Shin Splints

Medial Tibial stress syndrome, or more commonly known as shin splints, is a condition that describes pain in the front of your lower leg along your shin bone, often felt during or after exercise.

Many of us are familiar with the term shin splints, but do we know why it occurs and what is occurring?

Shin splints can most often be attributed to a change in load or physical activity, particularly activities that are repetitive or high impact. Changes can include a change in training frequency, duration or intensity. For example, an increase in training days each week or changing from walking on a flat path to walking up steep hills. Things also to consider include the quality and age of your footwear or the surface you train on.

The pain is a result of repetitive stresses to the tissues surrounding the shin bone (tibia) that results in inflammation of the bony tissue, called periosteum, that coats the bone.

The main complaint resulting from shin splints is pain and tenderness along the distal tibia. Pain can be described as both sharp or dull and throbbing. It occurs during and after exercise and in severe cases can feel almost constant.

Physiotherapists play a large role in the diagnosis and treatment of shin splints. Physiotherapy treatment will often involve education regarding pain relief and appropriate changes to your training, soft tissue massage, ultrasound therapy, and of course an exercise program. Specific taping techniques can also be used in certain cases that can give almost instant relief.

Our Physios are skilled in not only assisting you to reduce the pain and getting you back into training, but identifying all contributing factors that may have been involved. This can include things such as tight calves or flat feet. Appropriate measures and exercises can then be performed so that once returning to full training you are addressing all factors and unlikely to have symptoms recur.

If you think you may have shin splints, are experiencing anterior leg pain or are interested in how to safely progress your training regime, do not hesitate to contact us so we can help you.

Amin, I., & Moroz, A. (2017). Medial Tibial Stress Syndrome (Shin Splints). In Musculoskeletal Sports and Spine Disorders (pp. 281-282). Springer, Cham.  Australia, H. (2020). Shin splints.  OthroInfo, 2021, February 14, Shin Splints,–conditions/shin-splints



Hamstring Strains and Prevention

As many of us return sport this year after a year-long hiatus thanks to COVID-19, injury prevention should be something at the forefront of our minds – in particular, hamstring injury prevention.

Hamstrings strains are one of the most common sporting injuries. They occur frequently in sports that involve high speed movement including football, field hockey, cricket and running, to name a few. Hamstring strains have one of the highest re-injury numbers especially in soccer, football and rugby.

There are two types of hamstring strains: Type 1 hamstrings injuries commonly occur during fast pace running e.g sprinting or in football and commonly involve the bicep femoris muscle which is seen in the image below; Type 2 injuries are due to over stretching activities usually with the knee fully extended for example high kicking or during the splits. These injuries may occur at slow speed and commonly involve the semimembranosus muscle, also pictured below.

Hamstring strains commonly present with sudden onset of pain into the hamstring region. This pain usually prevents continuation of the activity that has caused the injury. In a type 1 hamstring injury, pain is generally located in the bicep femoris muscle, whereas in a type 2 hamstring injury, pain is usually located near the ischial tuberosity (sit bone) where the hamstring inserts into the bone.
On examination, they are tender over the location of the tear and may present with reduced strength on knee flexion (bending the knee) and have pain on knee extension (straightening the knee out) due to stretching the damaged muscle fibres. In high grade tears, bruising and inflammation can somtimes present in the posterior thigh.

Imaging through ultrasound and MRI can also be used to determine the severity and location of the hamstring strain if it is required by your physiotherapist.

Early management includes a rest, ice, compression and elevation program (RICE principle). After the initial management, the focus is to normalise walking and regain the strength and flexibility in the hamstring. This is achieved by implementing a graduated hamstring strengthening program.

Education on the recurrence of hamstring injuries is important as you are seven times more likely to re-injure a hamstring after a strain. Your physiotherapist can provide you with a hamstring injury prevention program if you play sport and it is highly recommended in athletes that participate in kicking and running sports.

The general recovery time frame for a hamstring strain is between 4-8 weeks, however this is dependent on the initial severity of the injury and the individual’s rate of recovery.

If you have hamstring pain or have had a hamstring strain in the past and want more information on hamstring rehab and specific exercises for a hamstring injury prevention program either for yourself, sporting group or club, please get in contact with one of highly qualified physiotherapists. They are all extremely competent in hamstring strain diagnosis and management, and are available for consultation at our Berwick, Clyde North and Pakenham Lakeside Physiotherapy clinics.


References:  Brukner, P. (2017). Brukner & Khan’s clinical sports medicine. (5th Edition) North Ryde: McGraw-Hill.  Ekstrand, J., Hägglund, M., & Waldén, M. (2011). Epidemiology of muscle injuries in professional football (soccer). The American journal of sports medicine, 39(6), 1226-1232.  Erickson, L. N., & Sherry, M. A. (2017). Rehabilitation and return to sport after hamstring strain injury. Journal of Sport and Health Science

Vertigo – Dizziness and the Vestibular System with Ross de Valle

Dizziness can be an extremely debilitating symptom and unfortunately is surprisingly common. It is estimated that 15% of the population will experience dizziness at some stage of their life. One of the primary causes of dizziness is dysfunction of the vestibular system.

The vestibular system is part of the inner ear and brain which monitors the position and motion of the head. It is essential in maintaining visual stability, postural stability, and perception of movement. The vestibular apparatus is part of the inner ear and is approximately the size of a 5-cent piece.

Disorders of the vestibular system affect an individual’s balance and often impact their ability to walk, run and even drive a car. Benign Paroxysmal Positional Vertigo (BPPV) is the most common vestibular disorder and is thought to account for up to 42% of all vestibular disorders (Bhattacharyya et al CPG 2017).

  • Benign – it is not life-threatening.
  • Paroxysmal – it comes in sudden, brief spells.
  • Positional – it gets triggered by certain head
    positions or movements.
  • Vertigo – a false sense of movement.

Luckily, physiotherapy can help in the treatment of vestibular disorders. A thorough assessment is vital to determine if the vestibular system is the cause of the presenting symptoms. This also allows appropriate treatment which may include ‘canal repositioning manoeuvres’ which are used to treat BPPV or a targeted rehabilitation program for cases of vestibular dysfunction due to other causes.

Ross de Valle has a special interest in the treatment of vestibular disorders. He has completed additional training in vestibular rehabilitation and is available for consultation at both our Berwick and Clyde North clinics.

References:  Bhattacharyya N et al. Clinical Practice Guidelines: Benign Paroxysmal Positional Vertigo (Update) Otolaryngol Head Neck Surgery. 2017; 156 (3_suppl): S1-S47

Physiotherapy Management of Tendon Injuries

Tendon injuries are seen commonly by our Physiotherapy team. Often injuries to a tendon are related to an increase in load which results in changes to the structure of the tendon, causing pain and dysfunction. Injuries such as tennis elbow, Patellar tendinopathy and Achilles tendinopathy can occur when a patient starts a new type of activity or increases the amount of load to a current activity. There is a limit to the adaptive nature of tendons and this can result in a repetitive strain or overload tendon injury.

Evidence based research has shown that one form of management stands above all types of treatment of tendon injuries. This treatment involves a finely balanced understanding of tendon structure and biomechanics.

The key for managing tendon injury is understanding the threshold of the tendon and it’s ability to withstand load. When a patient injures a tendon, it is important to manage the amount of load on the tendon to reduce overload, but it is equally important to find a way to continue to load the tendon under it’s threshold, to allow it to heal and strengthen over time. Tendons want and need to be loaded in the right way. Load is how a tendon grows and heals. Without any load, they weaken and become more susceptible to ongoing trauma and injury which becomes a perpetual problem often seen in chronic tendon injury. This is the complexity of tendon injuries. Some rest is important, but not too much. Some load is important, but not too much. Our physiotherapists at First Choice Health are experts in understanding tendon pathology and implementing plans to allow adaptive healing and strengthening of tendons to enable recovery from repetitive injuries.

By using strategies to improve technique and biomechanics, and strength exercises such as isometric and eccentric loading, tendon injuries can be managed and improved over time. Expert advice and a thorough strength plan is required to overcome tendon injuries so that you can return to all activities pain free and stronger than ever before.

If you have a niggly tendon injury or some tendon pain that won’t go away, give our clinic a call to start your path to recovery.

Sever’s Disease

Calcaneal apophysitis, much more commonly known as Sever’s Disease, is a condition that effects young, active people – generally from the ages of 8 to 14, and is a common cause of heel pain in this age group. [1]

Sever’s Disease develops when the area of cartilage in the heel (known as the growth plate) is irritated by repetitive stress from the Achilles tendon, which attaches into this growth area. Once a child is fully grown, these growth plates are replaced by bone, but until this point the growth plates are more vulnerable to irritation and pain. [2]

Pain from Sever’s is usually gradual in onset and rarely occurs in an acute injury. Common symptoms that your child may display include:

  • Pain during exercise, particularly high intensity jumping/landing sports like basketball, netball, soccer and football
  • Pain/limping after sport that is notably worse than before exercise
  • Tiptoe walking and not being willing to land on their heel as they walk
  • Pain/limping when getting out of bed before school [3]

Children we see with Sever’s generally report pain in the attachment point as outlined above, but this pain can also occasionally present going up the Achilles tendon or in the heel bone itself.

Treatment options for Sever’s are quite varied. Generally, there would be a discussion around your child’s current level of activity and making sure we load them effectively. Whilst some rest can be a handy tool, complete rest is not an option to be entertained except in only extreme cases, as the tendon requires load in order to remain healthy, and kids love to be active! [1]

Generally a ‘flare-up’ of Sever’s can last 2-3 weeks, but they can reoccur as the growth plate takes roughly 2 years from becoming active to fully mature – so being able to effectively manage periods of pain is important [4]. Ensuring that they also have high quality footwear for their chosen activity – and when being active at school – is important.

In addition to load management, placing a gel heel pad into your child’s runners, football boots or basketball shoes can be an effective way to reduce the load going through the heel during activity, as well as using taping techniques whilst they play. Post exercise – use of an ice pack on the heel can reduce the inflammation caused during the activity. [5]

Whilst Sever’s can be an annoying condition for our young athletes, it certainly shouldn’t prevent them from still being the active kids they are!

References:  1. Hendrix CL. Calcaneal apophysitis (Sever disease). Clinics in podiatric medicine and surgery. 2005 Jan 1;22(1):55-62; 2. Rachel JN, Williams JB, Sawyer JR, Warner WC, Kelly DM. Is radiographic evaluation necessary in children with a clinical diagnosis of calcaneal apophysitis (sever disease)?. Journal of Pediatric Orthopaedics. 2011 Jul 1;31(5):548-50; 3. Bailey CW, Cannon ML. Sever disease (calcaneal apophysitis). Journal of Osteopathic Medicine. 2014 May 1;114(5):411-; 4. Madden CC, Mellion MB. Sever’s disease and other causes of heel pain in adolescents. American family physician. 1996 Nov 1;54(6):1995-2000; 5. Smith JM, Varacallo M. Sever disease. 2017

Meniscus Injuries

Meniscus injuries are one of the most common injuries of the knee. The meniscus refers to two wedge shaped pieces of fibrocartilage in your knee joint between your tibia and femur. They have an important role in distributing load and act as a shock absorber within the knee joint.

Meniscus injuries can be degenerative or occur as a result of an acute injury. Acute meniscus tears during sport often involve a quick twisting of the upper leg on a slightly flexed knee whilst the foot stays planted. It can be with or without direct contact. In sport they can often occur alongside other injuries such as an anterior cruciate ligament (ACL) injury, so it is important to see a health professional for an appropriate diagnosis.

In the case of a degenerative meniscus tear an awkward twist getting out of the car or stepping down a step may be enough to cause a tear.

When injuring your meniscus, common symptoms include pain localised to the side of the joint (either side depending if the medial or lateral meniscus is involved) when you try to bend, straighten or twist the knee. Swelling can occur and in some cases, you may here clicking, popping or feel as if the knee is locking, as the cartilage may be catching between the joint surfaces and blocking full range of movement.

Your Physiotherapist can assist in the initial assessment and diagnosis of a knee injury and in many cases if a meniscus injury is suspected you will be referred for imaging. Depending on the classification of the tear (size and location) and your presenting symptoms (pain, locking, clicking) surgical management may be necessary.

Physiotherapy is an integral part of the rehabilitation process after a meniscus injury regardless whether treatment is conservative or surgical. Different treatment techniques are used depending on the stage of your rehabilitation. Initially, treatment may involve manual therapy such as massage and education for pain relief, and progress gradually to functional activities including strengthening and neuromuscular retraining exercises to assist your safe return to your previous levels of activity.

If you suspect you have a meniscus injury make sure to contact us and we can help with the initial diagnosis and support you through the rehabilitation process.

References: OthroInfo, 2021, February 16, Meniscus Tears,–conditions/meniscus-tears/ Sports Medicine Australia, 2021, February 16, Meniscus Injury A guide to prevention and management,

Plantar Fasciitis

Have you recently noticed a sharp, burning or stabbing pain into the bottom of your foot/heel? Are you noticing it is most uncomfortable when you first get out of bed and walk to the kitchen? If so, you could be suffering from a common inflammatory condition known as plantar fasciitis (pronounced plantar fas-ci-i-tis).

The main symptom associated with plantar fasciitis is pain experienced first thing in the morning, following prolonged periods of rest or sedentary positions and also after extended periods of exercise or standing. Pain is usually located in the heel and arch of the foot, but can occasionally be located into the ball of the foot as well.

The plantar fascia is the thick fibrous tissue on the underside of the foot, starting from the calcaneus (heel bone) and connects along the sole to the ball of your foot. It acts like a rubber band by stretching and contracting as you walk. The plantar fascia can be put under quite a bit of force, particularly when participating in activities with running or jumping movement.

Plantar fasciitis is diagnosed when this soft tissue is inflamed.  This can occur following an acute injury, however it most commonly develops due to overuse.

Factors of overuse plantar fasciitis include:

  • A sudden increase in activity/exercise load
  • Weight gain
  • Poor footwear
  • Poor biomechanics (excessive pronation)

Physiotherapy treatment usually involves initially reducing pain and inflammation. This is done through activity modification, footwear advice and using manual therapy such as soft tissue massage, ultrasound and strapping the arch of the foot.

Our physiotherapists can provide a graded exercise program focusing on stretching and strengthening the soft tissue of the foot and surrounding musculature. Our physiotherapists can also assist in prescribing arch supporting orthotics, if they believe this is indicated.

All of our physiotherapists are skilled in diagnosing and treating plantar fasciitis.  If you have been suffering with this condition and would like some help, don’t hesitate to contact any of our Berwick, Pakenham Lakeside or Clyde North physiotherapy clinics to book an appointment.

Carpal Tunnel Syndrome

Carpal Tunnel Syndrome (CTS) is a condition involving compression of the median nerve the nerve that runs down the inside of the forearm into the palm side of the wrist (pictured below).

CTS is most common in females aged between 40-60 years old and individuals with diabetes mellitus other risk factors for are:

  • Overloading the wrist and/or fingers
  • Previous wrist fracture or injury
  • Pregnancy
  • Arthritis

CTS is characterised by gradual onset of pain into the palm side of the wrist and numbness or paraesthesia (tingling or pins and needles) into the thumb, index finger, middle finger and the inner half of the ring finger (pictured below).

It is also quite common to experience either tingling or pins and needles at night as a result of carpal tunnel. As well as having pain into the wrist and hand it can also radiate to the forearm, elbow and shoulder.

Individuals with CTS usually present with difficulty or pain with gripping activities like holding a phone, opening a door or opening a jar. Patients may find relief from symptoms by flicking or shaking the hand.

As the condition progresses individuals may report burning like pain and numbness and paraesthesia symptoms may become constant.

Examination by a physiotherapist in which they can complete CTS specific tests to determine if carpal tunnel is the cause of your wrist pain. Nerve conduction tests can also be used in confirming the diagnosis of CTS and if surgery is required.

Treatment initially focuses on de-loading the wrist by:

  • Avoiding aggravating activities
  • Resting the wrist and taking more breaks if your job relies heavily on your hands
  • Applying ice to reduce swelling
  • Wearing a wrist brace or night splinting

Physiotherapy treatment focuses on manual therapy and exercises to assist with improvement of nerve flexibility, wrist and hand strengthening exercises are also a focus of treatment.

Medical treatment involves the use of non-steroidal anti-inflammatory drugs (NSAIDs) as a conservative option. If wrist pain and nerve symptoms do not improve from this a corticosteroid injection can be administered and may provide temporary relief. But if pain and nerve symptoms persist, surgery may be required to help release the compressed median nerve.

If you have wrist pain and any of these symptoms sound familiar please contact our clinics at Pakenham lakeside and Berwick Physiotherapy for a assessment with on of our physiotherapists.

References:  Brukner, P. (2017). Brukner & Khan’s clinical sports medicine. (5th Edition) North Ryde: McGraw-Hill.  Genova, A., Dix, O., Saefan, A., Thakur, M., & Hassan, A. (2020). Carpal tunnel syndrome: a review of literature. Cureus12(3).  Chesterton, L. S., Blagojevic-Bucknall, M., Burton, C., Dziedzic, K. S., Davenport, G., Jowett, S. M., … & Roddy, E. (2018). The clinical and cost-effectiveness of corticosteroid injection versus night splints for carpal tunnel syndrome (INSTINCTS trial): an open-label, parallel group, randomised controlled trial. The Lancet392(10156), 1423-1433.  Bobowik, P. Ż. (2019). Effectiveness of physiotherapy in carpal tunnel syndrome (CTS). Postępy Rehabilitacji, 2019(2), 47-58. doi:10.5114/areh.2019.8502


Frozen Shoulder

Have you noticed of late a gradual increase of stiffness and/or pain in your shoulder, sometimes without any obvious mechanism of injury? Wondering why on earth lying on one side of your body at night is agony, and basic tasks like getting dressed or hanging the washing on the line are getting harder and harder?

Frozen Shoulder, referred to as Adhesive Capsulitis, is a condition characterised by painful and/or restricted shoulder movement [1]. The condition involves the shoulder capsule (strong band of ligaments that surround our shoulder joint) becoming thickened and suffering contracture. There is currently some debate over whether the condition is due to inflammation, fibrosis of the capsule, or both [2].

Whilst most cases of Frozen Shoulder are idiopathic (no known cause), cases of Frozen Shoulder can be seen more commonly in people with type 2 diabetes, thyroid disorders, those who have had recently been immobilised after shoulder surgery or have suffered a recent traumatic fall, recent stroke and cancer sufferers, as well as a previous history of Dupuytren’s contracture [3, 4].

The condition is far more common in those over the age of 40, with the most common age group being 40-60 year olds. In addition, Women are more likely than Men to suffer the condition [5].

There are three main stages of Frozen Shoulder, being:

  • Freezing – The ‘Freezing’ stage or ‘Pain over Stiffness’ is usually characterised by sharp pain with movement in the shoulder joint, with progressively worsening movement.
  • Frozen – This phase, also known as the ‘Stiffness over Pain’ phase where pain may diminish, however stiffness usually plateaus or could get slightly worse.
  • Thawing – This final phase involves the progressive increase of movement and reduction of pain [6].

In all the condition generally lasts for between 9-18 months, but can last from 5-24 months [6]. Diagnosis is usually formed by a mixture of symptoms, physical range and strength assessment and imaging [7,8].

Treatment for Frozen Shoulder in our clinic can vary but can involve gentle range, stretching and strengthening exercises, complimented by joint mobilisations and soft tissue release.

Common exercises for adhesive capsulitis include pendular movements, crawling hands up the wall, doorframe and child’s pose stretch, and the use of shoulder pulleys, to gently encourage further range in the affected shoulder by using the non-affected shoulder.

In addition to this, we have seen some success in pain and movement improvements with a short course of prednisolone (oral cortisone). In more severe cases, treatment options can include both corticosteroid injections into the shoulder, or a hydro-dilatation, which is where a combination of saline and cortisone is injected into the capsule in order to distend it, and ‘break’ the contractures in the capsule [9]. Research has shown that initial conservative treatments such as these can be effective in 90% of patients, without the need for surgical intervention [9].

Whilst Frozen Shoulder is at times a scary and frustrating condition, with effective and efficient physiotherapy your symptoms can be managed well, and our physios are extremely well placed to guide you through this. If you think the above condition sounds like you, be sure to come down and see one of our expert therapists for an assessment ASAP!

References:  [1] Dias R, Cutts S, Massoud S. Frozen shoulder. Bmj. 2005 Dec 15;331(7530):1453-6;  [2] Cho CH, Song KS, Kim BS, Kim DH, Lho YM. Biological aspect of pathophysiology for frozen shoulder. BioMed research international. 2018 May 24;2018; [3] Mezian K, Chang KV. Frozen Shoulder. StatPearls [Internet]. 2019 Feb 25; [4] Whelton C, Peach CA. Review of diabetic frozen shoulder. European Journal of Orthopaedic Surgery & Traumatology. 2018 Apr;28(3):363-71; [5] Uppal HS, Evans JP, Smith C. Frozen shoulder: a systematic review of therapeutic options. World journal of orthopedics. 2015 Mar 18;6(2):263; [6] Chan HB, Pua PY, How CH. Physical therapy in the management of frozen shoulder. Singapore medical journal. 2017 Dec;58(12):685;  [7] Kelley MJ, Shaffer MA, Kuhn JE, Michener LA, Seitz AL, Uhl TL, Godges JJ, McClure PW, Altman RD, Davenport T, Davies GJ. Shoulder pain and mobility deficits: adhesive capsulitis: clinical practice guidelines linked to the international classification of functioning, disability, and health from the Orthopaedic Section of the American Physical Therapy Association. Journal of orthopaedic & sports physical therapy. 2013 May;43(5):A1-31;  [8] Li JQ, Tang KL, Wang J, Li QY, Xu HT, Yang HF, Tan LW, Liu KJ, Zhang SX. MRI findings for frozen shoulder evaluation: is the thickness of the coracohumeral ligament a valuable diagnostic tool?. PLoS One. 2011 Dec 7;6(12):e28704;  [9] Cho CH, Bae KC, Kim DH. Treatment strategy for frozen shoulder. Clinics in orthopedic surgery. 2019 Sep;11(3):249.


Osgood-Schlatter Disease

You may know someone who has experienced anterior knee pain when growing up or may have experienced it yourself. It’s common to hear that this pain is simply ‘growing pains’, but what exactly is the cause for this?

Osgood-Schlatter disease is a condition that affects adolescents who are experiencing a growth spurt and are quite active individuals. This condition is an inflammation of the bone at the top of the tibia (shin bone), which is the attachment site for the patella tendon.

The main symptom experienced is pain when exercising. The location of pain is common across the bony prominence just below the patella (knee cap), known as the tibial tuberosity. Pain is caused by a repetitive strain during exercise/activity from the quadriceps muscle and patella tendon. Swelling, redness and the development of a ‘bump’ can also occur.

Osgood-Schlatter disease is most prevalent in boys aged 11-15 years old, however, it can affect girls who are physically active aged 8-13 years old.

Initial Physiotherapy treatment usually involves manual therapy techniques such as soft tissue massage, heat and/ or ultrasound to reduce muscle tightness in the quadriceps. This aims to reduce the amount of load placed on the patella tendon. Patella tendon taping can also be effectively used to de-load the tendon and reduce pain, swelling and inflammation of the area.

A physiotherapist can then implement an exercise program focusing on muscle stretching, strengthening and activity modification.

This condition may come and go for a period of 12-24 months as the child is still going through an active growth spurt. However, Physiotherapy intervention can assist in managing this appropriately.

Our team of physiotherapists are skilled in diagnosing and treating Osgood-Schlatter disease effectively. If you or someone you know have been suffering with this condition and would like some help, don’t hesitate to contact any of our Berwick, Pakenham Lakeside or Clyde North physiotherapy clinics to book an appointment.