February 27, 2018

ACL Injury – Are You at Risk?

Written by Ky Wynne, Physiotherapist at LifeCare Prahran Sports Medicine.

The anterior cruciate ligament, or ACL, is one of the primary passive stabilisers of the knee joint. The primary role of the ACL is to resist excessive sliding and rotation movements of the knee, whilst also providing feedback on the joint position to the brain.


As any follower of sport would know, this injury is common. It is likely that you know someone who has suffered this injury, or seen a player suffer this injury playing sport. A recent high profile example is Robert Murphy of the Bulldogs, who ruptured his ACL in the 2016 AFL season (see below).

  Figure 2. Robert Murphy knee injury (source: heraldsun.com.au)

Figure 2. Robert Murphy knee injury (source: heraldsun.com.au)

Statistics show that ACL injures are the most common knee ligament injury, carrying a significant impact relating to loss of function and playing time. The factors contributing to ACL injury have been well researched, with risk factors considered non-modifiable and modifiable. The figure below lists some of these common factors. While we can’t change the unavoidable variables, for example, the hardness of the pitch you are playing on (1), there is evidence to show some factors can be influenced. Whilst studies differ on the variables which can be modified, a number of them include:

•    Poor quadriceps / hamstring muscle balance: Studies show when athletes have weaker hamstrings in relation to their quadriceps they exhibit a higher risk of ACL injury (1, 2).
•    Knee control when moving is shown as a significant risk factor for ACL injury, particularly movement of the knee inwards with or without rotation inwards (2).
•    Hip muscle strength and control affects knee control (see above), with studies showing reduced activation of some hip muscles alters control and increases ACL injury risk (1, 3).
•    Knee proprioception describes the knee balance and awareness. When this is reduced or impaired for a variety of reasons, this can increase ACL risk (3).
•    Jumping / landing control: Studies show that knee and foot position when landing in particular can affect ACL injury risk (2).
•    Anterior knee / patellar pain: Evidence shows that pain around the anterior knee (e.g. patellofemoral pain) increases the risk of ACL injury (4).

  Figure 3. ACL risk factors.

Figure 3. ACL risk factors.

This list is in no way exhaustive; however, these are a number of the key factors which could amplify an individual’s risk of suffering an ACL injury. Positively, the modifiable risk factors can be influenced by completing targeted strength and control exercises. Studies demonstrate positive results in relation to reducing the number of ACL injuries when individuals complete targeted injury prevention programs (1, 5, 6).

If any of the modifiable risk factors mentioned above sounded familiar to you and how you move, it is recommended to consult a LifeCare Physiotherapist with a view of commencing an injury prevention program. Simply click below to book an appointment with your local LifeCare physiotherapist.

February 27, 2018

Are You Suffering From Plantar Fasciitis?

Written by Greg Diamond, Senior Musculoskeletal Physiotherapist at LifeCare Cottesloe.

So you’ve got a pain in the heel or foot that is progressively getting worse. You notice one day some slight niggle which went away but starts occurring more and more often with greater intensity. It’s worst when you’ve been off it for a while and go to stand up or put weight through it. This is often especially noticeable on getting out of bed in the morning, those first few steps are agonising but gradually get easier with walking. Congratulations, you have been admitted into the plantar fasciitis club!

This is not a fun club, this is a frustrating journey that may take time and different treatment options to resolve. So what is it? This is NOT a clear cut answer but bear with me. The standard answer would say something like an inflammation of the insertion (point of attachment) of the plantar fascia (a thick band of connective tissue running across the bottom of the foot from toes to heel). The inflammation may involve the body of the fascia as well. Sometimes a bone spur digging into the fascia may be the source of the irritation or conversely the pull of the fascia on the bone may create the bone spur.

Plantar Fasciitisjpg

Over use may certainly contribute to the chance of having or developing a plantar-fasciitis but at times there appears to be no known contributing factor. A clue may lie in the fact that the body has connective fascial bands that run down and around the body from head to feet and tensing one part can have an effect quite distant to the original site of tension.

Because of this it is important to consider problem areas that are not only at the site of pain. These include soft tissue trigger points, especially in the calf, hamstrings and buttocks. The mobility of the small bones of the foot and ankle joint should also be assessed and treated if found to be abnormal. Often one of the overlooked tissues that provoke these types of problems are the nerves. If the nervous system is out of whack then all parts of interesting problems can ensue. What’s the answer? Get a full assessment from a musculoskeletal expert! Yes that includes us! In the short term:

  • Wear soft soled supportive shoes during the day
  • Keep a pair of slippers beside the bed to slip straight into in the morning
  • Use ice to reduce inflammation
  • Roll your foot over a golf ball for a deep massage effect and
  • Take anti-inflammatory medication.

Stubborn swelling may respond to a corticosteroid injection but save surgery as a last desperate option, even the worst of these can spontaneously resolve given enough time.

For a full assessment, book in with your local LifeCare physio by clicking the below.


February 26, 2018 -->

Acute Vs Chronic Back Pain

Written by Anna Gould, Physiotherapist at LifeCare Cottesloe Physiotherapy.

As physiotherapists we see people with back pain almost every day, in my experience it would probably account for about 60% of my caseload. As a result we see lots of people going through their own journey to reaching full function again. Back pain is such a common problem, the healthcare industry and therefore the media has been very invested in this problem and as a result there are many ideas, beliefs and attitudes towards back pain. These beliefs have a large impact on peoples’ disability and recovery. 

One common misconception is the difference between acute and chronic back pain. The word chronic relates to the time frame of the pain, not the severity of the pain. If pain has been experienced for longer than 12 weeks it is referred to as chronic. We refer to acute back pain when the injury or pain is new, in the first 4 weeks and sub-acute pain lasts between 4 and 12 weeks. Chronicity does not relate to the severity of pain as many are lead to believe. 

Why is this important? This changes our management and treatment of the pain vastly. 

If you ever have experienced that sudden, extreme back pain where you're on the phone to the reception staff literally begging for an appointment, we’ll treat it quite differently to your ongoing year-long back pain. 

In the acute stage we usually try to calm the situation down a bit, at this stage your muscles are usually kicking in to protect you from what your body may perceive as a threat. Usually this threat was a sudden increase in load and this tensing of the muscles is usually helpful for a few minutes, however they tend to stay sensitive for longer than needed which actually fuels the pain further. Therefore, we usually massage or dry needle those muscles and we want to limit your movement slightly to prevent this happening again. The most important thing to remember in this stage is that acute inflammation won't last for long, it is very unlikely you have done any serious damage and that if we do tell you to limit a particular movement, this will not usually be for more than a day or two. After this period we will begin to integrate movement into the back and your daily life again. 

chronic back pain.jpg

In chronic pain situations we aim to normalise movement and decrease the fear of pain. Chronic pain is a rather complex situation as it is beyond just a physiological response of the body. The brain can continue to submit pain signals long after any damage or inflammation has ceased, therefore we look at chronic pain very differently. We have to look at things like your daily habits, movement patterns, stress, anxiety and your understanding of the pain. We will encourage you to move more, try the things that you are fearful of in a graded and educated manner. Chronic pain can most certainly be resolved however one must remember that it takes active participation and willingness to learn. 

One thing to never forget is that the back loves to move! A common misconception is that the back must be protected as it is easily damaged, the truth is, is that it needs to move to be happy and healthy so don’t be fearful of movement. Your back is not as precious as you might think! I have held cadavers and I can tell you that they are very, very strong structures, it is difficult and borderline impossible to physically push out a disc or misalign a vertebra as it designed to be very durable and last a lifetime. 

If you are experiencing back pain there is so much that can be done to manage it. The most important advice I can give you would to keep calm, keep moving and call us if you need to. We are well equipped to help you deal with your back pain. Personally I love to treat them as they respond quickly to the right treatment and eliminating the pain can have a profound effect on ones’ life. 

We’re here to help!

If you’re experiencing acute or chronic pain and are in need of an experienced physio, click on the button below to book your next appointment. 

January 30, 2018 -->

FODMAPs - What Are They, and Are They Causing You Problems?

Written by Paula Christofakakis, Dietitian at LifeCare Malvern.

FODMAPs- what is it?

Abdominal pain, gas, bloating, constipation… do any of these sound familiar? These symptoms may not just be the result after consuming a large meal. More and more people are presenting with gut related concerns and food intolerances which can affect your quality of life.

Where do FODMAPs fit in?

FODMAPs are found in everyday foods and refer to Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols, which are sugars that can often be poorly absorbed in the small intestine. FODMAPs are fermented by intestinal gut microflora resulting in gas production, which contributes to other IBS symptoms such as bloating, wind, abdominal pain and constipation. For most people these sugars don’t cause any problems but some of us don’t digest them well.

The Low FODMAP diet restricts High FODMAP foods (listed below) and was developed by a team of researchers to help reduce and manage these IBS symptoms with one study showing it to provide relief in 56% of patients with Crohn’s or Ulcerative Colitis (Gearry et al JCC 2008).  

Vegetables and spices.jpeg

Examples of some High FODMAP foods include:


How can a Dietitian help?

Education on the Low FODMAP diet takes time, and an experienced dietitian can provide individualised treatment specific to an individual’s symptoms. Patients can work together with a dietitian to develop meal plans, shopping guides and options when dining out. Reduction or removal of high FODMAP foods from the diet with slow re-introduction to suit each individual’s needs and symptoms, can be managed by a dietitian in the context of achieving a nutritionally adequate diet.

Are you in need of a dietitian after reading this article? Click below to book an appointment with a LifeCare dietitian. Please note that dietitians are only available at selected clinics.

January 29, 2018 -->

How Are Backpack Loads Really Affecting Your Children?

Originally posted by LifeCare Cottesloe.

One of the joys I get from treating children and adolescence in physiotherapy is finding out what their goals and aspirations are when they are older. Their futures are so bright and boundless. I love the creativeness and imagination they have when I hear what role they will have in this world. Despite the advancements in technology, you would think that the weight of their school books would be replaced by tablets and laptops. Instead, what I find common in a typical schoolbag are piles of books loaded on top of laptops, tablets, sports gear, etc. Not to mention the way in which they are carried.

Did you know that a child’s backpack should not weigh more than 15% of their bodyweight? That is the rule of thumb and yet come exam time or end of sport season, children are visiting the clinic with musculoskeletal pains eerily identical to an adult’s presentation.

A 2002 South Australian clinical trial published in the journal of Musculoskeletal Disorders explored the posture response to backpack loading in adolescence aged from 12 to 18 years. It showed a clear difference between standing postures loaded with a backpack against those unloaded. It found that regardless of where the backpack was positioned it resulted in a horizontal displacement of the participants, irrespective of age and gender with the largest forward movement produced at T7 (mid back). This is to counteract the heavy weight of the back pack that can pull a child backward. Furthermore, in 2010, a study explored the impact of these loads on the lumbar spine on MRI. It found significant changes in lumbar disc height or curvature when the child was instantly loaded with a backpack. Yet children are exposed to these changes on a daily basis.

There were several limitations to these studies but what it does highlight is that we need to think about what kind of future we want to set these children up with. Their physical well-being is just as valuable as the education they receive in these prime years.

 Children's backpacks are loaded with piles of books.

Children's backpacks are loaded with piles of books.

The things we can do to improve your child’s spinal and musculoskeletal health include:

Cues for good posture – Can your child hold a good posture without a backpack? Are they able to maintain that posture under load? The cue for good posture I like to use is for the child to ‘imagine you have a puppet string pulling you up from the top of your head’. Can your child hold that posture for at least a minute? If the child shows signs of early fatigue, then there is a high chance that when loaded with a heavy backpack, they will be compensating with other body parts to uphold that weight.

Wear a backpack correctly- When worn correctly, the weight in a backpack is evenly distributed across the body with shoulder and neck injuries becoming less common. Utilise the compartments effectively - place heavier items closest to the centre of the back and avoid backpacks with tight, narrow straps that dig into the shoulders and can interfere with circulation and nerves. These types of straps can lead to tingling, numbness, and weakness in the arms and hand. Shoulder bags or carrying a backpack with one strap is obviously not ideal.

Lighten the load – Actually weigh the backpack that your child is carrying on a typical day. Again, it shouldn’t be more than 15% their body weight. If it is, work out a way with your child to avoid any unnecessary weight. Do you really need your laptop and tablet at the same time? Are there pdf or online versions of the textbook available or photocopies that can be made to minimise the weight? It might be worth the investment to purchase a second hand copy of the text books to leave in your child’s locker so that they don’t have to lug such heavy weights from school to home and vice versa.

Organisation – Encourage kids to use their locker or desk throughout the entire day, remove unnecessary items and homework planning! Work out with the child what homework they will be able to complete on the weekend and thus which books can come home and which one’s should be left at school.

Set up their work station – Set up their desk and make sure it maintains the correct height as they grow. An organised desk means they can see what they have on there and what they need to bring back from school. Make their desk the centre point where school materials come to and from, rather than the backpack that accumulates paper or the dining table where books and stationary collect dust.

Starting these good habits now can ensure a happy and healthy spine for your child when they enter adulthood and the inevitable work force.

If you have had your child complain of pain from their back pack, come and see us! You can book an appointment at your local LifeCare clinic by clicking the below.


1. Grimmer K, Dansie B, Milanese S, Pirunsan U, Trott P. (2002). Adolescent standing postural response to backpack loads: a randomised controlled experimental study. BMC Musculoskeletal Disorders. 3(10). 2. Brackley HM, Stevenson JM, Selinger JC. (2009). Effect of backpack load placement on posture and spinal curvature in prepubescent children Work. 32(3):351-60.

January 29, 2018 -->

7 Tips For Improving Your Sleep

Written by Greg Diamond, Senior Musculoskeletal Physiotherapist at LifeCare Cottesloe.

Because we deal with people’s pain we often hear the lament of, “I’m not sleeping well at the moment!” Now sometimes it’s due to the pain situation they are currently experiencing, but often you find it is part of a pattern of poor sleep that can have a raft of consequences, including making pain worse.

When we sleep, the body restores itself. It’s like the factory re-set button and it involves repairing damage dealing with invaders (viruses and bacteria predominantly) and strengthening the immune system.

No sleep or poor sleep sets you up for physical injury, infection and chronic inflammation.

You need your sleep!

Without good sleep your health will be compromised, it’s just a matter of when. The sleep studies are pretty conclusive that 7 to 8 hours a night is on the money…except for a very small percentage (7%) of the population that may be wired differently.

Alarm clock-humans need 7 to 8 hours of sleep.jpeg

So now that we have set the benchmark, how are you doing? Are you a Rip Van Winkle and could sleep for 100 years? Or are you Count Dracula and up all night?

Here are 7 ways to prepare for and have a better sleep:

  1. Have a regular bed time and a “going to bed” ritual that you follow every night. Our brains and bodies like routine so once we train them to recognise that this is heading to “beddy-bye’s” time, they automatically start preparing.
  2. As part of that ritual, stop using your technologies (especially computers, tablets and mobile phones) one hour before bed. The light they emit interferes with melatonin production which is the hormone we secrete that prepares us to slide into the land of nod. Technology also stops our brain moving into the type of brain waves (alpha) that we need to sleep.
  3. On a similar theme, try and reduce the light you are exposed to an hour before sleep. Dim the lights, blow out some candles and stop throwing big logs on the fire. Before modern times and our exposure to “light pollution”, our bodies/brains prepared for sleep as the sun set and night settled in. But now we have so much light we confuse our systems, so try and pretend the sun is setting and allow the melatonin release to do its thing.
  4. While you are it, reduce any source of extraneous light in your room. Yes, it may seem obvious but we sleep better in the dark (under-bed monsters excluded)!
  5. Tryptophan is an amino acid that chemically aids sleep and it’s levels can be raised by eating/drinking foods that stimulate its production a half hour before sleep: milk and a plain sweet biscuit or; bananas or; a smoothie of Greek yoghurt, tart cherries and almond milk (my favourite).
  6. Avoid stimulants like coffee, tea, Coke (-a-cola that is!) and even a hot chocolate has some caffeine in it.
  7. Use a meditation or relaxation technique after lying down to aid the relaxation of the body in its journey to sleep. An example of a relaxation technique is described on my YouTube channel 50 Fit and Fabulous if you need a run through.

If you are experiencing a lack of sleep due to muscle pain or an injury, you can book an appointment at your local LifeCare clinic by clicking the below.

December 22, 2017 -->

Run Away From Runners Knee

Originally posted by LifeCare Kingsway Physiotherapy

Summer is well and truly here and you found some motivation to get into shape and start running. If you keep it up, you might even sign up for a running event later in the year. But then your knee has started to hurt and you're considering why you even contemplated this "running" lark. 

Pain on the outside of your knee is very common in runners. So common in fact that it has been named several times over; "Ilio-Tibial Band Syndrome", "ITBS", "Runners Knee", "Friction Syndrome" and the list goes on like that hill you can't quite conquer. For the purpose of this blog, we will refer to the subject as "ITBS". 

So what is ITBS?

ITBS is an overuse injury which leads to pain on the outside of your knee. The ITB (ilio-tibial band) is a thick tendon that runs from the outside of your pelvis, down the side of your thigh and attaches onto the top part of your shin. As the band crosses the outside of your knee, it runs over a bursa. This bursa is simply described as a fluid filled sac designed to reduce friction between the band and the underlying bone. In ITBS, this bursa becomes irritated and inflamed which leads to pain as the knee repeatedly moves from flexion to extension (as it does during every stride you take).


Common Causes?

  • Training load/error
  • Muscle tightness 
  • Muscle weakness 
  • Often the cause is multi-factorial

Diagnosis is generally fairly simple to make. A familiar tale of pain which comes on during running and is exacerbated with every time your heel strikes the ground. Tenderness is readily brought on by direct pressure on the outside of your knee. Imaging such as X-rays or MRI scans are rarely required. 

How to get rid of this pesky ITBS?

The key to successful treatment is identifying the underlying cause/s. A thorough assessment from a physiotherapist will be able to determine the cause in your individual case. Common treatments include:

  • Training advice; we endeavour to keep runners running. COMPLETE REST is RARELY ADVISED. 
  • Addressing muscle tightness; massage, dry needling, foam rolling 
  • Rectifying muscle weakness with progressive strengthening exercises 

ITBS is a debilitating overuse injury for runners. With a thorough assessment and effective treatment it can be swiftly overcome. If you are struggling with ITBS, then call your local LifeCare practice or click below to book online with one of our physiotherapists today and we will strive to get you running away from your runners knee!



December 22, 2017 -->

How Long Will This Take? Time Frames Of Tissue Healing

Originally posted by LifeCare Kingsway Physiotherapy.

Just like Rome, the human body wasn't built in a day and it certainly doesn't repair itself in that time frame. The body's response to damage is complex and variable, it depends on the extent of damage, the type of tissue, your age, your health and many more variables you cannot control. You cannot control how fast your body repairs itself following injury, you can only optimise it by avoiding factors that slow the normal healing process. This includes avoiding activity that re-injures the tissue such as running after a hamstring strain or even standing on a fractured foot. Activity that reproduces your pain and makes it more sensitive or intense is likely to limit your ability to heal, so therefore "no pain no gain" is not a relevant mindset.

Just like the way your body deals with a cold or an infection, the body has a set process to deal with tissue damage. Tissue describes a collection of similar cells which make up a type of body tissue, examples include muscle, epithelial (Skin and blood vessel lining), connective (Bone, ligament and tendon) and nerve. The process is similar for each tissue, with small variations in the cells involved in the healing process. Not every tissue will heal in the exact same manner, this is due to blood supply to the area, the function of the tissue and the ability to protect the tissue in response to injury.


The majority of tissue injuries occur when a large amount of pressure is placed upon a structure. The pressure, either quickly applied or accumulative over time, causes breakdown of tissue and damage occurs. An immediate reaction begins in response to damage in the tissue, this occurs in four distinct phases. Each phase takes time to complete and usually overlap before the next phase begins.

Tendon and Muscle Injuries.jpg

Phase 1: Bleeding (Vascular component of Inflammation) 

The immediate response to damaged tissue is usually bleeding and swelling around the injured tissue. This occurs at a cellular level when cells and blood vessels that make up the damaged tissue die and release a chemical called histamine which increases the rate of fluid flooding the area from the surrounding blood vessels. This causes dilation of blood vessels surrounding the damaged tissue, allowing migration of white blood cells, platelets and other blood products in and around the damaged tissue - starting the cellular inflammatory process. This occurs immediately following tissue damage and is managed in minutes to hours after injury.


Phase 2: Cellular Inflammation Phase 

The arrival of blood products to the damaged site allows for the tissue to prepare for the healing process. White blood cells, specifically leukocytes, infiltrate the damaged tissue and consume debris and dead tissue in a process called phagocytosis. Once the damaged tissue is removed, the remaining tissue is prepared for rebuilding and the damaged cells no longer produce inflammatory chemicals, slowing down the inflammatory process. When damaged tissue is unable to be completely cleared or removed from the damage site, inflammation continues to cycle without stopping, this is called chronic inflammation. The normal process of inflammation spans between minutes following damage and the next 72 hours post injury. 

Phase 3: Proliferation 

In the dying stages of inflammation, specialised cells called fibroblast begin to rapidly multiply in and around the damaged tissue in a process called proliferation. Fibroblasts reconstruct damaged blood vessels in the area and lay down bundles of collagen to rebuild the damaged tissue at the damage site. This may include surrounding muscle/connective/epithelial tissues that were also damaged by the abnormal load causing tissue breakdown. Once the immature tissue is laid down, the wound begins to contract to reduce the size of the damaged site. This begins in the first day of injury and extends up to a month post injury.


Phase 4: Remodelling 

Remodelling describes the maturation of immature collagen cells within the wound that are roughly laid out in the proliferation phase. Type III collagen which is laid down in the proliferation phase is disorganised and randomly orientated. This collagen converts during the healing process to Type I, by applying gentle force such as stretch, contraction, weight bearing pressure to the healing tissue, aligning the fibres to run inline with the direction of tension and reduce the occurrence of scar tissue. This process begins in the weeks following tissue damage and can extend over 12 months or more depending on the size and type of the wound.

This basic overview explains why tissue cannot simply heal overnight but takes weeks to months to fully restore. As Physiotherapists our job is to manage patient expectations regarding recovery from injuries and how to best manage your specific condition. In many cases medical and surgical assistance is required based on the best possible outcome or safest approach to rehabilitation. This will be assisted by your Physiotherapist who can perform manual therapy to assist with the condition of damaged tissue and instruct on appropriate activity and exercise to facilitate tissue healing.

If you would like to consult a Physiotherapist about your injury, call your local LifeCare practice or book online by clicking the button below.