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If you’re a runner dealing with pain at the front of your hip, you may have assumed it’s a strained or overused hip flexor. After all, that’s the go-to explanation, right? Not so fast. While the hip flexors are often blamed, true hip flexor tendinopathy or strain is less common than you might think - especially if your pain shows up during specific parts of your run. Let’s take a quick look at the biomechanics of running. During the stance phase - when your foot is in contact with the ground - the hip flexors are not highly active. Instead, they’re most engaged during the early swing phase, when your leg is moving forward and off the ground. So if your pain is triggered during foot strike or while loading the leg, it’s unlikely your hip flexors are the root cause. However, we also need to look at the type of running you are doing. If you are a sprinter, this may be the case. But, in the general population and recreational athletes, we see endurance runners. Where the activity of the hip flexors is significantly reduced compared to sprinters. This raises the question: What else could be causing that anterior hip pain? One common culprit in endurance runners is bone stress injury, such as a femoral neck stress reaction or stress fracture. These injuries can irritate or inflame nearby tissues, including the hip flexor tendon, which might explain why you feel pain in that area - even if the tendon isn’t the source of the issue. In other words, your hip flexor might be hurting, but that doesn’t mean it’s injured. Other possible causes of anterior hip pain include: • Labral pathology • Femoroacetabular impingement (FAI) • Iliopsoas bursitis • Referred pain from the lower back or pelvis If your pain worsens with impact, persists after runs, or doesn’t improve within a day or two, it’s worth seeking evaluation. A Physiotherapist can assess movement patterns, strength imbalances, and structural contributors that may be driving your symptoms to help determine the best treatment forward. In short: Don’t be too quick to blame the hip flexors. Anterior hip pain in runners is often more complex and deserves a deeper look to ensure proper treatment. Struggling with hip and don't know where to start? Book an assessment with one of our physios today!

If you’ve ever started a new training program or increased your running distance, you might have felt a dull ache or sharp pain along the front of your shin. This is commonly referred to as shin splints. But, did you know that shin splints aren’t actually one single condition? The term shin splints is more of an umbrella phrase used to describe pain in the shin area from a variety of causes. Let’s break it down. Why Do Shin Splints Occur? Shin splints usually develop from overuse or overload of the muscles, tendons, and bones in the lower leg. Contributing factors can include: • Sudden increase in training load (more running, higher intensity, or harder surfaces) • Poor footwear that doesn’t provide adequate support • Biomechanical issues, such as flat feet, high arches, or weak hip/core muscles • Repetitive impact activities like running, jumping, or dancing • Training surfaces like hard concrete, uneven ground, or too much treadmill running can increase stress • Insufficient recovery between sessions In simple terms, shin splints happen when your body isn’t keeping up with the demands being placed on it. Front vs Inside Shin Pain Not all shin splints feel the same — where your pain is located can give clues about the underlying cause: Pain on the Inside of the Shin (Medial Shin) • Most often Medial Tibial Stress Syndrome (MTSS) • Feels like a dull ache or soreness along the inner edge of the shin bone • Caused by irritation where muscles attach to the tibia • Common in runners and people who suddenly increase training load Pain on the Front of the Shin (Anterior Shin) This can come from a few different causes: • Tibialis anterior overload/tendinopathy, e.i. pain along the outer front of the shin, worse when lifting the foot (e.g., during running or uphill walking). • Stress reaction or stress fracture → sharp, pinpoint pain on the front of the shin bone that worsens with impact and may linger at rest. • Chronic Exertional Compartment Syndrome (CECS) → cramping, tightness, or pressure at the front of the shin during exercise, easing with rest. Sometimes accompanied by numbness or weakness in the foot. In short: inside shin pain = usually muscle overload (MTSS), front shin pain = can be muscle, bone, or compartment-related. The Different Types of Shin Splints “Shin splints” isn’t a diagnosis on its own. It’s a general term that can include several different conditions: Medial Tibial Stress Syndrome (MTSS) The most common type of shin splints. Pain is felt along the inside edge of the shinbone (tibia) and is usually caused by irritation of the muscles and tissues that attach there. Stress Reactions and Stress Fractures If overload continues, the shin bone itself can develop tiny cracks called stress fractures. Pain is usually sharp, more localised, and worsens with impact. Chronic Exertional Compartment Syndrome (CECS) A less common condition where muscle swelling during exercise is restricted by tight surrounding tissue, causing cramping, pain, or tightness that eases with rest Other Causes: Tendinopathies (e.g. tibialis anterior tendinopathy) Nerve irritation Vascular issues (rare) Because there are so many possible causes, a professional assessment is needed. Treatment and Management of Shin Splints The right treatment depends on the cause, but general approaches include: Short-Term Relief • Relative rest: Swap running/jumping for cycling, swimming, or other low-impact options. • Manual therapies: treatments like massage, dry needling, cupping, and joint mobilisation can help ease tight muscles, improve blood flow, and reduce pain. • Footwear check: Supportive, activity-appropriate shoes are key. • Surface change: e.g. move from running on concrete to grass to reduce impact. Rehabilitation and Prevention • Strength training: Focus on calves, shins, hips, and trunk for better load tolerance. • Mobility work: Work to improve ankle mobility & flexibility of the muscles around the ankles. • Load management: Gradually increase running distance and intensity (no more than ~10% per week). • Surface check: Where possible, run on softer, varied surfaces like grass or trails rather than always on hard concrete. • Training variety: Mix impact and non-impact workouts to reduce repetitive stress. When to Worry About Stress Fractures While many cases of shin splints settle with rest and rehab, stress fractures require more caution. You should seek assessment if you notice: • Sharp, pinpoint pain in one spot on the shin • Pain that worsens the more you exercise • Pain that lingers at rest or at night • Swelling or tenderness over the bone Stress fractures usually need a longer period of rest, medical imaging, and a carefully guided return to sport. Final Thoughts Shin splints are very common, especially in runners and athletes, but they’re not always straightforward. Because shin pain can stem from issues like MTSS, stress fractures, or compartment syndrome, getting a clear diagnosis is key. The good news is, with the right combination of rest, manual therapies, strength training, load management, and recovery strategies, most people make a full return to activity. If you’ve been struggling with shin pain, or you’re worried about the possibility of a stress fracture, book an assessment with your physiotherapist. The sooner we can get to the root of the problem, the quicker you can get back to pain-free movement.

Hey everyone, This time of year, in the middle of winter sports and running events, we often see a surge of knee-related issues walking (and sometimes hobbling) into the clinic. One of the most common conditions we treat is patellofemoral pain syndrome (PFPS) or “Runner’s Knee”. So, let’s take a moment to dive into what it is, why it happens, and how we can help you manage it. What Is Patellofemoral Pain Syndrome? PFPS is a broad term used to describe pain at the front of the knee, typically felt under or around the kneecap. It is particularly common in active individuals, especially those who frequently run, jump, or squat. Due to its prevalence among runners, it is often referred to as runner’s knee. Activities involving repeated knee movement, as well as prolonged immobility, can aggravate the discomfort. Those with PFPS may experience sensations such as clicking, grinding, or rubbing around the kneecap, and the pain can sometimes be triggered by applying pressure to the area. If any of this sounds familiar, keep reading! What Causes PFPS? PFPS can be caused by trauma to the front of the knee, but there’s usually not a single cause. Instead, PFPS tends to result from a combination of factors, such as: • Muscular imbalances (e.g. weakness or tightness) • Restricted joint mobility • Repetitive or excessive loading through the knee • Anatomical factors We also look beyond the knee as issues at the hip and ankle can significantly contribute to PFPS symptoms. For example, reduced ankle dorsiflexion can shift forces abnormally through the knee, increasing stress on the body and altering movement patterns; hence ultimately resulting in PFPS. How We Assess It at Active Balance Physio & Wellness At our clinic, we take a holistic approach to evaluating and treating PFPS. Our assessments go beyond just the knee—we look at strength, flexibility, joint mobility, and overall movement patterns throughout the entire lower limb. We combine standard physiotherapy assessment techniques with advanced technology when appropriate, such as VALD Force Decks and Dynamometers. Keep an eye out for upcoming posts where we’ll dive deeper into how the Vald Force Decks work! This thorough evaluation helps us accurately identify conditions like patellofemoral pain syndrome (PFPS) and tailor an effective treatment plan. How We Treat Patellofemoral Pain Treatment is always tailored to the individual, but typically includes: 1. Load Management We help you reduce aggravating movements temporarily while staying active in a way that supports recovery. Taping techniques, such as McConnell taping , can also help offload the patellofemoral joint (joint underneath the kneecap) and ease symptoms. 2. Strengthening & Mobility Work You’ll learn self-management techniques, including: • Foam rolling • Targeted mobility exercises • Personalised strengthening program designed to improve muscular balance and enhance joint control 3. Manual Therapy This may include massage, dry needling, and/or joint mobilisations to ease pain and improve your movement quality; setting the stage for effective exercise and return to activity. Experiencing These Symptoms? If you think that you’re experiencing PSFS, you don’t have to keep pushing through the pain. Book an appointment with us at Active Balance Physio & Wellness. We’re here to help you move better, feel better, and get back to doing what you love. Feel free to contact us via our website, email, or phone number, 0450877731.

Is it normal to be sore after Myotherapy Treatment During and immediately after treatment During the initial 15-30 minutes of myotherapy treatment, pain inhibition and movement facilitation will occur. In the later stages of treatment (greater than or equal to 15-30 minutes), analgesia with inhibition of autonomic and motor functions will occur. The result will be sympathoinhibition and muscular relaxation. Vasodilatation in the injured muscle tissue will also occur, promoting the normal healing processes. The resulting response after treatment are varying degrees of fatigue, disorientation, lethargy and relaxation. Often patients will state that they feel "high" post treatment. There is also a cutaneous reddening of the skin and a sudomotor reaction which creates an increase in perspiration over the entire body. 12 Hours Post Treatment The immediate post-myotherapy responses subside after a few hours. Roughly 12 - 72 post treatment, the patient will feel muscular aching which feels similar to delayed onset muscle soreness. The intensity of the muscle soreness varies depending upon the chronicity of the condition. The more chronic the pathology, the more intense the muscle soreness and the longer it lasts. Clinically it is not unusual for patients to report a return of the original injury acute symptoms, i.e., return of arm or leg pain or paresthesia that has been absent. Management With continued treatment, the post-myotherapy local soreness lessens with a concomitant drop in pain complaint and an increase in pain-free function. With treatment once every 10-14 days (needed to allow the body to go through the acute healing processes), the superficial muscle hardening decreases, allowing treatment of the deeper muscle hardening which clinically appears to be the chief cause of pain. On many occasions, a patient's symptoms including paresthesia and referred pain is reproduced when the pathological muscle hardening is located. A stretching program is initiated to facilitate a continued increase in circulation and to promote lengthening of shortened muscles and related soft tissues. It is important to note that the techniques should stretch as much of the anatomical muscular chain as possible. Stretching individual muscles does not appear to be as effective. Once the muscles are able to shorten and lengthen without stimulating the nociceptors, the patient will have less pain when functioning or performing therapeutic exercises. At this point, a comprehensive reconditioning program can be initiated to deal with the usual physical deconditioning that affects the chronic pain patient. Continued myotherapy visits of increasing intervals between treatments as the muscle hardening decreases is recommended to completely treat the individual and restore function.

Is high-intensity impact and resistance training safe for osteoporosis? Osteoporosis makes bones weak and prone to fractures, leading many to believe that gentle, low-impact exercises are the only safe option. Yet, recent studies, such as the notable LIFTMOR research, challenge this assumption, suggesting that high-intensity impact and resistance training could be not just safe but beneficial for individuals with this condition. The main concern with high-intensity exercise for those with osteoporosis has been the heightened risk of fractures. But bones adapt and strengthen in response to stress. The LIFTMOR study, conducted with postmenopausal women with low bone mass, demonstrated that with appropriate supervision, high-intensity training can significantly improve bone density and reduce the risk of injury. The LIFTMOR research provided evidence that high-intensity progressive resistance training (HiPRT), paired with impact loading, improved bone density and functional performance in a safe manner. This finding indicates that high-intensity training, under careful guidance, can be a potent intervention for osteoporosis. Professional supervision is key to safely introducing high-intensity exercises. Exercise physiologists are trained to design individualized exercise plans, considering the extent of bone density reduction and overall health. A safe introduction to high-intensity impact and resistance training involves thorough assessments—understanding your health and bone density is essential for customizing your exercise program. Gradually increasing exercise intensity allows the body to build strength and adapt safely. Correct exercise form is crucial to reduce injury risk and ensure the effectiveness of the exercise. Regular reviews of your exercise response facilitate timely adjustments to the program. Guided and informed by health professionals, high-intensity impact and resistance training can be integrated into an osteoporosis management plan. The LIFTMOR study’s insights provide a new perspective on how exercise can be used to manage and potentially improve bone health and function.

What is it? Iliotibial band syndrome is where a tendon called the iliotibial band gets irritated or swollen from rubbing against your hip or knee bones. The tendon is on the outside of your leg, and it goes from the top of your pelvic bone down to your knee. It rubs against your bones when it gets too tense/overworked. It then can create knee pain on the outside of your knee. In clinic we have seen this issue commonly in longer distance runners, but can also occur in other sports such as: Basketball players. Cyclists. Hockey players. Runners. Skiers. Soccer players What does it feel like? Symptoms may include: Sharp pain on the outside of your knee A dull ache after activity Clicking or snapping on your hip or knee Warmth and redness on the outside of your knee Hip pain What causes it? Common causes of ITB syndrome include: Excessive foot pronation - where your foot rolls in too much during your walking / running cycle creating over stretching of the ITB. Hip abductor weakness - weakness in your glute muscles can allow your knee to collapse in slightly which puts more pressure on the ITB. Increasing speed too quickly during running Running downhill or undulated surfaces Having worn out running shoes How can I reduce my risk of developing ITB syndrome Avoid running up or down a hill or any slanted surface. Make sure you have the right technique no matter what activity you do. Shift training intensity gradually. Slowly speed up when you’re bicycling instead of suddenly switching from slow to fast (or fast to slow). Slowly warm up and slowly cool down. Wear supportive shoes Treatment and management of ITB syndrome The treatment of ITBS is usually non-operative, and physiotherapy should be considered the first and best line of treatment. Typically completely avoiding aggravating activity (running or cycling) for 3-6 weeks while building up the strength other the hip and knee muscles during this time. Myofascial treatment can be effective in reducing the pain experience in acute phase, when pain and inflammation in the insertion is felt. The trigger points in Biceps femoris, vastus lateralis, gluteus maximus, and tensor fascia latae muscles will be addressed by a myofascial treatment. Exercises to strengthen the abductor muscles and stabilise the hip can be helpful if clinically indicated. ITB syndrome can be a challenging one to get on top of, however if you think you’re suffering and not sure where to go from here, reach out to the clinic and we can give you some assistance !

An ankle sprain is a common athletic injury and about 20% of acute ankle sprain patients develop chronic ankle instability. Following an acute ankle sprain, deficits in postural control, proprioception, muscle reaction time and strength typically occur, and when these deficits aren’t addressed, this can lead to chronic ankle instability (CAI). Typically if you are unable to complete jumping and landing tasks within 2 weeks of a first time ankle sprain and have lower postural control, you are more at risk of developing a CAI outcome. Chronic ankle instability includes a “loose” ankle (lots of motion occurring at the ankle), and feelings of instability with reduced calf strength and proprioception. How do I know if I have chronic ankle instability? Typically a client will have a history of ankle sprains, report not much rehabilitation after ankle sprain occurring, a dependence on bracing when playing sports, and typically take other precautions against weight bearing, strenuous activities and walking on uneven surfaces. Other symptoms might include ankle stiffness or aching, especially after activities that require a lot of load through the ankle. What do we typically see with chronic ankle instability? Clients will typically have calf strength deficits, possibly poor hip control, reduced balance - both static and dynamic, and reduced ability to hop. What can I do about it or what does conservative management look like? Chronic ankle instability deficits might look different for different people but typically we will: Start off with some balance work Begin strengthening through the calf and hip and progressively load this. We might also brace or tape a client if they have to return to high risk activity (such as jumping and change of direction sports) initially while we build their strength back up. We will then begin some plyo and jumping work to start working on their shock absorption and building some stability. Have any questions about chronic ankle instability, or think this might be you? Give us a call and one of our physiotherapists will be happy to assist.