptoms of fibromyalgia has been shown to be increased pain amplification by the central nervous system and reduced activation of the sympathetic nervous system. Essentially this means that small pain signals in the body are processed as large pain signals by the central nervous system.

What causes it?
Fibromyalgia is a complicated condition that is poorly understood. This can be very frustrating for sufferers, who often find themselves being shuffled between health practitioners looking for answers and long term relief. While the pain generally feels muscular, usually little to no muscular damage or injury can be found on physical assessment or investigations. The symptoms can also mimic those of an infectious illness or other chronic diseases. Often a diagnosis of fibromyalgia is reached after other diseases and causes have been ruled out.
 
The cause of fibromyalgia is as yet unknown. It was initially thought that the depression and reduced activity that are often associated with fibromyalgia could be causative, however it has been shown that these are symptoms of fibromyalgia rather than causes. Other significant signs are a lack of REM (good quality) sleep in sufferers and a positive result of more than 11 out of 18 muscular trigger points.
 
What is the treatment?
Following a diagnosis of fibromyalgia, the primary strategy is to understand and manage your symptoms. This can involve pacing activities and exercise so as to reduce ‘crashes’ and pain cycles that lead to frustration. Identifying activity, employment and a routine that doesn’t exacerbate symptoms can have a significant impact on quality of life for someone with fibromyalgia. Having psychological support can also be very important to help deal with the emotional distress of a complex chronic condition that has no outward physical signs.

Treatments that have been shown to help reduce symptoms are TENS (electrical stimulation) which produces an endorphin response and can reduce pain; certain medications may be helpful when prescribed by a doctor; and education and understanding of this condition, helping to manage and maintain some control over your symptoms. Physiotherapists can have a large role in education and helping patients find a routine and activity level that helps them manage their condition as best as possible, as well as providing symptomatic relief during pain cycles with manual therapy, stretching and massage techniques.

It is always best to see a medical professional for advice on your individual injury or condition.

Maintain a routine.  
 
A new routine may take a while to develop and will depend on the demands placed on you by your work or children. However, some things can help with both mental and physical health when staying at home for long periods. Waking up and going to sleep at the same time every day can have a significant impact on wellness, ensuring that you have a better sleep and also feel more settled when you wake up. 
 
Use screens thoughtfully. 
 
Technology can help us to connect with those who are not there, yet can also take us away from things happening around us. Delete or at least limit the time you spend on apps that you find distracting, such as news or social media and schedule in quality catch-ups with friends and family via video.  
 
Take time to adjust your home workstation.
 
If you will be spending hours at a time on your computer, it is essential to take the time to ensure your workstation is set up optimally to reduce stress on your body while working. You can chat with your physiotherapist for some tips on how to set up your home office.
 
Stay in touch with your physio.
 
If you are struggling with pain at home, your physiotherapist may offer a variety of online treatment solutions, even if you can’t make it to the clinic. Remember that in Australia, physiotherapy and allied health services have been open during this time, classified as an essential service, so appointments should still be available. Reach out to your physiotherapist if you are in pain.
 
Join an online fitness group and workout with others.
 
Joining a daily online workout session is one way to keep active and also stick to a schedule. Many of the videos allow you to join in live, helping to increase commitment and a sense of community with your fellow exercisers.  
 
Stretch before bed. 
 
Start with just three simple stretches (eg: calves, hamstrings and triceps) and slowly build up your repertoire. Stretching before bed can help to prepare your body for rest while also improving flexibility. Try to hold each stretch for at least 30 seconds for optimal effect.  

If you are experiencing regular neck pain that just won’t go away, it’s possible that parts of your daily routine are contributing without you realizing. Here are a few common everyday activities that might be making your neck pain worse...

1. Your sleeping position
 
It’s easy to underestimate the impact your sleeping position can have on you. However, spending hours in one position will undoubtedly have an effect on your body. Pillows that are too high or too flat can mean your cervical (neck) joints are sitting at the end of their range in too much flexion or extension. Similarly, sleeping on your stomach often means your thoracic (upper/mid back) spine is locked into extension and your neck is fully rotated. In simpler terms, this means your joints are under more stress than necessary. Ideal sleeping posture allows your spine to maintain its natural curves.
 
2. Your daily commute
 
Many of us make sure our work stations are ergonomically set up to reduce stress and strain throughout the day. Few of us take the same consideration when it comes to driving. In fact, the set up of your car can be just as important as your work desk, particularly if you are driving more than 30 minutes every day. The correct setup in your car can mean you use less effort to drive and turn your head less often to check traffic.
 
Ensuring that your steering wheel, seat and mirrors are set up correctly could make a difference to your posture and perhaps reduce neck pain and headaches. If you find that driving is still affecting your pain after making these changes, try catching public transport or riding a bike on alternative days if that's possible for you.
 
3. Your downtime
 
Many of us unwind by watching TV or our laptops at the end of the day. Your position during this time can be something you don't really consider. However, looking up to view a screen mounted on a wall or looking down at a small screen or laptop can put pressure on the structures of the neck. Take a few minutes to consider what posture you’re sitting in before settling down to binge watch a series and see if you can either lower the height of your screen or raise it slightly so your neck can be in a more neutral position.
 
4. Your exercise routine
 
Any activity that requires sustained positions or repetitive neck movements can contribute to neck pain. Cyclists can be stuck in neck extension while looking ahead and breast stroke swimmers can also have excess neck extension. Freestyle swimmers with reduced thoracic or neck rotation can have difficulty achieving rotation when breathing which can cause pain and discomfort over time.
 
Your physiotherapist is able to identify any daily habits or activities that might be contributing to your neck pain. Come and see us for an appointment to see how we can help.

Most tissues in the body have healed completely in six to 12 weeks following an injury. However, many people have severe pain that lasts much longer than this. We know that the intensity of the pain you feel is not always associated with a corresponding amount of actual tissue damage. In some cases, there can be a severe amount of pain with almost no detectable damage. With this in mind, we explore some reasons why your pain might not be getting better, long after the tissues have healed.

You’re afraid of the pain?
 
Pain can mean many different things, for some of us pain can affect our ability to work or can be a symptom of a serious disease. What you believe about your pain can either amplify or reduce the symptoms you experience. If you feel that every time you experience pain you are causing more damage, you will naturally pay more attention to this and your nervous system will amplify the signals in an attempt to keep you safe.
 
But if you understand the cause of your pain and know that while there is discomfort, you are not in danger of causing more damage, often the pain will feel less severe. This is one of the benefits of seeing a physiotherapist after your injury as they can help you to understand your pain, giving you more control over your recovery.
 
You started moving differently after the injury?
 
Immediately after an injury, it’s natural to change the way you move to avoid painful movements. After a while, these changed movement patterns can become a problem and actually begin to cause pain and discomfort on their own due to the altered stress patterns placed on your body.
 
Correcting these adaptive movement patterns can often go a long way in reducing pain after an injury. You might not have noticed these changes and might need a physiotherapist to identify and help you to return to your usual movement pattern.
 
You have lost muscle strength since the injury?
 
While a certain amount of rest following an injury is helpful, if we stop moving altogether our muscles will lose strength. This can mean that our posture changes, we fatigue easier during our normal activities and we are more susceptible to further injury. Less movement also means we actually focus on the pain more when it does happen. Physiotherapists are able to advise you on the right types and amounts of exercise for you in the period following your injury.
 
The pain has affected your lifestyle?
 
When pain affects your ability to sleep, work and even concentrate, it’s not surprising that this can have a negative affect on your overall well-being and mental health. This can create a negative cycle of anxiety and depression that perpetuates and increases the experience of pain. If your pain is really getting you down, speaking to a mental health professional can actually be a valuable part of your physical recovery.

Many other factors can obviously contribute to your neck pain not getting better, but these are four examples we commonly see. Contact your health professional for help with any persistent pain you may be experiencing.

What is it?
Our knees are complex hinge joints, designed to provide stability from side to side and smooth movement forwards and back as you walk, kick and run. The patella, or kneecap, is a small bone embedded in the tendon of the quadriceps muscle that protects the knee and also provides extra leverage to the quadriceps, amplifying their strength. The patella moves up and down in a groove at the front of the knee as the knee bends and straightens. Usually this movement is smooth, with little friction, however, if something causes the patella to move in a dysfunctional way, the soft tissue between the kneecap and the knee can become irritated, causing pain in a typical pattern. This condition is often referred to as ‘runner’s knee’, PFJ syndrome or patellofemoral pain syndrome (PFPS).

What causes it?
The patella usually sits in a balanced position in the shallow groove at the front of the knee and moves easily without friction. The patella is attached to the quadriceps muscle at the top and connected to the lower leg via the patella tendon at the bottom. When the quadriceps contracts, this pulls on the patella and acts to straighten the knee. If one side of the quadriceps is stronger or tighter than the other, it can cause the kneecap to pull to one side and over time become irritated.

There can be many factors that cause a muscle imbalance or weakness on one side of the quadriceps. In most people, the outer aspect of the quadriceps tends to be stronger and tighter than the inner muscle.

Certain postures and leg positions require the outer muscles to work harder and the inside muscles to become less active. Lack of arch support in your feet or simply a physical abnormality of the knee can also place stress on the movement of the patella.

What are the symptoms?
This condition is characterized by pain felt on the inside or behind the patella with activities that require repetitive bending of the knee. There may be a sensation of crunching, clicking or grinding and some people report that their knee suddenly gives way. The pain is commonly felt when running, going up and down stairs or when doing squats and is generally relieved with rest. The pain may start as a small niggle and gradually become worse over time.

How can physiotherapy help?
The first step in effective treatment is to exclude any other conditions and have a physiotherapist confirm the diagnosis. Your physiotherapist is able to determine which factors are contributing to this condition, which could include poor posture, a lack of arch support in your feet or poor running technique.

Once these factors have been identified, you will be provided with a specific treatment program to best approach your condition. PFJ syndrome usually responds well to biomechanical analysis and correction of any muscular weakness and imbalance. Having the correct shoes and orthotics can also make a huge difference. There are some short-term treatments, such as patella taping, dry needling, trigger point therapy and ultrasound, which may help alleviate symptoms quickly and keep you active while you address the other factors contributing to your pain.

Stretching has long played an important role in the world of sport and fitness, with many athletes stretching religiously before and after exercise in hopes of preventing injuries.

More recently, this practice has been called into question with many people wondering if stretching really makes a difference to athletic performance. The answer, like most things, is not black and white, as we explore a little in this article.

A brief introduction to stretching
 
Stretching is a type of movement that increases flexibility by lengthening muscle fibres to the end of their range. Stretching before and after exercise has been thought to reduce the risk of injury, improve athletic performance and reduce muscle soreness after exercise.
The two most common types of stretching are static and dynamic stretching. Static stretching is when you lengthen your muscle and then hold that position for a period of time.
 
Dynamic stretching uses movement and momentum of the body to stretch muscles to their end range, without holding the stretch at the end.
 
What does the research say?
 
Some research has suggested that static stretching before an activity can actually reduce power, strength and performance. However, these reductions were shown to be minimal and not noticed at all if the stretches were held for less than 45 seconds.  It has also been found that stretching does improve flexibility but only for a short period of time. A few minutes after stretching, your joints move further, and with less resistance, so you may have improved flexibility immediately after stretching.
 
Why stretch at all?
 
One thing that is undeniable is that stretching feels great, with many people feeling more relaxed and reporting a rush of endorphins after a good stretching session. It is also difficult to test the long-term effects of stretching specific muscles showing abnormal tightness. A long-term static stretching routine will improve your overall flexibility, and this is thought to help prevent injuries, although the evidence is inconclusive.
 
If you’re an athlete, the decision to stretch or not can be a personal one. A warm-up prior to intense exercise that includes some form of dynamic stretching is generally recommended for reducing injury risk, but of course is no guarantee. Strength and balance training may have a far greater impact on reducing injuries in the long term.
 
Your physiotherapist is able to guide you on the best stretching advice for your individual activity and they may be able to identify some areas where improving your flexibility will help to reduce injuries and improve performance.

There is no doubt that the human body can be very resilient. Short of regenerating new limbs, our bodies are capable of recovering from large amounts of damage, including broken bones. With this in mind, many people are happy to let nature take it’s course following an injury, thinking that seeing a physiotherapist will only act to speed up already healing tissues.
The speed of recovery, however, is only one measure of healing and despite our body’s incredible capacity for repair, injury repair can be less than straightforward. Here are a few things about injury healing you may not have been aware of...

1. Scar Tissue is more likely to form without treatment.
Scar tissue can cause ongoing pain and stiffness in skin, muscles and ligaments. Physiotherapy can prevent excessive scarring from forming through advice regarding movement, massage and other hands-on treatment.

2. Your ability to sense the position of your body, known as proprioception, is often damaged after an injury and can be retrained.
Impaired proprioception is a major factor in re-injury. If you’ve ever heard someone say “my knee/ankle/shoulder still doesn’t feel 100%” then this could be why. The good news is that with a specific exercise program, proprioception can be improved and restored.

3. Once healing has finished, your body may not be exactly the same as before.
Following an injury, ligaments may be lax, joints may be stiffer and muscles are almost always weaker. While the pain may be gone, there might still be factors that need to be addressed to prevent more complicated issues in the future.

4. You may have picked up some bad habits while waiting for the injury to heal.
While in pain, we often change the way we do things, this can lead to the development of poor movement patterns and muscle imbalances. Even though the pain has gone, these new patterns can remain and create further problems down the road.

5. Injuries don’t always heal completely.
On occasion, injuries may not be able to heal completely on their own. The most serious example of this is a fracture that cannot heal if the bone is not kept still enough. Other factors that may prevent an injury from healing include poor circulation, diabetes, insufficient care of the injury and poor nutrition.
 
Your physiotherapist can assess your injury and develop a treatment plan that will both restore you to the best possible function and prevent further injuries.