Anterior Shin Splints
What are Anterior Shin Splints?
Anterior shin splints are a common complaint, especially among participants of running sports. The term ‘anterior shin splints’ is colloquially used to describe shin pain along the anterior (front) edge of the shin. Anterior shin splints are the most common cause of painful shin bones. Posterior shin splints are similar, but the pain and injury experience is elsewhere.
anterior Shin Splints
Anterior shin splints symptoms present on the anterolateral part of the shinbone and involves the tibialis anterior muscle. The tibialis anterior muscle lifts your foot to ensure that you don’t trip on your toes. It also has a specific job to stabilise your superior tibiofibular joint during the weight-bearing support phase. When your tibialis anterior is weak or lacks muscle endurance, your foot can require dorsiflexion, which can cause you to increase your step height, which can increase shin bone stresses. Anterior shin splints can occur in combination with stiff ankle dorsiflexion. This lack of ankle motion is a typical result of inadequately rehabilitated ankle sprains.
If you feel pain along the front-outside of your shin bone – you are likely to suffer from either anterior shin splints or tibia stress fractures. Medically, anterior shin splints and tibial stress fractures are also knowns as anterior tibial stress syndrome (ATSS).
What Causes Anterior Shin Splints?
Anterior shin splints are caused by overstraining of your muscles where they attach to your shin.
The most common cause is overuse or overtraining associated with inefficient foot and leg biomechanics. Anterior shin splints can result from several mainly biomechanical factors (abnormal movement patterns) and errors in training.
Some of the most common causes of anterior shin splints include:
Overtraining / Overloading:
- Increasing your training too quickly
- Running on hard or angled surfaces.
- Running up hills.
- Insufficient rest between loads
- Overpronation of your feet
- Over supination of your feet
- Decreased flexibility at your ankle joint
- Poor hip-knee-leg muscle control (dynamic alignment)
- Poor buttock control at in the stance phase
- Poor core stability
- Tight calf muscles, hamstrings
- Weak quadriceps, foot arch muscles
- Inappropriate footwear
- Wet or heavy shoes
What Structures are Injured?
Generally, shin pain arises from a combination of three structures:
- Shinbone (tibia)
As a result of repeated overuse, one or more of your muscles in the lower leg may become injured through excessive loading stress. This overload can result in muscle tenderness, inflammation or knots. The most common muscle that causes anterior shin splints is tibialis anterior.
All bones have a hard ‘shell’, called the periosteum. The tendons, which connect the muscle to the bone, attach on to this periosteum. This zone at which the tendon meets the bone is known as tenoperiosteum.
Almost all cases of ‘anterior shin splints’ has some element of inflammation of the tenoperiosteum. Swelling of different tendons leads to pain in different areas of the shin.
Damage to the shin bone usually concentrates in the lower one-third of the shin bone (tibia). The bone damage may be mild, such as a simple stress reaction, or maybe a severe stress fracture. Except in the worst cases, bone damage is not visible on standard x-rays. A bone scan or MRI may exclude or confirm a bone injury if your physiotherapist or doctor need to investigate further.
What Are The Symptoms Of Anterior Shin Splints?
Where Do Anterior Shin Splints Hurt?
- Anterior shin splints cause dull, aching pain in the anterolateral aspect of the lower leg (tibia).
- Depending upon the exact cause, you may experience shin pain along the outside of your shinbone, or within your associated muscles.
- The area may be tender to the touch.
The Four Stages Of An Overuse Injury:
Your physiotherapist will guide you concerning how much exercise you can do. Here are some basic guidelines until you seek your physiotherapist’s opinion:
- Shin discomfort that disappears during warm-up.
Injury identification and treatment in stage one allows continuing activity as long as the injury does not worsen. We recommend professional guidance to confirm your diagnosis and to implement treatment strategies to ensure that your condition does not deteriorate.
- Shin discomfort that may disappear during warm-up but reappears at the end of the activity.
At stage two, the activity may continue at a modified pain-free level while being treated. Professional assessment and treatment is highly recommended and must continue until you have wholly resumed regular exercise and training levels.
- Shin discomfort that gets worse during the activity.
If the injury progresses to stage three, the activity must immediately cease. Professional guidance will confirm the diagnosis and ensure that the condition has not deteriorated into bone stress fractures. We recommend a thorough rehabilitation program to return to your desired activity and exercise levels gradually.
- Pain or discomfort all the time.
All activity must immediately cease. Professional guidance is essential to exclude stress fractures or more significant tibia fractures. Potentially, you may need to be non-weight bearing on crutches or mobilising in an air cast. Please book an appointment with your healthcare professional who has a particular interest in shin pain to investigate and rehabilitate you based on their assessment thoroughly.
How is Anterior Shin Splints Diagnosed?
Anterior shin splints are usually diagnosed based on your medical history and a physical examination by your physiotherapist. In some cases, an X-ray or other imaging studies such as bone scans or MRI can help identify other possible causes for your pain, such as a stress fracture.
Please consult your trusted physiotherapist for specific advice regarding your shin pain.
Treatment for Anterior Shin Splints
What is the fastest way to heal anterior shin splints?
Phase 1 – Early Injury Protection: Pain Reduction & Anti-inflammatory Phase
As with most soft tissue injuries, the initial treatment is – Rest, Ice and Protection.
In the early phase, you may be unable to walk or run without pain, so your shin muscles and bones need some active rest from weight-bearing loads. Your physiotherapist will advise you on what they feel is best for you. Ice is a simple and effective modality to reduce your pain and swelling. Please apply for 20-30 minutes each 2 to 4 hours during the initial phase or when you notice that your injury is warm or hot.
Anti-inflammatory medication (if tolerated) and natural substances, e.g. arnica may help reduce your pain and swelling. However, it is best to avoid anti-inflammatory drugs during the first 48 to 72 hours when they may encourage additional bleeding. Most people can tolerate paracetamol as pain-reducing medication. As you improve a kinesio-style supportive taping will help to support the injured soft tissue and provide some stress reduction for your shin bone.
Phase 2: Regain Full Range of Motion
If you protect your injured shin muscles while they heal and strengthen. This healing may take several weeks. During this period, you should be aiming to optimally remould your scar tissue to prevent a poorly formed scar that will re-tear in the future. It is important to lengthen and orientate your healing scar tissue via massage, muscle stretches, neurodynamic mobilisations and specific exercises. Your physiotherapist will guide you.
Phase 3: Normalise Foot Biomechanics
Anterior shin splints commonly occur from poor foot biomechanics, e.g. flat foot. To prevent a recurrence, you should have your foot thoroughly assessed. In some instances, you may require a foot orthotic (shoe insert), or you may be a candidate for the Active Foot Posture Stabilisation program.
Your physiotherapist will happily discuss the pros and cons of both options to you.
Phase 4: Restore Muscle Strength
Your calf, shin, quadriceps, gluteal and other lower limb muscles may need strengthening to enable a safe resumption of sport or training.
Phase 5: Modified Training Program & Return to Sport
Most anterior shin splints occur due to excessive training loads. Running activities place enormous forces on your body (contractile and non-contractile).
To prevent a recurrence as you return to your sport, your physiotherapist will guide you with training schedules and exercises to address these critical components of rehabilitation to both prevent a recurrence and improve your sporting performance.
Depending on the demands of your chosen sport, you will require specific sport-specific exercises and a progressed training regime to enable a safe and injury-free return to your chosen sport.
Your PhysioWorks physiotherapist will discuss your goals, time frames and training schedules with you to optimise you for a complete return to sport. The perfect outcome will have you performing at full speed, power, agility and function with the added knowledge that a thorough rehabilitation program has minimised your chance of future injury.
How Long Does It Take For Anterior Shin Splints To Heal?
There is no specific time frame for when to progress from each stage to the next. Many factors will determine your anterior shin splints rehabilitation status during your physiotherapist’s clinical assessment.
You’ll find that in most cases, your physiotherapist will seamlessly progress between the rehabilitation phases as your clinical assessment and function improves.
You should carefully monitor each activity and exercise-level progression. Attempting to progress too soon to the next level can lead to re-injury and frustration.
The severity of your anterior shin splints, your compliance with treatment, and the workload that you need to return to will ultimately determine how long your injury takes to rehabilitate successfully.
Are Anterior Shin Splints Serious?
Left untreated and with continued overtraining, anterior shin splints can progress into tibial stress fractures, which will require a minimum of six weeks resting on the couch. Less commonly, if your muscle sheaths become compressed by engorged muscles – muscle compartment syndrome can develop. Muscle compartment syndrome is a severe shin complaint that often requires surgical intervention to prevent permanent muscle damage.
For specific advice regarding your situation, please consult your physiotherapist.
Common Sources of Shin Pain & Injury
- Shin Splints
- Stress Fracture
- Tibialis Posterior Tendinopathy
FAQs about Shin Splints
Sports Injury Management
You probably already know that a sports injury can affect not only 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 significantly to how we treat you this year. The good news is that you can benefit considerably from our knowledge.
What Should You Do When You Suffer a Sports Injury?
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 usually 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, you can use heat packs. We recommend 20-minute applications a few times a day to increase the blood flow and hasten your healing rate. The heat will also help your muscles relax and ease your pain. If you're not sure what to do, please call us to discuss your situation specifically.
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 compressive dressing will also help support the injury as you lay down the new scar tissue. This early healing 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 about what to do next.
Gravity will encourage swelling to settle at the lowest point. Elevation of an injury in the first few days is beneficial, especially for ankle or hand injuries. Think where your damage 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 medications 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 the 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 return to sport - we'll detect and help you correct any biomechanical faults that may affect your technique or predispose 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:
- An inappropriately treated previous injury (e.g. 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, 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, but 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
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.
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.
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.
For more friendly advice or guidance, please call your nearest clinic to discuss your specific needs.
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
Your physiotherapist's training includes hands-on physiotherapy techniques such as:
- Joint Mobilisation (gentle joint gliding techniques)
- Joint Manipulation
- Physiotherapy Instrument Mobilisation (PIM)
- Minimal Energy Techniques (METs)
- Soft Tissue Techniques
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.
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.
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.
- Muscle Stretching
- Core Exercises
- Strengthening Exercises
- Balance Exercises
- Proprioception Exercises
- Real-Time Ultrasound Physiotherapy
- Swiss Ball Exercises
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.
Aquatic water exercises are an effective method to provide low bodyweight exercises.
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.
Women's Health Physiotherapy is a particular interest group of therapies.
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.
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.
Post Running Muscle Soreness:
Is it an Injury or just DOMS?Have you ever finished a big run and felt sore right after it? What about two days afterwards? Do you ignore it or have it checked out? The most common causes of post-run pain are either a legitimate muscle injury or delayed onset muscle soreness (DOMS).
Tips to Determine if it is a Muscle Injury or is it DOMS?Differentiating between a muscular injury and DOMs is essential to ensure you are not overlooking a potentially sport-limiting injury and you are getting the injury managed appropriately. Early identification is key!
What is DOMS?Delayed Onset Muscle Soreness or DOMs for short, is an exercise-related muscle condition that arises after intense, unaccustomed, physical exercise. The condition gets its ‘delayed’ name as symptoms are not usually felt until 24 to 72 hours after the exercise, normally peaking at the 48-hour mark after exercise. Research has demonstrated that DOMS is associated with tearing of myofibrils often at multitudinous junctions - best described as microtrauma. This process is followed by inflammation and a shift in intramuscular fluid and electrolytes. This process in combination with other local factors at the cellular and increased intramuscular pressure promote are what causes the soreness and stiffness experienced in DOMS. Tenderness is typically felt at the end of the muscle (at the tendon) where it attaches down along the affected limb and then as the condition progress. This can be felt throughout the muscle belly itself. The swelling, inflammation, tenderness and pain that arises can manifest as decreased joint range of motion, decreased strength and a decreased ability to absorb shock while exercising. This alteration is muscle function can last up to 10 days!
Muscle InjuriesAcute muscle injuries are quite different in how they present compared to DOMS. Typically, pain and stiffness is felt immediately in the affected tissue or shortly after. A ‘pop’, twinge, feeling of being kicked - without anyone actually kicking you - or an immediate collapse to the ground. As expected, the amount of damage to the tissue with a muscle injury exceeds that of DOMS. Any general movement of the muscle will reproduce your symptoms and if the injury is severe enough - bruising can begin to develop with some associated swelling. At the time of injury, following the RICE protocol (Relative Rest, Ice, Compression, and Elevation) is your best go-to treatment. You should also avoid HARM factors. No heat should be applied to the affected area. You should also avoid alcohol consumption, running or other painful movements. Initially, it is a good idea to avoid massage until a professional has assessed the injury. All the HARM factors have the potential to increase bleeding, which may exacerbate your injury. Research suggests no anti-inflammatory drugs following a muscle strain is the best way to go. If you are seeking pain relief, it is best you consult your regular GP or a pharmacist for pain relief options that don't slow down your healing rates. More info: How to Treat an Acute Soft Tissue Injury
Benefits of DOMS?Thankfully yes! The body adapts to the physical exercise that was undertaken once the DOMS resolves. So when you go and perform the same exercise again, the chance of DOMS onset decreases! However, adaptation to the causative exercise occurs rapidly after DOMS resolves. This adaptation with repeated exercise is called the “repeated-bout effect.” More info: Delayed Onset Muscle Soreness (DOMS).
How to Tell the Difference?Your physiotherapist will be your best option for an efficient and accurate diagnosis between the two conditions, however, there are some simple factors to help piece together your injury when it comes to deciding whether or not to consult help. DOMS is more unpleasant when commencing a movement but eases as the muscle is warmed up, whereas a muscle injury will reproduce pain with any movement of the injured muscle. The most definitive factor is taking a detailed history of the injury. If pain was experienced during the event or immediately after, you are most likely looking at a muscle injury. If the pain is worst the day after and gets worse over the following days, you are most likely dealing with DOMS.
What to Do if You Have DOMS or a Muscle Injury?If you suspect you have a muscle injury, it is best to consult your physiotherapist earlier rather than later. A thorough assessment is required to ascertain what exactly it is you have injured and start rehabilitation immediately to help minimise your time out of the sport! If you suspect you have DOMS, you need to avoid therapeutic interventions that increase muscle pain (e.g. excessive stretching, deep tissue massage) and vigorous physical activity should be postponed until resolution of pain and restoration of function due to:
- Decreased shock absorption
- Decreased coordination of muscle sequencing motion
- Compensatory recruitment of uninjured muscle groups
- Increased relative work intensity of the affected muscles at the same workload
- Altered strength balance of agonist and antagonist groups
- Inaccurate perception of functional deficits
1. Post-Run NutritionAfter 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.
CarbohydratesWithin 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.
ProteinIntense 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.
RehydrationIt 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 ExerciseLow-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 RecoveryWays 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 MassageA 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. IceThere 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. SleepA 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.
- 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 PhasesThe 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 FactorsThe 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.
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 TreatmentTendinopathies 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 SportEvery 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 PreventionTo 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 PrognosisWhile 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 the PhysioWorks Difference?You'll be impressed with the experienced physiotherapists, massage therapists and reception staff who represent PhysioWorks. To ensure that we remain highly qualified, we are committed to participating in continuing education to provide optimal care. If you've been searching for health practitioners with a serious interest in your rehabilitation or injury prevention program, our staff have either participated or are still participating in competitive sports at a representative level. We also currently provide physiotherapy and massage services for numerous sports clubs. Our experience helps us understand what you need to do to safely and quickly return to youryouryour sporting field, home duties, or employment.
How You'll Benefit from the PhysioWorks Difference?At PhysioWorks physiotherapy and massage clinics, we strive to offer our clients quick, effective and long-lasting results by providing high-quality treatment. We aim to get you better quicker in a friendly and caring environment conducive to successful healing. With many years of clinical experience, our friendly service and quality treatment is a benchmark not only in Brisbane but Australia-wide.
What are Some of the BIG Differences?Our therapists pride themselves on keeping up to date with the latest research and treatment skills to ensure that they provide you with the most advantageous treatment methods. They are continually updating their knowledge via seminars, conferences, workshops, scientific journals etc. Not only will you receive a detailed consultation, but we offer long-term solutions, not just quick fixes that in reality, only last for a short time. We attempt to treat the cause, not just the symptoms. PhysioWorks clinics are modern thinking. Not only in their appearance but in the equipment we use and in our therapists' knowledge. Our staff care about you! We are always willing to go that 'extra mile' to guarantee that we cater to our clients' unique needs. All in all, we feel that your chances of the correct diagnosis, the most effective treatment and the best outcomes are all the better at PhysioWorks.
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. 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 UsesMastitis 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!
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
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 InjuriesIn the adolescent leg, common injuries include:
Osgood-Schlatter's DiseasePain 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 DiseasePain 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 PainAnterior 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 LigamentsThe 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) injuriesThis 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 injuriesYour 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 DiseaseHeel 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 SprainAn 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 issues More info: Sprained Ankle
Patellar InstabilityPatellar (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 DissecansSeparation 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 FracturesA 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.
Image source: https://radiologyassistant.nl/pediatrics/hip/hip-pathology-in-childrenAn 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
- Osgood Schlatter's Disease
- Sinding Larsen Johannson Disease
- Patellofemoral Pain Syndrome
- Patella Dislocation
- Meniscus Tear
- Discoid Meniscus
- Juvenile Osteochondritis Dissecans
Heel & Ankle
Common Youth & Teenager Sports InjuriesCommon Youth Neck & Back Pain Common 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.
- All Private Health Insurance Funds including BUPA, Medibank Private, HCF
- For a full list of Hicaps instant claim funds see here: Hicaps Funds
- HCF More for Muscles Program
PhysioWorks practitioners are registered providers for government, Workcover and insurance companies including:
- Australia Post; Coles Myer; Woolworths
- Department of Veterans' Affairs
- CTP & Sports Insurers