Month: July 2014

The Patellar tendon joins the lower end of the knee cap to the top of the shin bone. Acute inflammation of this tendon is known as patellar tendonitis. If this is managed appropriately, symptoms should improve within 6 weeks. Assessment by a chartered physiotherapist to address the reason for the acute inflammation e.g. muscle imbalance, biomechanical problem, training error etc is advisable so that the injury does not become more chronic (lasting more than 6 weeks). When pain below the knee cap persists beyond 6 weeks, one possible cause is patellar tendinopathy. Tendinopathy (or tendonosis) means that inflammation in the tendon is no longer present but the tendon shows signs of microscopic degeneration. Many factors can contribute to patellar tendinopathy e.g. overuse, strength imbalance between various muscles, postural mal-alignment of the lower limb, biomechanical foot type, reduced ankle movement and lack of muscle strength or flexibility. At Iona Physiotherapy, we will first take a detailed history e.g. how long the pain has been present, your training regime etc before undertaking a comprehensive biomechanical and physical assessment with regard to the above possible causes. Treatment will include addressing any of the factors that are causing excessive load on the tendon and a progressive strengthening programme. There is a specific type of exercise that has been shown in research to rehabilitate tendinopathy (reversing degenerative changes) and help you return to your sport/activity, which is known as eccentric training

Groin pain can become chronic (lasting for more than 3 months or recurrently presenting) for some athletes. A small percentage of this will have a hernia that may require surgical repair (Gilmore’s Groin) but the majority have a collection of non-structural groin problems that will respond to comprehensive rehabilitation.

Bone, ligamentous, tendinous or muscular pain can all occur individually or collectively. The common factor at play is ‘abnormal tension’ on the groin. This may be due to over-training, poor flexibility, poor core control or poor gluteal muscle control.

At IONA Physiotherapy, a detailed assessment of your training regime and physical factors will be undertaken. Sometimes, diagnostic imaging (MRI) may be required to assist in treatment decisions, but in the majority of cases, surgical referral is not considered until conservative management has failed to resolve your symptoms.

Rehabilitation will follow (link to groin strain) and temporary ‘relative’ rest may be necessary to get the symptoms under control and allow progressive rehab.

‘Relative’ rest simply means looking at all training / sporting activities and reducing the most provocative elements to get you down to the point where no symptoms are produced during activity. Total rest does not work – you may not feel pain while you rest, but often the symptoms re-appear more severely when you recommence your sport.

Certain sports carry with them a risk of acute groin injury/ groin strain. Sports such as GAA, soccer and rugby that involve running, kicking and fast change in direction, carry an increased risk of groin injury compared to repetitive sports like swimming or cycling.
The most common muscle involved is the Adductor Longus and if this is strained, sudden pain will be felt on the inside thigh up to the groin. Often these injuries are very straightforward to diagnose and treat. A thorough history taking and physical exam can usually identify the injured structure.

Treatment will involve advice to rest, ice, compression and protection (taping or brace) to treat the initial pain and swelling and importantly, prevent any further injury from occurring. Strapping can be very effective in the first few days for pain relief. Manual therapy and exercise will follow. Exercise focused towards stretching long-term muscle tightness in the area and strengthening primarily gluteal and core muscles and later, adductor muscles.

Manual therapy (massage) will be used if indicated by the presence of increased adductor muscle tone in the early days or shortened scar tissue a number of weeks later. The key theme of your rehab for a groin strain will be building the blocks towards a safe return to your sport and preventing a similar injury occurring in the future.

Osteoarthritis (OA) commonly affects the hip joint. Pain and stiffness are the most common symptoms, although a ‘creaking’ sound (crepitus) can be heard later on for some people. Pain can be felt in the groin, the thigh or buttock.
Occasionally, hip joint OA may even present exclusively with pain in the knee and not the hip! As OA involves degeneration of the joint cartilage, pain is primarily provoked by loading the joint, for example, bearing weight during running or walking.

Stiffness tends to be worst in the morning time or after a prolonged period sitting e.g. at a desk job or after a long car journey.

OA is a condition that needs to be managed and conservative treatment is enough for many people to help them do so. The focus of treatment is on optimising your quality of life and conserving the joint for as long as possible. Conservative (non-surgical) treatment includes the following:

• Exercise – research supports exercise as the most important element of treatment. Exercise prescription will be bespoke, depending on your physical assessment but the most common elements for people with hip OA include mobility exercises (stretches or Yoga) and strengthening exercises for anti-gravity muscles that protect the joint (gluteal and core muscles).
• Analysing your current lifestyle and suggesting modifications that lead to less load on the joint. Examples include changing sporting activity from long-distance running to swimming or, in the case of a less active individual for whom walking has become painful, introducing a walking stick to reduce pain and foster a better walking pattern.
• Manual Therapy – may be useful to assist with pain relief or improving mobility. It is possible to regain some mobility, particularly in the early stages of OA.
• Medication – pharmacological management can improve quality of life for people with hip OA and should be discussed, in detail, with your GP.

After a trial of conservative treatment, if your hip OA symptoms are not responsive, it may become appropriate to discuss the timing of referral to an orthopaedic surgeon, for consideration of hip surgery.

There are many different types of arthritis and osteoarthritis is the most common type of arthritis at the knee. Osteoarthritis involves the gradual degeneration of a joint, whereby the cartilage gradually wears away -which is why osteoarthritis is often referred to as “wear and tear.”
Symptoms include pain and stiffness after rest, pain after activity, swelling and loss of movement. In fact, stiffness in the morning (after bed rest) is a common feature of osteoarthritis.

At IONA Physiotherapy, following a detailed history, your assessment will include gait analysis (looking at how you walk), checking for any swelling, assessment of your range of motion, lower limb flexibility, your lower limb muscle strength and other specific knee tests if indicated.

Treatment may include manual therapy to improve movement and reduce pain, an exercise programme to improve muscle strength/flexibility and possibly advice regarding the use of a stick.

If swelling is present, you may need to use ice to help reduce the swelling and your G.P. may have prescribed NSAID’s (non steroidal anti- inflammatory drugs.)

If the osteoarthritis is advanced, then an arthroscopy (key hole surgery) or a knee replacement may be required. After your surgery, you will require physiotherapy to restore normal movement, strength and function.

Patellofemoral pain syndrome (pain behind the knee cap) is a common problem in runners, cyclists and those involved in jumping activities.
The pain may be caused by abnormal forces behind the knee cap or training error. The patella is a sesamoid bone (floating bone) within the quadriceps muscle and many factors, such as weak gluteal and quadriceps muscles or suboptimal foot biomechanics can alter it’s tracking. It is the altered tracking, which leads to abnormal forces behind the patella which causes the pain. Women are more prone to patellofemoral pain syndrome due to the shape of the female pelvis. Symptoms often include knee pain walking up or down stairs, with running/ jumping and prolonged sitting.

At IONA Physiotherapy, you will receive a thorough assessment, which will include a biomechanical assessment of your whole lower limb, including your hip, knee and foot. Such a biomechanical assessment is crucial to determine the cause of your patellofemoral pain syndrome.

Treatment will depend on the specific reason for your patellofemoral pain but may include a strengthening or stretching programme, manual therapy, advice regarding footwear, orthotics (if required)and advice regarding your specific training regime. It is helpful if you can bring your shoes and sports footwear with you for your first appointment if you have knee pain.

In between the femur (thigh bone) and the tibia (shin bone) are two C shaped pieces of a tough type of cartilage (fibrocartilage) called the medial and lateral meniscus.
These act as shock absorbers in the knee. The one on the inside of the knee (medial meniscus) is more commonly injured than the one on the outside of the knee (lateral meniscus).

A meniscal injury may occur as a result of trauma (often a twisting type injury) or due to degenerative changes (wear and tear.) Often when people say that they have “torn cartilage” in their knee, they mean that they have a meniscal injury or tear of the meniscus in the knee. Sports involving twisting type movements such as soccer or gaelic football are common causes of meniscal injury at the knee.

Symptoms often include, pain, swelling and sometimes locking or giving way.

Assessment at IONA Physiotherapy will include specific tests to your knee to assess the likelihood of an meniscal injury. Small tears usually respond well with physiotherapy, however a larger tear may require an arthroscopy (key hole surgery.) You will need to be seen by a chartered physiotherapist after your surgery to ensure that your range of movement, muscle strength and function returns to normal.

• Collateral ligaments: The MCL (medial collateral ligament) is located on the inside of the knee, while the LCL (lateral collateral ligament) is located on the outside of the knee. These knee ligaments may be injured by a force to the side of the knee.
• Cruciate ligaments: these ligaments, as the name suggests are arranged in the shape of a cross relative to each other. The ACL (anterior cruciate ligament) is placed in front while the PCL (posterior cruciate ligament) is situated behind the ACL. ACL injuries are much more common than PCL injuries and are usually a non contact injury. Patients often describe a popping sensation in the knee followed by immediate pain and swelling.

Assessment at IONA Physiotherapy will include specific tests to help determine if you have injured one of these knee ligaments.

Treatment may include advice regarding control of swelling, exercises to strengthen the muscles around your knee to maximise stability, advice regarding taping or use of a knee brace, balance retraining and rehabilitation that is tailored to your sport. Referral to an orthopaedic surgeon and an MRI of your knee may be required.

Depending of the extent of the injury and your level of activity, sometimes surgery is advisable and you will need to attend physiotherapy after your surgery.

The most common type of knee fracture is of the patella (knee cap) but fractures of the ends of the femur (thigh bone) and tibia (shin bone) that make up the knee joint are other causes of knee fracture. Symptoms of knee fracture are likely to include pain, swelling and pain on weight bearing. A knee fracture will generally occur due to trauma. A common cause of fracure of the patella is a fall or a direct blow (such as a hockey stick or hurl)to the knee cap. Pedestrians hit by a car from the side can sustain a knee fracture at the tibia or femur.
Once your orthopaedic surgeon is satisfied that there is sufficient bone healing, you will need to commence physiotherapy. The initial focus during physiotherapy will be on regaining normal range of movement, but establishing a normal gait pattern and muscle strength is also very important.

Treatment may include manual therapy and massage to restore normal movement, gait re education and an exercise programme to restore normal movement, strength and function. If you play sport, you will receive a rehabilitation programme tailored for you, designed to return you to your specific activity.