When Should I consider Knee Surgery?

Posted on October 27th, 2011

A common, unfortunate knee injury in the sporting population is a rupture of the anterior cruciate ligament (ACL). The ACL is a strong ligament that runs deep within your knee joint and provides stability and control with knee movements.

Signs & Symptoms of an ACL rupture:

– pain and swelling

– increased translation (movement) of the shin bone on the thigh bone which causes instability, collapse and giving way of the knee

This injury is managed either conservatively or operatively. An orthopedic specialist will usually base this decision on the following considerations:

– the level of instability experienced: if your knee gives way with simple tasks such as relaxed walking then surgery is your best option

– trauma to surrounding structures: it is not uncommon to have sustained an injury to other soft tissue structures in the knee when you tear your ACL

– if you wish to return to sports: particularly high level, competitive sports, it is recommended to have surgery as you will need appropriate knee stability, strength and control

– social issues must also be considered: such as surgical expenses, time off work, any impact on family life etc

Although the orthopedic specialist may recommend that the best option for your knee is to have it surgically managed, ultimately you have the final decision in regards to your health care. If you are having trouble making a decision, speak with your friendly physio team at PhysioCare, speak with your surgeon and speak with people who have undertaken the surgical option.

Radiological Investigations

Posted on October 21st, 2011

There are several different types of diagnostic imaging that your physio, doctor or specialist may refer you for. When you are referred for diagnostic imaging, it may be to confirm or exclude a diagnosis. Physiotherapists are able to refer patients for x-rays, ultrasounds and MRI.

So what is the difference between diagnostic investigations?

– X-rays: provides information about bony problems such as fractures, abnormal bone growths, calcification, joint alignment and joint spaces.

– Computed Tomographic (CT) Scans: are useful in examining bone and soft tissue particularly in the spine.

– Ultrasound: used to examine and visualise muscles, tendons and organs in real time. 

– Magnetic Resonance Imaging (MRI): is most valuable in detecting spinal disk/disk root abnormalities, avasular necrosis (bone destruction due to lack of blood flow) and bone marrow tumours.

Shoulder Problems: Why so common?

Posted on October 17th, 2011

To someone who works in this field for any length of time it becomes evident that there is a large amount of people presenting for treatment of their shoulder pain. So why is this the case? How is it that so many people seem to suffer from shoulder inuries and can we prevent this? To answer these questions we first need to think of the anatomy of the shoulder joint…
As you may be aware your body is made up of a multitude of different joints and not all of these are the same. If you take the hip for instance, this is what could simply be described as a “ball-and-socket” joint, this mean the bony shape of this joint provides extra stability and strength. By comparison, the shoulder joint is less of a ball-and-socket but rather more like a ball-sitting-on-a-suacer (except the saucer is only 1/3 the size of the ball), obviously this in not as stable a joint and thus more prone to injury. Sitting above this joint sits your “acromial arch” which is basically a bony bridge sitting above your shoulder formed by the collar bone and the shoulderblade, there is only about 8mm of space between the underside of this bridge and the top of your shoulder. Its not much room to move! 


Due to its less stable anatomical stucture the shoulder must rely on ligaments and muscles to provide stabiltiy as you move, The “rotator cuff” muscles are the primary muscles used for shoulder stability. These are a group of four muscles which act in uinson to “suck” the ball back onto the saucer and provide what we call “dynamic stabiltiy”. Unfortunatly if these muscles become fatigued or injured they can lose some of their control over the shoulder, meaning that the tendons of these muscles are more likely to be pinched underneath the bony bridge that was discussed above (pictured: left).  

Other predisposing factors towards this pinch include;

  • Repetetive overhead activities
  • Repetetive lifting of heavy objects, especially above your head
  • Sitting/working with a slouched, round shouldered posture
  • Muscle imbalance eg. building up your chest more than your back
  • Traumatic injury through slips, falls or sporting injury

Some tips for preventing or delaying injury:

  • Take regular brakes from lifting/overhead activity. Get up to the correct level, do not overstretch yourself
  • When working at a desk make sure to take a few seconds every 15-20mins to roll your shoulders back and regain some blood flow to you muscles + realign your posture
  • Adjust your workstation so you a not working in twisted or kinked positions.

Please remember that this is only a description of one kind of shoullder injury, always consult with your Physiotherapist for a comprehensive and accurate diagnosis.

How to manage a cork

Posted on October 11th, 2011

If you were to head out and watch any local sporting competition this weekend it is highly likely that you would witness sombody sustain a “cork”. Almost all of us have experienced this throughout our lives, the sickening pain of knee meeting thigh is not any easy one to forget. 

But how to manage it? Is the question that often springs to mind as you limp from the field pretending that you cannot now feel your heartbeat throbbing in your leg. Unfortunatly the age-old “get your thumb in and rub it out” is not really the sound advice that people once thought.

Basically when that knee/elbow/footy boot meets your soft tissue it causes a number of problems;

  1. Microtearing of small muscle fibres
  2. Activation of your mechanoreceptors and nociceptors (pressure and pain sensing nerve endings)
  3. Widening of your local blood vessels bringing more blood flow to the area
  4. An influx of chemicals which act as inflammatory mediators in the area
  5. All combining to cause swelling, bruising and an increase in pressure on the nerve endings in that area

Basically…. a red, warm, swollen and tender area of tissue.

So what to do? Well as mentioned in our previous post dated 03/10/11, an acute injury should always be managed with ice. In this case the best therapy is Rest, Ice, Compression & Elevation (RICE) for anything up to 3 days and in severe cases even longer.

So when to give it a rub? The only time this will really be needed is if the cork is severe enough that it leaves behind a hard, thickened area of tissue and concealed bruise. this should only be attempted once all of the swelling, redness and warmth has left the area. Regardless you should not be performing this prior to day 5.

Remember to always consult your Physiotherapist for expert advice and management

Ice or Heat for Injuries?

Posted on October 3rd, 2011

What is the best management for an acute (new) injury? Automatically, people tend to believe that applying a heat pack to the injury will be the best treatment option. However, as I will explain below, applying heat should actually be avoided for the first few days after an injury.

Let’s take this scenario – you are running up the goat track of Castle Hill, you roll your ankle and you immediately experience pain, swelling and an inability to put weight through your ankle. Your ankle has become inflammed which brings a large amount of heat to the site of the injury. Applying ice to your ankle every 2 hours for 20 minutes is the best management for your acute injury. Once the heat has gone from your ankle and the inflammation settles, you no longer use ice.  This usually takes around 2 to 3 days depending on the severity of your injury.

This principle applies for ALL acute injuries. If you apply a heat pack to the already inflammed ankle, you could be prolonging the inflammation that is occurring. This will in turn delay the healing process. Remember for acute injuries – Rest, Ice, Compression and Elevation (RICE).