FHL Tendinopathy

Flexor Hallucis Longus (FHL) Tendinopathy

What is FHL Tendinopathy?

FHL Tendinopathy is a condition in which pain emanates from the collagen fibres that compose the Flexor Hallucis Longus (FHL) tendon. Tendinopathy can occur at three locations along the length of the FHL tendon including:

  1. The back of the ankle
  2. Under your mid-foot
  3. Under the base of your big toe

What is FHL Tenosynovitis?

FHL Tenosynovitis is a condition where inflammation or swelling occurs to the sheath through which the FHL tendon passes. Often the terms FHL tendinopathy and tenosynovitis are used interchangeably. The two conditions often occur together.

What are Tendons?

Tendons are the tough fibres that connect muscle to bone. Most tendon injuries occur near joints, such as the shoulder, elbow, knee, ankle and foot. A tendon injury may seem to happen suddenly, but usually, it is the result of many tiny tears to the tendon that have occurred over time.

Who Suffers from FHL Tendinopathy or Tenosynovitis?

FHL Tendinopathy and Tenosynovitis occurs most commonly in several athletic populations where training programs involve excessive, repetitive or prolonged loading of the FHL tendon. These populations include:

  • Athletes of all ages who participate in activities requiring large amounts of forefoot push-off including: running, jumping, hopping and rising onto the toes, e.g. ballet dancers, long-distance runners, soccer players, ice skaters, divers and gymnasts.
  • The general population, who have recently returned to physical activity involving large amounts of forefoot push-off
  • Workers in standing based roles. These may include correctional or security officers, nurses and hospitality staff.

What are the Signs and Symptoms of FHL Tendinopathy or Tenosynovitis?

FHL Tendinopathy and Tenosynovitis often present with a gradual onset of pain and is less likely to occur with acute trauma, for example; a change in the type or quantity of activity in training program involving forefoot push-off.

Symptoms of FHL Tendinopathy and Tenosynovitis as a result of gradual onset include:

  • Pain in the form of a dull ache that worsens to a sharp pain with activity involving forefoot pushes off including walking, running, jumping, hopping, rising onto the toes, demi-pointe work and pointe work.
  • Pain along the length of the FHL tendon. Pain can occur in several locations, including:
    • the back or inside of the ankle,
    • underneath the arch of the foot,
    • underneath the base of the big toe.
  • Swelling in the rear/inside of the ankle.
  • Occasional clicking at the back or inside of the ankle.
  • Pain with movement of the big toe.
  • Potential locking or catching of the big toe if left untreated.

FHL Tendinopathy and Tenosynovitis rarely present due to acute trauma. In these sporadic cases, the symptoms are similar to that of an FHL Tendinopathy and Tenosynovitis resulting from overuse. However, the mechanism of injury will be different and is usually the result of a direct, blunt knock to the back of the ankle.

(Brukner & Khan, 2006; Howell, 2015; Mak & Assai, 2016; Michelson & Dunn, 2005; Peters, 2015)

Why Does FHL Tendinopathy or Tenosynovitis Occur?

The FHL muscle design is to assist with movement of the ankle, foot and big toe. The role of the FHL muscle is to allow the foot to point at the ankle and the big toe, as well as allowing heel roll in at the heel inwards. This function enables us to perform activities such as: running, jumping, hopping and rising onto the toes.

The FHL tendon, like any other tendon in the body, becomes accustomed to a certain amount of loading to assist with movement. However, when overloading over a short period without time to adjust, or if an insult occurs to the FHL tendon that lowers its ability to tolerate load without adequate time to heal, the FHL tendon can become overused. Overuse results in damage to the collagen fibres, which make up the tendon. This damage leads to the tendon being unable to perform its role, which in turn leads to further changes in the structure of the tendon, ultimately leading to pain and dysfunction.

What are the Risk Factors of FHL Tendinopathy and or Tenosynovitis?

Many factors can contribute to FHL tendinopathy and tenosynovitis, including:

Intrinsic Factors

  • Poor Foot Control
  • Poor Ankle Control
  • Tight or weak musculature in the foot and leg
  • Incorrect Training Technique
  • Previous Injury

Extrinsic Factors

  • Training Activities
  • Recent Change to Training Program
  • Training Environment
  • Amount of Training
  • Training Equipment
  • The fit of shoes if required
  • Fatigue
  • Inadequate Warm Up and Cool Down

How is FHL Tendinopathy or Tenosynovitis Diagnosed?

Several strategies can diagnose FHL Tendinopathy and Tenosynovitis correctly. Your physiotherapist will usually ask you a number of questions regarding your injury as well as performing a number of physical tests. Imaging is another option that can also be used in the diagnosis of FHL Tendinopathy and Tenosynovitis.

Physiotherapist / GP Outcome Measures

  • Pain Description
  • Pain Location
  • History of Injury
  • Activity Levels / Changes
  • Pain Provocation
  • Functional Activities
  • Specific Muscle Tests

Imaging

  • Ultrasound
  • MRI

Treatment for FHL Tendinopathy and/or Tenosynovitis

Exercise

Exercise is important in the management of FHL Tendinopathy and Tenosynovitis to enable the FHL tendon to adopt a new level of activity without an increase in pain, inflammation or further tendon degeneration. As you recover, your physiotherapist will assist you in progressing your exercise program through a number of levels based on your stage of recovery. This progression usually occurs through the utilisation of a traffic light system based on the loading that your FHL tendon can tolerate enabling a safe return to activity. You will be progressed based upon your physiotherapist’s professional assessment.

Load Management, Activity Modification and Activity Prioritisation

To enable the recovery of the FHL tendon it is of great importance to participate in training and everyday activities within the limitations of the tendinopathy. As a result, you may need to temporarily modify your training activities and/or decrease the number of training sessions that you participate in. All training sessions and activities should not aggravate your pain both during and after training for 24 to 48 hours.

Stretches, Massage, Foam Rollers and Trigger Balls

Massage, foam rolling or use of a trigger ball can be used on your calves, back of the ankle and under the foot to assist with recovery by lengthening tight muscles and therefore decreasing the tension placed on the FHL tendon.

Stretches can also be performed as long as the stretch is felt across the muscle belly of the FHL (deep leg), rather than at the FHL tendon at the back of the ankle, under the arch of the foot or at the base of the big toe.

Transverse Frictions & Ultrasound

Transverse friction or tendon massage and ultrasound can both assist in the healing of FHL Tendinopathy and Tenosynovitis, as long the technique is tolerated by the individual. This occurs through the increased circulation to the damaged area.

Adjacent Joints & Lower Limb Biomechanics

Your physiotherapist will ensure that your surrounding joints and muscles are moving and activating appropriately to prevent the FHL from overworking and overloading the FHL tendon. Areas, where biomechanics are particularly important in cases of FHL Tendinopathy and Tenosynovitis, include the ankle, foot and toes.

Medications / Pharmacology

NSAIDs, corticosteroids and other pain and anti-inflammatory medications can be used in conjunction with physiotherapy to assist in the recovery of FHL Tendinopathy and Tenosynovitis by helping to settle pain and inflammation locally. Your physiotherapist may refer you to a GP or sports doctor to discuss what medications are required in your management of FHL Tendinopathy and Tenosynovitis.

Splinting

Splinting is not always required in the treatment of FHL Tendinopathy and Tenosynovitis and is generally only utilised in advanced cases.

Surgery

In advanced cases of FHL Tendinopathy and Tenosynovitis surgery can be utilised as a last resort following the failure of conservative treatment strategies to reduce constriction of the tendon. If surgery is required, it is usually followed by physiotherapy to assist with rehabilitation and return to regular activity.

How is Your Treatment Rehabilitation Monitored?

Your physiotherapist will work with you to regularly assess your level of ability as you progress through your rehabilitation program. This occurs through the retesting of a number of outcome measures to determine your progress. Your physiotherapist can even work with your support team (family, boss, coach, teachers etc.) to assist with your recovery and eventual return to your regular activities.

Common Ankle Injuries

ankle pain
Sprained Ankles

The most common ankle injury is a sprained ankle, but ankle pain can have numerous sources.

Ankle pain that results from a traumatic injury is often a sports-related injury. But you don't necessarily have to be an athlete or even a social sportsperson to twist your ankle.

Something as simple as walking on an uneven footpath can cause a rolled ankle, resulting in an ankle sprain. Ankle injuries can potentially occur at any age. Thousands of people sprain their ankle every day around the world. Just while you've been reading this article, a few hundred people have sprained their ankle. While ankle pain can result from a large number of ankle and foot injuries, the most common ankle injuries are sprains (low and high ankle), which involve ligaments and bones in the ankle. But you can also fracture a bone, tear muscles or over-stress a tendon when you sprain your ankle.

High ankle sprains are generally a more significant injury. These injuries require thorough assessment and treatment to avoid long-term ankle arthritis. If you can't perform a single-leg calf raise within a few weeks of the injury, please seek an early professional ankle assessment.

Related links:

Ankle Fractures

An ankle fracture occurs when there is a break in one or more of the bones. The most common ankle fractures are avulsion fractures of your distal fibula, which can be a side effect of an ankle sprain. These are generally less troublesome than if you experience a talar dome fracture with your actual ankle joint. Potts fracture is a significant fracture of your tibia and fibula simultaneously. All suspected fractures require medical investigation and professionally managed by your health professional to avoid long-term foot and ankle issues. If your healthcare professional suspects an ankle fracture, you will be referred for at least an Xray and potentially to an orthopaedic surgeon. Related links:

Ankle Tendinopathies

While muscle strains are more common in your legs, there are important muscles which converge into tendons that wrap around your ankle to stabilise your ankle and foot to protect them from sprains and allow you to walk and run. These muscles and their tendon vitally provide you with a normal foot arch and avoid flat feet.

Your muscles or tendons can become injured or inflamed as a result of overuse or trauma. The inflammation is called tendonitis. They can also tear, completely rupture, or sublux out of place. Medically tendon injuries are known as tendinopathies, and at the ankle may include:

Ankle Arthritis

Your ankle pain and dysfunction can lead to degenerative conditions such as ankle osteoarthritis. While arthritis usually is a chronic deterioration of your ankle joint, it is crucial to slow the progression of ankle arthritis. Please seek the professional advice of your ankle and foot health practitioner, e.g. physiotherapist or podiatrist.

Biomechanical Conditions

Biomechanical disorders may result in foot deformation, painful weight-bearing and potentially nerve compression. In simple terms, this is where your foot and ankle do not have normal bone alignment and motion contr. Here are a few possible conditions related to poor ankle biomechanics.

Muscle Injuries

Nerve-Related Ankle Pain

Children & Youth Conditions

Systemic Conditions That Can Cause Ankle PAin

Soft Tissue Inflammation

Other Useful Information

FAQ

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.

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.

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 Barefoot Running?

Barefoot running is a term that means either running either without shoes or with minimalist shoes. Barefoot running has gained popularity over the last few years as a way to return to pure running and has been proclaimed to help reduce the rate of running injuries. But is this accurate?To gain a more scientific basis on whether barefoot running is advantageous or not for you, let’s look at what researchers have discovered.

Who is Suited to Barefoot Running?

When you run without shoes, you tend to land on the front part of our foot. This is called a forefoot strike. Landing through the centre of your foot is called a midfoot strike.If you were to land barefoot on your heel, it's called a rearfoot strike, the ground-shock would be excessive, and you would develop heel pain or injury, plus some other injuries further up your leg. That's why most barefoot runners tend to have a forefoot or midfoot strike. When you put on a traditional jogger with rearfoot cushioning, this cushioning allows you to land on your heel without damage. This is why lot of shoe runners become rearfoot strikers.

Ground Reaction Forces

The graphs below chart what is called ground reaction forces. The chart to the left is a rearfoot strike technique, and the right chart demonstrates a forefoot strike.

What does this Mean?

Generally, the higher the force, the greater the risk of injury. When you look closer, however, you can see that the ground reaction forces are actually higher in the forefoot strike chart. Surely this would mean that you would get more injuries running with a forefoot strike technique. Not exactly. As well as considering the ground reaction force, you also need to look at the vertical loading rate.

Vertical Loading Rate

Vertical loading rate (see the chart below) is a measure of how quickly the ground reaction forces increase.The steeper the curve, the greater the risk of injury. Running with a rearfoot strike produces a steeper curve, and makes some leg injuries more likely, but once again not all.

Running Shoes vs Barefoot Running

Does this mean you should toss away all of your running shoes? Maybe hold on them just a little longer. The evidence is not clear yet as to whether a forefoot/midfoot strike does actually reduce your injury rate. What appears to occur is the barefoot running reduces loads in one area only to increase loads in another. And, since you are probably running on firm or rough surfaces such as footpaths, roads or gravel, you'll need some form of cushioning and protection for your feet. Don't you hate landing on those little stones!

What Should You Do?

If you are running without injuries at present you would probably be silly to change. Changing footwear and technique may simply add another increase in loading and create new injuries elsewhere. Certainly, at PhysioWorks, we are seeing more forefoot injuries in barefoot runners, which does make sense given the load charts. Plus, most of these injuries occur within a few weeks of changing your running style.However, if you have been suffering injuries from running, barefoot may be a consideration for you. Changes to your running technique such as reducing your stride length or your shoe style could help you. You may also have some muscle control issues in another part of your body that could be altering the way you adapt your running style. So, before you toss your running shoes, it may be in your interest to consult with a running physiotherapist, a sports podiatrist or a running coach who can analyse your running style, assess your body for weakness or tightness, check your leg and foot biomechanics or simply help you to retrain your running technique or some slightly weak muscles.Most problems that cause running injuries are simpler to fix than you may think.

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.

Common Youth Leg Injuries

youth sports injuries

Why are Children's Injuries Different to Adults?

Adolescent injuries differ from adult injuries, mainly because the bones are still growing. The growth plates (physis) are cartilaginous (strong connective tissue) areas of the bones from which the bones elongate or enlarge. Repetitive stress or sudden large forces can cause injury to these areas.

Common Adolescent Leg Injuries

In the adolescent leg, common injuries include:

Osgood-Schlatter's Disease

Pain at the bump just below the knee cap (tibia tubercle). Overuse injuries commonly occur here. The tibia tubercle is the anchor point of your mighty quadriceps (thigh) muscles. It is because of excessive participation in running and jumping sports that the tendon pulls bone off and forms a painful lump that will remain forever. This type of injury responds to reduced activity and physiotherapy.More info: Osgood Schlatter's Disease

Sinding-Larsen-Johansson Disease

Pain at the lower pole of the knee cap (patella). Overstraining causes Sinding-Larsen-Johansson disease. It is the because of excessive participation in running and jumping sports that the tendon pulls bone off the knee cap. This type of injury responds to reduced activity and physiotherapy.More info: Sinding Larsen Johansson Syndrome

Anterior Knee Pain

Anterior knee pain or patellofemoral syndrome frequently gets passed off as growing pains. Cause of this pain includes overuse, muscle imbalance, poor flexibility, poor alignment, or more commonly, a combination of these. Anterior knee pain is one of the most challenging adolescent knee injuries to sort out and treat. Accurate diagnosis and treatment with the assistance of a physiotherapist with a particular interest in this problem usually resolves the condition quickly.More info: Patellofemoral Pain Syndrome

Knee Ligaments

The cartilage between the leg bones have a better blood supply and are more elastic in adolescents than in adults. As adolescents near the end of bone growth, their injuries become more adult-like, hence more meniscal and ACL (anterior cruciate ligament) injuries are likely. MCL (medial collateral ligament) injuries result from a lateral blow to the knee. Pain felt on the inner side (medially) of the knee. MCL injuries respond well to protective bracing and conservative treatment.More info: Knee Ligament Injuries

ACL (anterior cruciate ligament) injuries

This traumatic knee injury is significant. Non-contact injuries of the ACL are becoming more common than contact injuries of the ACL. Adolescent females are at high risk. Combination injuries with MCL or menisci are common. Surgical reconstruction is needed if the adolescent wishes to continue participating in "stop-and-start" sports.More info: ACL Injury

Meniscal injuries

Your meniscus is crescent-shaped cartilage between the thigh bone (femur) and lower leg bone (tibia). Meniscal injuries usually result from twisting. Swelling, catching, and locking of the knee are common. If physiotherapy treatment does not resolve these types of damages within six weeks, they may require arthroscopic surgery.More info: Meniscus Tear, Discoid Meniscus

Sever's Disease

Heel pain is commonplace in the young adolescent due to the stresses of their Achilles tendon pulling upon its bony insertion point on the heel (calcaneum). It is a common overuse injury as a result of excessive volume of training and competition, particularly when loads are increased dramatically in a short period. Diminished flexibility and muscle-tendon strength mismatching may predispose you. Physiotherapy, reduced activity, taping and orthotics are some of the best ways to manage this debilitating condition for the active young athlete.More info: Sever's Disease

Ankle Sprain

An ankle sprain is probably the most common injury seen in sports. Ankles sprains involve stretching of the ligaments and usually occur when the foot twists inward. Treatment includes active rest, ice, compression and physiotherapy rehabilitation. An ankle sprain usually improves in 2-6 weeks with the correct treatment. Your ankle physiotherapist should check even simple ankle sprains. A residually stiff ankle post-sprain can predispose you to several other lower limb issuesMore info: Sprained Ankle

Patellar Instability

Patellar (kneecap) instability can range from partial dislocation (subluxation) to dislocation with a fracture. Partial dislocation treatment is conservative. Dislocation with or without fracture is a much more severe injury and usually will require surgery.More info: Patella Dislocation

Osteochondritis Dissecans

Separation of a piece of bone from its bed in the knee joint is Osteochondritis Dissecans (OCD). This injury is usually due to one major macro event with repetitive macro trauma that prevents complete healing. This injury is potentially severe. Treatment varies from rest to surgery. An Orthopaedic Surgeon's opinion is vital.More info: Juvenile Osteochondritis Dissecans (JOCD)

Growth Plate Fractures

A fracture through the growth plate can be a severe injury that can stop the bone from growing correctly. These fractures should be treated by an Orthopaedic Surgeon, as some will require surgery.

Avulsion Fractures

youth pelvis hip avulsion
Image source: https://radiologyassistant.nl/pediatrics/hip/hip-pathology-in-children
An avulsion fracture occurs when a small segment of bone attached to a tendon or ligament gets pulled away from the main bone. The hip, elbow and ankle are the most common locations for lower limb avulsion fractures in the young sportsperson.Treatment of an avulsion fracture typically includes active rest, ice and protecting the affected area. This period of active rest is followed by controlled exercises that help restore range of motion, improve muscle strength and promote bone healing. Your physiotherapist should supervise your post-avulsion exercises. Most avulsion fractures heal very well.  You may need to spend a few weeks on crutches if you have an avulsion fracture around your hip. An avulsion fracture to your foot or ankle may require a cast or walking boot.In rare cases, an excessive gap between the avulsed bone fragment and main bone may not rejoin naturally. Surgery may be necessary to reunite them. In children, avulsion fractures that involve the growth plates also might require surgery. All avulsion fractures should be reviewed and managed by your trusted physiotherapist or an Orthopaedic Surgeon.For more information regarding your youth sports injury, please consult your physiotherapist or doctor.

Common Youth Leg Injuries

Pelvis & Hip

Knee

Heel & Ankle

Common Youth & Teenager Sports Injuries

Common Youth Neck & Back PainCommon Youth Arm Injuries

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.

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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