Author: QBF Design

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.

Pronation is the normal way the foot rolls-inward when you walk or run. For some people, the foot remains in a rigid position when they walk or run meaning that little or no pronation occurs. This is often referred to as a supinated or “high arched foot.” The supinated foot shock absorbs shock poorly, meaning that higher forces than normal occur at certain points in the foot and up through the lower limb. A supinated or high arched foot can predispose to injuries such as plantar fasciitis, achilles tendonitis, stress fractures, shin splints e.t.cetc. After completing a lower limb biomechanical assessment and detailed examination of your foot, we will discuss your treatment options. Treatment may include orthotics, stretching exercises and advice on footwear to prevent injury. If an orthotic is required, it is a different type of orthotic than that needed for a flat foot and this can be explained in greater detail at your appointment. Generally footwear that has extra shock absorbency or “bounce” suits the high arched foot best.
If you are making an appointment about a foot problem it is helpful if you bring in your shoes and sports footwear along with you to your first appointment.

The Achilles tendon connects the calf muscle to the heel bone. Thankfully, Achilles tendon rupture is not very common (estimated at 18 per 100,000 people). It is quite likely that a certain degree of degeneration is established within the achilles tendon in order for an achilles tendon rupture to occur.
When this degeneration is present within the tendon, achilles tendon rupture may occur with jumping, take off with running or a forced movement of the foot. Symptoms usually include feeling a “snap” at the back of the Achilles that is associated with pain and a sensation of having been kicked. In fact with an achilles tendon rupture patients often report looking behind them immediately after the injury to see “who kicked them!”

This is followed by a significant difficulty rising up onto the toes on the affected side and an inability to push off while walking.

Swelling and bruising are typically present. It is important to seek assessment by your chartered physiotherapist or doctor urgently if an Achilles tendon rupture is suspected.

If it is confirmed on examination, you will receive an urgent referral to an orthopaedic doctor who will discuss the best management option with you.

Early intervention is important to achieve a good outcome and return to sports and physical activity.

The Achilles tendon connects the calf muscle to the heel bone. Achilles tendonitis means inflammation of the Achilles tendon and this can progress to Achilles tendinopathy when tendon degeneration occurs, as a result of overuse.
Symptoms include pain in the region of the Achilles tendon that is often worse first thing in the morning, worsens with activity and/or is worse the day after exercise.

Achilles tendinopathy can develop for a variety of reasons which cause too much stress on the Achilles tendon including; increasing your training too quickly, tight calf muscles, biomechanical abnormalities (such as flat feet or high arched feet), lack of sufficient ankle movement, inappropriate footwear etc. At IONA Physiotherapy we will take a comprehensive history of your recent physical activity, along with carrying out a biomechanical assessment of your lower limbs.

Depending on the findings during your assessment, treatment may include manual therapy and massage, exercises, orthotics and advice on appropriate footwear and your training regime.

It is important that the reason for your Achilles tendinopathy is established so that it can be treated effectively and prevented from becoming a chronic condition. It is helpful if you bring in your shoes and sports footwear with you to your first appointment.

The term “shin splints” refers to an overuse injury that causes pain along the inner edge of the tibia (shin bone.) They typically develop after physical activity such as running, jumping, dancing etc.
It is caused by inflammation of the muscles, tendons and in severe cases even the bone itself (tibia).

Biomechanical abnormalities such as tight calf muscles, flat feet or high arched feet can all predispose towards shin splints. Tight calf muscles cause the muscles around front of the leg or shin to have to work harder (and create greater forces) to overcome the extra resistance created by the tight calf muscle. Other contributing factors include training error (e.g. too much too soon) and inappropriate foot wear.

At IONA Physiotherapy we will take a comprehensive history of your recent physical activity, along with carrying out a biomechanical assessment of your lower limbs. There are other causes of shin pain including stress fracture, compartment syndrome, referred pain etc., so a comprehensive musculoskeletal assessment is important.

Treatment for shin splints will depend on the findings in your individual assessment and may include manual therapy, massage, exercises, orthotics, advice on appropriate footwear and your training regime. It is helpful if you bring in your shoes and sports footwear with you to your first appointment.