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The Achilles tendon runs behind the ankle, it connects the calf muscles to the heel bone. A common condition that affects this structure is called achilles tendinopathy (achilles tendinitis, achilles tendinosis), which refers to any pathology associated with this tendon. Pain is usually localized to the mid part of the tendon or its attachment to the heel bone. Patients often complain of pain and stiffness in the mornings or after prolonged periods of rest, generally it improves once they are warmed up and get moving. Physical activity/sport can further aggravate their symptoms and the pain can get worse 24-48 hours after exercise. There may or may not be swelling and thickening of the tendon, but pressing it will hurt. The Achilles tendon is used when you stand on your tippy toes, walk, run, jump or climb stairs so you will most likely find all these activities painful.
​ What’s the cause? There are many factors that could increase the risk of getting achilles tendinopathy such as age, leg muscle weakness, ankle instability, poor foot mechanics, bad footwear, certain drug use and metabolic diseases. We are still unsure about the actual cause of tendinopathy but we know that it occurs when the tendon cannot withstand or adapt to the excessive loads placed on it. This can be from too much repetitive stress and not enough time for the tendon to repair which causes inflammation or degeneration of tendon structure. ​ What can I do? What are the treatment options? We know that tendons need to be loaded so effectively managing load is crucial for recovery. Relative rest may help initially to offload the tendon and improve pain. Braces, taping, orthotics/ heel lifts, correcting footwear, changing training surfaces and cutting down training loads will also help to manage symptoms in the short term. Acute management may also include a combination of treatment modalities such as joint mobilisations, massage, stretching in conjunction with an exercise based intervention. The use of corticosteroid injections is controversial due to conflicting studies. Although they can provide some temporary pain relief, there is no long term benefit. Additionally, there can be some adverse effects including weakening of the tendon and possible rupture. Exercise - there is substantial evidence that shows exercise provides significant improvement in pain and function for those with Achilles tendinopathy. Traditionally, a 12 week eccentric loading program was the accepted form of treatment however research is now suggesting isometric exercises, heavy slow resistance training and combined loading programs yield positive outcomes for this condition. How long will it take to recover? Depending on what stage the tendon injury is in. If identified early, modifying training loads may allow the tendon to adapt and recover more quickly. This can take weeks to months taking into account the time required to properly rehab and progressively increase training loads to meet the patients physical demands. In the later stages, it can take up to 6 months or even longer, especially when symptoms are severe and the condition has persisted for a long time. Some helpful exercises for Achilles tendinopathy: Isometrics: ​Isometric calf holds have been shown to produce some pain relieving effects as well as maintain some muscle strength. These can be done in a few positions, try to hold for 30-45 second, repeat 5s, at least 3x/daily.
Seated calf raises:
Sit on a chair or bench and start with the feet on the floor about hip distance apart. Lift the heels as high as possible and then slowly lower the heels back down to the ground. Repeat 20 times, three times daily. If this is too easy, you can add a weight on top of the legs and adjust the repetitions accordingly.
Standing calf raises:
Stand with the feet hip width apart, you can use a table or chair to help you balance. Lift the heels up slowly for 3 seconds, lower down slowly for 3 seconds. Try to complete 20-25 reps for 3 sets, at least 2-3x/week. Once you are able to do that quite well, you want to increase 10%-15% body weight and continue progressing the weights incrementally each week.
Low back pain - what is it?
Low back pain, simply put, is something that most people will experience at least once in their life. It usually occurs when the capacity of your lower back has been exceeded and pain ensues. There are many different structures that may become irritated and cause lower back pain. These episodes can vary in severity and duration. Generally speaking, in the majority of cases symptoms subside over a 4-6 week window, although on occasions it may take longer. This in itself is not something to be concerned about. During episodes of lower back pain it can be hugely beneficial to understand the triggers that increase your back pain, and just as important, the things that alleviate your pain. Once these are managed well it can have a significant impact on controlling your symptoms. This in turn enables you to return to your normal activities as soon as possible. ​ How could a Physiotherapist help A physiotherapist can help identify and correct predisposing factors to your back pain and hasten your recovery, using methods such as massage, mobilisation, taping and exercise prescription. If you have had an episode of lower back pain the chances of it reoccurring are higher. This is due to weakening of the stabilising muscles of the back. A physiotherapist can guide you through a rehabilitation program aimed at preventing future episodes. Important - Consult your physiotherapist or doctor if;
Below are three exercises that Dr Stuart McGill, a Canadian world-renowned researcher in spine biomechanics has devised to assist in increasing the capacity of your back, without putting undue stress through your spine.
​ These can be done during periods of pain and also on an ongoing basis. It is important that the correct regressions/progressions are prescribed by a skilled progressional to make sure the technique is correct and symptoms controlled. The ‘Big 3’ exercises ​ 1) The Modified Curl-Up Set-up requires the hands (palms down) under the lumbar spine. This helps to maintain the natural curve of the spine during the exercise. Keeping one leg extended, bring the other up into a bent position, with the foot planted in line with the knee of the extended leg. The abdominal muscles are braced and the elbows are slightly raised off the ground. Then elevate your head and shoulder blades off the floor. Imagine trying to lift from your sternum, not curling up through your neck. Movement is minimal and should only be a few centimetres. Maintain this for a few seconds and then slowly lower back. ​ It may not look like you’re doing much but if done properly you will feel your abdominal muscles working. Also make sure you breathe during the exercise and don’t hold your breath.
2) The Side Plank
Begin on your side with your elbow underneath your shoulder and your feet in a scissor position, with the top foot on front. Tense your trunk muscles, then lift your hips up and forward so that your body is in a straight line. Make sure your body is not rolled forward by keeping your shoulders/chest open. Hold for a few seconds and then bring your hips back and down to the floor. If you have shoulder problems try placing the upper hand over the shoulder and pulling the elbow down across the chest. ​ The side plank can be performed from the knees if you have decreased strength or an inability to engage the abdominal wall without pain.
3) The Bird Dog
Whilst kneeling in the all-4 position have your hands underneath your shoulders and your knees underneath your hips, with your spine in neutral position. Gently tense the abdominal muscles, ensuring all the movements come through the large ball and socket joints of the hips and shoulders. ​Simultaneously raise the opposite arm and leg. The aim is to hold both limbs parallel to the floor. Hold for a few seconds and then return them to the ground without losing the abdominal control.
Any Questions?
Let us know if you have any questions/queries, or if you need guidance with managing your lower back pain. ​Reference: McGill, S. (2015) Back Mechanic - the secrets to a healthy spine that your doctor isn’t telling you. Tennis Elbow  What is Tennis Elbow?
Do ONLY tennis players get this injury?
How can it be treated?
Exercising during your pregnancy is great! During pregnancy, your body undergoes A LOT of changes. Not only does exercise improve general well being but it also helps manage some of these changes. Research has shown regular exercise can help prevent excess weight gain during pregnancy, control blood glucose levels (reducing risk of gestational diabetes) and reduce your risk for preeclampsia (just to name a few).
Benefits of Exercise during your Pregnancy - Why should I exercise? Here are some more benefits!
Exercise Guidelines - How often should I exercise? This really depends on what your starting point is! Have you been exercising regularly leading up to your pregnancy or are you completely new to it? The American College of Obstetricians and Gynecologists (ACOG) guidelines state ‘an exercise program that leads to an eventual goal of moderate-intensity exercise for at least 20-30 mins per day on most if not all days of the week’. If you have just started to exercise in pregnancy, it is recommended that you gradually build up to this. For example, this might mean starting at 15-20 mins on non-consecutive days initially. You can do the “talk test” to gauge “moderate intensity”, you should be able to have a conversation with someone whilst doing exercise. Women are encouraged to get into some type of exercise during pregnancy, even if they have never exercised prior pregnancy. If this is you, it is best you commence your exercise journey under the guidance of a Physiotherapist or Exercise Physiologist who is trained in Women’s Health. If you have been exercising prior pregnancy, we do advise seeing the mentioned health professions to go through a thorough evaluation of your current program to make sure it is appropriate. Recommended exercise - What’s the best exercise? There isn’t a one fits all approach. Find an exercise that has a strength, flexibility and aerobic component, something you find fun and convenient for you. Some great forms of exercise when pregnant are:
Cautions for Exercise during Pregnancy While most forms of exercise are safe, there are some exercises that involve positions and movements that may be uncomfortable or harmful for pregnant women. Be guided by your Physiotherapist/ Exercise Physiologist, but general cautions include:
Most women are encouraged to participate in exercise/ physical activity throughout pregnancy. However, there are some women who have conditions or circumstances that may need to be considered before they start an exercise program. I recommend that the next review you have with your GP or obstetrician, ask - “Do I have any medical issues that would affect me participating in exercise? If you have any questions, or you would like to have more guidance with your pregnancy journey please feel free to contact us at Movement 101. Clarissa Yiu Physiotherapist & Accredited Exercise Physiologist World Continence Week 2021  The 2 most common types of Urinary Incontinence are: Stress UI Loss of urine associated with an increase in pressure (e.g., cough, laugh, jump) Urge UI Loss of urine associated with a strong sense of urgency 4 ways women can reduce their risk of incontinence  Staying active
Research suggests women who are active have lower levels of incontinence and stronger pelvic floor muscles. Physical activity can also help prevent constipation, helping reduce incontinence. See a Women's/Pelvic Health Physio Women's health physios can diagnose and treat incontinence. They can also help you prevent it! A physio may recommend pelvic floor exercises, teach good bladder/bowel habits, offer lifestyle advice, and advise on exercise. Check your beverages Try reducing your intake of caffeinated, sweetened, & alcoholic drinks to see how your bladder responds. These drinks are known as "bladder irritants" and can make symptoms of urinary frequency and urgency worse. Maintain a healthy weight range Research has shown increased body weight increases incontinence risk. Losing body fat may help significantly reduce incontinence symptoms. However, fat loss is not a healthy goal for all women - especially those who have disordered exercising or eating history. For those women focus on the previous 3 strategies above. If you have been having any trouble with leaking book in with our Womens Health specialist Clarissa Yiu Fungus  What’s a topic you don’t hear men speak about too often? Their foot health perhaps??! Something that can be quite prevalent amongst men but not regularly spoken about is skin and nail fungus. The idea of scrubbing our feet in the shower or applying cream almost sounds outlandish right? As a Podiatrist and a foot nerd, I wanted to highlight this condition and provide some simple tips to prevent this from occurring. Condition 1: Athlete’s Foot Athlete’s foot is a skin infection of the foot due to a thing called “dermatophyte fungus” which typically presents itself in the soles of the feet and in between the toes. Athlete’s foot will usually present itself with dry, itchy & scaling skin. In more severe cases, it can also cause inflammation, cracks & blisters also. Infection is usually acquired by direct contact with fungus, for example, walking barefoot in a public change room. Other risk factors include: occlusive footwear (work boots, steel caps), excessive sweating, immunosuppressant medications, showers & sporting locker rooms. Simple prevention & treatment
Condition 2: Nail Fungus (onychomycosis) Nail fungus is a fungal infection of the nail bed, matrix (the area where your fingernails and toenails start to grow) or nail plate. Nail fungus causes discolouration, thickening and separation from the nail bed. The cause is similar to Athlete’s foot but with the fungal infection affecting the nail rather than the skin. Nail fungus is often harder to treat than Athlete’s foot and can persist for months sometimes even years, so prevention is key. Prevention is the same as Athlete’s foot however there a few key differences in treatment. Keep in mind, nail fungus is more stubborn and likely to hang around longer so if a particular nail treatment is unsuccessful after a few months then you should switch to another one. It could take up to 18 months to fully resolve so be persistent and consistent! Simple prevention & treatment
Lateral elbow tendinopathy, also known as lateral epicondylitis is the technical name for tennis elbow. It is a condition where there is pain and or swelling in the forearm extensor tendon on the outside of the elbow. Patients will normally have pain with lifting up the wrist and fingers and report difficulty gripping or holding objects. If it's mild, you may only feel symptoms with certain movements involving the arm and wrist. However in more severe cases, pain can be constant which disrupts sleep, interferes with work and persists for a long time.
What’s the cause? You may have caused a tear or irritated this tendon from overloading or overuse. It can be due to sports mainly racquet or throwing sports. But more commonly,we see this condition with repetitive work for people like plumbers, painters, butchers, carpenters, hairdressers and computer workers. It can also be from excessive lifting, carrying, gripping and poor arm strength or technique. What can I do? What are the treatment options? Firstly, rest. If you can modify or stop doing the repetitive activity that’s aggravating you, it might just get a chance to heal and your symptoms will improve. Unfortunately, tennis elbow may not completely resolve with just rest so I would strongly suggest working with a physiotherapist for the best outcomes. The literature recommends conservative management as the first line treatment for tennis elbow. Some people opt for an elbow or wrist brace for support to improve pain and function in the short term. However, there is no clear indication in which splint or brace is superior and there is very low evidence for whether it’s beneficial or not as an adjunct to treatment. Exercise - There is strong evidence for exercise as the ‘ideal’ treatment for tennis elbow, whether it be exercise alone or in conjunction with other modalities. Most practice will use a combination of physiotherapy treatments (joint mobilisations, manipulation, massage, taping, etc) and exercise for a more positive response amongst patients. Although there is no consensus on a specific type, frequency, duration or intensity of exercise, the general guideline is to target the wrist extensors with a progressive strengthening and endurance exercise program. How long will it take to recover? If picked up early, you can definitely see improvements in a 6 week course of physiotherapy, (some studies have noted up to 60% improvement). If left untreated, it can take more than 6 months to 2 years for recovery. People who present with higher pain levels and disability at baseline are more likely to still have pain after 1 year. Additionally, those who report shoulder and neck pain with tennis elbow had poorer prognosis in the short and long term. Patients who do lots of manual or office work involving repetitive arm and wrist movements may be more resistant to treatment and take longer to recover. Some helpful exercises: (please refer to video) Isometric WE: Isometric contractions - this is a good starting exercise to help provide pain relief, by tensing the muscles on the forearm, you can use your other hand to add a bit of resistance. This has been shown to provide some pain reduction. Hold for at least 1 minute and try to do at least 10 reps. Ball squeezes: Hold a soft squishy ball, (you can try socks, rolled towel or putty) in your hand and squeeze the ball gently, hold for at least 5 seconds and aim for 20 reps. This will activate the forearm muscles and help improve grip strength. Wrist extension with DB: Have your arm resting on a bench, grasp a weight with an overhand grip (palms facing down). Raise the dumbbell up (wrist extension) and then slowly lower the weight all the way down. Try to do 10-15 reps. Supination with DB: Hold the dumbbell at the bottom, rotate the dumbbell so that the thumb turns outwards, palms facing up. Rotate the hand back the other direction until your palm is facing downward. Repeat 20 times on each side.  Ankle sprains are a very common injury. There's a good chance are that you yourself have had an ankle sprain or two in your life as well. They occur more often with sports like basketball, netball and soccer but they can happen to anyone at anytime. So what are ankle sprains and why are they so common?
What are ankle sprains? A sprain injury essentially means that you tear the ligament/s that hold the bones of a joint together. Ligaments protect joints by giving them stability during movement. So in an ankle sprain, one or more of the ligaments protecting the ankle are torn. A sprain injury essentially means that you tear the ligament/s that hold the bones of a joint together. Ligaments protect joints by giving them stability during movement. So in an ankle sprain, one or more of the ligaments protecting the ankle are torn. Most people when they think of an ankle sprain think of twisting or rolling the ankle inwards. This is the most common method of spraining the ankle, however it is not the only method. The ankle can also roll or twist outwards and people can sprain the medial or inside of their ankle. When we roll the ankle inwards through inversion, we sprain the ligaments on the outside of the ankle. If we roll the ankle outwards through eversion, we can sprain the ligaments on the inside of the ankle. The most commonly torn ligament is on the outside of the ankle, known as the ATFL (Anterior talofibular ligament). What to do for an ankle sprain When you sprain your ankle, there will usually be some amount of swelling and possibly bruising around the side of the ankle you have sprained. The area will be tender to touch and moving the ankle will feel stiff and sore. The swelling usually begins to subside after 2-3 days but can last for over a week. Initially after the sprain it helps to apply compression through taping the ankle, which will also give it some stability. Despite the ankle feeling stiff and sore, it is important to start weightbearing and walking on it as soon as you can. This will help to mobilise your ankle joint sooner which will help to speed up the recovery. Complete rest of the ankle initially is not recommended to assist in recovery. The most important part of recovery following an ankle sprain is treating it with specific ankle exercises as part of rehab. Following the injury muscles around the ankle are usually injured as well or weakened due to decreased use and swelling. Thus it is important to strenthen your ankle through exercises. The biggest part of ankle rehab is training your proprioception, which a term that refers to the joint's awareness of the position of the body. By training your proprioception through balance and stability exercises, you will help to increase your ankle stability and minimise the reccurence of any ankle sprains in the future. Do I need to get a scan Not every sprained ankle requires a scan like an x-ray or ultrasound to diagnose if you have torn the ligaments or broken any bones. Ankle sprains can be very painful and so naturally people think of wanting to scan for any broken bones or severely torn ligaments, however a physical examination and history taking from your physiotherapist will give you a diagnosis for most ankle sprains. Your physiotherapist will also be able to determine if you need to be sent off for scans if necessary. 5 Things to Know About Ankle Sprain 1) They're common! 2) They can occur on the outside and also inside of your ankle 3) You don't need to have an ultrasound or x-ray scan to diagnose your ankle sprain 4) Early weightbearing and walking is more important than rest following an ankle sprain 5) Exercises help you achieve the best recovery - specifically proprioception exercises!
​Patellofemoral pain syndrome is a broad term used to describe pain in the front of the knee and around the patella, or kneecap. It is sometimes called "runner's knee" or "jumper's knee" because it is common in people who participate in sports, particularly females and young adults, but patellofemoral pain syndrome can occur in anyone.
​Symptoms? Normally pain develops gradually and worsens with activity. The pain is often felt at the front of the knee, in and around the kneecap, but can sometimes be felt at the back of the knee. You may feel pain when:
What causes it? The cause is thought to be multifactorial with most cases due to overloading of the knee; especially sudden increases in duration, frequency and intensity of certain activities. Other factors include:
Treatment Treatment will depend on each individual’s case but detailed below are some common treatment options:
Exercise Examples 1: Step ups 2: Bulgarian split squats
Plantar Fasciitis & heel pain  The most common cause of heel is Plantar Fasciitis or chronically known as Plantar Fasciopathy. The Plantar Fascia is a thick band of tissue that runs across the bottom of the foot originating from the heel and attaching into the toes. The Plantar Fascia provides support into the arch of your foot with other ligaments, tendons and bones. This is critical for the support of our feet with weightbearing activities that we perform through our everyday lives. Excess stress to the Plantar Fascia can cause micro tears and lead to injury. These repetitive micro tears result in the catalyst for the development of Plantar Fasciitis. Some examples of excess stress can be:
 Most common symptoms include:
Treatment for Plantar Fasciitis can consist of:
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