Your health and wellbeing deserves quality care. Make sure to discuss any concerns you may have directly with your preferred physiotherapist, so that you can receive the appropriate guidance for your unique situation.

Your health and wellbeing deserve informed, personalised care. For tailored support, please discuss any questions or concerns with your physiotherapist of choice.

Photo by Dr. Manuel González Reyes from Pixabay

Under normal conditions, the bursa need not swell up to protect the tendon, but if the tension in the tendon increases beyond the acceptable norm, swelling in the bursa physically pushes the tendon away to avoid friction over the bone. Bursitis is therefore often caused by repetitive motion or excessive pressure by the muscle and may on rare occasion result from a traumatic event. The symptoms may vary from local joint pain and stiffness to a sharp, stabbing pain surrounding the area, and the pain peaks during and after provocative activities, while joint stiffness can be a common symptom in the mornings.

Addressing the underlying cause of the increased risk of friction is ultimately what is needed.

• Surgeons may offer to remove the bursa but this leaves us wondering what would then act as the barrier and the early warning sign to protect the tendon from damage when repeatedly rubbing against the bone? So rather than shooting the messenger…
• We recommend determining why the tendon or muscle is tensioned beyond what the bursa deems safe.
• Home remedies in the interim could alleviate the symptoms and at times, allow for the condition to resolve, but if you do not see a marked improvement within 3 days and an ultimate resolution through use of a home remedy or any formal treatment, we recommend a change in your approach.

The goal with any treatment for bursitis should be to correct the bio-mechanical imbalances which caused the increased tension in the muscle and the initial irritation for the bursa, and unless proven otherwise, our experience says to look at altered joint mobility or altered nerve control for the muscle in question, as the primary suspect.

Your health and wellbeing is deserving of quality care so be sure to discuss any concerns you may have directly with your preferred physiotherapist, so that you can receive the appropriate guidance for your unique situation.

DOMS is one variety of muscle damage caused by exercise but is typically nothing sinister; the other occurs during and immediately after exercise and this is ‘acute muscle soreness’.

What are the symptoms of DOMS?

Apart from short term loss of muscle strength, reduced range of motion and possible swelling of the muscles, the most significant symptom of DOMS is a dull muscular ache. Passive stretching increases the symptoms, which explains the feeling of stiffness.

What are the causes of DOMS?

The primary cause of DOMS is muscle strains or ‘Myofibril tears.’ Small scale damage results in an inflammatory response with intramuscular fluid and electrolyte shifts. Blood tests can confirm this micro-trauma though the detection of markers like ‘creatine kinase’ and ‘lactic dehydrogenase’.

Muscle strength, motions and functions are impaired in someone experiencing DOMS due to swelling, altered muscle firing patterns and pain.

How do I know if I have DOMS or an injury?

Innocent soreness (as in the case of DOMS) is a tender, tired or burning feeling, usually an achy, stiff or tight feeling, typically occurring bilaterally and has a delayed onset.

An injury on the other hand causes deep, sharp, stabbing pains, typically only on one side and starts less than a day after activity, if not during. These are the signs that there may be a more serious injury and one should not assume that it’s just DOMS. Additionally, an injury will typically last longer than just a few days. General soreness from DOMS should peak at 24 to 48 hours after activity and last only up to 3 days. If symptoms are not subsiding after that, something more serious is possible.

What is my best course of action?

DOMS responds well to light activity of a similar nature to that which cause it …E.G. if you’re stiff from running, taking a leisurely walk should help. If symptoms linger beyond 3 days, or if any improvement seems negligible, schedule an appointment directly with your Physiotherapist, as you may be suffering DOMS or an injury. Try to remember what could have caused your pain and what it feels like, as this can help in your diagnosis. Contact us to ascertain the specifics of your condition and create an individualised plan to get you back on track with advice on how to avoid DOMS going forward.

What are the symptoms of Fibromyalgia?

Each individual can experience different symptoms, but the most common are:

• Fatigue that is disproportionate to the level of the individual’s activity and sleep
• Stiffness, tenderness and a high level of pain in the muscles and joints
• Anxiety, depression and possible bowel function problems
• Poor sleep patterns or waking after long bouts of sleep, but still feeling tired all day.
• Poor memory and alertness. A ‘foggy’ feeling in the brain.

The symptoms of Fibromyalgia are cyclical and each symptom can create the onset of another. The typical cycle would be:

An injury or disease leads to limited physical activity – which leads to muscular tension or stiffness – leading to stress/depression/anxiety – which leads to poor sleep – leading to pain – which leads to disease etc …and so the cycle will resume and continue. Breaking this cycle is essential to the recovery of a Fibromyalgia patient.

What are the causes of Fibromyalgia?

Far more prevalent in women than in men, there is really no known cause of this disease. It is extremely difficult to diagnose and treat, as it is neither an inflammatory, degenerative, nor an auto-immune disease.

What is known is that Fibromyalgia appears to manifest itself after:

• A stressful event like a motor accident or the death of a loved one
• A traumatic injury
• Repetitive poor sleeping patterns
• The sudden onset of an unexpected or chronic illness like Lupus or Rheumatoid arthritis

What is my best course of action?

Alleviating any of the symptoms of Fibromyalgia, even temporarily, can enable the sufferer to break the chain of symptoms and experience some relief or potentially break the cycle altogether.

Because it is difficult to diagnose and other conditions like an underactive thyroid, Vitamin D deficiency, or Rheumatoid arthritis can mimic this disease, extensive testing by a doctor or Rheumatologist may be necessary to eventually establish that you have Fibromyalgia.

Through alleviation of the pain, even for a few days, your Physiotherapist can assist you in finding, starting and maintaining comfortable and regular exercises, in addition to providing guidance on sleeping more comfortably. The combination of a reduction in pain, improved sleep and regular exercise provides a massive leap towards snowballing back in the right direction. Contact us for advice, referral to the correct specialist if necessary and positive treatment of this complex, yet but not necessarily incurable, disease. 

1. The hip adductor or inner thigh muscles – most commonly the ‘adductor longus’
2. The Iliopsoas or hip flexer muscles, which bend the hip forward on either the left or right side
3. The hip joint or it’s ligaments
4. The abdominal wall
5. The pubic bone

Athletes who compete in sports that involve repetitive turning, twisting, kicking and sprinting can experience Groin pain and so it is very common amongst soccer players.

Groin pain also affects participants in other sports like hockey, rugby, tennis, basketball and running.

What are the symptoms of Groin pain?

Groin pain can range from a dull ache to a sharp pain, particularly when one or more of the aforementioned structures are expected to function or stretch. If any of these fail, Groin pain begins to manifest as mild or occasional pain. Depending on each individual presentation, pain may improve with warming up or may become progressively worse when continuing with an activity.

What causes Groin pain?

Injuries to the groin are mainly a consequence of cumulative overuse and minor injuries that ultimately become complex or chronic. Its more common for Groin pain to become chronic over a period of time, but if it happens very suddenly a haematoma (bruising or bleeding) can become apparent. The underlying injury in this case is most often a tendon strain at the tendinous insertion of the inner thigh muscles to the bone.

What is my best course of action?

As the pelvis and hip complex forms an integral part of human activities, even mild cases of groin pain can become chronic if not attended to. Accurate diagnosis of the source of the Groin pain/dysfunction is essential. While Groin pain is most commonly associated with stress to any of these structures, it can also be experienced from a hernia or other possible origins. Your Physiotherapist will conduct a clinical examination to identify the involved structures along with that which may have predisposed you to the excessive injury and decide if an MRI or ultrasound will be useful to determinate the location and extent of the injury. If a structural hernia is suspected or an MRI is required, you may be referred to a Doctor or orthopaedic surgeon.

Every component of how the hip functions needs to be assessed and any injuries treated. The treatment in this case needs to be holistic, targeting every facet of this complex structural system. Contact us directly to get you back on track, or the sports field, as soon as possible and better equipped to prevent future incidents.

Very commonly, I see patients who are experiencing pain on the side or the back of the hip and the source is either the lower back or in the muscles surrounding the hip. You may even have evidence on x-ray suggesting joint damage or disease while the source of YOUR pain is still not the joint! Listen to your pain and assess the location. In the end, if your physiotherapist and your doctor are both unable to diagnose and successfully relieve your pain, a local anaesthetic can be injected into the hip joint to determine if the pain is located within the joint or not. But just for now, especially if your pain is not in your groin, forget about the films, scans and injections!

Your first step when you are feeling pain in the hip area should be to have your physiotherapist assess the quality of movement, the aggravating and easing factors and the history leading up to the point where you started feeling the pain. We will look at the entire picture rather than basing our opinion on just an x-ray. Once we have established a diagnosis, the treatment is targeted at allowing healing, restoring good quality movement and rehabilitating all the involved structures to avoid a recurrence of the problem. Be mindful that any single one of the possible conditions which may be causing your pain, could have local and more distal causes or influences. We will still look at the way your back, knees or feet may be impacting on the hip condition, no matter what your diagnosis.

The exercises are at times difficult and once your pain has been relieved, rehab is often the last thing on your priority list! However, your dedication to your rehabilitation programme, will ultimately determine how often you need to do damage control for a recurrence of the same pain.

I’ll divide the possible pathologies you may be faced with into the types of structures involved. Firstly, we’ll look at the soft-tissue and then at the bones, cartilage and ligaments.

Pain from the surrounding soft tissue can range from a continuous, dull ache to a sharp, shooting pain, typically when you put weight onto the leg. It’s no wonder that people often think its the joint.

Pain originating from the joint often occurs following trauma but it may be a developmental problem or even as a result from your recent cortisone injection!

If you’ve had a look at the two links above and you’re still no closer to finding the source of your pain, we welcome you to contact us. No two conditions are alike and your distinguishing symptom may not be mentioned in these summaries. We are happy to help even if you aren’t sure if physiotherapy is what you actually need.

What are the symptoms of FAI?

The symptoms of FAI are hip and joint pain with limited mobility.

• It can start suddenly as an injury, or gradually build up during various activities
• There is usually a restriction when turning the leg in, or pulling the knee to the chest
• Pain can be provoked or exacerbated trough long periods of sitting, crossing the legs, walking, or during or after sports and general exercise
• It is usually experienced as deep groin pain at the front of the hip, but can occasionally be felt on the side of the hip or the buttock.

What are the causes of FAI?

The 2 main causes of Hip impingement are:

1. A deformity of the socket of the hip joint (Pincer deformity) – in which the front rim of the socket protrudes enough for the ball to bump into the socket’s rim during movement.
2. A deformity of the ball of the hip joint (Cam deformity) – in which the ball can become misshaped and jam into the socket during movement.

Occasionally there are problems with both ball and socket, known as a combined deformity, but this is not as common.

What is my best course of action?

X-rays of the pelvis and the hips are usually undertaken to confirm the diagnosis of FAI. An MRI or CT scan can also possibly be required. The pain is generally self-limiting and non-operative treatment is usually recommended.

It is especially important to note that these bone shapes may be a result of a person’s habitual movements and lacking stability around the joint (rather than assuming that its congenital), so rehabilitation alone can address the cause where biomechanics are to blame and operating in such a case may bring initial relief, but would not have addressed the cause of the symptoms and so the condition is likely to re-develop.

Your Physiotherapist can assist FAI by using a variety of techniques which will: mobilise the hip joint to stretch tight structures; strengthen deep, intermediate and superficial hip muscles to improve joint control; improve the length and flexibility of soft tissue; improve proprioception (Joint position sense), functional control and dynamic stability of the hip …and the rest of the body, as it is all connected and should function as a unit in the end!

The use of painkillers and anti-inflammatory drugs may help reduce pain and inflammation, but should not be used as a long-term management as neither of these will address the underlying issues. Contact us for a comprehensive assessment and to begin an individualised, structured rehabilitation program and only if that fails, despite your full commitment to the task, would we recommend you obtain a surgical opinion.

Athletes participating in sports like soccer, rugby, golf and ballet are high risk candidates for these labral tears, because of the strain put on the Labrum by all the twisting over the hip. Structural abnormalities of the hip can however also play a role in increasing the likelihood.

What are the symptoms of a Hip Labral tear?

Not always, but in most cases, pain or an ache is felt over the lateral hip area, in the groin, or in the deep buttock region. One can at times also feel a ‘clicking’ as the hip socket is moved, and the perception is of it locking or giving way.

The symptoms may be worse when sitting with your knees below your hips, with crossed legs (when the hip is rotated) …or on the edge of a seat so that you are contracting the muscles that flex the hips.

What are the causes of Hip labral tears?

There are 3 primary causes of Hip labral tear:

1. Structural abnormalities – Hip problems from birth can promote wear and tear of the joint and ultimately result in a Labral tear.
2. Repetitive motion – Sudden twisting or pivoting motions practiced on a regular basis, as with the aforementioned sports or other daily activities, through pure wear and tear of the hip joint.
3. Trauma – Injury or a dislocation of the hip joint, as in contact sports or an accident can also be a cause.

What is my best course of action?

Your Physiotherapist can be contacted directly and will embark on an assessment to form a clinical diagnosis based on your symptoms and clinical signs, like restricted movement. An MRI may well be recommended, as it is difficult to get a specific diagnosis without it.

With or without any definite diagnosis, treatment would start by avoiding aggravating activities and building the stability that may be lacking in the joint. The focus will be on restoring flexibility and strength through: assessing your biomechanics and muscle function; restoring limited range of motion and improving soft tissue muscle length and resting tension; strengthening superficial muscles and activating deep stability muscles in addition to augmenting joint position sense and proprioception – all the while, ensuring that you trust your hip’s ability to resume normal function. Without trust, even a perfect joint is worthless!

After making these significant improvements in functionality, your Physiotherapist will: improve functional activities through a series of daily exercises; do drills to improve agility and speed and recommend a suitable modified and monitored sports program.

Not all Hip labral tears respond to conservative treatment, but if surgery is still required, this program will have put you at a great advantage for surgical consideration, so contact us now to embark on a treatment program to have you back in action or ready for optimal post-operative recovery ASAP!

What is a ‘Ligament sprain’, as opposed to rupture?

To elaborate a little, ‘Ligament sprain’ occurs when its inelastic fibres are stretched through too great a range and tearing of the ligament takes place. The tear can be just a few fibres and classed as mild or grade I, but when classed as severe or grade III, a complete ‘rupture’ of the ligament has taken place, leading to joint instability.

How do ligament sprains happen?

The most common type of sprain is a sprained ankle, usually occurring amongst runners and sports people in general but it could happen to anyone. To give an example, in the USA alone, 25 000 ankle sprains occur daily. A runner going over a curb, catching the foot and twisting the ankle is a typical example. Knee and ankle sprains also happen in stopping and turning sports like hockey or soccer or in baseball where a player slides into the plate and twists the knee. The whipping arm action of the baseball pitcher and swing of the Golfer can also cause shoulder and elbow sprains and thumb, finger and wrist sprains happen in sports like skiing where one falls with an outstretched palm, or netball and cricket through catching injuries.

What are the symptoms of sprains?

Pain, inflammation and bruising are all common signs and symptoms of a sprain. At the time of injury, you may hear or feel a “pop” in your joint. With a mild ankle sprain, the pain may not be too intense and you may just have a limited ability to move the affected joint, but with a ruptured ankle ligament one may not be able to bear any weight on the foot.

What is my best course of action?

Mild sprains can sometimes be successfully managed at home with relative rest, compression and elevation but if the symptoms aren’t improving significantly each day over any 3 consecutive days, it’s likely that the management at that time is not sufficient. For your own peace of mind, to assure that the treatment is being correctly administered and to reduce the recovery time, it is advisable to consult a Physiotherapist directly to get started on the correct rehabilitation program, in addition to the management of your symptoms. It is essential to contact your Physiotherapist if you can’t walk more than a few steps, move the affected joint, or if you feel any numbness in the injured area. Severe sprains or ruptures may even require surgery, but you can save time and money if you contact us first, as Physiotherapists are the specialist for this type of injury, trained to have you back in action ASAP and refer immediately should that be required.

What is a ‘muscle strain or tear?’

Muscle strains are the most common source of muscle pain and are also known as muscle tears in the more severe cases. They vary greatly in severity from mild up to a complete muscle rupture. Muscle sprains that occur in the ankle, calf, thigh and biceps usually happen at high speed when the muscles are overloaded. When occurring in the back, shoulders and neck, it is more commonly as a result of muscle fatigue from postural strains.

What are the symptoms of muscle strain or tear?

Naturally, pain is experienced in the affected area and the pain can vary according to the severity of the tear. One can also experience:

• Weakness of the muscle – an inability to perform normally
• Bruising of the muscle
• The muscle feels tight and strained
• You cannot fully stretch the muscle

What is my best course of action?

If you experience these symptoms and the injury appears to be fairly mild your immediate course of action should be to apply a compression bandage on the affected area. It’s also a good idea to elevate the area if it’s swollen by, for example, raising your leg above your body. If you are still able to perform, then reduce training to a level where pain is no longer experienced.

Should your home treatment be ineffective and the injury continues to niggle, or if you are experiencing severe pain, or are unable to move normally, then it is advisable to immediately contact your Physiotherapist, who is trained to accurately diagnose the exact nature of the injury, advise on and carry out the best treatment for you. If the injury is sports related and waiting/resting is not an option you’d like to consider, you can save time (and often money too) by contacting your Physiotherapist directly to get back into action ASAP.