One of the most important characteristics of a Health Profession is the ability to question what has gone before with ongoing research and to continually evolve treatment techniques and management protocols depending on the new information derived from that research. The field of Tendon injuries is a prime example. Over the last 15 to 20 years it has been proven conclusively that the vast majority of tendon injuries do NOT in fact have a significant inflammatory component to them. Most are due to repetitive stresses through the tendon which accumulate to cause microtears in the fibres of the tendon and eventually cause changes in the collagen component of the connective tissue within the tendon. This is now why Sports Physios and Physicians call these conditions TENDINOSIS rather than TENDONITIS. So, Achilles tendonitis and Tennis Elbow aren’t really tendonitis at all! Because for the most part they lack the inflammatory ingredient that the name implies. This would explain why anti inflammatory medications, both oral and topical, are often unhelpful historically.

What we do know for sure is that early diagnosis and intervention is hugely important in the recovery time to be expected. The pathology within the tendon material can progress dramatically with non treatment and continued overloading . Caught early a tendinosis of an Achilles or elbow or shoulder can be a 2 to 6 week recovery only. Once secondary changes occur in the nature of the collagen ( from normal type 1 to dysfunctional type 3 ) and the vascularisation in the injury site alters to be inefficient and even obstructive in the delivery of the elements of repair… then Houston we have a problem. Recovery will be months to years.

So of all injuries physios see, early intervention to tendon injuries is perhaps the most urgent !

A complete history of the development of the pain and common stiffness associated with tendinosis ( and the rarer Tendonitis …yes they still do occur ) is so important. Finding the exact cause or combination of causes is paramount. Proper management is as important as proper treatment here. So we must find out what it is you have been doing, to what extent you are doing it and exactly how you have been doing it. And we must change it. As well, of course, your physio will guide you in do’s and don’ts in your activities of daily living to expedite your tendon’s recovery.

A full physical assessment will reveal to the physio the type and extent of your tendinopathy . Putting the patient through the causative action is often revealing as it can be helpful in correcting a biomechanical error in performance and can lead to an alternative safer action. The cause of the overloading is a key to fixing the problem. It can be as simple as hauling an enthusiastic athlete back a rung or two or a to the point letter to an overbearing employer demanding an unrealistic workload. Most commonly it is a self inflicted repetitive injury in someone who has simply pushed their tendon past the tipping point where the recovery/healing process cannot keep up with the repeated load for whatever reason.

And so our knowledge evolves and therefore so do our treatment techniques and exercise regimens. Your physio will describe these in detail at your assessment consultation.

Treating hip and groin pain is akin to sonar and submarine exploration of our deepest ocean valleys… the depth of the structures and the multi-layering of landscape make specific diagnosis difficult at times. Many structures in the hip and pelvis give similar symptoms and frequently the cause of people’s pain comes from a combination of factors. Therefore seeking professional diagnosis and treatment is essential. At Avalon Physio Centre your physio will go through a series of passive and active and resisted tests which, along with your history, will allow an excellent indication of the problem at hand. Gait analysis is commonly required as this region of the body is the fixation point for your longest and most powerful lever… the leg. How you walk and run therefore impacts immediately and directly to the hip joint, labrum, capsule, ligaments and multiple layers of muscles. Similarly stiffness in the lower spine and pelvis ( or conversely instability ) can cause imbalance and altered biomechanics in the hip and groin too.

Once analysis has been performed and a provisional diagnosis arrived at, your physio will immediately set about settling the painful structures and provide an explanation to the proposed pathway to recovery, which may be lengthy or short depending on the problem. Suffice to say fixing a new / acute problem is easier than healing a chronic/ old one. So, please seek treatment as early as you can if your symptoms aren’t disappearing quickly….ask the advice who can help you ASAP.

Heel Pain can be the result of many causes, of course. Everything from trauma to sciatica to Achilles Tendinosus to Sever’s Disease ( Growing Pains in the Young and active ). But more and more commonly physios are seeing increased numbers in the incidence and diagnosis of Plantar Fasciitis. Because of it’s current rise in “Popularity” you can buy any number of gadgets, ointments and devices claiming to cure it. It is a really interesting condition which is mostly due to the overloading of the “fascia” or trampoline-like connective tissue under your foot which runs from the heel bone and spreads out to the balls of your feet. Most people only report for treatment when they have been struggling with pain under their heel for months and it has worsened to be unbearable to walk on. Most commonly people report severe early morning pain on first rising which settles a bit with walking but eventually builds again with time on their feet.

Treated early ( first days to 2 weeks ) the condition is easy to settle. However, once the condition is allowed to gain hold ( Months ), it is increasingly difficult to eradicate. Therefore the appeal of magic products which claim amazing quick recovery. Everyone wants to be out of pain as quickly as possible. Generally they don’t work because the factors which caused the condition to occur in the first place are still in play. The primary focus of a practitioner here is to analyse the cause of the overloading and to change the factors feeding it.

Often there is a trigger or event, such as a long walk on hard sand or standing long hours on a hard floor or the start of an exercise programme, which is the straw that breaks the camel’s back and the condition worsens from there. The structures under the foot which hold up your arches are able to cope with a certain load, but if you exceed that load too long or too often they will break down and become increasingly inflamed. Additionally as the arches collapse the foot tends to roll in or Pronate which then directly loads a bony point on the inner edge of your heel bone underneath.

This is the trouble spot. That bony point is supposed to be tucked away and protected from load bearing directly.

So, fixing one of these requires a multitude of things to be done…. All at the same time! Most people try one thing at a time, like ice for a week, or stretches that someone showed them or just orthotics without also stopping the activity which is driving the overload.

You need an astute physio to assess the causes of your overloaded feet and treat the condition locally with manual techniques, massage, supportive taping and ice… but also to guide you FIRMLY in the things to do, such as correct footwear, floor surfaces, arch support, icing, rest, stretching appropriately… and also FIRMLY to pull you back from continuing activity and practices which are preventing your underfoot structures from healing themselves. You need to do many things all at the same time. This takes commitment and perseverance. A lot of people are not prepared to do it. But it is the only way to make Chronic Plantar Fasciitis better.

If you are fed up with your sore heels and want a common sense and evidence based treatment that will work, call us.

No, physiotherapy can’t cure arthritis… either osteo or rheumatoid. Nor Lupus nor psoriatic arthritis nor scleroderma for that matter nor spinal inflammatory joint disorders like ankylosing spondylitis amongst others. But a commonsensical well trained physiotherapist can be invaluable to sufferers of such conditions. Invaluable to the team of people who assist sufferers of such conditions, including you, your GP and your rheumatologist.

Physios do not claim to cure any of the above but with measured doses of careful and considered manual therapy complemented by an achievable strengthening programme we can maximise the mobility and use of arthritic limbs and spines.

Similarly, designing sensible individualised general exercise programmes for people suffering from the more aggressively inflammatory joint disorders is possible. Credence must be given to the ebb and flow of these, at times, debilitating conditions. Push on in good phases and make a sensible retreat in flare up periods. Not rocket science.

The Northern Beaches is choc – a block full of retirees and oldies who love the wonderful northern beaches environment and lifestyle. Why wouldn’t you choose to retire up here? But equally, what a tragedy when you can’t get out there to enjoy it? When feelings of frailty and fear of falls stops you from doing what you formerly used to love doing. Sometimes it’s a result of one fall and sometimes it’s just a gradual decline in fitness and strength. Almost always it is accompanied by the awareness of worsening ability to balance, change direction steadily and cope with uneven surfaces.

Fact No. 1 Balance and the ability to change direction safely and cope with uneven surfaces are simply skills that can be improved with practice. Like any other skill. You just haven’t practised them in a safe environment for a while.

Fact No. 2 Old people are able to strengthen their muscles at approximately the same rate as young people.

Fact No. 3 Strengthening programmes lead to significant reduction to falls risk.

Fact No 4 Strengthening and balance exercises can be half-way fun!

One way to get started, of course, is to get started with groups of similar situated retirees in local community centres which are often extremely well run. Or aquarobics groups for an even softer introduction. But if you are not a group person and want a one on one, more personal programme of supervised exercises, our physios can certainly provide this for you. We don’t tend to use big machines like in the large gyms. Instead we like to use your own natural body weight for resistance. Maybe small hand weights and maybe some resistance bands too. But mostly functional strength and balance exercises which mirror real life challenges. This way, we believe, you are much more confident with the challenges of curb and stair climbing and with negotiating getting out of a deep chair easily and with slopes and dips in pavements.

Be assured, contact and communication with your G.P. re any general health issues will be sought as required. Similarly any visual disability whether depth perception or focus problems may entail the assistance of your optometrist.

Our professional Physiotherapists can prescribe either a specific exercise programme that targets problematic regions of your body or a general programme more tailored to general fitness , tone and wellbeing. An important point of difference with our exercise prescription is that whatever exercise we give we try to make it as functional and achievable as we can and also do-able at home . So we tailor a series of exercises in our rooms specific to your needs and get you to perform these between sessions with minimal equipment at home . Being locals we can even advise on local terrain and facilities available near your home that you can take advantage of.

Our new Power Wall and full length mirrors give us an additional advantage . By being able to change anchor points of resistance on our Power Wall we can very specifically target a line or angle of pull of a swimming action , a golf swing in the impact zone , a serve or overhead in tennis etc . Our Power Belt with resistance Bands can be so useful in developing core control and perfect limb alignment in running . The visual feedback provided by our full length mirrors with all exercises and core work has been a fantastic teaching tool in our patients gaining insight into moving in the correct alignment and with excellent control…no matter what the task.

All this in a professional caring local environment .