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Keep moving with kneecap pain


Keep moving with kneecap pain

Pain in the front of the knee, around the kneecap can be a common issue in people presenting to Physiotherapy. This issue can be caused by an irritation of the patellofemoral joint, the joint between your kneecap and the base of your thigh bone. Often pain can occur in this joint when running, walking up or down stairs or during other exercise such as squatting. Pain in this area often relates to pressure on the kneecap as it articulates with the bottom of your thigh bone – your femur. The force on this joint is mainly influenced by two things: the amount of force being produced by the quadriceps muscles on the top of your thigh, and the amount of knee bend or flexion that occurs when the joint is under load.

Here are a few strategies you could implement to reduce your patellofemoral pain whilst continuing to exercise:

  1. Choose exercise activities that gradually expose the knee to greater stresses.
  There is a systematic review by Hart et al. (2022) that has looked at the average reaction force that different activities place on the patellofemoral joint in healthy individuals. Walking: 0.9x body weight Descending stairs: 2.8x body weight Ascending stairs: 3.8x body weight Running: 5.2x body weight Squatting: 1 – 18x body Looking at these averages, a good way to try and reduce the load on the patellofemoral joint could be to target start with a low loading exercise such as walking and gradually progress to stairs and then running. As you can see, there is a very large variability in the loads that are placed on the knee during squatting movements. Therefore, if you can minimise the amount of knee bend during your squats, you may be able to reduce your knee pain.
  1. Modify your current exercise program to reduce the stress on the knee joint.
  We know that the joint reaction force will increase with greater knee bend. Choosing squat variations that limit your knee from bending more than 90 degrees could allow you to maintain lower body strength whilst reducing your pain. Choosing exercises that are double-legged rather than single-legged may reduce the tendency of your knee to track inwards, which may help to settle your patellofemoral pain. If you are a runner, increasing your step rate may help you to settle your knee pain and keep you running. If you keep the same running pace, an increased step rate will reduce your stride length, which reduces the amount of knee bend through the weight-bearing portion of the running cycle. This can then reduce the reaction force in the patellofemoral joint, and it will be easier to maintain better alignment through your hips to avoid a scissoring pattern. Then once symptoms have settled you can begin gradually re-expose the knee to more loads over time so that it can get used to it. As with many areas of the body, this advice is generalised and may not be affective for individuals with varied anatomy and movement patterns. Try a few of these strategies, and if you’re still having issues with your knee pain, we’d be happy to help you here at the clinic. Reference: Hart, H. F., Patterson, B. E., Crossley, K. M., Culvenor, A. G., Khan, M. C. M., King, M. G., & Sritharan, P. (2022). May the force be with you: understanding how patellofemoral joint reaction force compares across different activities and physical interventions—a systematic review and meta-analysis. British Journal of Sports Medicine, 56(9), 521–530. https://doi.org/10.1136/bjsports-2021-104686

Lateral hip pain


Lateral hip pain

Pain on the outside of the hip is a common complaint especially for those who have shifted towards an increase in their physical activity or ceased physical activity leading to a stress to the tendons that surround the hip.

Some times this pain can also be a result from an inflamed bursa in the hip but it is important to note that there is often an issue with the glute tendon itself and so this muscle and tendon also needs to be addressed in order to restore pain free movement.

To help manage this pain it is important to reduce compressive loads on the outside of the hip, so try to avoid sleeping on that side or crossing your legs, as this stretches and puts pressure on these structures. If you do sleep on your side, place a pillow between your knees. Also try to avoid stretching out the glutes as this also puts compressive pressure on the area of pain. Until you build more strength around the hip, it is best to reduce walking up hills and stairs. Putting an ice pack or frozen peas right over the widest part of the hip is helpful to reduce the pain.

A really helpful exercise in the early management of this pain is a simple exercise using a belt or a tied up scarf around your thighs. You can do this in sitting or laying on your back with the feet on the bed and the knees bent up. Once you have the belt around your thighs, simply press the affected side into the belt and hold. This is called an isometric exercise, where you switch on a muscle and keep it switched on so as to stimulate blood flow and it is also a really good way to desensitize the area of pain. It is a gentle way to begin activating these glute muscles so that you can then progress slowly with more challenging glute exercises once the pain settles more and more.

Be patient with yourself, lateral hip pain can be tricky and can sometimes take a while to get on top of. There are other treatments that can help, such as shockwave therapy and corticosteroids injection but as this pain is often a result of an issue in your glute tendon, it is important that you rebuild the strength and control around your hips.

Exercise Guidelines


Exercise Guidelines

  Many clients ask how much exercise should I be doing? It is a question that is often asked and not many people seem to be able to answer.   In many cases, injuries are caused by deconditioning and muscle atrophy, which leads to problems with pain and loss of physical function. It is important that people get sufficient exercise to maintain their level of function and current fitness levels, however it is important that people know how much activity they should be doing.  

General Exercise Guidelines

The Australian Government department of health states that adults between the ages of 18-64 should accumulate a total of 300minutes of vigorous exercise per week, including completing specific muscle strengthening exercise on 2days. For people aged 65 years + it is recommended that people complete 30 minutes of moderate intensity exercise every day.  

What is vigorous exercise?

Vigorous exercise is counted as exercise where you are breathing hard and fast, with a moderate increase in your heart rate.  

What is moderate intensity exercise?

Moderate-intensity aerobic activity means you're working hard enough to raise your heart rate and break a sweat. One way to tell if you're working at a moderate intensity is if you can still talk but you can't sing the words to a song.  

Is walking enough?

People often ask if walking is enough. If you are walking at a moderate intensity as described above, for 30 minutes per day, then you should be meeting recommended exercise guidelines for people aged 65 +. However, if your physio advises strengthening a muscle group or area, then walking is not sufficient.  

How to build strength?

https://www.youtube.com/watch?v=2tM1LFFxeKg   Strength is often recommended to rehabilitate an injury and protect an area of the body. Strength is built by placing the tissue under stress so that you are causing microscopic damage to the tissue. Once this damage occurs, the body will heal the area, making it stronger and able to withstand greater stresses in future. Our bodies have adapted to be able to cope with the demands of everyday activities, so it is important that when strengthening a muscle you are placing it under sufficient loads that are greater than what the body typically experiences.   If you are not meeting the recommended exercise guidelines including 2 sessions of muscle strengthening per week, you may be vulnerable to muscle loss or atrophy, and may be developing a greater risk of injury.     In summary, completing adequate levels of activity are important for maintaining physical functional and limiting the effects of injury. Physiotherapists are experts in instructing people on how to exercise in the presence of injury or pain. If you are unable to meet your activity levels due to injury, then ask the physio how to work around the injury whilst we help the body to heal.  

Remedial massage


Remedial massage

The intention in remedial massage is to ‘remedy’ the body. This style of massage holistically looks at the entire body, with its focus being treating pain, structural dysfunctions and helping in injury rehabilitation. Remedial massage therapists use assessments and tests to find out what structures are causing your pain or your postural dysfunction. Usually muscular pain such as low back pain, is caused by either weak muscles, overactive muscles or compensating muscles. Once the remedial therapist has found the cause of your pain/discomfort, the massage will then be focused around treating the muscles that are causing the pain in your body. Therefore remedial massage is specifically tailored to each individual unlike most relaxation massages. A remedial massage will involve a variety of techniques, targeting specific muscle groups. Some techniques include trigger point therapy, PNF stretching, Myofascial release and muscle stripping. The pressure in remedial massage can be at times deeper than in relaxation massage, but always working in what is tolerable for the client. People who will benefit from a remedial massage include anyone who is experiencing muscle tension, or anyone experiencing acute or chronic pain, some examples being low back or neck pain. Like relaxation massage remedial massage is also beneficial at stimulating blood flow throughout the body and assisting in toxin removal. Although remedial massage may not be considered as relaxing at a relaxation massage, it’s still very effecting at calming the mind and body. Especially seems as remedial massage treatments can take away your musculoskeletal pain, which has a direct effect on your mental and emotional state.  

What can Physio’s do for jaw pain?


What can Physios' do for jaw pain? The idea of seeing a physiotherapist for jaw pain may seem a bit out of context. You might think a dentist may have the tools to help. Physiotherapy for jaw pain has been around for a long time now. We treat Jaw issues from locking, pain, jaw deviations on opening and closing, and clicking sounds. These issues may come from a dental procedure, clenching/grinding at night, neck referral pains, degenerative disc, a physical altercation after having a rowdy night at the pub.   Physiotherapy treatment can include:

  • Soft tissue therapies to the surrounding muscles, potential even the pterygoid muscles inside your mouth (wearing gloves of course)
  • Joint mobilisations e.g. gentle tractions for a stiff locked joint
  • Exercise prescriptions
  • Dry needling
  • Neck treatments
  • And of course, education and advice

What is degenerative disc disease



What is degenerative disc disease

  Degenerative disc disease is commonly seen in lower back and neck CT’s and MRI’s. It is a radiological term used for explaining anatomical changes in a disc rather then a pathology. Having this in mind when degenerative disc disease is coupled with pain it is most commonly due to issues with surrounding structures e.g. weakness and/or stiffness. Having degenerative disc disease does not always mean that it is causing pain output. Weaknesses of surrounding structures can lead to shear, compressive or tensile forces which make the more vulnerable discs stress.   The protocols to then treat a painful back with a history of degenerative discs is to make sure surrounding structures are strong and supple. This will take away the forces on the vulnerable discs. It does not mean though that those discs will heal it only means a better managed pain state. These discs will always be structurally vulnerable due to their lifetime of stressors.   Do not wrap yourself in bubble wrap to avoid this natural wearing of discs as it will most likely happen quicker.  Be aware of remaining constantly active throughout your lifetime and treat your body with the respect it deserves.  

Lateral Hip Pain


Lateral Hip Pain

Have you recently started to get pain in the side of your hip? Has it been there before and then come back again? Have you had corticosteroid injections that have relieved pain temporarily or not at all? If so, read the blog below to help you get on-top of your stubborn hip pain and start the pathway back to performance.   Lateral hip pain can be referred to as Greater Trochanteric Pain Syndrome, Trochanteric Bursitis, Glute Medius Tendinopathy or Hip Bursitis. All these terms are used to describe pain inside the hip and buttock region, on the bony part on the side of your hip (greater trochanter) and sometimes down the outside of the thigh. The hip pain can be aggravated by sitting cross-legged, prolonged walking, prolonged sitting, climbing stairs/hills and lying on the painful hip.   Ultrasound imaging of lateral hip pain often illustrates inflammation or thickening of the trochanteric bursa or ‘bursitis’. A bursa is a small fluid-filled sac that provides a cushion between bones and tendons throughout the body to minimise friction. You may have been given a corticosteroid injection into your bursa to ease this inflammation.   These injections can be effective in reducing your pain, but this may only be short-lasting! Often trochanteric bursitis is a secondary reaction to a Gluteus Medius/Minimus tendinopathy or weakness in this hip muscle group. Dysfunction in these muscles can increase the compression force on the bursa and tendons. Prolonged and repeated compression of these structures without suitable exercise and lifestyle modifications can cause thickening and inflammation of the bursa, and potentially tendon degeneration.    

Why can neck pain cause vertigo, dizziness and/or headaches


Why can neck pain cause vertigo, dizziness and/or headaches

There have many different hypotheses for this conundrum over the past few decades. Few have stood the test of scientific rigor. Below are a few that have:

1)      Proprioception. This occurs more often in acute traumas like whiplash from car accidents. Where the damage in a joint or tissue can lead to abnormal afferent input into the vestibular nucleus. In turn disturbing vestibular input. In normal terms it kinks the balance link between the inner ear, brain and muscles. This is times by 10 due to the fact we have significantly more proprioceptors in the upper cervical joints then any other joint in your body.

2)      Sympathetic dysfunction. Your sympathetic part of your autonomic nervous system controls the survival mechanism of our body hence the "fight or flight". When damage occurs to your cervical spine it may stimulate sympathetic nerve fibres changing blood volume in the vestibular arteries supplying the brain stem. Hence constricting blood vessels in the vertebro-basilar system resulting in dizziness and/or vertigo. We have many of these sympathetic nerve plexuses around our spinal column.

3)      An obstruction in the vertebral artery. A stenotic obstruction in this artery can lead to all of the above symptoms. Neck rotation can block this artery leading to VBI (vertebral artery insufficiency).

4)      Cervicogenic vertigo associated with chronic migraines. The trigeminal nerve which is one of the cranil nerves has reciprocal connections to the vestibular nuclei. The trigeminal nerve innervates a lot of the upper cervical area in which could be an explanation to the symptoms stated above




  Tendinopathy refers to an unhealthy tendon characterised by overuse and the presence of tiny tears along with the breakdown of collagen fibres and other changes to the intracellular structure of the tendon.   Here are some vital facts to know about tendinopathies.   1) Tendinopathy does not improve with rest. Pain may settle temporarily but returning to activity is often painful again because rest does nothing to increase the tolerance of the tendon to load.   2) There is NO good evidence that these injuries are caused by inflammation. Therefore, anti-inflammatories often have limited effectiveness for these injuries.   3) The main factor for tendinopathy is overuse or simply too much of certain activities. Activities that require the tendon to store energy such as walking, running, jumping, along with loads that cause compression are the most common causes of tendinopathy. Tendon pain is sometimes caused with only subtle changes in activity.   4) Exercise is the most evidence-based treatment for tendinopathy – tendons need to be loaded progressively so that they can develop greater tolerance to load. In a vast majority of cases tendinopathy will not improve without this.   5) Modifying load is important in settling tendon pain. This often involves reducing tendon load that involves energy storage and compression.   6) Pathology on imaging is NOT equal to pain. This is one of the things that most people have the most difficulty understanding about tendon injuries. You can have severe pathology or tearing of the tendon, but this will not determine the amount of pain you will have or necessarily affect your recovery. Tendon pathology is also common in people without pain,   7) Tendinopathy rarely improves long term with only passive treatments such as corticosteroid injections, massage, acupuncture, dry needling, etc. Exercise is the most important treatment and passive treatments should only be used as adjuncts. There is lots of evidence to support this and if you are interested, more information can be found in the links provided.   8) Exercise needs to be individualised to a person’s pain and presentation. There must be progressive increase in load to enable restoration of function whilst respecting pain.   9) Tendinopathy responds very slowly to exercise. You need to have patience, ensure that exercise is correct and progressed appropriately, and try and resist the common temptation to accept ‘short cuts’ like injections and surgery. There are no short cuts.    
Abate M, Gravare-Silbernagel K, Siljeholm C, et al.: Pathogenesis of tendinopathies: inflammation or degeneration? Arthritis Research and Therapy. 2009, 11:235.
Cook J, Purdam C: Is compressive load a factor in the development of tendinopathy? British Journal of Sports Medicine. 2012, 46:163-168.
Littlewood C, Malliaras P, Bateman M, et al.: The central nervous system–An additional consideration in ‘rotator cuff tendinopathy’and a potential basis for understanding response to loaded therapeutic exercise. Manual therapy. 2013.
Malliaras P, Barton CJ, Reeves ND, Langberg H: Achilles and Patellar Tendinopathy Loading Programmes. Sports Medicine. 2013:1-20.




We all know we should exercise, and the science is clear, exercise is medicine. The following explains what an Exercise Physiologist is and why your doctor might refer you to one.   What IS AN EXERCISE PHYSIOLOGIST? Accredited Exercise Physiologists (AEPs) are university-qualified allied health professionals. They specialise in designing and delivering safe and effective exercise interventions for people with chronic medical conditions, injuries or disabilities. Services delivered by an AEP are also claimable under compensable schemes such as Medicare and covered by most private health insurers. When it comes to the prescription of exercise, they are the most qualified professionals in Australia.  


  EXERCISE TO IMPROVE YOUR MENTAL HEALTH Mental illness can have an impact on a person’s cognitive, behavioural and social functioning. Those with a mental illness often struggle to engage in their regular work, social and physical activities which can further impact the illness. Mental illness includes anxiety, depression, schizophrenia, bipolar affective disorder and personality disorders. There is mounting evidence that suggests exercise is an effective treatment method for people suffering from acute and chronic mental illness, with some studies suggesting that exercise is just as effective, if not more effective than pharmacological intervention in alleviating depressive symptoms.   EXERCISE TO MANAGE CHRONIC PAIN AND ILLNESS  Chronic pain is pain that persists beyond the expected healing time of an injury. Unlike acute pain which is caused by tissue damage, chronic pain is less about the structural or tissue damage and more about the sensitivity of the nervous system and ‘non tissue related factors’. Significant research has shown that exercise is an essential component in the treatment of chronic pain. Studies have shown that it can be an effective way to reverse this downward cycle of deconditioning and worsening pain, and gradually over time help those with chronic pain engage more in activities of enjoyment and essential activities of daily living with greater ease.   EXERCISE TO REDUCE YOUR RISK OF FALL AND IMPROVE YOUR BALANCE Falls can result in permanent disability, restriction of activity, loss of confidence and fear of falling, all of which reduce quality of life and independence. There is now good evidence that exercise can prevent falls in older people by decreasing a number of key risk factors. For example, exercise can improve muscular strength, balance, balance confidence and walking speed, as well as psychological factors such as mental ability and mood.   EXERCISE TO INCREASE YOUR MUSCLE MASS AND BONE STRENGTH Osteoporosis occurs when bones lose minerals, such as calcium, more quickly than the body can replace them, leading to a loss of bone thickness (bone density). Any bone can be affected by osteoporosis, but the most common sites are the hip, spine, wrist, upper arm, forearm or ribs. Exercise can help bones modify their shape and size so they become stronger and this can prevent injuries. Exercise also increases muscle strength and improves balance which can help reduce the risk of falls.   EXERCISE TO CONTROL YOUR DIABETES OR PREDIABETES Diabetes mellitus is a metabolic disease indicated by an elevated fasting blood glucose level due to deficiencies in insulin secretion or inability to use insulin. Everybody benefits from regular exercise but for people with diabetes mellitus (Type 1 or 2) exercise can play a vital role in the management of their condition. Exercise cannot reverse the damage to the cells in the pancreas that leads to the decreased production of insulin. Exercise can improve the way the muscles respond to insulin, which, in turn, helps regulate the blood glucose level for some hours after the exercise. Exercise also increases glucose uptake by the muscles and can lower the dose of insulin required by improving the body’s response to insulin.   EXERCISE TO IMPROVE OUTCOMES DURING CANCER TREATMENT AND BEYOND Cancer is developed when abnormal cell function occurs.  can develop within all parts of the body and can invade surrounding and distant sites by spreading through the blood vessels and lymphatic systems. If diagnosis and treatment are not administered in the early stages of the disease, cancer can be life-threatening. The potential benefits of exercise during and after treatment are significant and research has proved its effectiveness. Exercising during chemotherapy can help ease side effects, such as fatigue and nausea, and can help to boost the immune system of those undergoing cancer treatments.   Our Accredited Exercise Physiologist at Pottsville and Cabarita Physiotherapy will take you through a full screening to assist in prescribing you the appropriate program to achieve your goals in a safe manner. You can book an appointment with our Exercise Physiologist Sammy here  or call 6676 4000