Proximal Hamstring Tendinopathy

Proximal Hamstring Tendinopathy

What is Proximal Hamstring Tendinopathy?

Proximal hamstring tendinopathy, also known as high hamstring tendinopathy; is the term for an injury to the hamstring origin tendon at its attachment site into the ischial tuberosity of the pelvis.

Who Suffers from Proximal Hamstring Tendinopathy?

Proximal hamstring tendinopathy is most common in middle to long distance runners and those who participate in repetitive jumping, kicking and running sports such as soccer (football) and AFL.

What Does Proximal Hamstring Tendinopathy Feel Like?

Proximal hamstring tendinopathy often presents with the gradual onset of pain and is less likely with acute trauma.

Sufferers’ often report:

  • Deep buttock pain – constant and dull in nature that is worsened with activity
  • Pain in the posterior thigh
  • Pain can radiate down the thigh towards the knee along with the hamstring muscles.

Pain is always related to loading the hamstring muscles and increases with repetitive action activities such as running and football codes. In some cases, pain can be elicited with the compressive force on the hamstring insertion from sitting.

What Causes Proximal Hamstring Tendinopathy?

The role of the hamstring tendon is to transfer the force of the hamstring muscle group to the pelvis. The hamstrings are prone to tendinopathy as they contribute to the decelerating of the straightening knee during activities such as sprinting and hill climbing (Petersen et al, 2005).

When an exercise load is applied to the proximal portion of the hamstring tendon, the tendon is responsible for transferring this load to the pelvis. The normal tendon strengthening process occurs when the tendon has to undertake this action repetitively, the tendon adapts to withstand the load. These normal tendon changes are designed to keep your body continuing to participate in your chosen activity at the performance level required for as long as possible. Normally the tendon is capable of intrinsic repair, meaning that the consequences of loading are minimal and recover in preparation for the next bout of exercise (usually 24 hours).

However, if an excessive load is continually applied to the tendon, these changes occurring in the tendon can exceed the rate of repair. This can result in tendon pain and dysfunction. In some cases, the ability to repair is impaired by a multitude of factors that can result in the repair to not occur and to start to reduce the tendon’s ability to adapt, in some cases this can even result in failed healing. All of this leads to the formation of tendinopathy (Kannus 1997, Sharma and Maffulli 2005, Warden 2007).

Proximal Hamstring Tendinopathy Risk Factors

There are a number of factors that can contribute to the development of proximal hamstring tendinopathy. Your physiotherapist is the best person to discuss these with as they are highly trained to identify all the contributing factors in relation to your tendinopathy.

In some cases, proximal hamstring tendinopathy may occur following an acute hamstring tear. However, in most cases tendinopathy is an overuse injury. There are a number of intrinsic (within the athlete) and extrinsic (external to the athlete) factors which may increase the likelihood of developing injury.

Intrinsic Risk Factors:

  • Previous injury – loss of muscle strength and flexibility may predispose an athlete to injury.
  • Gluteal muscle dysfunction – reduced gluteal muscle strength can increase the hamstring strength requirements during activity.
  • Anterior pelvic tilt – an athlete in anterior tilt may increase compressive forces across the ischial tuberosity.
  • Female gender.
  • Overweight.
  • Core weakness – Core muscle strength is required to ensure that the pelvic alignment is maintained during activity, loss of pelvic control may result in increased loads through the hamstring tendon at the pelvis.
  • Stiffness of the hip – loss of hip active motion may increase the requirement of the hamstrings and pelvis in active movement.

Extrinsic factors:

  • Training Load Changes – A sudden change in load, most commonly an increase in load can be associated with PHT; alternately a period of unloading (eg a holiday, off-season) and sudden increase to your normal load, may be enough.
  • Training errors – inadequate rest between training sessions, poor technique
  • Poor equipment – old or worn footwear
  • Insufficient warming up and recovery methods.
  • Fatigue – Injury risk can be significantly increased when the body is fatigued.

Your physiotherapist will address any of these factors that may be influential in the development of your proximal hamstring tendinopathy. If you have any specific concerns that you would like them to investigate, please ask your physiotherapist.

Tendinopathy Phases

Tendinopathy is a continuum of pathological processes and your treatment plan can be aided by correct identification of the current phase of injury and the application of appropriate exercise in the rehabilitation of your injury. Inappropriate loading may delay your recovery and your return to sport.

Identification of the phase helps to identify an entry point for your rehabilitation and how much you can perform in your recovery and balancing your activity levels in your rehabilitation plan.

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

How is Proximal Hamstring Tendinopathy Diagnosed?

Proximal hamstring tendinopathy is one of many causes of lower buttock pain. The correct diagnosis is vital to your treatment plan and recovery!

Your physiotherapist or a sports doctor can confirm the diagnosis clinically. This is undertaken with a combination of your history of injury and pain provocation tests. It is important to understand that diagnostic imaging may not be required in your diagnosis. Imaging such as MRI is often used to exclude other conditions that can mimic pain similar to proximal hamstring tendinopathy.

In some cases, an MRI may be undertaken to ensure that your injury is proximal hamstring tendinopathy and not a complete rupture of the tendon. MRI can also be used to visualise any bone marrow oedema at the ischial tuberosity in conjunction with your injury.

Proximal Hamstring Tendinopathy Treatment

Your physiotherapist is highly skilled in the management of proximal hamstring tendinopathy and your subsequent safe return to sport. Among other tests, your physiotherapist will use your pain provocation tests, strength measures, and functional activities as an effective tool to monitor your pain, function and when to progress exercises or return to sport.

They’ll also be happy to discuss your injury rehabilitation with your coach.

How Do You Treat Proximal Hamstring Tendinopathy?

Proximal hamstring tendinopathy treatment has progressed significantly in recent years. Based on this, it is now more important than ever to be assessed and treated by a physiotherapist who is up-to-date in the latest proximal hamstring tendinopathy research findings and treatment strategies.

Exercise!

There is increasing importance in exercise in the management of tendinopathy. Isometric exercise, or exercise that the joint angle and muscle length do not change during exercise, have proven effects at pain relief for athletes suffering from tendinopathy.

How Will Your Physiotherapist Progress Your Treatment?

Tendinopathy treatment is progressed based on your tendon’s ability to withstand your exercises load. For most athletes, the traffic light system is utilised in order to clearly define how much training is too much.

Red will indicate that you need to reduce your exercise load. Amber indicates that you can exercise at current loads. Green indictaes that you can safely increase your exercise loads.

Your physiotherapist will explain how to interpret your symptoms and plan your exercise loads based upon their assessment and your symptoms.

Managing Your Activity Load is the Priority!

Exercise load management is vital to the successful treatment of a proximal hamstring tendinopathy. Mild load increases will stimulate new tendon growth. Overload leads to tendinopathy deterioration.

Reduce the load to a level that allows the tendon to recover. In severe cases, this may mean total rest from your sport or modifying training depending on the severity of tendinopathy. Your activity load should be discussed with your physiotherapist, who will plan and modify your program accordingly, based upon your pain provocation tests, traffic light response to activity and other symptoms.

When managing load you should be guided by how the tendon responds not just immediately but also 24 hours later. Tendons are known to have a latent response to loading. This means they can take 24 hours or more to react. It is important to modify your activity to remain pain-free during and for following 24 to 48 hours.

Proximal Hamstring Tendinopathy Prognosis

If you identify your hamstring tendon injury in the early stages then load management and reduction will allow the tendon time to adapt and quickly recover.  The reactive stage can be relatively short. Pain may settle in 5 to 10 days but the tendon will still be sensitive to high loads and training needs to be progressed gradually to prevent relapse. It is important that it does not progress into late stage 2 or stage 3 tendinopathy. These tendinopathies require additional time and rehabilitation.

Brukner and Khan (2002) suggested that a likely return to sport is in the order of 12 weeks. However, everyone is very different!

Some practitioners suggest that the prognosis with guided treatment can be summed up by the tendinopathy phase:

  • Phase I: days
  • Phase II: weeks
  • Phase III: months
  • Phase IV: years

Exercises to Avoid with Proximal Hamstring Tendinopathy

Avoid exercises that provoke your pain such as running up hills or stairs, bending forward with a straight knee (eg, hockey) until advised otherwise by your physiotherapist.

Massage, Foam Rollers & Stretches

Massage or foam rollering of your gluteals, quadriceps, ITB, and hamstrings, may assist in cases of hamstring tendinopathy. You can perform these in positions that do not hyperflex your hip with a straight knee. Ask your physiotherapist for specific advice.

Foam rollers can be found here: http://bit.ly/15M0fOj

Eccentric Strengthening

Eccentric exercises were for many years the “go to” exercises for tendinopathy rehabilitation. While definitely important, premature or overloaded eccentric exercises can delay your rehabilitation. Your physiotherapist will guide you when appropriate to commence strengthening that does not aggravate your hamstring tendinopathy. They may start you with isometrics that avoid tendon compression and progress from there towards a basic and then advance eccentric exercise program.

Adjacent Joints & Lower Limb Biomechanics

Researchers have identified several lower limb biomechanical issues may predispose you to hamstring tendinopathy. Your physiotherapist will assess things such as your ankle dorsiflexion, gluteal control, hip/knee bend ratio and running and landing technique. They’ll advise you if you require some treatment to address any deficiencies.

Other Treatments

Novel therapies such as the injection of sclerosing agents, platelet-derived growth factor (PDGF), and autologous blood into diseased tendons have shown promising results, but more clinical trials are needed. Your physiotherapist is happy to discuss these options with you when they consider them an appropriate treatment option.

Remember, all tendinopathies are different. Please seek the advice of your physiotherapist to determine the best rehabilitation appropriate to your tendinopathy.

FAQs for Hamstring Tendinopathy

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.

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.

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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