Hip Arthritis (Osteoarthritis)

Hip Arthritis (Osteoarthritis)

Article by J. MillerS.Armfield

What is Hip Arthritis?

Hip arthritis commonly describes the most common for of hip arthritis, which is known medically as hip osteoarthritis.

Hip osteoarthritis is a joint disease that mostly affects your hip joint cartilage. Articular cartilage is the hard slippery surface that covers the sections of bones that move against each other in your hip joint.

Healthy articular cartilage allows your hip joint bones to smoothly and painlessly glide over each other and also helps to absorb any shock forces not dispersed by your hip muscles.

What Causes Hip Arthritis?

In hip osteoarthritis, your top layer of articular cartilage breaks down and wears away. Eventually, your cortical bone that lies under the cartilage rubs together to cause pain, swelling, grating and loss of hip joint motion.

Muscle weakness and the resultant hip joint instability associated is thought to contribute towards the deterioration of your hip joint cartilage. Weaker hip muscles also provide less shock absorption capabilities than their strong counterparts, which increases your hip joint compression forces. Hip osteoarthritis usually happens gradually over time.

Some risk factors that might increase your likelihood of deterioration include:

  • Being overweight.
  • Age.
  • Previous joint injury.
  • Muscle weakness.
  • Stresses on the joints from certain jobs and playing sports.
  • Poor biomechanics.
  • Malformed joints or a genetic defect in your joint cartilage.

Hip osteoarthritis is the most common form of arthritis affecting your hip. Unlike some other forms of arthritis, osteoarthritis affects only joints and not internal organs. It is becoming more common with an ageing population. However, it can also occur in younger people, especially where there is a history of hip injury or heavy work.

Some research suggests that early intervention can delay the onset of the hip arthritis and may reduce the number of cases of hip osteoarthritis. There is not currently a cure for hip osteoarthritis.

What are the Symptoms of Hip Arthritis?

Hip arthritis results in hip pain, joint weakness, joint instability, and restrictions of movement that interfere with your most basic daily tasks such as walking, climbing stairs or driving.

Your symptoms can develop suddenly or slowly and may include:

  • Hip joint pain or tenderness that comes and goes. Typically there will be sharper pains in the groin, and sometimes an ache in the front of the thigh. Many people present with hip arthritis thinking that it is a knee problem.
  • Hip stiffness, particularly early morning stiffness.
  • Hip joint movement is difficult, especially inward rotation, movement of the leg across the body and hip extension.
  • Weak hip muscles, especially during sit to stand, squatting and stair climbing.
  • Hip joint swelling or deformity can be hard to detect because of the location of the hip joint.

How is Hip Arthritis Diagnosed?

Your initial diagnosis of hip osteoarthritis is usually clinically formed by taking a detailed history of your symptoms and a physical examination looking at the range of movement of your hip joint and any associated pain.

If hip osteoarthritis is suspected, a hip X-ray will assess your hip joint wear and tear, and sometimes a blood test to check for other factors.

In a small number of cases, a CT scan or MRI may be performed.

Hip Physiotherapy Effectiveness

Does Physiotherapy Help Hip Arthritis?

The short answer is Yes!

Short-Term Benefits

Poulsen et al 2013 compared patient education only, patient education plus manual therapy, and minimal (control) intervention (continue medication usage, minimal education on stretching) groups. At 6 weeks, significant differences were found, favouring patient education plus manual therapy versus the minimal (control) intervention group. At 6 weeks, 76.5% of patients in the education-plus-manual therapy group improved, versus 22.2% in the patient-education group and 12.5% in the control group. 1

Medium-Term Benefits

Fernandes et al 2010 enrolled 109 patients with mild to moderate hip OA and compared patient education versus patient education plus exercise at 16 months. The WOMAC physical function scores had improved significantly for the education-plus-exercise group. Their findings in this study show that participating in a 12-week exercise therapy programme in addition to patient education can reduce the need for THR or postpone surgery in patients with hip OA. This supports the recommendations stating that exercise therapy should be offered to patients with hip OA as first-line treatment. 2

Long-Term Benefits

Svege et al 2015 conducted a 6-year follow-up study of a previous study of 109 patients in which participants were randomized to 2 groups: exercise plus patient education and patient education only (control group).

Results showed that people who had exercise therapy were less likely to have a hip replacement. People who had exercise therapy were also able to wait longer before a hip replacement. The average time before having a hip replacement for people in the exercise group was five and a half years, compared with three and a half years for people who had not had exercise therapy. After six years, 22 of the 55 people who’d had exercise therapy had a hip replacement (40%) compared with 31 of the 54 people not in the exercise group (57%).

The people who had exercise therapy also rated their hip function as better.

This means that there is very good scientific support for the use of patient education, manual therapy and exercises prescribed by your physiotherapist assisting your hip osteoarthritis and delaying the need for hip replacement surgery. Please consult your physiotherapist to determine if you are a candidate for hip physiotherapy.

What’s the Treatment of Hip Arthritis?

PHASE I – Pain Relief & Protection

  • Managing your hip pain. Hip pain is the main reason that you seek treatment for hip arthritis.
  • Regular application of ice packs is highly recommended to reduce your hip pain.
  • NSAIDs or anti-inflammatory drugs (i.e. ibuprofen). Use of these medications should be discussed with your doctor.
  • Your physiotherapist will use an array of treatment tools to reduce your hip pain and inflammation. These may include ice, electrotherapy, acupuncture, unloading taping techniques, soft tissue massage and temporary use of a mobility aid (eg cane or crutch) to off-load the affected side.

PHASE II – Restoring Normal Hip ROM, Strength

As your hip pain and inflammation settles, your physiotherapist will turn their attention to restoring your normal hip joint range of motion, muscle length and resting tension, muscle strength and endurance, proprioception, balance and gait (walking pattern).

Hip researchers have discovered the importance of your hip muscle recruitment patterns with a normal order of deep, then intermediate and finally superficial muscle firing patterns in normal pain-free hips. Your physiotherapist will assess your muscle recruitment pattern and prescribe the best exercises for you specific to your needs.

PhysioWorks has developed a “Hip Core Stabilisation Program” to assist their patients to regain normal hip muscle control.

Please ask your physio for their advice.

PHASE III – Restoring Full Hip Function

The final stage of your hip arthritis rehabilitation is aimed at returning you to your desired activities. Everyone has different demands for their hips that will determine what specific treatment goals you need to achieve. For some people, it may be simply to walk around the block.

Your physiotherapist will tailor your hip rehabilitation to help you achieve your own functional goals.

PHASE IV – Delaying Hip Surgery

Hip osteoarthritis is a condition that gradually deteriorates even though your pain may come and go in the initial stages.

In addition to your hip muscle control, your physiotherapist will assess your hip biomechanics and start correcting any defects. It may be as simple as providing your will core abdominal exercises or some foot orthotics to address any biomechanical faults in the legs or feet. Your physiotherapist will guide you.

Fine-tuning your hip stability and function by addressing any deficits in core strength and balance, learning self-management techniques and achieving the ultimate goal of safely returning to your previous daily or leisure activities!

Your aim for any exercise or physiotherapy program is to delay the deterioration of your hip arthritis. Your best chance is to have strong hip muscles and bones performing activities that don’t traumatise your hip joint surfaces.

PHASE V – Hip Surgery

Hip surgery is usually required as your hip joint arthritis deteriorates and your hip joint becomes permanently deformed. The most common surgical procedure for an arthritic hip is a total hip replacement. Your hip surgeon may also recommend arthroscopic surgery or joint resurfacing.

Your prognosis following a total hip replacement is very good. In most cases, you will have no or considerably less pain plus improved hip function.

You will require a post-operative hip strengthening and rehabilitation program to prolong the life of your new hip and resume your most active lifestyle.

For more information about hip surgery, please your physiotherapist or doctor.

What Else Can You Do For Your Hip?

Lose Weight

Lose weight. You won’t just look better, you’ll feel better, too. Why? Every extra kilogram you carry around translates to added stress to your hip joints. Excess weight can mean more hip pain, no matter which form of arthritis you have.

Ice it!

When your hip joint is hot and inflamed, applying something cold can decrease pain and swelling by constricting blood vessels and preventing fluids from leaking into surrounding tissues.

Medications

Follow your doctor’s advice. Some medications will be designed for pain relief and others to reduce inflammation. Since most hip osteoarthritis sufferers normally have other medications, it is always wise to check with your doctor before changing.

Exercise – Keep Moving

Exercise helps to lessen your hip pain, increase your hip joint range of movement, reduce fatigue and help you feel better overall.

A well-rounded workout routine for people with hip osteoarthritis includes flexibility exercises to increase your hip joint and muscle range of motion, aerobic exercises to improve your endurance and decrease fatigue, and strengthening exercises to improve your muscle endurance and power.

Your physiotherapist is an expert in the assessment and prescription of hip arthritis exercises. Please ask them what is best for you.

General exercise such as swimming, hydrotherapy, Tai Chi, yoga, pilates, balance and walking programs are excellent if pain-free.

The key is to have a regular daily exercise program. The goal is to keep moving.

Strengthen Your Bones

Ask your doctor to check your bone density. If they are concerned they’ll arrange for a test to check if you have osteoporosis (bone thinning).

Follow their advice or the advice of your dietitian on your Calcium and Vitamin D intake. You need normal levels of both plus some form of weight-bearing exercise to strengthen your bones.

Treat Your Muscles with a Massage!

A quality remedial massage may be just the relief your hip muscles need. Treat yourself to a good rub down with someone you trust. The benefits vary from person to person but may include decreased pain and muscle stiffness associated with your arthritis, increased circulation, and an improvement in your sleep and immune functions. Mentally, massage can also decrease stress and depression.

Besides all it that, massage just feels good!

Common Causes of Hip & Groin Pain

General Information

Hip Joint Pain

Lateral Hip Pain

Adductor-related Groin Pain

Pubic-related Groin Pain

Inguinal-related Groin Pain

  • Inguinal hernia
  • Sportsman's hernia

Iliopsoas-related Groin Pain

  • Hip Flexor Strain

Other Muscle-related Pain

Systemic Diseases

Referred Sources

Hip Surgery

Hip Pain Treatment

A thorough analysis of WHY you are suffering hip pain from a movement, posture, or a control aspect, is vital to solving your hip pain. Only an accurate diagnosis of the source of your hip pain can solve the pain, quickly improve your day to day function, prevent a future recurrence,  or improve your athletic performance. The first choice of short-term therapy has been symptomatic hip treatment. This approach could include local chemical modalities such as cortisone injections or painkillers. Ice or heat could also assist along with some gentle stretching or exercise. However, persisting hip problems will require additional investigations to assess your joint integrity or range of motion, muscle length, strength, endurance, power, contraction timing and dynamic stability control. You should consult a healthcare practitioner who has a particular interest in hip pain and injury management, to thoroughly assess your hip, groin, pelvis, lower limb and spine. Due to the kinetic chain, they all have an impact, especially at the high athletic performance end. A quality practitioner will specifically educate you regarding your condition and combine with exercise and manual therapy as per the Clinical Practice Guidelines. (Cibulka et al., 2017) Hip pain education should also include teaching you specific activity modification, individualised exercises, weight-loss advice (if required), and methods to unload any arthritic joints. Recent research evidence-backed approaches have modernised physiotherapy treatment approaches to effectively managing hip pain. Together with a thorough hip assessment, your hip treatment can progress quickly to restore you to a pain-free hip and perform your regular sport or daily activities in the shortest time possible. For specific rehabilitation advice regarding your hip pain, seek the professional advice of high quality and up-to-date physiotherapist experienced in the assessment, treatment, prevention and optimisation of hip pain and related conditions. After assessing you, they will individually prescribe therapeutic activities based on your specific needs for daily living, values, and functional activities or point you in the direction of the most suitable healthcare practitioner for you and your hip condition.

Hip Pain Treatment Options

Your hip physiotherapist may consider an extensive range of treatment options including manual joint therapy to improve your joint mobility, muscle stretches or supportive taping. Your physiotherapist is also likely to add strengthening and joint control exercises as they deem appropriate for your specific functional and sporting needs. Please click the links below for more information about some of the conventional hip treatments that your physiotherapist may recommend or utilise for your hip pain.

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.

Book Online Now! 24-Hours

Ashgrove Ph 3366 4221     Clayfield Ph 3862 4544     Sandgate Ph 3269 1122

What is the PhysioWorks Difference?

Friendly & Caring Service

One thing that you'll notice about the PhysioWorks team is that they are very friendly and caring health professionals. We know that sometimes pain or injury can make you a little less tolerant, so we've trained our healthcare team always to greet and treat you like they would a family member or best friend.

Thorough & Unrushed

Everyone should be entitled to individualised professional care. That's why we book longer initial appointments to ensure that your unhurried first visit will include a thorough and individualised assessment of your injury or problem. This extra time, then allows us to discuss your short, medium and long-term goals and treatment options before commencing your rehabilitation.

You'll find that your PhysioWorks healthcare practitioner is not only a great listener, but also an excellent treatment planner to focus on your efficient and effective treatment outcome. After all, that's why you have chosen to see us in the first place.

What is the Aim of Your Initial Consultation?

Because we do spend more time than most physiotherapists thoroughly assessing, by the completion of your initial consultation, we should be able to determine and inform you:

  • What exactly is your problem
  • Why you are experiencing pain or dysfunction etc
  • What you can be doing to correct it
  • How long it will most likely take to recover
  • How to prevent a future recurrence

Your Tailored Treatment Plan

Your physiotherapist will design a specific treatment program specifically for you based upon your examination. Your treatment may include hands-on treatment, such as joint manipulation, mobilisation or massage. It will probably also include lots of helpful advice and home exercises. We'll also use other technology or treatment tools depending upon your needs.

Your treatment will vary depending upon your age, sex, sport, work requirements or lifestyle, so generic therapies tend to be effective than specifically targeted treatment plans.

As highly-trained exercise prescribers, your physiotherapist will usually instruct you on specific exercises and stretches for you to undertake at home to assist in your rapid recovery. We'll also offer you some helpful advice to help ease your pain, such as the appropriate resting positions or whether to use heat or ice and precisely for how long.

The result is prompt pain reduction, quicker natural healing and your successful return to full activity, whether it be work or sport, as soon as possible.

How Long is Your Physiotherapy Appointment?

Allow at least one hour for your initial physiotherapy session. Subsequent treatments are usually 30 to 60 minutes in duration. Your physiotherapist will inform you if additional or less time is required. Complex or multiple regions may require a longer consultation. Our receptionist will happily book an appropriate appointment for your clinical needs.

Do You Need a Referral to Consult a Physiotherapist?

A doctor's referral is not required to see a physiotherapist in private practice unless you are claiming a work injury (e.g. Workcover), or some other insurance claims. Department of Veterans Affairs patients will require a doctor referral. If you have been involved in a motor vehicle accident or you are planning for your treatment to be funded by an insurance company, it is good practice to consult your GP for a referral.

What About Private Health Insurance?

A proportion of treatment costs is rebatable under all higher table private health insurance schemes. The private health insurance rebates do vary considerably depending upon your specific coverage.

What is HICAPS?

PhysioWorks is linked to the HICAPS electronic health fund system so you can instantly claim your rebate at the time of treatment. You'll need to present your health insurance card to our receptionist.

Acute Injury Signs

Acute Injury Management. Here are some warning signs that you have an injury. While some injuries are immediately evident, others can creep up slowly and progressively get worse. If you don't pay attention to both types of injuries, chronic problems can develop. For detailed information on specific injuries, check out the injury by body part section.

Don't Ignore these Injury Warning Signs

Joint Pain
Joint pain, particularly in the joints of the knee, ankle, elbow and wrist, should never be ignored. Because these joints are not covered by muscle, pain here is rarely of muscular origin. Joint pain that lasts more than 48 hours requires a professional diagnosis.
Tenderness
If you can elicit pain at a specific point in a bone, muscle or joint, by pressing your finger into it, you may have a significant injury. If the same spot on the other side of the body does not produce the same pain, you should probably see your health professional.  
Swelling
Nearly all sports or musculoskeletal injuries cause swelling. Swelling is usually quite obvious and can be seen, but occasionally you may just feel as though something is swollen or "full" even though it looks normal. Swelling usually goes along with pain, redness and heat.
Reduced Range of Motion
If the swelling isn't obvious, you can usually find it by checking for a reduced range of motion in a joint. If there is significant swelling within a joint, you will lose range of motion. Compare one side of the body with the other to identify major differences. If there are any, you probably have an injury that needs attention.
Weakness
Compare sides for weakness by performing the same task. One way to tell is to lift the same weight with the right and left side and look at the result. Or try to place body weight on one leg and then the other. A difference in your ability to support your weight is another suggestion of an injury that requires attention.

Immediate Injury Treatment: Step-by-Step Guidelines

  • Stop the activity immediately.
  • Wrap the injured part in a compression bandage.
  • Apply ice to the injured part (use a bag of crushed ice or a bag of frozen vegetables).
  • Elevate the injured part to reduce swelling.
  • Consult your health practitioner for a proper diagnosis of any serious injury.
  • Rehabilitate your injury under professional guidance.
  • Seek a second opinion if you are not improving.

Acute Injury Treatments

  • Early Injury Treatment
  • Acupuncture and Dry Needling
  • Gait Analysis
  • Biomechanical Analysis
  • Proprioception & Balance Exercises
  • Medications?
  • Real Time Ultrasound Physiotherapy
  • Soft Tissue Massage
  • Dry Needling
  • Electrotherapy & Local Modalities
  • Heat Packs
  • Joint Mobilisation Techniques
  • Kinesiology Tape
  • Physiotherapy Instrument Mobilisation (PIM)
  • Running Analysis
  • Stretching Exercises
  • Supportive Taping & Strapping
  • TENS Machine
  • Video Analysis

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.
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