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. 

​What is a wrist sprain?
Wrist sprains are a general term used to describe any injury to the wrist that doesn’t include a fracture, but is most likely to be a ligament injury. While this can indicate that they are not serious injuries, wrist sprains can be complicated injuries that require supervision and treatment to recover fully.
 
The wrist refers to the area where the bones of the forearm, the radius and ulna, meet and join the bones of the hand. The wrist is able to twist on itself and allows the hand to move to face palm up (supination) or palm down (pronation). The hand is also able to move up and down (flexion/extension) and side to side (abduction/adduction). To allow such complicated movements, the joint surfaces of the wrist are held together by a series of ligaments. When a wrist is sprained, it is usually these ligaments that have been damaged. 

What are the symptoms?
The primary symptom of a sprained wrist is pain with movement of the joint or when taking load, such as when holding a heavy object.
 
Ligament injuries are given a grading scale to indicate their severity, which can help to guide treatment. Grade 1 refers to a stretching or laxity of the ligament fibres and injuries of this grade usually heal with rest within 2-3 weeks. A grade 2 classification signifies that there has been a partial tear of the ligament fibres and will often need more time and treatment for recovery. Grade 3 tears refer to a full thickness rupture of a ligament and may require splinting or even surgery.

The most common cause of a wrist sprain is a fall onto an outstretched hand. Ligament injuries can also happen gradually through over use, although this is less common.

What is the treatment?
Your physiotherapist is able to help diagnosis a wrist sprain and can help to rule out a fracture. An X-ray might be required and your physiotherapist will perform special tests to help identify exactly which structure has been injured, also giving the injury a grade, to help guide treatment.
 
How can physio help?
The key to effective recovery for a wrist sprain is ensuring that the right treatment protocols are in place for your particular injury. Grade 1 sprains will recover best with gentle exercises and early strengthening while Grade 2 to 3 injuries may require splinting or even a surgical consultation for repair.
 
If surgery is 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. 

1. Choose supportive footwear
 
One of the biggest culprits for ongoing knee pain is wearing unsupportive or high-heeled shoes to work. High heels often lead to tight calves and altered gait patterns, while unsupportive shoes can allow rolling in of the feet, which can then place extra stress on the knee joints. Having an assessment with your physiotherapist to see how your shoes might be affecting your knee pain is a worthwhile investment.
 
2.  Adjust your sleeping position
 
While most of the time, our knees get a well deserved rest during the night-time hours, there are a few sleeping positions that can place additional stress on the knees. Lying on your side with bent knees can place tension on the outer thigh muscles and the knee joint itself. Try to keep your knees straightened to only 30 degrees of bend and if you sleep on your side, place a pillow underneath the top knee to reduce stress on the joint.
 
Alternatively, if you sleep on your back it may be helpful to place a pillow under your knees so that they rest in a slightly bent position, to unload the joint.  Try experimenting with different pillow arrangements to see which combination works best for you.
 
3.  Avoid sitting or resting too much
 
When knee pain strikes, your first instinct is probably to get off your feet and stop exercising. The truth is that our knees, like all our joints, are designed for movement and regular exercise helps to keep them healthy. If you are having pain with high impact activities such as running, try switching to swimming and cycling before stopping exercise altogether. Resting in a sitting position for prolonged periods can also place excess stress over the knee cap and knee joint. When sitting for long periods, try to stretch your legs out ahead of you and avoid crossing your legs.
 
4.  Seek physiotherapy treatment
 
Many of us see putting up with pain as a sign of strength however, a small niggle that is easily treatable can turn into a larger problem if left over time. This may seem like an obvious point, yet the first step to recovery is often just seeking treatment.
 
Our physiotherapists are happy to discuss your condition with you and share their tips to help you stay pain-free.  

1. Ask your physio questions about your injury
 
Understanding your condition and how to best manage it is one of the most important factors for a successful recovery. Effective therapists allow time for you to ask questions in a non-judgmental environment. There are no stupid questions, if you don’t understand what is happening in your own body it is harder to follow advice and stick to your program. This can also help you to cope with pain and feel less helpless in your recovery.
 
2.  Follow your physio’s advice and do your exercises
 
Home exercises are a key part of your recovery, especially when treatment times are limited. Try to stick to your exercise program as seriously as you would a medicine schedule. It is also important to ensure that you are doing your exercises correctly at home. Don’t be afraid to double and triple check your technique during your appointments.
 
Your therapist will also provide you with advice regarding activities to avoid, how to stretch, when to rest and how to avoid further injury. If you’re not sure about something, ask your therapist to write it down for you.
 
3.  Notice your improvements
 
Nothing can be more disheartening than feeling like the appointments and exercises you’re diligently attending to are making no difference. As therapists, we make regular measurements to track your improvement and know that while  your symptoms might  be lingering, you are  actually moving more and increasing stress on your body as you recover. Set your own measurements to help you track your recovery. This can help you stick to treatment and feel more positive as you complete your recovery journey.
 
4. Set goals and work with your physio to meet these.
 
The goals of recovery are different for everyone. Some of us want to be able to reach peak performance, such as running a marathon. For others, just getting through the day with a little less pain would be a huge success. Know your own goals and take the time to discuss this with your therapist, who will guide your treatment to help you meet these milestones.
 
Our physiotherapists at The Physio Nook are happy to discuss your condition with you and share their tips to help you stay pain-free.  

1. Try a new activity.
 
When injury strikes, it can be tempting to stop exercising altogether and just rest while you recover.  An injury can be frustrating, but it can also be an opportunity to try out a different sport. If you’re a runner with an ankle injury, you can keep up your fitness by swimming instead. Cycling can be an excellent option for people for dealing with knee pain, and if you’re a swimmer with shoulder pain, maybe switch to running for a while. Check with your physiotherapist for some ideas to keep you moving. 
 
2.  Exercise within your limits.
 
If you’re getting pain at 5km, this doesn’t always mean you should give up running altogether. Your physiotherapist can help you monitor your symptoms carefully and plan an exercise routine that keeps your fitness up while reducing symptom flare-ups. Staying as active as possible throughout your recovery can also mean that you a better placed to get back to your best performance once symptoms subside.
 
3.  Take the opportunity to improve your footwear and equipment.
 
Injury and pain can be a great prompt to look at your equipment and technique. For example, with hip and knee pain, the type of shoes you wear can have a significant difference. Often pain has more than one cause, with technique and equipment often having a substantial impact on the stress placed on your body. Your physiotherapist is an excellent source of advice in this area, don’t hesitate to ask for an assessment.
 
4. Take to the water
 
Hydrotherapy has long been used to help patients with joint pain or muscle weakness exercise. The water helps reduce joint stress and provide extra sensory input that can reduce pain. Exercising in water can be especially helpful for sufferers of chronic pain or those who have pain with weight-bearing. Speak to your physio for a hydrotherapy program if you’re not sure how to approach exercise in water.
 
Our physiotherapists are happy to discuss your condition with you and share their tips to help you stay pain-free.