Calf Muscle Tear

Calf Muscle Tear

What is a Calf Muscle Tear?

How to Care for a Torn Calf Muscle

Calf pain felt in your calf muscle belly is often the result of a pulled or torn calf muscle. A torn calf muscle can sometimes be confused with an Achilles tendon rupture, significant Achilles tendinopathyleg cramps or even sciatica or referred pain from your lower back.

Similar to the history of an Achilles tendon rupture, you may think you were “hit” in the leg. Potentially, you may feel a “pop” or “snap”. But in nearly 100% of cases, you will feel a sudden pain in the back of your calf. Over the next few hours, you’ll have difficulty walking properly or standing on your foot or rising onto your toes. Swelling or bruising in the calf muscle will be apparent in severe calf muscle tears.

What Causes a Calf Muscle Tear?

Calf muscle tears usually occur during acceleration or changes in direction, e.g. a change of running speed. However, there is a small percentage of the populations who can tear their calf muscle by merely walking.

The most commonly torn calf muscle is your medial gastrocnemiusShields et al. (1985). However, you can tear any of your other calf muscles: lateral gastrocnemius, soleus, plantaris or flexor hallucis longus. Mid-belly calf muscle tears are most familiar with the Achilles musculotendinous junction second most likely. Campbell JT (2009), Delgardo et al. (2002).

Grades of Calf Muscle Tear Severity

torn calf muscle

Calf strain may be minor (grade 1) or very severe (grade 3). Your physiotherapist will grade your injury depending on their clinical findings or diagnostic tests such as MRI or diagnostic ultrasound.

Grade 1:

Grade one calf muscle tears are a result of mild overstretching resulting in some small micro-tears in the calf muscle fibres. Symptoms usually are quite disabling for the first two to three days. In most cases, your recovery will take approximately one to two weeks if you do all the right things. Your physiotherapist can help you to fast-track your recovery.

Grade 2:

Grade two calf muscle tears result in partial tearing of your muscle fibres. Full recovery takes several weeks, typically with proper rehabilitation. Return to high load or high-speed sport should be guided by your physiotherapist to prevent an unnecessary retear, which is reasonably common in moderate calf tears.

Grade 3:

A grade three calf tear is the most severe calf strain with a complete tearing or rupture of your calf muscle fibres. You should seek professional assessment and treatment guidance specific to all grade 3 calf tears.

It is essential to determine whether an Achilles tendon rupture of grade 3 calf muscle tear has occurred.  A diagnostic assessment may utilise an ultrasound or MRI. Full recovery can take several months. For Achilles ruptures, we recommend an orthopaedic surgeon’s opinion. Surgery may be required.

Exclude DVT

Deep venous thrombosis (DVT) is a potentially life-threatening condition that is caused by clotting in the leg veins.  These clots can dislodge and travel to your heart, lungs or brain, resulting in life-threatening life-changing conditions such as a pulmonary embolism. You should seek the professional advice of your healthcare practitioner if you suspect or wish to exclude a DVT. Delgardo et al. 2002 found 10% of calf strains scanned had evidence of DVT.

Pulmonary embolism warning signs include:

  • Sudden shortness of breath,
  • Chest pain or discomfort that worsens when you take a deep breath or when you cough,
  • Feeling lightheaded or dizzy, or fainting,
  • Rapid pulse,
  • Potentially, coughing up blood.

If you experience any of these signs, please seek urgent medical attention.

Sural Nerve Injury

Your sural nerve, which passes through your calf, may also be injured. If you experience heel or ankle numbness associated with a history of calf trauma, please consult your physiotherapist for diagnostic advice.

How to Treat a Calf Muscle Tear

Calf muscle tears are a prevalent condition that we see at PhysioWorks.  Unfortunately, a torn calf muscle often recurs if you fail to rehabilitate your calf tear adequately and you return to sport too quickly.

There are mostly six rehabilitation stages that need to be covered to rehabilitate calf muscle tears and prevent a recurrence effectively. These are:

Phase 1 – Early Injury Protection: Pain Reduction & Anti-inflammatory Phase

As with most soft tissue injuries, the initial treatment is RICE – Rest, Ice, Compression and Elevation.

Your calf muscles are a large, powerful group of three calf muscles (soleus plus your medial and lateral gastrocnemius). Your calf muscles produce very high contractile forces that enable you to run, jump and hop. In the early phase of your torn calf muscle, you’ll be unable to walk without a limp, so your calf will need some rest and weight-bearing avoidance strategies. Active rest may include crutches or a wedged walking boot.

Please seek the advice of your healthcare professional for specific recommendations relevant to your calf muscle tear.

General Recommendations:  Calf Muscle Tear Treatment – Phase 1

Phase 2: Regain Full Range of Motion

Your torn calf muscle will successfully repair itself with collagen scar tissue in most cases through your body’s natural healing process. It is important to note that mature collagen scar formation can take at least six weeks. During these initial six weeks, it is ideal that you optimally remould your scar tissue to prevent a clumpy non-aligned scar that will potentially re-tear in the future when placed under high load or speed.

Successful rehabilitation includes lengthening and orientating your healing scar tissue via massage, and muscle stretches, rolling, active movements and neurodynamic mobilisations. Signs that you have full soft tissue extensibility includes being able to walk without a limp and able to perform calf stretches with a similar end of range stretch feeling.

Phase 3: Restore Concentric Muscle Strength

Gradually progress your calf muscle strength and power. Progressions involve performing your exercise initially in non-weight bear, before proceeding to partial weight bear, full weight bear, and then eventually, resistance loaded exercises.

It is incredible how, just a few days off training can affect your global muscle strength. If your calf muscle tear is going to sideline you for a few weeks, then you may also require strengthening for both of your legs including your thigh muscles and gluteals, plus your lower core muscles. Please ask your physiotherapist for advice.

Phase 4: Restore Eccentric Muscle Strength

Calf muscles work in two directions. They push you up (concentric) and control you down (eccentric). Researchers suggest that most calf muscle tears occur during the controlled lengthening or eccentric phase. Your rehabilitation should always include eccentric and plyometric components within your training regime in preparation for a return to speed and full sport-specific or functional activities.

Your physiotherapist is an expert in exercise prescription and will guide you on an eccentric calf strengthening program when injury appropriate.

Phase 5: Restore High Speed, Power, Proprioception & Agility

Most calf injuries occur during high-speed activities, which place enormous forces on your contractile and non-contractile calf muscle structures. Your physiotherapist will guide your best prevention strategy to avoid a recurrent calf tear.

Depending on the specific requirements of your sport or lifestyle, your physiotherapist will introduce appropriate exercises and activities. These exercises usually that will address your speed, agility, proprioception and power to prepare you for lower recurrence risk sport-specific training.

Phase 6: Return to Sport

All sports are different. Depending on your chosen sport, your physiotherapist will address the physical needs of your activity or sport and incorporate them into your specific return to sport program. Your progressed training regime, including neuromuscular training, is your best chance to enable a safe and injury-free return to your chosen sport. Hubscher et al. (2010).

Your physiotherapist will discuss your specific goals, rehabilitation time frames and your training schedules to optimise your calf muscle tear rehabilitation for a complete and safe return to sport. The perfect outcome will have you performing at full speed, power, agility and function with the added knowledge that a thorough rehabilitation program has minimised your chance of future injury.

Summary

While the grade of your calf muscle tear will determine whether your rehabilitation process will take days, weeks or months, there is no specific period for your progressions from each stage to the next. Your injury rehabilitation status determined by many factors, including your functional ability and tissue healing maturity. These are all things considered by your physiotherapist during their clinical assessment of you.

Your physiotherapist will carefully monitor each of your progressions. The last thing you want is to attempt to progress prematurely to the next level and lead to re-injury and the resulting frustration of an extended rehabilitation period.

FAQs Calf Muscle Tears

Sports Injury Management

You probably already know that a sports injury can not only affect your performance, but also your lifestyle. The latest research continues to change sports injury management considerably.  Our challenge is to keep up to date with the latest research and put them to work for you.

How we treated you last year could vary greatly to how we treat you this year. The good news is that you can benefit significantly from our knowledge.

What Should You Do When You Suffer a Sports Injury?

Rest?

Rest from painful exercise or a movement is essential in the early injury stage. "No pain. No gain." does not apply in most cases.  The rule of thumb is - don't do anything that reproduces your pain for the initial two or three days.  After that, you need to get it moving or other problems will develop.

Ice or Heat?

We normally recommend avoiding heat (and heat rubs) in the first 48 hours of injury. The heat encourages bleeding, which could be detrimental if used too early. In traumatic injuries, such as ligament sprains, muscle tears or bruising, ice should help reduce your pain and swelling.

Once the "heat" has come out of your injury, heat packs  can be used. We recommend 20 minute applications a few times a day to increase the blood flow and hasten your healing rate. Heat will also help your muscles relax and ease your pain. If you're not sure what to do, please call us to specifically discuss your situation.

Should You Use a Compressive Bandage?

Yes. A compressive bandage will help to control swelling and bleeding in the first few days.  In most cases, the bandage will also help to support the injury as the new scar tissue is laid down. This should help to reduce your pain. Some injuries will benefit from more rigid support such as a brace or strapping tape. Please ask us if you are uncertain what to do next.

Elevation?

Gravity will encourage swelling to settle at the lowest point.  Elevation of an injury in the first few days is very helpful, especially for ankle or hand injuries.  Think where your injury is and where your heart is. Try to rest your injury above your heart.

What Medication Should You Use?

Your Doctor or Pharmacist may recommend pain killers or an anti-inflammatory drug. It is best to seek their professional advice as certain drugs can interfere with other health conditions, especially asthmatics.

When Should You Commence Physio?

In most cases, "the early bird gets the worm".  Researchers have found that intervention of physiotherapy treatment within a few days has many benefits.  These include:

  • Relieving your pain quicker via joint mobility techniques, massage and electrotherapy
  • Improving your scar tissue using techniques to guide the direction it forms
  • Getting you back to sport or work quicker through faster healing rates
  • Loosening or strengthening of your injured region with individually prescribed exercises
  • Improving your performance when you do return to sport - we'll detect and help you to correct any biomechanical faults that may be affecting your technique or predisposing you to injury

What If You Do Nothing?

Research tells us that injuries left untreated take longer to heal and have lingering pain.  They are also more likely to recur and leave you with either joint stiffness or muscle weakness. It's important to remember that symptoms lasting longer than three months become habitual and are much harder to solve.  The sooner you get on top of your symptoms the better your outcome.

What About Arthritis?

Previously injured joints can prematurely become arthritic through neglect. Generally there are four main reasons why you develop arthritis:

  • Previous injury that was inappropriately treated (eg old joint or ligament sprains)
  • Poor joint positioning (biomechanical faults)
  • Stiff joints (lack of movement diminishes joint nutrition)
  • Loose joints (excessive sloppiness causes joint damage through poor control)

What About Your Return to Sport?

Your physiotherapist will guide you safely back to the level of sport at which you wish to participate.  If you need guidance, simply ask us.

What If You Need Surgery or X-rays?

Not only will your physio diagnose your sports injury and give you the "peace of mind" associated, they'll also refer you elsewhere if that's what's best for you. Think about it. you could be suffering needlessly from a sports injury.  Please use our advice to guide you out of pain quicker . and for a lot longer.

If you have any questions regarding your sports injury (or any other condition), please contact your physiotherapist to discuss. You'll find our friendly staff happy to point you in the right direction.

Acute Sports Injury Clinic

PhysioWorks has established an Acute Sports Injury Clinic at our Ashgrove, Clayfield and Sandgate practices to assist with the early assessment and management of acutely injured sports injuries.

The acute sports injury consultation fee is significantly lower than a routine assessment and treatment consultation. In most cases, your private health will cover the full cost of your full acute injury physio assessment fee.

How to Best Care for Your Sports Injury?

There is never an excellent time for an injury. But we do know that most sports injuries occur over the weekend! That's why at PhysioWorks, we have established an Acute Sports Injury Clinic at a selection of our clinics on a Monday and Tuesday.

Why Use an Acute Sports Injury Clinic?

Your Acute Sports Injury Assessment Consultation allows us to provide you with:

  • A quick and accurate diagnosis. One of our Sports Physiotherapist's or an experienced sports injury-focused Physiotherapist will confidently guide your new injury management.
  • Early acute sports injury care, professional advice and education. What to do this week?
  • Fast referral for X-rays, ultrasound or MRI scans to confirm your diagnosis.
  • Prompt referral to Sports Physicians, GPs or Surgeons with whom we work if required.
  • Immediate supply of walking boots, braces and rental crutches if needed.
  • Low-cost professional service.

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sports physiotherapist brisbane

Who is a Sports Physiotherapist?

Sports Physiotherapy is the specialised branch of physiotherapy which deals with injuries and issues related to spokespeople. Practitioners with additional formal training within Australia are Sports & Exercise Physiotherapists.

What is Sports Physiotherapy?

Sports injuries do differ from common everyday injuries. Athletes usually require high-level performance and demand placed upon their body, which stresses their muscles, joints and bones to the limit.  Sports physiotherapists help athletes recover from sporting injuries, and provide education and resources to prevent problems.

Each sports physiotherapist usually has sport-specific knowledge that addresses acute, chronic and overuse injuries. Their services are generally available to sportsmen and women of all ages engaged in sports at any level of competition.

Members of Sports Physiotherapy Australia (SPA) have experience and knowledge of the latest evidence-based practice, skilled assessment and diagnosis of sports injuries, and use effective 'hands-on' management techniques and exercise protocols to assist recovery and prevent future damage. SPA members have access to the most recent advances in sports physiotherapy. You'll be pleased to know that most of PhysioWorks physiotherapists and massage therapists have a particular interest in sports injury management.

What is Physiotherapy Treatment?

Physiotherapists help people affected by illness, injury or disability through exercise, manual joint therapy, soft tissue techniques education and advice.  Physiotherapists maintain physical health, help patients to manage pain and prevent disease for people of all ages. Physiotherapists help to encourage pain-relief, injury recovery, enabling people to stay playing a sport, working or performing activities of daily living while assisting them to remain functionally independent.

There is a multitude of different physiotherapy treatment approaches.

Acute & Sub-Acute Injury Management

Hands-On Physiotherapy Techniques

physiotherapy treatment

Your physiotherapist's training includes hands-on physiotherapy techniques such as:

Your physiotherapist has skilled training. Physiotherapy techniques have expanded over the past few decades. They have researched, upskilled and educated themselves in a spectrum of allied health skills. These skills include techniques shared with other healthcare practitioners. Professions include exercise physiologists, remedial massage therapists, osteopaths, acupuncturists, kinesiologists, chiropractors and occupational therapists, just to name a few.

Physiotherapy Taping

Your physiotherapist is a highly skilled professional who utilises strapping and taping techniques to prevent and assist injuries or pain relief and function.

Alternatively, your physiotherapist may recommend a supportive brace.

Acupuncture and Dry Needling

Many physiotherapists have acquired additional training in the field of acupuncture and dry needling to assist pain relief and muscle function.

Physiotherapy Exercises

Physiotherapists have been trained in the use of exercise therapy to strengthen your muscles and improve your function. Physiotherapy exercises use evidence-based protocols where possible as an effective way that you can solve or prevent pain and injury. Your physiotherapist is highly-skilled in the prescription of the "best exercises" for you and the most appropriate "exercise dose" for you depending on your rehabilitation status. Your physiotherapist will incorporate essential components of pilates, yoga and exercise physiology to provide you with the best result. They may even use Real-Time Ultrasound Physiotherapy so that you can watch your muscles contract on a screen as you correctly retrain them.

Biomechanical Analysis

Biomechanical assessment, observation and diagnostic skills are paramount to the best treatment. Your physiotherapist is a highly skilled health professional. They possess superb diagnostic skills to detect and ultimately avoid musculoskeletal and sports injuries. Poor technique or posture is one of the most common sources of a repeat injury.

Hydrotherapy

Aquatic water exercises are an effective method to provide low bodyweight exercises.

Sports Physiotherapy

Sports physio requires an extra level of knowledge and physiotherapy skill to assist injury recovery, prevent injury and improve performance. For the best advice, consult a Sports Physiotherapist.

Vestibular Physiotherapy

Women's Health

Women's Health Physiotherapy is a particular interest group of therapies.

Workplace Physiotherapy

Not only can your physiotherapist assist you in sport, but they can also help you at work. Ergonomics looks at the best postures and workstation set up for your body at work or home. Whether it be lifting technique improvement, education programs or workstation setups, your physiotherapist can help you.

Electrotherapy

Plus Much More

Your physiotherapist is a highly skilled body mechanic. A physiotherapist has particular interests in certain injuries or specific conditions. For advice regarding your individual problem, please contact your PhysioWorks team.

Does Kinesiology Taping Help to Hasten Your Recovery Time from Swelling or Bruising?

Researchers, Bialoszewski et al. 2009, have discovered that kinesiology tape can quicken the reduction in joint swelling (oedema) and a  bruise (haematoma). The theory is that the elasticity of kinesiology tape lifts the skin away from the swollen tissue below by loosely "crinkling" the skin. This skin lift is known as a sub-dermal vacuum, which provides less physical resistance to the removal of the retained fluid by your lymphatic and venous drainage systems.Test this theory out by a quick squeeze of your skin. It will resemble an "orange-peel" appearance. You'll notice loose skin between your fingers. The lower skin tension allows your venous and lymphatic systems to drain the sub-dermal fluid away quicker. Now isn't that clever!
Planning on running a marathon, half marathon, participating in a charity run or just running for fun? Dreading the post-exercise soreness and fatigue? When you push your body to perform intense exercise or exercise it may be unaccustomed to, it is beneficial to know what to do to assist recovery after the event.Here are six tips to assist you in recovering after a running event.

1. Post-Run Nutrition

After exercise it is paramount you replenish the energy stores (glycogen/carbohydrates, electrolytes and protein) and fluid stores you lost during activity. This will assist the body in recovery from intense exercise and assist your immune system damaged by the exercise.

Carbohydrates

Within the first-hour post-exercise, when glycogen synthesis is highest, it is advised to consume a carbohydrate rich snack/meal which provides 1-1.2g of carbohydrate per 1kg of body weight.

Protein

Intense exercise causes a breakdown in muscle tissue. Protein is used to restore tissue and assist muscle adaptation. Essential amino acids from high-quality protein rich foods in the hour post exercise is recommended to promote protein rebuilding. 10-20g of protein in the first-hour post exercise is recommended.

Rehydration

It is essential to replace the fluid lost during exercise. To ensure proper rehydration electrolytes, particularly sodium, lost through sweat are required. Sodium assists to reduce urine loss and therefore increased fluid balance post exercise. It is recommended to weigh yourself before and after your race. A guideline to fluid replacement is 1L for every 1kg lost during the event.More info: Sports Dietitian

2. Cool Down Exercise

Low-intensity exercise can assist in removing lactic acid build up and promote blood flow to relieve tight and sore muscles. This can be performed as a light jog or walk after your event or the day following. This can be followed by a brief 5 to 15-min period of stretching to assist with tight muscles.More info:
  • 4 Reasons to do a Cool Down

3. Soft Tissue Recovery

Ways to assist soft tissue recovery at home include foam rolling and wearing compression garments. Foam rolling can be used on the back, ITB, hamstrings, quads and calves. It is recommended to spend 2x 1minute intervals on each area. Compression garments are recommended to be worn for 24hrs post exercise. Both techniques can assist in reducing post-exercise muscle soreness and may enhance recovery of muscle performance.More info: Foam Rollers

4. Recovery Massage

A post-run recovery massage can reduce excessive post-exercise muscle tone, increase muscle range of motion, increasing circulation and nutrition to damaged tissue, and deactivate symptomatic trigger point, reduced post-exercise soreness and delayed onset muscle soreness (DOMS). Soft tissue therapy has also been said to aid in psychological recovery alongside music, warm baths and showers to enhance muscle relaxation and allow recovery.More info: Recovery Massage

5. Ice

There is often debate whether ice baths (cold water immersion) is beneficial after exercise. In regards to running, ice helps to decrease inflammation resulting from an intense activity. This can help to decrease post activity muscle soreness.The day after intense activity, heat can be used to help relax tight muscles. Heat also promotes blood flow to an area, which can promote the recovery of lactic acid build up.More info: Ice therapy

6. Sleep

A good night’s sleep consisting of around 8 hours is important for muscle recovery among other biological functions. As mentioned above compression garments can be worn to bed to further assist with recovery. A good night’s sleep can be achieved by ensuring the room is cool, dark and quiet, and free of electronic distractions. Ideally one should have a well-developed sleep routine that consists of the aforementioned strategies and avoids caffeine and excessive fluid intake before bed.
Tendinopathy (tendon injuries) can develop in any tendon of the body. You may have heard of tendinopathies being referred to as its aliases: tendonitis, tendinitis, tenosynovitis and tendinosis. In simple terms, they are all tendon injury pathologies so the medical community now refers to them as tendinopathies.Typically, tendon injuries occur in three areas:
  • tendon insertion (where the tendon attaches to the bone)
  • mid-tendon (non-insertional tendinopathy)
  • musculotendinous junction (where the tendon attaches to the muscle)

What is a Tendon Injury?

Tendons are the tough fibres that connect muscle to bone. Most tendon injuries occur near joints, such as the shoulder, elbow, knee, and ankle. A tendon injury may seem to occur suddenly, but usually, it is the result of repetitive tendon overloading. As mentioned earlier, health care professionals may use different terms to describe a tendon injury. You may hear:Tendinitis (or Tendonitis): This means "inflammation of the tendon".Mild inflammation is actually a normal tendon healing response to exercise or activity loading, but it can become excessive, where the rate of injury exceeds your healing capacity.

Tendinopathy Phases

The inability of your tendon to adapt to the load quickly enough causes the tendon to progress through four phases of tendon injury. While it is healthy for normal tissue adaptation during phase one, further progression can lead to tendon cell death and subsequent tendon rupture.

1. Reactive Tendinopathy

  • Normal tissue adaptation phase
  • Prognosis: Excellent.
  • Normal Recovery!

2. Tendon Dysrepair

  • Injury rate > Repair rate
  • Prognosis: Good.
  • The tendon tissue is attempting to heal.
  • It is vital that you prevent deterioration and progression to permanent cell death (phase 3).

3. Degenerative Tendinopathy

  • Cell death occurs
  • Prognosis: Poor!
  • Tendon cells are dying!

4. Tendon Tear or Rupture

  • Catastrophic tissue breakdown
  • Loss of function.
  • Prognosis: very poor.
  • Surgery is often the only option.

What is Your Tendinopathy Phase?

It is very important to have your tendinopathy professionally assessed to identify it’s current injury phase. Identifying your tendinopathy phase is also vital to direct your most effective treatment since certain treatment modalities or exercises should only be applied or undertaken in specific tendon healing phases.

Systemic Risk Factors

The evidence is growing that it is more than just the tendon and overload that causes tendinopathy. Diabetics, post-menopausal women and men with high central adiposity (body fat) seem to be predisposed to tendinopathies and will need to carefully watch their training loads.

What are the Symptoms of Tendinopathy?

Tendinopathy usually causes pain, stiffness, and loss of strength in the affected area.
  • The pain may get worse when you use the tendon.
  • You may have more pain and stiffness during the night or when you get up in the morning.
  • The area may be tender, red, warm, or swollen if there is inflammation.
  • You may notice a crunchy sound or feeling when you use the tendon.
The symptoms of a tendon injury can be similar or combined with bursitis.

How is a Tendon Injury Diagnosed?

To diagnose a tendon injury, your physiotherapist or doctor will ask questions about your past health, your symptoms and recent exercise regime. They'll undertake a thorough physical examination to confirm the diagnosis. They will then discuss your condition and devise an individualised treatment plan.They may refer you for specific diagnostic tests, such as an ultrasound scan or MRI.

Tendinopathy Treatment

Tendinopathies can normally be quickly and effectively rehabilitated. However, there is a percentage of tendinopathies that can take months to treat effectively.As mentioned earlier in this article, it is important to know what phase your tendinopathy currently is. You physiotherapist can assist not only your diagnosis but also guide your treatment to fast-track your recovery.Before you seek the advice of your physiotherapist or doctor, you can start treating an acute tendon injury at home. To achieve the best results, start these steps right away:
  • Rest the painful area, and avoid any activity that makes the pain worse.
  • Apply ice or cold packs for 20 minutes at a time, as often as 2 times an hour, for the first 72 hours. Keep using ice as long as it helps.
  • Do gentle range-of-motion exercises and stretching to prevent stiffness.

When to Return to Sport

Every tendinopathy is different, so please be guided by your physiotherapist assessment. It may take weeks or months for some tendon injury to heal and safely cope with a return to sporting loads. Be patient, and stick with the treatment exercises and load doses prescribed by your physiotherapist. If you start using the injured tendon too soon, it can lead to more damage, and set you back weeks!

Tendinopathy Prevention

To minimise reinjuring your tendon, you may require some long-term changes to your exercise activities. These should be discussed with your physiotherapist. Some factors that could influence your tendinopathy risk include:
  • Altering your sport/activities or your technique
  • Regular prevention exercises.
  • Closely monitoring and record your exercise loads. Discuss your loading with your physiotherapist and coach. They will have some excellent tips.
  • Always take time to warm up before and cool down / stretch after you exercise.

Tendinopathy Prognosis

While most acute tendinopathies can resolve quickly, persisting tendon injuries may take many months to resolve. Long-term or repeat tendinopathies usually have multifactorial causes that will require a thorough assessment and individualised rehabilitation plan.  Researchers have found that tendon injuries do respond differently to muscle injuries and can take months to solve or potentially render you vulnerable to tendon ruptures, which can require surgery.For specific advice regarding your tendinopathy, please seek the advice of your trusted healthcare professional with a special interest in tendinopathies.

What is Therapeutic Ultrasound?

Therapeutic ultrasound is an electrotherapy modality which has been used by physiotherapists since the 1940s. Via an ultrasound probe through a transmission coupling gel in direct contact with your skin, ultrasound waves are applied.ultrasound Therapeutic ultrasound may increase:
  • healing rates
  • tissue heating
  • local blood flow
  • tissue relaxation
  • scar tissue breakdown.

How Could Ultrasound Help?

Ultrasound increases local blood flow. This increase may help to reduce local swelling and promote soft tissue healing rates. A higher power density may soften scar tissue.

Specific Ultrasound Uses

Mastitis or blocked milk ducts successfully respond to therapeutic ultrasound. The effect is quite dramatic, with improvement within 24 to 72 hours.The most common conditions treated with ultrasound include soft tissue injuries such as muscle, ligament injuries or some tendinopathies.Phonophoresis uses ultrasound in a non-invasive way of administering medications to tissues below the skin. This method may assist patients who are uncomfortable with injections. With phonophoresis, the ultrasonic energy forces the drug through the skin.

What is an Ultrasound Dose?

A typical ultrasound treatment will take from 3-10 minutes. Where scar tissue breakdown is the goal, this treatment time could be much longer. During the procedure, the head of the ultrasound probe is in constant motion. If kept in continuous motion, the patient should feel no discomfort at all.Some conditions treated with ultrasound include soft tissues injuries such as muscles or ligament injuries, tendinopathy, non-acute joint swelling and muscle spasm.

How Does an Ultrasound Work?

A piezoelectric effect, caused by the vibration of crystals within the ultrasound head of the probe creates the sound waves. The ultrasound waves generated then pass through the skin cause a vibration of the local soft tissues. This repeated cavitation can cause a deep heating locally though usually no sensation of heat will be felt by the patient. In situations where a heating effect is not desirable, an athermal application occurs. Athermal doses are typical during acute fresh injury and the associated acute inflammation.

When Should Ultrasound be Avoided?

Contraindications of ultrasound include:
  • local malignancy,
  • over metal implants,
  • local acute infection,
  • vascular abnormalities,
  • active epiphyseal regions (growth plates) in children,
  • over the spinal cord in the area of a laminectomy,
  • over the eyes, skull, or testes
  • and, directly on the abdomen of pregnant women. Treatment ultrasound differs from diagnostic ultrasound!
Like all medical equipment, when used by highly trained professionals, such as your physiotherapist, therapeutic ultrasound is very unlikely to cause any adverse effects. Please consult your physiotherapist for their opinion on whether therapeutic ultrasound could assist your injury.Therapeutic Ultrasound differs from Real-Time Ultrasound Treatment.

7 Ways to Prevent a Future Leg Injury?

You may reduce the chance of leg injury by following these seven simple tips:
  • Warm-up before you exercise.
  • Warm down when you finish. Warm down usually includes some simple stretching exercises and plyometric drills.
  • Wear well-fitting shoes, boots or braces that provide excellent joint support.
  • Tape or brace your ankles/knees in high-risk sports such as football, basketball, volleyball and netball.
  • Avoid activities on slippery, wet or uneven surfaces, or in areas with poor lighting.
  • Strengthen your leg muscles and regularly use a wobble disc or balance board
  • Maintain general functional fitness.
A British Medical Journal study found that pre-event stretching does not reduce the overall risk of injury. However, stretching does slightly reduce the risk of specific kinds of damage (injuries to muscles, ligaments and tendons). These soft tissue injuries are common in both elite and recreational sportspeople. It seems reasonable and common sense that stretching may not prevent you suffering a broken bone or a joint dislocation, but it could reduce your chance of a soft tissue injury.The other main finding was that stretching reduces the risk of experiencing soreness, which always makes exercising more enjoyable!While sustained stretches in isolation may not be the answer, other studies have shown that warming up does reduce your injury rate. While there is no "absolutely proven"method of warming up yet, the preferred options appear to be a graduated progression to prepare you for your sport. In simple terms, warm-up steadily from gentle exercises that increase in intensity and speed as you progress through your warm-up period.It makes common sense for you to warm things up slowly to start and then prepare with replicate skills, to what you will require shortly on the field, at the end of your warm-up.For more specific warm-up and injury prevention advice particular to your sport or work, please ask your physiotherapist to prescribe a warm-up and warm-down routine specific to you and your sport or physical activity.

Why Do Physiotherapists Prescribe You Exercises?

The prescription of exercise appropriate to you and your injury or fitness level is one of the many professional skills of a physiotherapist. Whether you have suffered an acute injury, chronic deconditioning or are recovering from surgery, the correct exercise prescription is essential. That's why your physiotherapist's knowledge and skills will personalise your exercise dose.Your physiotherapist not only is educated in injury diagnosis but also exercise physiology or the science of exercise. This training enables your physiotherapist to assess and diagnose your injury, plus also to prescribe injury, fitness or age-appropriate activities targeted to you now.

What Exercises Should You Do?

Your exercises shouldn't be painful. Please take caution with some overzealous exercise prescribers who believe that the more painful the activity, the better. Thus simply isn't true—notably, the frail, immunosuppressed, deconditioned or post-operative person.You'll find that your physiotherapist will thoroughly examine you and prescribe a series of exercises suitable for you in quantities that will not injure you further. Please seek an exercise expert, such as your physiotherapist, when you are planning your rehabilitation.

What Happens When You Stop Exercises?

Without some simple exercises, we know that specific muscles can become weak. When these supporting muscles are weak, your injured structures are inadequately supported and predispose you to linger symptoms or further injury. You can also over-activate adjacent muscles that may lead to further damage.It is also essential to understand that even if you are "in good shape", you may have crucial but weak localised or stability muscles. When you have an injury, you should perform specific exercises that specifically strengthen the muscles around your injury and the adjacent joints. Your physiotherapist will assess your muscle function and prescribe the right exercises specific for your needs.The exercises prescribed will usually be relatively simple, and do not require any special weights equipment, and can be performed safely at home.

Would You Stop Your Daily Prescription Drugs?

Your physiotherapist will prescribe your individualised dose or exercises. They are using their professional expertise to optimise your exercise dose. Would you just stop taking your regular blood pressure medication because you were too busy or didn't think it was working? We would hope not!Exercise, when prescribed by an expert such as your physiotherapist, should be treated as your recommended dose. Just like when you don't take your blood pressure medication, you can't expect the drugs to work of you don't take it as prescribed by your health professional.So, next time you skip your "exercise dose" just remember that you are not putting your health first. If you have any questions, please contact your Physio Works physiotherapist for your best care.
You know the feeling… dreaded “stiff and sore muscles” a day or two after you’ve done a little more exercise than usual.

What Causes Muscular Pain?

Shortly after exercise begins, a mix of lactic and carbonic acids builds up in muscle tissue. These acids are waste products of muscle contractions. Don’t worry these acids are normal. To produce “energy”, muscles burn stored glycogen. Lactic and carbonic acids are by-products of this metabolic process.The good news is that most of these acids convert back into glycogen and are restored in preparation for your next bout of exercise. Pain and muscle fatigue can exist until the acid levels in your muscles return to normal.

How Does Massage Help?

Massage helps to eliminate the irritation caused by these acidic wastes. Research shows that massage can increase muscle recovery much quicker than rest alone.

Why is Massage So Useful When You Exercise?

Regular exercise causes many body changes. To meet the demand for more oxygen and nutrients, one improvement is the increase in blood vessels to the muscles. This circulation increase helps to eliminate the waste products and toxins that build up with exercise. Importantly, it can take several weeks to develop an improved muscular circulation.Until the blood supply increases, you will have trouble with oxygen and nutrients supply. This allows toxic wastes to back up and stagnate. You will experience soreness, pain and stiffness. Many exercise enthusiasts regard aches and pains as the inevitable price to be paid. This is usually not true.

What about Muscle & Joint Stiffness?

Massage eases muscle and joint stiffness. Using massage strokes to reduce muscle tension and passive movement to stretch the connective tissue found around joints, massage will improve your performance. Massage also lengthens muscle and tendon units to help prevent injuries from occurring in the first place.

What about Soft Tissue Injuries and Massage?

Massage aids recovery from soft tissue injuries such as sprains and strains. Tissue repair accelerates by increasing circulation in the injured area. Massage therapy can help speed, improve recovery, and reduce discomfort from soft tissue injuries.

Massage is Drug-Free Treatment

Massage is a drugless therapy. Headaches, insomnia, neck and back pain, digestive disorders including constipation and spastic colon, arthritis, asthma, carpal tunnel syndrome and muscular aches and pains are just some of the problems that can respond to massage therapy.

Private Health Insurance Rebates

PhysioWorks Physiotherapy and Remedial Massage are more affordable than you think. Your Private Health Insurance (PHI) usually pays for the majority of your treatment fees, leaving you with only a small gap payment.

However, Private Health Funds do vary their rebates payable depending upon the level of cover that you have taken. Some funds have kept up with the costs of modern medicine whereas, sadly others haven't, with rebates similar to what they were a decade ago.

HICAPS - Instant Health Fund Claims


Most health funds are members of the HICAPS instant claims system.  Swipe your health insurance card at our reception counter, and you can instantly claim your physiotherapy treatment via our online Hicaps System. Remedial Massage is claimable via Hicaps for some but not all funds. For more information, please visit Hicaps for the latest funds which can use their instant claiming system.

Private health insurance rebates are available for all of our physiotherapists. Instant claims are possible via our in-practice Hicaps system.

Third-Party Insurers

PhysioWorks practitioners are registered providers for government, Workcover and insurance companies including:

  • Workcover
  • InjuryNet
  • Australia Post; Coles Myer; Woolworths
  • Medicare
  • Department of Veterans' Affairs
  • CTP & Sports Insurers
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