What is Chronic Pain?

What Is Chronic Pain?

Chronic pain has typically been defined as pain persisting for more than 3 months.  This pain can be experienced throughout the entire body, or at localised body parts.  Pain is a wonderful tool for our body to protect us from perceived threat of tissue damage.  However, so often our ability to accurately determine this threat is altered. 

When we experience chronic, or persisting, pain it can have a large impact on all facets of our lives.  It may mean that we are unable to participate in social situations, or struggle to maintain strength and mobility. Experiencing chronic pain takes up a portion of your daily energy and brain space, so you may also find yourself being distracted, forgetful or irritable. It’s a multifactorial experience, and requires a multiple factorial approach to treatment.

Considering what is chronic pain and what contributes to chronic pain is a complex process.  We know that pain can be increased by not enough sleep, by increased systemic inflammation, by stressful situations and by lack of social/ medical support etc. While initially this may seem overwhelming, it actually means that there are multiple avenues that we can explore to help improve your chronic pain.

The Difference Between Acute and Chronic Pain

This section will compare what is acute pain and chronic pain. The obvious difference between acute and chronic pain is the length of time that pain is experienced.  Acute pain usually occurs with a relatively sudden onset and often interferes with mobility and function. It can often be associated with a specific incident, or mechanism of injury, where a particular fall, movement, landing etc. occurs just before the pain begins.  This can indicate the presence of tissue damage, or a suddenly provoked protective response from the body. Acute pain has a rapid spike in symptoms for the first few days to weeks, then can decrease steadily over the next few weeks, lasting no longer than 3 months.

Continuing to compare what is acute pain and chronic pain, chronic pain continues to persist long after the initial tissue damage or threat has gone. When considering what is chronic pain, there is often a mismatch in the symptoms felt, and the activities or movements that provoke these symptoms.  As mentioned above, nociceptors may be trained to activate at a lower threshold. Hyperalgesia is when something that may usually cause only a minor pain response can be exaggerated (eg a light scratch causing immense pain).  Allodynia is when a non-threatening stimulus causes pain (eg a feather lightly touching the skin may feel like a cut).  These are just two ways in which the information received from the body can be mis-identified, causing a painful response.

The Causes of Chronic Pain

As mentioned above, pain is a sensation created from contextual information following activation of nociceptors from a perceived threat to body tissues. Chronic pain is the continuation of these painful sensations beyond normal tissue healing timeframes, or in the absence of any tissue damage.

When trying to define chronic pain and what causes it, It is important to appreciate that we don’t have specific “pain receptors” in our body that become activated causing “pain signals”.  Instead, we have nociceptors or free nerve endings that respond to changes in mechanical, thermal or chemical stimuli.  I.e changes to movement/pressure, temperature or chemicals such as histamine. These nociceptors are activated and send electrical signals up to the brain.  It’s in the brain that these signals are interpreted and contextual information is added. If enough nociceptors are activated, and enough “danger” context is added, then the outgoing information that we feel in the body is pain. When we experience what is chronic pain, these nociceptors are being more frequently activated, and/or the danger context is being added much more quickly and frequently regardless of the threat of actual tissue damage.

The NOI Group (where so much of the latest research in pain science research and education comes from), describes a dynamic protective buffer between the onset of protection by pain, and the tissue’s actual tolerance before damage begins to occur. This is a warning system the gives us physical signals that we are about to push into our tissue’s threshold.

TWIN PEAKS IMAGE

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You may push into this buffer slowly, eg running a marathon that you haven’t properly trained for, or quickly, eg a sudden burst of increased physical activity and experience pain and potentially tissue damage.  After this tissue damage has occurred, your protective buffer adjusts.  Your protect by pain threshold is lowered and you’ll experience the same or similar response as you did before but now at a decreased amount of effort/ load/ activity. This protective buffer can also be influenced by the overall inflammation in the body, stress, expectation of pain, lack of physical conditioning, poor sleep and nutrition or a history of physical injuries.

The Symptoms of Chronic Pain

It can be difficult to define chronic pain beyond the persistence of pain over 3 months.  The symptoms that people experience are complex and varied.  Chronic pain may be caused by underlying conditions such as endometriosis, arthritis, ankylosing spondylitis or fibromyalgia and chronic fatigue.  When we initially think of chronic pain symptoms we immediately think of the physical: dull, achy pain, sharp shooting pain; pins and needles or burning etc.  Other chronic pain symptoms include decreased sleep, decreased participation in social interactions or physical activities, increased irritability, decreased concentration, decreased productivity.  Unfortunately, the list is long, which is why it’s so important for us to address the whole person in treatment of chronic pain. Similarly, when asked how long is chronic pain, the answer can’t be easily given as it depends on the person, scenario, and interventions.  

Understanding the Mental Health Impact of Chronic Pain

The mental health impact of chronic pain is significant. As mentioned above there are so many situations where chronic pain can have a negative impact. Mental health issues and chronic pain go hand in hand.  Those experiencing persisting pain are more predisposed to symptoms of depression, anxiety or psychological distress.  This relationship works in both directions, people with diagnosed depression or anxiety are more likely to experience chronic pain.  The pain itself can be further be  influenced by low mood, rumination, inability to sleep and social isolation, often creating an important cycle to break.

How to Manage and Treat Chronic Pain

As chronic pain is a multifactorial experience it means there are so many strategies to help manage your pain. Ultimately we want to change the chronic pain meaning in your body and increase the amount of activity you can do before the protect by pain response is triggered (remembering the protective buffer from before). We do this by finding our ‘Goldilocks’ Zone’; not too little, not too much, but just right! There are many things that help to support this zone. It’s difficult to say how long is chronic pain, as it differs for the individual. Here are some tips that consider the physical, mental and social aspects of chronic pain.

  • Increase the amount of incidental activity you do by gradual amounts.
  • Pick an activity you can accomplish without causing a flare up (eg a 7 minute walk), repeat that more frequently. General exercise has an overall anti-inflammatory effect on the body.
  • Pick a meaningful activity to do more of. You might find that picking up your grandchild is much more comfortable than picking up dirty laundry.
  • Change the context! Repeat the activity but in an environment you enjoy. Eg a walk by the river, or to a café with a friend.
  • Try to sleep more.  Go to bed when you are tired, sleep in a dark and quiet room, avoid caffeine later in the day and avoid screens before bedtime.
  • Add in a mindfulness/meditation.  Even a brief mindfulness activity can help to balance the nervous system and assist in decreasing inflammation.
  • Eat food that makes you feel good!  Try to add in one more fruit or vegetable to your meals and vary the colours of your food.
  • Aim to focus on your function versus your pain.  The more attention we give our pain the more overwhelming it feels.
  • Ask for help!  Have an engaged team of health professionals to assist you in creating a plan and to support you in this journey. This can include a Physiotherapist, a Psychologist and a GP.

How Barefoot Can Help with Chronic Pain

If you are suffering with chronic pain and don’t know where to start, get in touch.  The physiotherapists at Barefoot Physiotherapy can help you create a plan to get you moving and back in control.

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What Is Shoulder Impingement & How Can You Fix It?

Pain and injury in the shoulder can have a variety of causes. One of the most common issues we see is shoulder impingement. So what is shoulder impingement? Shoulder impingement refers to a condition where poor co-ordination causes certain structures within the shoulder to get squashed or compressed when moving. Everyone is different and there are several reasons why the shoulder may be moving poorly, including muscle tightness, nerve irritation or muscle weakness. Working out the main contributing factors for each person is key to establishing how to fix shoulder impingement.

What Is Shoulder Impingement?

Understanding shoulder anatomy helps explain what shoulder impingement is. What we think of as the shoulder is referred to as the glenohumeral joint. It is a ‘ball and socket’ joint made up of the humerus (upper arm bone and ‘ball’ component) and the glenoid fossa (the ‘socket’ component that is on the edge of the shoulder blade). A roof is formed at the top of this joint by the acromion (part of the shoulder blade) and the collar bone. The space between this roof and the humerus is called the subacromial space. Tendons for the muscles that create movement and stability in the shoulder as well as bursa (small fluid filled sacs) which help reduce friction sit in the subacromial space. During normal shoulder movement, the humerus glides downwards within the socket as the arm is raised to allow smooth and pain-free movement. When shoulder impingement is present, the humerus does not glide properly and ends up pushing up into the structures at the top of the joint. These include the bursa, acromion and tendons of the rotator cuff muscles. As the humerus ‘impinges’ on these structures the result is poor movement patterns, pain and weakness in the shoulder. Shoulder impingement is quite common, with some data suggesting it accounts for 50% of all shoulder pain.

What Is an Impingement in the Shoulder Caused By?

We understand that shoulder impingement is due to the humerus not gliding properly, but what causes this to occur in the first place? There are a number of causes of shoulder impingement. Muscle tightness in shoulder muscles – particularly the ones that run through the subacromial space – can contribute to shoulder impingement. Tightness in these muscles may occur due to poor posture or overuse, especially in overhead positions (such as swimming, throwing or repetitive overhead lifting). An imbalance in the strength of muscles around the shoulder may also contribute to poor movement patterns which in turn can cause shoulder impingement. Due to the hard bony surrounds of the subacromial space, swelling causes a reduction in space for the tendons and bursa and therefore cause shoulder impingement. Swelling might be due to another injury such as a labrum tear or bursitis caused from a traumatic event (such as a fall onto the shoulder). In a small percentage of cases, some people are predisposed to shoulder impingement due to slight variations in the shape of their bones, in particular the shape and angle of the acromion. Sometimes, repetitive activities can also contribute to the growth of bone spurs which also fill the space and contribute to impingement.

Shoulder Impingement Symptoms

Shoulder impingement can have a variety of symptoms. We can use symptoms to help determine what is shoulder impingement and what is a different shoulder condition. In most cases, knowing the symptoms alongside some physical tests with a physio is sufficient to establish if the problem is shoulder impingement. However sometimes imaging (such as an ultrasound or MRI) may also be used to help make a diagnosis. Key symptoms that may be experienced with shoulder impingement include:

  • Pain – most people will experience pain either at the front of the shoulder or on the outer part of the upper arm. Pain can vary from a dull ache to a sharp, pinching type feeling. You may also get pain into the neck or upper back as well. Pain will usually be aggravated with particular movements of the shoulder – in particular overhead movement such as swimming, throwing or even washing/brushing your hair or reaching into a high cupboard. Reaching behind you, either into your back pocket or to do up your bra may also cause pain. Many people also find lying on the affected arm can also provoke pain and may find sleep is quite interrupted as a result.

  • Restricted range of motion – often the aggravating movement mentioned (reaching overhead or behind you) will start to feel limited in range.

  • Weakness – many people will find they feel weaker in the affected arm when they have shoulder impingement

Is Shoulder Impingement Permanent?

Given how painful and disruptive shoulder impingement can be, it is understandable to question whether it can be fixed. Knowing that often the cause is due to changeable factors such as overuse, muscle tightness or weakness helps us understand that it usually can be fixed. Some people may have more difficulty solving their impingement (for example if they have a predisposing acromion shape), but with a combination of physio, medication and activity modification most people should make a full recovery.

How to Fix Shoulder Impingement:

Treatment for shoulder impingement is usually centred around physiotherapy. Other modalities may be incorporated alongside physio treatment. Shoulder impingement treatment with a physio may include:

  • Nerve treatment – its common for the nerves of the arm to also get irritated and treatment to the spine may be needed to help restore normal movement of the arm nerve

  • Muscle releases or massage – as tight muscles can be the cause of shoulder impingement, hands on treatment to release the muscle tightness usually plays an important role in restoring normal shoulder movement and resolving impingement. Treatment for muscles can include trigger pointing, massage or even dry needling.

  • Spinal joint mobilisation – full shoulder movement is also dependent on neck and thoracic spine movement. Stiffness in the neck/thoracic spine may be present with shoulder impingement so your physio may include treatment to the neck or upper back to ensure restoration of full movement and good mechanics

  • Activity modification – in the early stages of treatment, your physio will likely advise you to avoid aggravating activities, such as swimming, throwing or overhead strength exercises. These adjustments should only be temporary to allow the inflammation to settle down and once your shoulder is moving better, your physio can help you gradually add these activities back in

  • Postural advice – poor shoulder posture can contribute to the development of shoulder impingement or may occur as a result of compensation when the shoulder is painful. Either way, to reduce the chance of future shoulder problems your physio may give you advice about shoulder posture

  • Muscle retraining – retraining the muscles in the shoulder is a key step in rehabilitating shoulder impingement. Your physio should give you specific exercises that focus on ensuring the muscles are co-ordinating and working together properly. Once good movement patterns have been established the focus can then shift to strengthening to help make your shoulder more resilient to future injury

Talk to a Physio Today About Shoulder Impingement Syndrome

Shoulder impingement is a very common cause of shoulder pain and dysfunction. While it can be very limiting and disruptive to daily life it is responsive to physiotherapy treatment so you don’t need to continue suffering. If you have shoulder pain or think you might have shoulder impingement, contact the team at Barefoot Physiotherapy today to discuss it further or book in so they can complete a thorough assessment and develop a personalised treatment plan for you.

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How to Treat Hamstring Tendinopathy

Hamstring tendinopathy is becoming an increasingly recognized cause of pain in both sitting and activity related posterior thigh pain. This pain is often present at the top of the hamstring underneath the gluteal fold, where the hamstring tendon attaches onto the ischial tuberosity. It is important to know how to treat hamstring tendinopathy as the hamstrings make up the bulk of the muscle in the back of the thigh and are formed by three muscles and their tendons. The muscles are semimembranosus, semitendinosus, and biceps femoris.

As hamstrings are known as runner’s muscles, hamstring tendinopathy is often diagnosed in clients who are avid runners. Typically, runners who have suddenly increased their training volume, training intensity or have started hill running.  However, with the right management of active self-treatment and strengthening exercises you can get back to running pain-free.

At Barefoot Physiotherapy, we utilise a combination of hands-on techniques, activity, and exercise modifications, strengthening exercises and advice and education to help clients cure their hamstring tendinopathy and get back to moving and feeling good.

What is Hamstring Tendinopathy?

Let’s break it down further – what is high tendinopathy and how do you heal high Hamstring Tendinopathy?High hamstring tendinopathies are more commonly referred to as a proximal hamstring tendinopathy, due to the usual location of symptoms high on the hamstring. People who have developed a proximal hamstring tendinopathy will often complain of a deep, annoying buttock pain during activities such as running, prolonged sitting/ driving or hill walking/ running.  

The role of a muscle’s tendon is to attach the muscle to bone. A normal tendon consists of fibrous tissue which contains type one collagen, the structure is often imagined looking like a rope. There are specific cells in a tendon designed to look after the tendon structure. Tendons are vascularized however there is less blood supply at the part of the tendon which attaches to bone, which is consequently where tendinopathy will occur. Tendons do not like sudden changes to load, and in some occurrences, this is what will cause tendinopathy.

What are the Causes?

When determining how to treat hamstring tendinopathy, you need to understand the causes of a proximal hamstring tendinopathy. Unlike an acute hamstring tear, the pain typically comes on gradually and is usually aggravated by repetitive activities such as prolonged sitting and running.

As previously mentioned, a tendon doesn’t like sudden variances in load. When the hamstring tendon is put under a high load that exceeds its ability to effectively recover, the tendons structures can change. The changes that occur when a tendon is unhappy involves collagen structures becoming disorganised and therefore unfavourable alterations occur to the neurovascular and cellular components of the tendon. These changes can therefore result in the pain symptoms at the site of tendon insertion. 

Who is most likely to get a high hamstring tendinopathy? The most significant risk factor for hamstring injuries is a history of previous injury to the muscle. Therefore, seeking out physiotherapy treatment for an acute injury can be paramount in preventing further injury. The following is a list of common causes of proximal hamstring tendinopathy: running, jumping, and kicking, history of lower limb injury, lack of flexibility (stiffness in muscles), weakness in muscles, inadequate warm-ups, muscle fatigue, increasing age and muscle imbalances.

How to Treat Hamstring Tendinopathy

At Barefoot Physiotherapy, we utilise the best evidence-based research to know how to treat high hamstring tendinopathy. In your assessment at Barefoot, your physiotherapists will ascertain the extent of your injury and formulate a plan for the best steps to start your healing. In most instances, your physiotherapist will suggest a conservative approach to rehab including initial rest, icing of the area, stretching and strengthening of the affected muscles and surrounding muscle groups. In some instances when the pain doesn’t improve with conservative management, further treatment interventions may be required. However, your physiotherapists will consult with you and your GP if they believe alternative treatments such as corticosteroid injections may be beneficial.

Treating Proximal Hamstring Tendinopathy

Your Barefoot physiotherapist will be highly skilled in knowing how to treat a hamstring tendinopathy and will prescribe a management plan which may include some of the following exercises.

Initial phase:

The initial phase of rehab will include relative rest or a reduction in training volume. Your physiotherapist will help you understand your individual aggravating factors for the tendon and work with you to build solutions. This might include regular breaks from sitting, avoiding hill walking, using a cushion to sit on and tendon relieving exercises such as isometric hamstring contractions i.e., digging your heel into ground while you are sitting. 

Loading phase:

The next step in your rehab will be to gradually reload the tendon. In knowing how to treat a proximal tendinopathy, specific stretching and strengthening exercises are a must. Muscles which may be strengthened include the hamstring group, glute muscles and abdominal muscles.

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1. Squats:

Squat exercises are functional and a great way to start rebuilding appropriate strength throughout the whole lower body to ensure the surrounding muscles of the hamstrings are strong. When performing a squat, your physiotherapist will assess your form to ensure your back is not over-active, glutes are engaged, and you have the appropriate hip range to complete the movement. Reps and sets will be determined based on your ability to load your body and how many you can complete before fatigue. Typically, you will want toes facing slightly out, feet about shoulder width apart and the ability to maintain a neutral back throughout the movement.

2. Romanian dead lift:

In this position, your physiotherapist will instruct you to activate your deep abdominals, create a slight bend in the knees and hinge at the hip, feeling a tension building in the hamstrings and glutes. Focus on pushing hips backwards like you are going to sit down and then standing back up straight without over-extending into the back. Reps and sets will be determined based on your ability to load your body and how many you can complete before fatigue.

3. Hamstring Bridge:

A hamstring bridge is an excellent targeted exercise to the hamstring muscle group. Your physiotherapist will instruct you to lie on the ground with your heels on the bed and feet flexed back towards you. You will then tuck your pelvis and push heels into the bed and create a lift. Your hamstrings should be firing the most and some glutes. If there is any discomfort in your back let your physiotherapist know and stop the exercise. Reps and sets will be determined based on your ability to load your body and how many you can complete before fatigue.

The exercises listed above show how to treat a high hamstring tendinopathy. These are three key strengthening exercises that are commonly used by our physiotherapists. There are many more exercises which can be utilised to restrengthen your hamstring and your physiotherapist will work with you to tailor a specific program to your exercise ability and stage of rehab.

Treat Hamstring Tendinopathy with Barefoot Physiotherapy

The aim of this article was to help you understand how to heal high hamstring tendinopathy and how Barefoot Physiotherapy can assist you in this process. If you or anyone you know is suffering from deep buttock pain, pain with prolonged sitting, or running/hill walking, it could be a hamstring tendinopathy and one of our friendly Barefoot Physiotherapists can help. 

Your Barefoot Physiotherapist will work with you to construct a treatment plan which best suits you and your lifestyle so you can get back to enjoying the activities you love pain free. You can give us a call on 1300 842 850 or book into our Brisbane clinic online.

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How to Activate Glutes

There’s a reason that glute activation is such a popular area of focus for health and fitness professionals. While there are many different approaches for how to activate glutes, the importance of doing so is clear.

The ‘glutes’ actually refers to a group of muscles located around the hips, that make up the buttocks. Together, the glutes play an important role in stabilising the hips and pelvis, supporting the lower back (especially during lifting) and contributing to knee and ankle stability. As a result of this, good glute activation is of high importance for injury prevention and also injury recovery. The best way to improve and maintain glute activation is through specific exercises. These are covered in more detail below:

Why Are My Glutes Switched Off?

Before we get to how to activate your glutes, it is relevant to understand why they may not be working well in the first place. There are a couple of reasons that your glutes may not be firing as expected.

First of all, the phenomenon of ‘pain inhibition’ can play a significant role. Studies have shown that in the presence of pain, glute muscle activity is often significantly decreased or inhibited. This can be from local pain (such as the hip) or further removed, such as the ankle. There are a number of theories as to why muscle activity is inhibited in these instances, what we do know is that just because the pain resolves does not mean the muscles automatically start activating normally again.

There is also some evidence that spending a lot of time in sitting, where the glutes are on stretch while the hip flexors (the opposing muscle group) are activated may also contribute to poor glute activation. What is definitely clear, is that because the glutes play such an important role in the stability and movement of the lower back, hip, knee and even ankle, glutes that don’t activate well can contribute to pain and injury in a wide variety of areas.

The importance of knowing how to activate glutes

At this point, the importance of knowing how to activate your glutes is clear so you are likely asking “How do I activate my glutes?”. To understand the how, it is relevant to know some basic anatomy. The glutes are a collection of muscles, which can be broken into 3 further subgroups.

  • Gluteus maximus is the primary hip extensor (takes the leg out behind you). It plays an important role in walking and running and when working correctly, generates lots of power
  • Gluteus minimus and glutes medius make up the hip abductor group. That is, they take the leg out to the side. This means they are also key for providing stability at the hip, knee, and ankle
  • Piriformis, obturator internus and externus, superior and inferior gemelliwork together as hip rotators. They will typically be referred to as “deep hip rotators” and are usually not what we are referring to when talking about glutes. It is also worth noting that often these hip rotators take over when the other glutes are not strong enough and this can also lead to pain and injury. Just another to make sure you are activating your glutes well!

How to activate your glutes?

As with all muscles, glutes are best strengthened with targeted exercises. When looking for how to activate your glutes, choosing the right exercises is important. Good technique and finding the muscle activation cue that works for you is also important.

Some examples of cues are “Push your legs away from one another” and “Create tension in between your feet”. When glutes are well activated, the hips and pelvis should be stable (even when on one leg) and the knees should not drop inwards.


Glute activation exercises

Slow marching

When people are first learning how to activate glutes, walking on the spot is a really great way to feel what is happening. In most cases, if you feel the upper glute muscles with your hands whilst walking on the spot, you can feel them switch on when you stand on that leg and switch off as you swap sides. You can use this both to learn how to activate my glutes as well as to strengthen them

  • March on the spot – the slower the better
  • Use a mirror to ensure the pelvis is staying square – not dropping down to one side or rotating
  • To progress, you can hold a weight in close to your chest

Squat

Squats are one of the most well-known glute exercises. Important points to remember are:

  • Start with activating the glutes before moving (try some of the cues above)
  • Send the hips backwards and down (like sitting down), also allowing the knees to bend. The upper body will have to come forwards slightly however avoid collapsing forwards
  • Return to the start position, being sure to initiate the movement at the hips – driving them forward and up
  • Squats can be done on both legs at the same time or progressed to single leg where suitable. You can also modify the depth of the squat depending on your strength/experience

Muscle release glute

Crab walk

Walking sideways is a great way to work the gluteus medius and minimus as it really targets hip abduction.

  • Start with a small bend in your hips and knees and think of switching on your glute muscles
  • Then take slow, purposeful steps to one side (10-20 steps) before returning in the opposite direction
  • You can add a resistance band around the knees for extra challenge – just ensure that you are still focusing on pushing the knees apart, rather than rotating them outwards

Hip hinge

To really activate the gluteus maximus, this exercise targets hip extension

  • Start with feet hip width apart, slight bend in knees and activating the glutes
  • Keeping the spinal in neutral, send the hips backwards whilst keeping the knees in the same position. Your body should resemble a shape similar to the number 7
  • Focusing on initiating movement from the hips and return to the start position
  • As with squats, you can make this more difficult by working into more range, adding weight or doing it on one leg

Step up

This exercise is very important for how to activate glutes as most people will go up/down stairs during their day and having good muscle activation is important. It is also a good exercise for those who do a lot of running or walking for exercise

  • Place one foot on a low box or step and activate the glute muscles
  • Ensuring the pelvis stays square and stable and the knee does not collapse inwards, step up onto the box
  • Keeping the same control and activation, lower back to the start position
  • Do all on one side, then swap legs and repeat on the other side
  • You can make this more difficult by adding weight or increasing the box height

Glute activation with Barefoot Physiotherapy

Having good glute activation is key for injury prevention and performance enhancement. If you are concerned about your glute muscles, book in to see on of the physiotherapists at Barefoot Physio so they can assess your glutes, work out if they are contributing to pain or injury, prescribe you personalised exercises and ensure you know how to activate your glutes.

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What Causes Knee Pain?

Knee pain is a common reason that people present to physiotherapy. They may be suffering from knee pain in isolation or within a broader complaint of symptoms. Your knees are important in mobility and day to day activities, and are influenced directly from the feet, ankles and hips. This article will look into what causes knee pain and the most common presentations we see in our clinic. The vast majority of knee pain can be treated conservatively (without the need for injections or surgery) through a treatment program created by your Physiotherapist. Most of the knee pain presentations that we see at Barefoot Physiotherapy are a result of sustained increased load though there are many factors to take into consideration.

What Causes Knee Pain?

The knee joint is a modified hinge joint that moves primarily in one linear direction. A relatively small amount of rotation occurs as the knee moves through full extension and flexion. The joints that make up the overall knee joint complex include the tibiofemoral (between the thigh and shin), the patellofemoral (the kneecap) and the nearby tibiofibular (between the two shin bones). There are a series of ligaments and cartilage structures also involved in this joint: Medial and lateral collateral ligaments (MCL and LCL respectively) external to the joint capsule, Anterior and Posterior Cruciate Ligaments (ACL and PCL respectively) and the fibrocartilage meniscus within the joint capsule. Around the patella or kneecap are the patella tendon and ligaments.

Knee pain can also come from tightness or overuse of muscles in the area, or from nerve irritation presenting with symptoms in this area.

Depending on the activities, age and history of the client, the physiotherapist will perform a variety of assessments to determine what causes knee pain in the individual person. A younger or more athletic person may have pain stemming from an acute injury to the above tissues, or from muscular overload. Whereas an older person may be more likely to have osteoarthritis or nerve irritation in the area. This is not a hard and fast distinction, and it is important not to rule causes in or out prior to a thorough assessment from a health professional.

The Most Common Reasons for Knee Pain

As previously mentioned, there are many knee pain reasons. Prior to a physical assessment, your physiotherapist will discuss a detailed history, including any injuries or niggles you may have sustained recently or over your lifetime that may be relevant.

  • Acute injuries: These are more commonly seen in a sporting context, either from a fall, physical contact/ tackle, or an awkward pivot. This may include ACL or MCL tears, meniscus tears or muscle strains. More rarely there may be a bony fracture involved.
  • Tendinopathies: This is an overload of the tendon (where the muscle attaches to bone) and is due to an increase of loading that occurred beyond the capacity of the tissue. Tendinopathies are commonly seen with a recent addition of plyometrics or running.
  • Nerve Irritation: neural involvement can present as a feeling of overall muscle tightness around the knee, or a feeling of pulling/shooting behind the knee particularly when then hip and knee is straight.
  • Osteoarthritis: as we age it is common to have arthritic changes within joints, and especially common within the knee joint. This can present as pain, decreased ranges or difficulty moving in certain ways. It is important to remember that though we can’t alter arthritic changes (outside of surgery), we can positively influence the body’s response to these changes and moving better and getting stronger can decrease the overall pain experienced.
  • Paediatrics: Conditions such as Osgood-Schlatters Disease are relatively common in adolescents undergoing a growth spurt, leading to an overload of the tissues at the front of the knee. In this population it is important to rule out Perthes Disease, an idiopathic necrosis of the femoral epiphysis (top of the thigh bone) which can refer as knee pain.

What Are My Treatment Options for Sore Knees?

We now know there are multiple factors involved in what causes knee pain, therefore there are multiple factors that can be addressed in your treatment. Once we have ruled out the need for immediate imaging, our initial goal is to de-load the area and reduce the symptoms you are experiencing. Your physiotherapist will use a combination of hands-on treatment to reduce any relevant nerve irritation and muscle spasm; this may include joint mobilisations, soft tissue massage or dry needling.

You will be given advice on immediate load management and changes to activity, in the initial stages of rehabilitation we want to find a zone of activity to keep you moving without any aggravation of symptoms. Following this initial de-load period, your management will consist of muscle activation and retraining, likely focusing on glutes, hamstrings, quads, calves, and abdominals (this is different for every person).

At Barefoot Physiotherapy we also assess the entire body to determine if there are any areas that also need to be addressed to reduce the overall load on the knees and the rest of the body. From here we build on increasing strength whilst maintaining improvements to ranges and symptoms. Our Barefoot Physiotherapy clients all receive a home exercise program that is relevant to them, their presentation and the activity they want to return to.

The Best Exercises for Sore Knees

The best exercises for improving knee pain and reducing the underlying factors in what causes knees to ache follow the principles of de-load, retrain, and reload.

De-load: This usually involves muscle releases to help improve pain free movement ranges. Most often they will focus on the knee itself, plus any other areas your physiotherapist has found relevant for you. Typical releases include glute, deep hip rotator or quad muscles with a trigger ball, calf releases using your thumb or a trigger ball, gentle active range movement stretching glutes, adductors, calves, or quads.


Retrain: Once the area has been de-loaded it is important to retrain movement and activation patterns to prevent accumulated strain from causing symptoms in the future. Your physiotherapist will help you find cues for glute activation, quad and hamstring co-contraction, intrinsic foot activation and improved balance, amongst others.

Reload: This section becomes a bit more exciting as we add a strength component. The muscle activation cues you will have already practiced now get to be layered on larger movements like squats, deadlifts, dynamic balance, and lunges. If you have a particular activity to return to, this part of the rehab can be specialised to your specific movement demands.

Muscle stretch quads

How Can I Prevent Sore Knees?

To prevent sore knees in the future it is important to stay mindful of your overall load management. For example, if you are wanting to start running you need to consider more obvious elements such as speed and length of your run, but also your strength and balance capacity, the surface you run on or the shoes you run in. As you increase the load in one area, it is important to include an effective warm-up to help prepare the body, but also to make sure the body is receiving enough support in the form of rest/ sleep, nutrition, and muscle de-loading. This is true of any activity, whether that is training for a marathon, going for a hike, or playing with the grandkids.

Have Knee Pain? Contact A Physiotherapist Today

The aim of this article was to help you gain a better understanding of what knee pain is, how it is caused and who can help. Whether you have been experiencing long term knee pain, or just starting to feel a bit of a niggle, Barefoot Physiotherapy can help get you back to your activities as quickly as possible with our knee pain Brisbane treatment. If you have any concerns regarding knee pain, see Barefoot Physio for a thorough assessment, treatment, and management plan.

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Common Running Injuries and How to Avoid Them

Running is a great form of exercise that really works the whole body from legs to lungs and everything in between. Given that running seems so simple, people often underestimate the load it places on the body, which can lead to running injuries. Runners at any level of fitness can experience pain or injuries and physios are well equipped to help manage and prevent injuries. Using hands-on treatment as well as exercise prescription and training adjustments, physios play an important role in treating running injuries. This article will explain common running injuries and how to avoid them so that you can keep enjoying your run.

Common Running Injuries and How to Avoid Them


Given the repetitive nature of running, it’s not surprising that a majority of common running injuries are often overuse related. ‘Overuse’ or rather, accumulative strain injuries, are more than simply too much running.

For runners of all fitness levels, load management plays a key role in common running injuries and how to avoid them. Load management can include how many days of total running in a week, the intensity or how fast the running is, the total number of kilometres in a week, the number of rest days as well as considering other activities in the week (like strength training or playing social sport).

Delayed onset muscle soreness is the achy feeling in your muscles when they are recovering from exercise. Anyone who has tried a new activity or even had a big day of gardening will know the experience of DOMS. For most runners, DOMS is a regular part of training. DOMS is a normal response from the body and most commonly occur after increasing the distance or intensity of a run. They are not a cause for concern and can usually be managed with gentle stretching and movement.

How injuries occur

How Do Running Injuries Occur?


As mentioned, many running injuries are related to poor load management. Therefore, when it comes to avoiding common running injuries, having a program that is individualised to your needs and fitness is key.

Common running pains often occur when there is too big of an increase in training, too quickly. This can be an increase in volume – either suddenly going from 5km run to 10km run or an increase in load across the week, such as going from 3 days of running to 5 days of running. An increase in intensity can also contribute to injuries – such as adding in sprints or high intensity running without preparing the body.

A good rule of thumb for any training program progression is to increase by no more than 20% and to only change one variable (eg. distance or intensity) at a time.

It is also important to consider other factors in injury prevention other than training. Load refers to all aspects of the body – so while training is a big contributor, other influences to consider are sleep, rest/recovery between sessions, strength, past injury history, not warming up appropriately and nutrition.

What are some common running leg injuries?

Due to the nature of running, most injuries occur in the leg. Common running leg injuries include:

  • Hip pain or hip bursitis
  • Hamstring muscle tear/hamstring tendinopathy/hamstring muscle tightness
  • Anterior knee pain/patellofemoral pain
  • Achilles pain/Achilles tendinopathy
  • Shin splints
  • Plantarfascia pain/plantarfasciopathy


While there are a wide range of running injuries, the underlying treatment approach is consistent. Treatment for running injuries will typically include:

  • Deloading the area: this may include hands on treatment from your physio, including joint treatment, dry needling, massage, nerve treatment or taping. As well as modifying your training to an appropriate level – this may be a reduction in volume, swapping out some running for cross-training such as bike or pool sessions or occasionally a short period of complete rest

  • Improving function: once the injured site has been deloaded, the focus shifts to improving the range of motion and strength of the injured area, as well as ensuring good strength and flexibility of the entire leg and body for future injury prevention. This may include more hands on treatment from the physio as well as a home exercise program

  • Appropriate reloading: Once symptoms have decreased alongside improved mobility and strength, the goal shifts to getting you back into full training. Your physio will work collaboratively to create a gradual return to training schedule

How to know when to see a physio for your running injury?


As mentioned, some general muscle aches are to be expected from running. However, knowing the difference between normal training soreness and injury pain is important. Many common running injuries start out mildly and get worse over time. What most people think of as small niggles, are often the early signs of an injury and should be addressed sooner, rather than later. Delayed onset muscle soreness is the main common running pain that is not a cause for concern. It is the dull generalised ache across the whole muscle (or a number of muscles) that usually occurs 1-2 days after a big training session. It should ease slightly with gentle movement (such as going for a walk or light run) and resolve entirely around the 48-hour mark. Most other common running pains are the start of injuries and should be addressed by a physio sooner rather than later. Key signs to look for include:

  • Pain is in a particular spot, such as right on the heel or under the knee cap (not generalised across the whole muscle)
  • Pain gets worse with more running
  • Pain is accompanied with stiffness or weakness/heaviness
  • Difference side to side (eg sore on the left, but not the right)
  • Pain does not resolve within 1-2 days

How to prevent running injuries

Muscle release quads

There are many strategies when it comes to common running injuries and how to avoid them. As previously discussed, load management is the most important approach. Either having a physio or experienced coach help determine the appropriate amount of training for your fitness level is the first line of defence for injury. However, determining the right amount of running is not foolproof and even with careful planning, injuries can still occur.

Another important step to consider is incorporating strength training alongside running to ensure that your leg muscles are properly conditioned. Again, this should be personalised to you by a physio or coach but may include exercises like squats, lunges and calf raises. Getting assessed by a physio early on is also very important for preventing common running leg injuries. Physios can help identify areas of restriction or weakness that may contribute to an injury and help put a plan in place so that niggles don’t become more serious injuries. You don’t even have to have a niggle to see a physio – in fact, the earlier you see a physio, the less likely you are to need time off training with a serious injury.

Expert treatment for your running injuries


Whether you are getting started on your running journey or are well into your career, Barefoot Physio can help with common running injuries and how to avoid them. Utilising sensitive nerve and range of motion tests to identify potential problems, they combine hands-on treatment and home exercise programs to develop a personalised treatment plan to help prevent and treat injuries so that you can continue running.

Pelvic Floor Physiotherapy in Brisbane

What Is Women’s Health Physiotherapy?

At Barefoot Physiotherapy, we offer various physiotherapy services; one of them being Women’s Health Physiotherapy. In fact, this is one of our primary service offerings in Brisbane. So, what is Women’s Health Physiotherapy? 

Women’s Health Physiotherapy typically refers to Physiotherapy focusing on Pelvic health. At Barefoot Physiotherapy, we use the term to cover Physiotherapy concerns across the female lifespan, including adolescence, antenatal, postnatal and menopause stages of one’s life. 

Most commonly, all these concerns will relate to the function and pain in the bladder, bowel, pelvis, lower back muscles and pelvic floor muscles. However, it can also incorporate a return to function and exercise concerns pre and post-pregnancy, gynaecological surgery and around menopausal age. At Barefoot Physiotherapy, we aim to empower women across the lifespan to maintain control of their bodies to live their best barefoot lifestyles. Working with a physiotherapist to address any of the above issues can help improve your overall quality of life and wellbeing. 

What Is Women’s Health Physiotherapy?

Women’s Health Physiotherapy is different to general physiotherapy as its practitioners have a special interest and extra training in a range of female-oriented concerns across the lifespan. A women’s health physiotherapist will work with you with the aim of helping you achieve your physical best. 

So what is Women’s Health Physiotherapy? As previously mentioned, it generally tends to focus on women’s pelvic health concerns across the lifespan. Contrary to common misconceptions, it isn’t just for pregnant women; but in fact, it addresses the changes to the female body throughout the various stages of life. Clients who work with a Women’s Health Physiotherapist have someone to guide them and organise a health team if needed to achieve their individual goals. 

A general musculoskeletal physiotherapist can assist with injuries to various body areas, including symptoms associated with pregnancy and gynaecological surgeries. However, they may not have a deeper understanding of how to effectively treat pain and injuries stemming from the pelvic region long term and prevent reoccurrence. Therefore, they will often refer to a Women’s Health Physiotherapist who can utilise their extra knowledge, hands-on skills and exercise prescription in this area to achieve the client’s goals and keep the area strong and healthy to prevent reinjury. 

Why Would I Be Referred to a Women’s Health Physical Therapist?

So why would you be referred to a Women’s Health Physical Therapist? At Barefoot Physiotherapy, we don’t do internal examinations: the only type of Women’s Health Physiotherapy we typically refer for is an Internal examination. If this is needed, we have great contacts to refer to and work with to help get you the best care. Therefore, there are plenty of reasons your GP/ general physio may recommend you to Barefoot Physiotherapy for Women’s Health concerns. 

These concerns can include;

  • Lower back, mid-back and neck pain pre and post-pregnancy
  • Pelvic girdle pain or coccyx pain 
  • Sacroiliac joint dysfunction or pain  
  • Postnatal pelvic floor assessments (excluding internal examinations)
  • Bladder concerns including; stress urinary incontinence, urge incontinence/ overactive bladder syndrome, bladder pain syndrome and urinary retention. 
  • Bowel function concerns including incontinence and constipation 
  • Painful sexual intercourse (dyspareunia)
  • Exercise programs for menopausal women 
  • Exercise programs to increase bone density 
  • Exercise programs for a return to exercise post-pregnancy 
  • Advice and education on safe exercise throughout pregnancy 
  • Endometriosis pain
  • Vaginal Pain 

If you are unsure about what health practitioner is needed to help resolve your women’s health concern, give us a call anytime to address your concern, and we can assist you in determining the best course of action. 

What Happens at a Women’s Health Physio Appointment?

Hopefully, by now, you will have a greater understanding of “what is Women’s Health Physiotherapy?”. Let’s now break down what happens at a Women’s Health Physio appointment. 

At Barefoot Physiotherapy, your typical initial assessment will start with a detailed subjective examination. This will include asking the client to detail previous medical history, previous injuries or physical concerns, current physical injuries or concerns, any current medications, who your current health care team is, and any other relevant information to your presentation. 

Then your Physiotherapist will go through a series of objective assessments, including testing for underlying neural irritation, any movement restrictions throughout the body, tightness in joints or muscles or any specific weakness in the pelvic floor or deep abdominal muscles. We don’t do any internal examinations; we have thorough assessment techniques that we use. And if we deem that an internal examination is necessary, we may refer you to a trusted colleague.

Once your Women’s Health Physiotherapist has a thorough understanding of your presentation, they will utilise the remainder of the appointment for treatment; this may include but isn’t limited to; manual therapy to relieve tight muscles/joints/ nerve irritation, advice and education about exercise, activity modification and postures and muscle activation or light strengthening. 

Depending on the reason for your visit, your Women’s Health Physiotherapist may also recommend an SIJ belt or taping to help relieve your symptoms. 

What Are The Benefits of a Female Health Physio?

When visiting Barefoot Physiotherapy for Women’s Health Physiotherapy, there are a variety of benefits of working with an educated, knowledgeable and experienced team. 

At Barefoot Physiotherapy, we pride ourselves on providing the best possible treatment by staying up to date with cutting edge research around pelvic health. We undertake extensive extra training and learn from various leaders in the women’s health industry to constantly upgrade our skills in hands-on treatment, advice and education, and exercise prescription. This extra training also allows us to find excellent options for clients in terms of practitioners who provide internal women’s health examinations to be confident they are working with a team of highly trained professionals. 

Whilst general physiotherapists can provide pain relief for some common musculoskeletal women’s health concerns; a general physio might not know how to effectively prevent reoccurrence with certain women’s health issues or who to refer to for specific women’s health concerns (for instance; internal examinations or pessary fittings for pelvic organ prolapse). Therefore, it is highly beneficial to seek out a Women’s Health Physiotherapist from the start of your physiotherapy journey. 

Hopefully, this article has helped to understand the question of “what is Women’s Health physiotherapy?”, and you now feel confident to request a Women’s Health Physiotherapist early on in your care. 

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How Can a Female Health Physio Help With Pregnancy?

A major area of Women’s Health Physiotherapy is the focus on antenatal and postnatal issues. A female’s body undergoes major changes throughout pregnancy. Therefore, as the body adapts, females can develop issues or concerns with pain and dysfunction, which can last throughout the entirety of their pregnancy and into post-pregnancy if not addressed by a Women’s Health Physiotherapist. 

Women’s Health Physiotherapy can help prevent pregnancy-related concerns such as; pelvic girdle and coccyx pain, pregnancy and postnatal lower or mid back pain, incontinence (bladder or bowel), pelvic organ prolapse and or exercise-related muscle fatigue/ pain. A Women’s Health Physiotherapist can address the above issues through advice and education around pelvic organ health, hands-on therapy to release tight muscles causing discomfort, exercises to increase pelvic floor strength and endurance and postural education. In addition, they can work with you to develop a safe plan for exercise during pregnancy and a graded return to activity post-pregnancy. 

Women’s Health Physiotherapists aim to empower you to feel confident in your body, prevent issues from occurring or reoccurring and achieve your individual goals. 

Find the Right Women’s Health Physio For You

This article has aimed to provide you with the answer to the question “What is Women’s Health Physiotherapy?” and how Barefoot Physiotherapy can help you resolve your women’s health concerns. 

At Barefoot Physiotherapy, we always utilise the most cutting edge research to shape our treatments, and you can be confident that your Physiotherapist will listen to your concerns and work with you to achieve your goals and resolve your issue. Therefore, if you need Women’s Health Physiotherapy in Brisbane, please don’t hesitate to reach out to us to chat about what you would like to come in for or book an appointment. You can book an appointment by calling us on 1300 842 850, or you can book online here. 

Why Do I Have Lower Back Pain?

Lower back pain can be one of the most debilitating conditions that clients present with at Barefoot Physiotherapy. Clients will often ask, “why do I have lower back pain?” especially when they can’t correlate it to a specific mechanism of injury or if it has a gradual onset. 

Physiotherapy can significantly increase the quality of life for people suffering from pain in their lower back region. Manual therapy techniques, exercise prescription, advice, and education play an important role in our client’s rehab and, when prescribed together, prove to provide the best outcomes overall for clients. 

It is ideal to start Physiotherapy as soon as you begin to feel any symptoms of lower back pain; this helps reduce the severity of the discomfort and get you back to being pain-free quicker. This article will help you understand what causes back pain in lower back areas and what Physiotherapy can do to help manage it. 

Why Do I Have Lower Back Pain? 

At Barefoot Physiotherapy, clients present with lower back pain from a variety of underlying causes. Your Physiotherapist aims to not only relieve your symptoms but utilise a thorough assessment to determine the underlying cause and to help prevent the back pain from reoccurring.

When clients ask us, “why do I have lower back pain?” we will start with taking a thorough past and current medical history, including any previous aches/ pains or injuries to the body. This helps your Physiotherapist understand what condition your body is in, walking in the door.

Sore lower back causes are often related to a history of tight/reduced hip range, sore or weaker glute muscles, reduced ability to activate core muscles, and accumulated strain on the body. However, these issues might not be the cause if the client has had a direct, forceful mechanism of injury to the lower back, for example, a fall or a rugby tackle. Individuals with pain in their lower back may feel any of the following symptoms: a general ache in the muscle or joint, tightness throughout the back region, sharp/ pulling pains with movement, and it can affect the client’s ability to move freely, i.e. walking, sitting and running. 

Common Backache & Pain Causes 

The following section lists some of the main musculoskeletal causes of back discomfort that clients present with at Barefoot Physiotherapy. 

  • Accumulative strain injury (reduced movement range or strength in hips, thoracic and lower back) 
  • A reduced range of motion throughout the hips, lower back, and thoracic region can build up tightness in these regions. 
  • If there is movement restriction, you are more likely to overstretch yourself in these positions and therefore cause yourself pain. Clients will often describe having a big day of driving or gardening and then waking up with a muscle spasm throughout their lower back. This is an example of how reduced muscle range can contribute to lower back pain. As both driving and gardening typically require 90 degrees or above hip flexion. However, if the hips are tight, they don’t have full ability to perform these tasks easily and will therefore recruit nearby muscle to assist, i.e. lower back. This overload on the muscle from a repetitive task can cause pain and discomfort.   
  • Acute injury to the lower back (a fall, rugby tackle, car accident etc.) 
    • An acute injury can cause tissue or muscle damage to the lower back region, resulting in pain. 
    • There are many structures in your lumbar region, including lumbar joints, discs, ligaments and muscles; injury to any one of these areas can cause pain and require Physiotherapy to reduce discomfort and restrengthen the muscles. 
  • Regardless of the type of injury, your Physiotherapist will determine if there are any ‘red flags’ in your presentation and recommend whether imaging or medical referral is necessary. 

What Causes Back Pain in the Upper Back? 

The upper back region is another common area of complaint that clients will present with at Barefoot Physiotherapy. Sedentary lifestyles and sitting jobs are a large contributor to the prevalence of upper back and neck aches.

Some of the main causes of upper back pain we find are sitting posture, length of time spent sitting, weak upper back muscles and nerve irritation. Prolonged periods of sitting can cause upper back pain as the muscles don’t get to move and, therefore, become stiff and eventually weaker. For instance, if you held your wrist in one position for multiple hours, it would also become sore. In addition, nerve irritation can also affect the upper back muscles, as when our nerves aren’t gilding well, they can cause the joints and muscles around them to tighten, which has a flow-on effect for the rest of your body. Therefore, if you are experiencing any neck or upper back discomfort, it is a good idea to get it checked by a Physiotherapist to resolve your symptoms and learn some strategies to prevent it from reoccurring. 

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What Causes Back Pain in the Lower Back? 

When asked “what causes back pain in the lower back?” we will often start questioning what the client’s typical day of activity looks like. This helps us ascertain the reason for the build-up of pain and helps to understand the client’s individual causes of discomfort.

Similar to upper back pain, a very common reason for lower back pain is lack of movement, which leads to a build-up of tightness and irritation throughout the lower back muscles, joints and ligaments. In addition, awkward posture and positioning, which is overloading the back structures, i.e. in sitting, exercise, heavy lifting and manual labour, can cause irritation and discomfort in the area. Therefore, it is important to ensure that you consult a Physiotherapist when you first start to develop back ache symptoms to address the underlying issue. 

Long Term Back Issues 

Back issues can develop over a period of time due to a consistent overload on the structures of the body, or it can be from an acute specific injury to the lower back region. In both circumstances, it is imperative to receive Physiotherapy treatment as soon as possible to avoid any long term changes in muscle strength, muscle length, range of motion and nerve irritation. This article has so far discussed the most common backache pain causes that are musculoskeletal in nature; however, some causes of lower back pain can be more sinister in nature. If your symptoms don’t fit a clear musculoskeletal pattern, your Physiotherapist will likely order imaging of your back and recommend you consult your GP for other possible causes of your pain. 

How Can I Reduce Pain or Discomfort in the Lower Back? 

With any back pain, it is ideal to consult your Physiotherapist to have a treatment plan individualised to your injury. As a guide, your Barefoot Physiotherapy lower back pain treatment will typically include; manual therapy, advice and education, strengthening exercises, stretching or trigger point releases and self-management strategies. When reducing pain, a part of the treatment plan is helping clients understand how they can prevent their lower back discomfort from reoccurring. It is very important to ensure clients have good work postures, exercise techniques, manual loading, and heavy lifting ergonomics in this instance. When you move well, you are less likely to overload your muscles and injure yourself. 

There are some typical exercises and stretches examples listed below that clients will often be prescribed for their lower back pain management; however, it is recommended your consult your health professional to decide what works best for your body.

  1. Glute trigger point releases with a lacrosse ball 
  2. Glute stretches 
  3. Hip flexor stretches 
  4. Child’s Pose Stretch 
  5. Deep 360-degree breathing exercises 
  6. Pelvic tilts 
  7. Glute activation squats 
  8. Cat / Cow stretch 
Muscle stretch lats

Treat Back Problems With a Physiotherapist 

I hope through reading this article you have gained a better understanding of the question “why do I have lower back pain?” and feel confident to seek out professional help from your Physiotherapist to help ease your symptoms, treat the cause and get you back to living your best Barefoot Lifestyle. If you are experiencing any of the lower back pain symptoms mentioned, please don’t hesitate to reach out to the friendly team of Physiotherapists at Barefoot Physiotherapy, who can help you relieve your pain and improve your quality of life. You can give us a call on 1300 842 850 or book online. 

Muscle release forearm

How to Fix Tennis Elbow with Physiotherapy

How to Fix Tennis Elbow: Our Approach

Tennis elbow, or lateral epicondylalgia, is a diagnosis of overuse injury to the elbow. It can be a painful injury that usually occurs when the elbow is overloaded, typically due to repetitive motions of the wrist and arm.

Tennis elbow is defined as a tendinopathy of the extensor muscles in the forearm. These muscles attach to the outer part of the elbow at the lateral epicondyle of the distal humerus bone and run down to the wrist. Whilst the injury is called tennis elbow, only approximately 5% of people suffering from tennis elbow draw correlation to tennis.

This article will explain how to treat tennis elbow, the symptoms of tennis elbow and manual therapy and exercises which are used to treat it. At Barefoot Physiotherapy, we have experience treating a wide variety of clients who present with tennis elbow symptoms; the following information is backed by our team of experienced Physiotherapists.

What Are the Symptoms of Tennis Elbow?

Knowing how to fix tennis elbow means we must first understand how the symptoms are caused, so we can identify the problem and treat the source of the pain.

Tennis elbow is defined as a type of tendinopathy which is essentially the inflammation (swelling) of tendons, and this can cause pain in the elbow and forearm region. The tendons of the forearm extensors are bands formed of tissue whose role is to connect the muscles of your forearm to your elbow bone or lateral epicondyle.

As previously mentioned, you can get tennis elbow without playing tennis, as movements such as repetitive gripping activities can also cause the tendons to become inflamed. Typical symptoms of tennis elbow are pain and tenderness at the elbow’s lateral epicondyle, this pain can also radiate into the upper or lower portion of the arm. People with tennis elbow may also experience swelling in the elbow, weakness in the forearm or reduced range of movement. If you are suffering from tennis elbow you may have pain when gripping or lifting objects, driving the car, turning doorknobs, or opening jars, or potentially while typing.

Misconceptions About Tennis Elbow

As with any area of the body, the reason you are experiencing pain in your elbow can vary. Not all pain experienced in the elbow or forearm is tennis elbow. Pain and discomfort in the outer elbow region can often be misdiagnosed as tennis elbow or lateral epicondylalgia.

There are many structures which can influence the movement and feeling in the elbow and therefore a thorough investigation of a client’s symptoms is always essential to ensure there isn’t a misdiagnosis. At Barefoot Physiotherapy, we often see clients who have underlying nerve irritation which is diagnosed as tennis elbow, if there is nerve irritation in the brachial plexus (which is the nerves that supply the arm) they can cause pain at the lateral elbow. In addition, wrist or shoulder dysfunction or pain can load up the elbow and cause the elbow joint discomfort and symptoms similar to tennis elbow. Furthermore, general upper body muscular weakness can also cause discomfort after repetitive movements.

How to Fix Tennis Elbow Quickly

At Barefoot Physiotherapy, we aim to provide pain relief as soon as possible for clients with tennis elbow. Understanding how to fix tennis elbow quickly requires a focus on pain relief and symptom management. This enables the Physiotherapists to sooner start the required treatment for long term resolution of the injury.

On assessment at Barefoot Physiotherapy, we will first check to ensure there are no further underlying issues contributing to your pain including muscular tightness or nerve irritation. Treatment to upper body nerves and tight muscles can help relieve pressure and inflammation at the area, assisting in providing the client with pain relief. In addition, if it is safe to do so, your Physiotherapist will advise the use of over-the-counter anti-inflammatories to help reduce the internal source of inflammation.

In the session, your Physiotherapist may also assess that the use of supported strapping tape at the region is beneficial for you and your individual symptoms. Once sufficient pain relief is achieved, the source of symptoms needs to be identified so appropriate treatment can commence for long term tennis elbow relief.

How to Cure Tennis Elbow Long Term

At Barefoot Physiotherapy, we aim to help clients achieve long term success for all their goals. To understand how to cure tennis elbow, we undertake our Barefoot Treatment plan.

This plan, as previously mentioned, entails a thorough investigation of your previous physical history including any repetitive injuries, pain, or other health conditions. Then, an initial assessment which includes testing for any nerve irritation present throughout your body, reduced range of motion or tightness in muscles or joints. If present, we aim to clear nerve irritation first, so any gains made in muscle range or strength can hold between sessions. Your Physiotherapist will also likely discuss the need for you to rest the painful joint as much as possible, and work with you to initially modify any aggravating activities.

Once sufficient pain relief and reduction in inflammation is achieved, your Physiotherapist will work with you with a combination of manual therapy, advice and education and exercises to improve your elbow strength and resolve your tennis elbow injury.

Treating Tennis Elbow with Exercises

When working with your Physiotherapist on how to fix tennis elbow, you will likely be prescribed exercises focused on lengthening and strengthening the target muscle groups. This will not only help reduce your symptoms but will also assist in preventing future problems with the elbow.

The following are examples of exercises which may be used; however, it is recommended that you consult your own health professional for a personalised exercise program.

Lengthening exercises will often include wrist/ elbow extension and flexion stretches. Light strengthening exercises can be completed in elbow/ wrist flexion and extension before progressing to supination and pronation. You may use a light handheld weight or resistance bands to increase the difficulty of the exercise and build strength.

Grip strengthening is another important part of a tennis elbow home exercise program. Grip strength exercises can help build up forearm and wrist strength that can improve your ability to do activities of daily living pain free.

A combination of these exercises can include a towel twist which works grip strength and the wrist flexors and extensors. Whilst strengthening of the local elbow and wrist muscles is important, dependent on your underlying cause of symptoms, your physiotherapist will likely recommend the strengthening of other upper body muscles. This can include, but is not limited to; biceps, triceps, latissimus dorsi, rotator cuff muscles and intrinsic hand muscles.

Address Your Tennis Elbow with Barefoot Physiotherapy

As the article has summarised, if you are experiencing any pain or discomfort in your elbow or forearm it could be due to an overuse injury such as tennis elbow and it is recommended to book in to see a health professional for a thorough assessment and treatment plan.

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What Causes Hip and Groin Pain?

Hip and groin pain is prevalent across the population, from athletes to office workers. There are many factors to be considered in what causes hip and groin pain. As a person ages across the lifespan, the factors contributing to this pain change. In a younger population, muscle and cartilage tears are more prevalent in an athletic population. As you get older, muscle overload, such as tendinopathies, can occur as can osteoarthritic changes to the joint. All of these can be managed alongside a physiotherapist and the vast majority of hip and groin related conditions can be managed conservatively with a combination of manual therapy, exercise and guidance regarding activity.

What Causes Hip and Groin Pain?

The hip is a large ball and socket joint, connecting the femur (thigh bone) to the pelvis. This means the leg can be moved in all directions to a varying degree and provides force transfer between the lower limb and the torso. The hip joint is surrounded by strong ligaments and muscles that assist in stability and movement.

When considering what causes hip and groin pain it is important to look at a variety of factors, including range of movement, strength and lifestyle factors. Outside of acute injuries, what could cause hip and groin pain is often a combination of many factors that all need to be addressed in treatment and management. Hip and groin pain can be influenced by bony or cartilage changes such as osteoarthritis, labral tears or Femoro-acetebular impingement, muscle overload such as iliopsoas or adductor tendinopathies, movement restriction from muscular tightness and pregnancy related changes such as pubic symphysis inflammation.

It is important your Physiotherapists assesses the whole picture when diagnosing and treating hip and groin pain. This way any treatment will have lasting effects not just resolving your symptoms but solving the underlying issue long term.

What are the Symptoms of Hip and Groin Pain?

When determining what causes hip and groin pain, your Barefoot Physiotherapist will undertake an assessment around the joint, carrying out a number of movement and muscle tests, the exact tests will be dependent upon the individual’s presentation. Your Physiotherapist will ask you about what symptoms you are experiencing and if you are experiencing hip or groin pain you may notice:

  • clicking or catching in the hip joint
  • stiffness in movements
  • pain that is worst in the morning
  • pain that improves with activity
  • referred pain into the buttocks or thigh
  • pain that started after an increase in physical activity
  • localised pain that increases with single leg activity
  • sudden pain after a loaded movement, such as kicking
  • an ache around the outer hip, in a “C” shape

These are some of the more common symptoms reported by hip and groin pain and can help your physiotherapist determine priority for treatment.

How Will a Physio Diagnose Hip and Groin Injuries?

When diagnosing a hip injury causing groin pain, your physiotherapist will complete a number of objective assessment tests. At Barefoot Physiotherapy, our treatment framework helps to guide our process so it is thorough and we can get to the root cause of your pain. Some of these tests include palpation of various tissues involved in the hip complex; range of movements such as hip flexion and rotation and lumbar (low back) movement; intra-articular orthopaedic tests; resisted muscle activation; functional movements such as squats or single leg stance.

During these tests, we are looking for restriction in movements, asymmetries in range and strength and pain replication. While these tests are not fully accurate in diagnosing, they can be helpful in creating a picture to guide clinical decision making and management. Once your Physiotherapist has a good idea of what type of hip/ groin pain you are presenting with, they will move on to treatment of the area which will be discussed below.

How to Treat Hip and Groin Injuries:

Regardless of what could cause hip and groin pain, at Barefoot Physiotherapy, a client’s treatment plan typically consists of symptom management, a focus on increasing mobility of the affected area, and targeted functional strengthening of the affected muscle groups.

The initial stage of symptom management may include a reduction of the aggravating activities, utilising pain relief or anti-inflammatory medication, muscle releases and/or low level muscle activation exercises. You may be able to begin initial management independently, however where possible it is best to seek out a health professional’s advice to alleviate pain as quickly as possible.

For long term, sustainable results, it is recommended that you see a physiotherapist to create a management plan that gets you back to enjoying your activities pain free. As you progress on a strengthening program, your Barefoot Physiotherapist can help guide you to ensure you are maximising your exercises with appropriate muscle activation and loading into appropriate movement ranges for your body. At Barefoot Physiotherapy, we also treat any underlying neural irritation that may be contributing to your symptoms or adding to muscle tightness and movement restriction in the area.

The Best Exercises for Hip and Groin Injuries

When working on a rehab program for a hip injury causing groin pain it is important to go back to basics. Your Barefoot physiotherapist will introduce muscle activation and motor control exercises involving the back, hips and lower limb. Examples of this may include pelvic tilts working through comfortable ranges in anterior and posterior tilt positions to improve mobility in the low back, or glute activation exercises to increase muscle fibre recruitment of the glutes i.e. in a squat position, step up or sit to stand.

If appropriate, you may be prescribed stretches for the psoas, glute and thigh muscles to help maintain an increase in movement ranges. Strengthening exercises usually start with double leg dynamic and functional options, such as squats and lunges, and static single leg options to include balance work. An overall lack of abdominal strength and control can be a component of what causes hip and groin pain and therefore exercises targeting these areas will be included in your exercise management program.

As your treatment progresses these exercises can be tailored to more specific activities that you like to do for sports, hobbies, or other recreational activities. For instance, if you are getting back to running, there will be a focus on running drills to further strengthen the hip or if you are wanting to return to heavy lifting your exercises will focus in on technique and form at the gym.

The exercises utilised in your recovery can be continued after your symptoms have resolved, now with a different ratio or focus. You may do less frequent specific activation exercises and start to increase the load used in your strength work. It is important to continue strength and mobility work even after the resolution of initial pain symptoms so that your body is better able to tolerate the activities of your daily life.

Talk to Expert Physiotherapists

As mentioned in the article there are a variety of factors contributing to hip and groin pain. Working with a physiotherapist can help you manage your symptoms and get you back to pain free activities. At Barefoot Physiotherapy, we undergo a thorough assessment and provide an appropriate management plan to get you back on track. If you are suffering from hip or groin pain, you can contact us on 1300 842 850 or book with our Brisbane physiotherapists online.