KARIONG PHYSIOTHERAPY

What is the Rotator Cuff

5/5/2025

What is a rotator cuff?
The rotator cuff are a group of four small muscles around the scapula (shoulder blade). These muscles have two actions – rotation of the shoulder, and holding the bones that make up the shoulder together to add stability to the joint.

How do they tear?
Rotator cuff tears usually come about when the shoulder sustains a sudden stretch or is over exerted such as a heavy lift or throwing manoeuvre. The tendons of these muscles can become torn over time, particularly if someone is very active or does a lot of manual lifting.

Why does my shoulder suddenly hurt?
Rotator cuff tears may be present for years without causing any pain or limitation. It is usually after a sudden increase in load eg. starting a new workout routine, a new sport, or after long periods of heavy load on the shoulder eg manual labour and the tendons become irritated and start to cause pain.

Does a tear repair?
The tear itself may never repair, although it is possible. Many shoulders, when imaged will have some degree of degenerative tears, regardless of pain or other symptoms. The goal of physiotherapy treatment is to strengthen around the tear to allow the intact portion of the muscle to compensate.

If it doesn’t repair, then how do I fix my shoulder?
Physios can conduct a physical assessment and use that information in combination with your description of your symptoms to determine the cause of your shoulder pain.
If part of a rotator cuff is torn, a physio can work with you to strengthen the remaining fibres of that muscle and tendon, as well as the other muscles in the system. Working with you, your physio will create an exercise program that combines exercises to settle pain, targeted strengthening specifically for the four rotator cuff muscles, and functional strengthening for the entire shoulder complex.

If you have been struggling with a sore shoulder get in touch and let us help you

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What is Bursitis?

2/19/2025

What is it?
Bursitis is a common condition that occurs when a bursa, a small fluid-filled sac that sits between muscles, tendons, and bones, becomes irritated and inflamed. These sacs play a crucial role in cushioning and reducing friction. Bursitis often develops secondary to another condition such as impingement or tendinopathy.

My scans showed bursitis – is this why my joint hurts?
Even if bursitis is identified on imaging tests such as ultrasounds, it may not always be the primary source of pain. In most cases, bursitis is secondary to an underlying cause, such as tendinopathy. It is also worth noting that thickened bursas are commonly found in non-painful hips and shoulders. A recent study found that 78% of non-painful shoulders had some degree of bursal thickening when imaged. This is because the thickening of a bursa can be an adaptive mechanism to deal with extra demands – like getting calluses on your hands.

Do I need a cortisone injection?
As a powerful anti-inflammatory, cortisone can provide short-term relief and make movement more comfortable. Cortisone can be helpful when the pain is especially intense and you are unable to perform physiotherapy exercise. However, it’s important to note that cortisone does not address the underlying cause of the pain, and symptoms often return once the medicine wears off.

Can physiotherapy help?
Physiotherapy plays a pivotal role in managing bursitis and addressing the root cause. The treatment approach will vary depending on the cause, but it typically includes a combination of manual therapy, strengthening exercises, and strategies to manage physical load. Physiotherapists also emphasise educating patients about their condition, enabling them to take an active role in their recovery and prevent future issues.

Do I still need physiotherapy if I have a cortisone shot?
Even if cortisone provides temporary relief, physiotherapy is essential for long-term recovery. Without physiotherapy to address the underlying cause of the bursitis, pain is very likely to return once the effects of cortisone fade. Combining both approaches ensures a comprehensive treatment plan that addresses both the symptoms and the root cause of bursitis.

If you’re struggling with pain from bursitis and want to address the underlying cause of your pain, talking to a physiotherapist is an important first step. With our guidance and a personalised treatment plan, you can address the source of your pain, improve your mobility, and reduce the risk of recurrence.

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What is Osteoarthritis?

2/9/2025

What is it?

OA usually presents as an ache in the joint that made worse with a lot of activity or long periods of stillness.
Osteoarthritis is often described as wear and tear of the cartilage inside joints, although this can be a helpful analogy when talking about the condition, it is often not the whole story.
Osteoarthritis (OA) is usually something that builds up over time and can become more or less painful with sudden changes to activity.

What Causes OA?

Researchers are not certain what causes osteoarthritis. There are a number of risk factors, such as age, trauma or surgery to the joint, and a family history of OA. Over-use or repetitive use of a joint is though to play some role in the development of the condition. However, experts believe the benefit of activity far outweighs the possible risk of developing OA and that exercise can sometimes even be protective against osteoarthritis.

Do I need to stop exercising?

No, in fact, well prescribed exercise is how the condition is treated. While your symptoms are especially flared up, you may need to reduce weight-bearing exercise such as walking or running, while you work with a physio to settle your pain and begin to strengthen your knee. You physio can also work with you to find alternative exercise and activities, such cycling or swimming, while your pain settles.

Can it be fixed?

While the cartilage itself may not improve when looked at on x-rays, pain levels can be improved significantly with activity modification, strength and mobility exercises. Specific exercise to improve strength of the muscles surrounding the knee will improve the body’s ability to adsorb shock through the muscles rather than the joint itself.

If you think you might have OA get in touch with us as let us see how we can help!

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Why Does My Hip Hurt?

1/15/2025

There can be many causes for hip pain. A common source of pain often seen in physiotherapy clinics is gluteal tendinopathy. This usually presents a deep ache in the back and/or side of the hip. This condition often feels stiff and sore in the morning and can be sharply aggravated by tasks such as increased walking, standing or climbing stairs.

What is it?
The gluteal muscles, or ‘gluts’, are a group of three muscles that sit around the hips. They are responsible for extending (lifting the leg backward) and abducting (lifting the leg to the side) the hip, as well maintaining stability during standing and walking. Like all muscles, they are attached to bone at either end via a tendon. At times these tendons can become irritated and inflamed which can cause pain, stiffness, and weakness.

Why?
Tendons become irritated and inflamed when they are over-worked, and the body can’t keep up. This can be a result of sudden increase in load such as standing, running, or other forms of physical activity. Sometimes there is no change to the amount of activity, but the body’s ability to recover has changed. This can be the case as we age or when there is a sudden change in hormones, particularly during menopause in women.

How is is diagnosed?
Physiotherapists are trained to assess pathology to determine the source of your symptoms. We use a combination of the subjective history (what you tell us), careful questioning, functional assessments and special tests to rule in and rule out different structures and pathologies.

Imaging such as x-rays or ultrasounds are rarely necessary or definitive in cases of suspected gluteal tendinopathy as these images often show that there are changes to these structures even when they are not the source of symptoms.

What can be done?

Once diagnosed the first goal is to bring the pain under control. This means reducing load on the specific tissue that has become aggravated. Very rarely is complete rest recommended and your physio can work with you to adapt your physical activity to reduce load while still maintaining as much as possible.

The next step is to gradually increase load on the tendon. It is important to build the tendon and muscle strength up in a controlled way. This will involve some fairly light glut specific exercises at first targeted at the gluteal muscles and then progressing to more challenging exercises.

If you have pain around your hip, either new or if it has been going on for a while, check in with us and we can help you figure out what is going on and create a management plan so that you can get back to what you want to do

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Lateral Ankle Sprains

1/6/2025

What is it?
A lateral ankle sprain is a very common injury that occurs when the foot rolls inward. This places force on the structures on the lateral side (outside) of the ankle. When this happens there can be damage to the soft tissue that supports that side of the ankle. This is commonly called rolling your ankle.

What have I injured?
There are a number of structures that may be damaged when rolling the ankle – bone, ligaments, muscles, and tendons. Through their assessment, your physio will identify which structures are likely to be injured.
Each of these injuries have different properties, different healing times, and management strategies.

How do I treat it?
Initially the goal is to protect and calm down pain without completely restricting movement. Treatment in the initial 24 to 48 hours includes:

Compression – this could be a bandage or a tubed bandage. The goal is to reduce swelling around the ankle. Ice is also sometimes suggested for swelling and may also help reduce the pain.

Protection – depending on the severity it is okay to begin some careful, gentle moving around. Using pain as a guide in the first few days is a good rule of thumb. Sometimes taping, a supportive brace or even a crutch can be helpful for day to day activity. In the absence of a fracture a CAM boot is very rarely necessary. Ask your physiotherapist about what will be most appropriate for you.
Ice – Ice doesn’t reduce swelling or promote healing as much as we once believed, but it may make a small difference and may also reduce some of the pain sensation.
Elevation – keep the foot up and let gravity do its work. If you are unable to walk around as normal your ankle will swell, by elevating the ankle any fluid or swelling in the ankle will start to drain toward the rest of the body.

After a day or two swelling and pain should start to subside This is the time to start some movement and exercise. Your physio will be able to help guide you through this process by providing appropriate exercises and support for your specific injury, this rehab program will likely include:

Range of motion - often pain and swelling result in a reduction in range of movement. This needs to be addressed as early as possible to ensure that there is no long term loss.
Strengthening - depending on the tissues involved, there may be a reduction in strength around the ankle that your physio will worth with you to improve.
Balance and proprioception - this is the often neglected part of ankle rehab the is the reason that an ankle still feels "not right", even years after the injury. Ligaments, muscles, and tendons are responsible for proprioception (the body's ability to know where it is in space). When there is an injury to these structures, this ability is impaired and does not improve without specific and deliberate rehabilitation.

How long will it take to get better?
It always depends on the severity, the tissues involved, and what you are looking to get back to doing. Your physiotherapist will work with you to get you back to what you want to do as quickly as possible while also doing so safely.

If not rehabbed properly the ankle can become unstable or weak. This can lead to pain, recurrent sprains, and functional impairments. A well tracked and progressed rehab program will ensure you get the best out of your body and prevent future ankle sprains.

If you have a new or ongoing ankle injury come have a chat to one of our physios to discuss the best way to manage it or progress your performance.

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Vertigo - BPPV

10/8/2024

What is it?

BPPV (benign paroxysmal positional vertigo) a very common cause of dizziness. It can be associated with trauma to the head or neck but often occurs without an obvious injury. It is caused by a disruption to the vestibular system – the organ in the inner ear which senses position and movement of the head. In this condition the small calcium crystals in the inner ear which help sense head position, called otoconia, become dislodged from one part of the vestibular system and begin to move around in another section. This means that the system senses motion even when the head is still, resulting in an uncomfortable dizzy sensation which can often feel like the room is spinning.

BPPV is characterised by feelings of dizziness or a sensation of the room spinning. This most often occurs after changing head position, very commonly when rolling over in bed or looking up. The feeling is often transient, resolving a minute or two after the head stops moving.

This dizziness can cause feelings of unsteadiness, loss of balance, or falling as well as nausea and even vomiting. Nystagmus – an involuntary, jerky eye movement – is also a common sign of BPPV as the eyes try to correct their position relative to the perceived head movement.

While uncomfortable, BPPV is rarely a sign of serious pathology but can become a safety risk if it causes loss of balance or falls.

Signs and Symptoms

Dizziness – particularly after changing head position
Feeling like the room is spinning
Loss of balance, unsteadiness causing falls
Nystagmus (abnormal eye movements)
Nausea
Vomiting

How can physio help?
After taking a thorough history, if your physio suspects you may have BPPV they will perform a clinical test, called the Hallpike-Dix manoeuvre. This test aims to reproduce symptoms in order to confirm the diagnosis. After the diagnosis is confirmed, your physio can perform a technique called the Epley manoeuvre in order to treat the condition. This technique involves moving the head and body through a series of positions which moves the otoconia back into the correct part of the vestibular system so that the vestibular system can work properly and stop your dizziness.

It is very common for the first treatment for BPPV to be effective, resulting in a complete resolution of symptoms. Your physio may also teach you how to perform this technique yourself at home if your symptoms recur. Your physio may also teach you some vestibular rehab exercises which can help retrain your vestibular system and improve your balance. These exercises focus on retraining eye movement control and balance training with the goal of helping you mange dizziness symptoms should they return.

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What is the Rotator Cuff

What is Bursitis?

What is Osteoarthritis?

Why Does My Hip Hurt?

Lateral Ankle Sprains

Vertigo - BPPV