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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.

The Role of Manual Therapies in Preventing Overtraining at Active Balance Here at Active Balance, we understand that the pursuit of fitness and peak performance can sometimes lead to the dark side of training: overtraining . While pushing one's limits is part of the journey to better health, overtraining can lead to decreased performance, increased injury risk, and a host of other physical and mental health issues. This is where manual therapies, including physiotherapy, remedial massage, and myotherapy, become invaluable tools in your fitness regimen. Let's delve into how these therapies can help prevent overtraining. Understanding Overtraining: Overtraining syndrome occurs when the body does not have enough time to recover from the stress of training, leading to: - Persistent fatigue - Decreased performance despite increased effort - Increased susceptibility to injuries - Mood disturbances - Sleep disturbances How Manual Therapies Help: 1. Physiotherapy: - Recovery Enhancement: Physiotherapists at Active Balance assess and design recovery protocols that include specific exercises, stretches, and mobilisation techniques that aid in quicker recovery between sessions, reducing the chance of overtraining. - Injury Prevention: By addressing biomechanical issues and muscle imbalances, physiotherapy helps prevent injuries that might occur due to the repetitive stress of training. - Education: Our physiotherapists educate on the importance of rest, recovery, and balanced training, helping athletes understand their body's signals for overtraining. 2. Remedial Massage: - Muscle Recovery: Remedial massage at Active Balance targets muscle tissue, improving blood flow, reducing muscle tension, and breaking down scar tissue or adhesions that can form from overuse. - Stress Reduction: Physical stress from overtraining can be compounded by psychological stress. Massage therapy helps in reducing cortisol levels, promoting relaxation and mental recovery. - Pain Management: By managing pain and soreness, remedial massage can prevent the cycle where pain leads to compensatory movements or overcompensation in other muscle groups, which can lead to further issues. 3. Myotherapy: - Trigger Point Therapy: Myotherapists at Active Balance specialise in finding and treating trigger points, which are often the result of repetitive strain and can lead to pain and decreased performance if not addressed. - Nerve Mobilisation: Overtraining can cause nerve irritation or entrapment. Myotherapy techniques can help mobilize nerves, reducing symptoms like numbness, tingling, or pain that can halt training. - Muscle Function: By improving muscle function through focused manual therapy, myotherapists help in maintaining muscle balance, which is crucial in preventing the compensatory patterns that lead to overtraining injuries. Integrating Manual Therapies into Your Routine: - Regular Sessions: Schedule regular sessions with our therapists at Active Balance to keep your body in check, especially during periods of intensified training. - Post-Event Recovery: After competitions or intense training blocks, consider manual therapy as part of your recovery strategy to return to normal training without the risk of overtraining. - Listening to Your Body: Manual therapy sessions provide an opportunity to discuss symptoms of overtraining, allowing for adjustments in your training plan. - Combining Therapies: Often, a combination of physiotherapy, remedial massage, and myotherapy can be more effective than any single therapy in managing and preventing overtraining. Conclusion: At Active Balance, we're committed to not just treating injuries but preventing them. Manual therapies play a critical role in this preventative approach by ensuring your body is ready for the demands of your training, both physically and mentally. By incorporating these therapies into your training regime, you're not only investing in recovery but also in the sustainability of your training, leading to better performance and longevity in your sport or fitness activity. Book an appointment with us to explore how we can tailor a manual therapy plan to keep you balanced, preventing the pitfalls of overtraining. Remember, the goal is not just to train harder but to train smarter.

Strain vs Sprain: Understanding the Differences