Peak Physio

ITB Syndrome ⚠️

The Iliotibial band (ITB) is a long piece of fibrous connective tissue that runs from the outer hip to our knee. At the hip, the ITB connects to the fascia of the tensor fascia latae (TFL), gluteus medius and gluteus maximus muscles and plays an important role in both pelvis and knee stability.

ITB Syndrome is an overuse injury often seen in athletes or people who have recently started a new running or walking program. Often pain is mostly experienced over the outside of the knee.

Rehabilitation should focus on load management, improving biomechanics as well as building the strength of the muscles around the ITB. This should include the hip abductors, hip flexors, hip extensors as well as the muscles surrounding the knee.

These exercises might include:
❇️ Fire Hydrant
❇️ Psoas March
❇️ Single LEg bridge
❇️ Crab Walk
❇️ Bulgarian Split Squat
❇️ Sideways Step Up

Higher Level Strength Exercise Ideas for Mensicus Rehabilitation 🏃🏻‍♀️

The meniscus is a fibrocartilaginous structure located in the knee joint which acts to absorb shock, transmit force and increase knee stability. Higher level exercises should increase the knees tolerance to a variety of stressors.

Higher level strengthening exercises should target the hip, knee and ankle joints.

Try these exercises:
💪🏻 Side Plank
💪🏻 Wall Squat with Soleus Raise
💪🏻 Bridge with Hamstring Curl
💪🏻 Copenhagen Adduction Side Plank
💪🏻 Step Up with Resistance Band for Terminal Knee Extension

Swimmers Shoulder is an umbrella term for shoulder pain incurred from greater training demand, inappropriate load or impaired joint biomechanics during the swim stroke. Pain will typically present in the anterolateral shoulder as a result of impingement, rotator cuff tendinopathy or tear, labral injuries or neurological impingement.

Swimmers will clock between 6 and 8 km’s each week, requiring about 3km’s average per arm. Whilst swimming involves a kick from the lower limb, about 90% of force is generated from the upper limb. To optimise stroke efficiency, full range of motion is desired with strength from the musculotendinous unit to support same.

Changes in load from training intensity, duration or frequency can be enough to change the demand on the musculoskeletal structures. Increases in swim volume, tissue load with paddles, drills or speed work can overload and subsequently fatigue the rotator cuff muscles. Without adequate rest and recovery strategies, tendinopathies or impingement patterns can develop.

Read more about Swimmers Shoulder on our Website or copy the link https://www.peak-physio.com.au/swimmers-shoulder/

CLIENT SPOTLIGHT ~ JACKO

Best-on-ground performance in some of the worst football conditions you will ever see puts the exclamation mark on Peak Physio client Jack “Jacko” Lanyon’s return to football for the Newcastle City Australian Rules Football Club.

Jacko initially consulted with Jason on the 18th of March this year for assistance with returning to football following left and right shoulder stabilisation surgery in 2023.

We won’t bore you with the details of his surgery but he was approximately 7 months post right shoulder surgery and 5 months post left shoulder surgery.

Jacko saw his surgeon in early April where he was cleared for return to sport, pending physiotherapy clearance.

We put Jacko through a comprehensive battery of tests to determine his range of motion, strength and stability, particularly in challenging/compromising positions such as overhead and arms away from the body.

Some of the higher level tests we used were the Athletic Shoulder Test (ASH Test) and the Upper Quadrant Y Balance Test.

We also completed some subjective questionnaires aimed at assessing his confidence to return to contact sport.

Following this assessment, we took him through some graded return to contact including tackling, bumping and competitive training.

Jacko returned to play through the reserves but after only 1 game he was elevated to the senior team.

Our Physio Jason (who also plays for Newcastle City Football Club) has worked closely with Jacko throughout his return to football, including taping both shoulders each week and monitoring and progressing his rehabilitation.

Jason can confirm first hand that Jacko has been an integral part of the team over the past few months, and if his shoulders can stand up to the weekend’s conditions, they must be going well!

If you’ve been injured and need assistance returning to sport quickly and safely please get in touch with our team.

Early Rehab Ideas for Acromioclavicular (AC) Joint Injuries!

The AC joint is where our clavicle (collar bone) meets our scapula (shoulder blade) and is located at the top of the shoulder. This joint is commonly injured in contact sports with direct hits to the tip of the shoulder, or during a fall on an outstretched arm.

Higher grade injuries can require surgery, so if you believe you have injured your AC joint, make sure to see a Physiotherapist to help diagnose the severity of your injury.

Low-moderate grade injuries are managed conservatively, initially consisting of a short period of rest and immobilisation using a sling or taping.

Once pain is reduced, passive and assisted range of motion exercises begin, to restore the mobility lost as a result of the injury and immobilisation. These exercises might include:

👉🏻 Wall crawls
👉🏻 Assisted external rotation with a stick
👉🏻 Table flexion slides
👉🏻 Table abduction slides

Scapula control is introduced with closed chain exercises, which are then progressed to open chain exercises, including:

👉🏻 Scapula retraction against a wall (closed chain)
👉🏻 ‘T’ scapula retraction (open chain)

Once these exercises are pain-free and range is restored, strengthening exercises of the shoulder and rotator cuff can be introduced, such as:

👉🏻 External rotation at 90°
‼️ And much more!

DYNAMIC BALANCE EXERCISES 🦥

Balance training with movement has a great transfer to activities of daily living. When walking around in the grocery store we aren’t looking at our feet!

Balance training in addition to speed/ reaction time and strengthening is an important addition to any program.

Exercises shown:
✅ Tandem walking
✅ Heel toe tap with tandem walk
✅ Toe walking
✅ Heel walking
✅ Jogging
✅ Grapevine

SHOCKWAVE THERAPY 💥🌊

How does shockwave work?

👉🏻 Compressed air accelerates a projectile within the applicator/wand
👉🏻 Energy is created when the projectile strikes the head of the applicator/wand
👉🏻 This energy is converted into shockwaves which pass into the tissue

Cellular Mechanisms:
👉🏻 Increased collagen synthesis
👉🏻 Cellular proliferation and wound healing
👉🏻 Neovascularization
👉🏻 Decrease in inflammation
👉🏻 Pain reduction

In layman’s terms:

Energy applied to the tissue → pain relief + ‘kick starts” the healing process

Does it work?

Shockwave is effective in treating lower limb tendons and improves pain and quality of life in these patients (Elgendy et al., 2023) (Dedes et al., 2018).

Regarding Achilles tendinopathies specifically (in particular mid-portion achilles tendinopathy), there is evidence supporting the effectiveness of shockwave in addition to a tendon loading program with significant improvements in short and long term pain and functional scores observed (Abdelkader et al., 2021) (Paantjens et al., 2022).

At Peak Physio we offer shockwave as part of our physiotherapy sessions at no extra cost to you.

If you are wondering whether shockwave might be appropriate for you, please give us a call or make an appointment to discuss with one of our physiotherapists.

Ankle-Go Testing ⚽️🏃🏻‍♂️🏐🏃🏼‍♀️

The Ankle-GO score is an objective criterion for return to sport after lateral ankle sprain.

Once patients have regained adequate range of motion, strength and proprioception, more challenging and dynamic tests such as those included in the Ankle-GO score can be extremely useful for guiding decisions around return to sport and higher level ankle loading.

It has been found that a low Ankle-GO score at 2 months post injury had a 9x greater risk of recurrence within 2 years (Picot et al., 2024).

This is consistent with the findings of another 2023 paper which reported that an Ankle-GO score of

SI JOINT PAIN 🦋

The sacroiliac (SI) joints are located on each side of the spine where the sides of the pelvis (hip bone) attaches to the tailbone (sacrum). Pain of the SI Joint is usually felt around the low back and hip region.

SI Joint pain is usually caused by either an increase or decrease in the available motion at the sacroiliac joint or by changes in bony alignment. SI Joint pain may also be brought on with pregnancy due to the hormonal changes the body experiences which act to relax the ligaments around the SI Joint.

Strengthening the muscles around the SI Joint such as those around the low back, groin, hip and abdominals can help decrease pain, improve mobility and improve the stability of the pelvis.

5x SIJ exercises:
▶️ Bridge with Segmental Roll Down
▶️ Bridge with Single Leg March
▶️ Tabletop with Leg Float
▶️ SIJ Distraction with Dowel (which aims to create space between the hip and pelvis)
▶️ Supermans with alternate arm/leg lifts

Strength Testing with Dynamometer 💪🏻 📈

Strength testing is a very common assessment performed by our physiotherapy team.

Many clients that attend our clinic have reduced strength. Reduced strength or ‘weakness’ is a common feature of pain and injury. We also know that strength training has been shown to reduce the risk of sports injuries (Lauersen et al., 2014).

Using the dynamometer to test strength gives us an accurate objective measure which can be used to highlight differences between sides (or muscle groups) and track progress as we implement a strengthening program.

In this example, we can clearly see the patient has reduced shoulder external rotation strength on the right side.

A likely outcome from this assessment would be that we prescribe the patient some strengthening exercises for that movement/muscle group and then re-test each time we review them to track their progress.

Exercise ideas for end-stage quadriceps strengthening post ACL injury 💡

The Anterior cruciate ligament (ACL) is a thick band that stretches across from the shin to the thigh bone within the knee. This ligament prevents various movements within the knee including forward shifting movement of the shin and rotational forces within the knee.

When an ACL injury or surgery occurs one of the main things we aim to address within the process of rehabilitation is developing strength within the quadricep.

The quadricep is the 4 muscles at the front of your thigh. These muscles connect onto the knee cap and play a major role in many functional activities such as walking, running, squatting and jumping.

Not only does strengthening the quadricep help us get back to the functional activities we need to do from day to day. It also helps us to reduce the chance of injury within the knee generally and specifically following an acl injury.

Here are some ideas for high level quadriceps strengthening exercises post ACL injury.

🧨 Weighted squats
🧨 Single leg squats
🧨 Sissy squats
🧨 Weighted lunges

Patella Tendinopathy Part 2 ▶️

Later stages of rehab should focus on increasing single leg stability and control whilst also increasing the force generated through the knee.

Here are 5 exercise ideas for mid-late stage recovery:
🔺 Reverse Nordic Curls
🔺 Bulgarian Split Squat
🔺 Staggered or Single Leg Squat to Bench
🔺 Squat Jump
🔺 Runner’s Touch with single leg hop

Plyometrics are explosive exercises that can be done by anybody, not just athletes! 🧨

Plyometrics aim to produce a maximal amount of force in a short period of time, through exercises such as hopping and jumping. They involve a slow eccentric contraction, before a fast concentric contraction to produce a powerful movement.

Plyometrics should be done during the later stages of rehab of injuries such as ankle sprains, achilles tendinopathy or muscle tears. This reconditions the muscles, joints and tendons to be prepared for the load they will experience in running and other sports.

Plyometrics also can be part of anybody’s general program, as they strengthen tendons and improve our power and functional capacity.

Be careful before adding plyometrics to your program, as they are high load on tendons and joints. Make sure you complete a good warm up, don’t go overboard and get clearance from your Physiotherapist. It is recommended to have 48-72 hours between plyometric sessions to allow for optimal recovery.

SCAPULA MOBILITY:

The scapula or the shoulder blade like all of our joints loves movement. These exercises are easy to do when your at work, driving or first thing in the morning 👏🏻

MEET THE TEAM: JAI 🤼🤠🐾🦵🏻

LAST DAY OF APRIL FALLS 🍂 If you find someone who just had a fall ➡️

1. Check if they have an injury. Call for help if needed
2. No not try to pull them off the floor, you could injure them and yourself
3. Lend them a stable support base for them to get up
4. Direct them to a stable structure to come up
5. Stay with them until they feel safe, or call someone they know to help

Patella Tendinopathy, also known as Jumper’s Knee, is a common overuse injury affecting the patella tendon which connects the base of the patella (knee cap) to the tibia (shin bone).

Tendons have a high capacity for load. However, if the demand on the tendon becomes greater than the current tendon tolerance, then the tendon may become painful and symptomatic.

Effective physiotherapy management of this condition occurs in stages.

⭐️ During the early stages of recovery, exercises should consist of a variety of isometric exercises and transition toward eccentric exercises.

Here are 6 exercise ideas for early stage recovery:
👉🏻 Wall Squat
👉🏻 Wall Squat with Swiss Ball
👉🏻 Knee Extension with Isometric Hold
👉🏻 Single Leg squat with heel elevated
👉🏻 Squat with Heels elevated
👉🏻Couch stretch for quadriceps

The MCL is the ligament that runs along the inside of the knee that acts to stabilise the knee and resist forces to the outside of the knee.

Rehabilitation toward the middle-late stages of recovery should incorporate a combination of strength, stability and dynamic balance exercises.

Strengthening the knee through exercises encouraging side to side movement are important in increasing the knees ability to tolerate forces pulling across the outside and inside of the knee.

This is particularly important in athletes wanting to return to sport where power and agility are needed.

Here are some ideas for high level knee stability exercises post MCL injury.

✅ Lateral Lunge to Single Leg Stand
✅ Curtsey Lunge
✅ Tall Short to Single Leg
✅ Transverse Step-Up
✅ Lateral Bound over Hurdle

THORACIC MOBILITY 🌷

Our thoracic spine plays a large role in determining our posture, and our ability to move during functional tasks. Whether you’re an athlete or regular Joe, increasing movement in our thoracic spine can help with our alignment and stay pain-free

Exercises shown:
👉🏻 Thoracic Extension on Roller
👉🏻 Snow Angels on Roller
👉🏻 Thread the Needle
👉🏻 Cat/Cow
👉🏻 Side-lying Book Openers

APRIL FALLS 🍂🚶🏻‍♀️🤝🏻 how to correctly use a walking stick

Using a walking stick or cane can increase stability and support whilst walking for individuals with reduced balance or specific injuries/weaknesses.

Some tips to ensure safe use:
⭐️ On the opposite side to the affected limb
⭐️ Use with one hand
⭐️ Keep it close to the body

BICEPS TENDINOPATHY REHAB 💪🏻✅

Biceps tendinopathies commonly occur through a sharp increase in load in a short period of time, or extensive use over a long period of time. Biceps tendinopathies can occur in the distal or proximal attachments, but mostly occur in the proximal attachments near the shoulder.

Proximal biceps tendinopathies are a very common source of pain in the front of the shoulder, specifically in populations that do a lot of lifting, carrying, overhead or throwing activities.

Tendinopathy generally comes under the umbrella term of “overuse” injuries. Normally our tendons become stronger by becoming more stiff. However, when loaded excessively or over a long period of time, the tendon will try to deal with this load by thickening. In the long term, this is negative for the health and strength of the tendon, and can increase chances of a future tear.

Treatment of biceps tendinopathy involves a reduction in the load that has caused the pain in the first place. Once load is reduced, the below exercises can be used to gradually build up tendon strength:

💪🏻 Isometric bicep curl.
💪🏻 Eccentric bicep curl.
💪🏻 Supination and pronation.
💪🏻 Low rows.
💪🏻 External rotation.
💪🏻 Internal rotation.

APRIL FALLS: how to size a walking stick 🚶🏻‍♀️🍂

Walking sticks are not one size fits all! They should be sized depending on your height and arm length. There is an optimal way to use a walking stick to reduce the risk of falls and support balance 👏🏻

Ask your Physio the next time you’re in to ensure that your walking aid is doing it job ✅