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The 99% vs the 1%: why the basics will always beat the biohacks

Mon, 08 Jun 2026 10:57:14 GMT

The 99% vs the 1%: why the basics will always beat the biohacks

What we mean by the 99%

The 99% is everything that has a large, well-replicated, dose-dependent effect on how your body heals, adapts, and performs. It's unsexy. It's not going to get many Instagram likes. But it's where almost all the results actually live.

Here's what it includes:

Sleep. This is the single most powerful recovery tool available to you, it's free, and most people are chronically under-doing it. During deep sleep your body releases growth hormone, consolidates motor learning, regulates inflammatory markers, and repairs tissue. Shortchanging sleep doesn't just make you tired — it genuinely impairs healing, raises your pain sensitivity, suppresses immune function, and undermines every other effort you're making. Seven to nine hours isn't a luxury. It's non-negotiable.
Nutrition. You cannot build muscle, repair tendons, or recover from injury on inadequate protein. Full stop. The research is clear that most Australians — especially women over 40 and active older adults — are significantly under-eating protein relative to what their physiology actually needs. Beyond protein, adequate energy intake, micronutrient variety, and not being in a chronic caloric deficit are all prerequisites for tissue healing. If your body is under-fuelled, it will always prioritise survival over adaptation.
Training load management. Most of the injuries we see aren't from a single traumatic event — they're from accumulated load that exceeded the tissue's capacity to absorb and recover from it. Managing load means progressing gradually, respecting rest days, and understanding that more is not always better. Your tendons adapt more slowly than your cardiovascular fitness, and that gap is where most overuse injuries are born.
Consistency over intensity. Three moderate sessions per week done consistently for a year will outperform sporadic bursts of intense training every single time. The body adapts to repeated stimuli. It doesn't respond well to being thrashed after a week off.
Stress management. Chronic psychological stress elevates cortisol, increases systemic inflammation, lowers pain thresholds, and impairs sleep quality. It's not a soft issue — it's a physiological one. If your nervous system is running in threat mode, your body's capacity to heal and adapt is genuinely compromised.
Hydration. Simple, boring, effective. Connective tissue health, joint lubrication, cognitive function, and training performance are all measurably affected by even mild dehydration.

What we mean by the 1%

The 1% is everything at the margin. It includes ice baths, saunas , red light therapy, compression boots, cryo chambers, hyperbaric oxygen, most supplements (with a small number of evidence-based exceptions), and most passive treatments including (and we'll be honest here) a lot of what happens in physio clinics.

That doesn't mean these things are worthless. Some have decent supporting evidence in specific contexts. Cold water immersion, for instance, can reduce acute muscle soreness and has some merit for certain athletes in high-frequency training blocks. Saunas have emerging cardiovascular and longevity data. Creatine (one of the very few supplements with strong, consistent evidence) genuinely helps with muscle mass and bone density, particularly in older women.

But here's the critical point: the 1% only works if the 99% is already solid.

An ice bath after a session where you slept five hours, skipped breakfast, and are two weeks into a training block you've been running into the ground is not going to save you. Red light therapy on a tendon that's being chronically overloaded and under-fuelled is not going to fix it. And the most skilled hands-on treatment in the world will not produce lasting results if the lifestyle factors driving your problem haven't changed.

Why we all chase the 1%

It's not irrational. The 1% is visible, purchasable, and feels like doing something. It's also heavily marketed. You can buy a cold plunge tub. You can book a cryo session. These are concrete actions that feel proactive.

The 99% requires sustained effort, discipline, and delayed gratification — which is a much harder sell, even to ourselves.

There's also a common pattern in rehab where people feel like they're "doing the work" because they're showing up to appointments, wearing a compression garment, or icing regularly. These things have their place. But if you leave a physio session and go home to eat poorly, stay up until midnight on your phone, and skip the exercises you were given — no amount of passive treatment is going to get you where you want to go.

The hierarchy in practice

Think of it like a house. The 99% is the foundation and the walls. The 1% is the paint. Paint on a crumbling foundation is just decoration.

When we assess a new client, we're always looking at the full picture. Yes, we want to understand your injury, the mechanics, the tissue, the load history. But we also want to know how you're sleeping, what you're eating, how stressed you are, and what your training has looked like. Because if the fundamentals are broken, that's where the biggest gains are hiding.

The good news? Most people have significant room to improve the basics. And the basics compound. Better sleep improves training quality, which improves body composition, which reduces load on joints, which reduces pain, which improves sleep. It's a virtuous cycle — once you get it m oving.

So should you throw out th e ice bath?

Not necessarily. If the fundamentals are locked in and you want to explore the margins, go for it. The best recovery protocol is one you'll actually do consistently, and if cold water immersion helps you feel good and stay consistent, that's real value.

But if you're currently spending money on supplements, passive therapies, or recovery gadgets while sleeping six hours a night and eating on the run — that's the first thing we'd redirect.

The biggest return on investment in your health is almost always in the boring stuff. Do that first. Do it well. Then, if you want to tinker at the edges, you'll actually be able to tell if it's working.

Growing pains or something else? What parents need to know about Osgood-Schlatter and Sever's

Sat, 06 Jun 2026 00:52:11 GMT

Growing pains or something else? What parents need to know about Osgood-Schlatter and Sever's

The common scenario: Your kid has been complaining about sore knees or heels for a few weeks. They're limping off the footy oval, or wincing when they walk downstairs, or telling you their heel kills after soccer training. You're not sure whether to push them through it, rest them completely, pull them out of sport, or head straight to the physio.

If your child is somewhere between eight and sixteen and active in sport, there's a reasonable chance what you're dealing with is either Osgood-Schlatter disease or Sever's disease, two of the most common conditions we see in young athletes, and two of the most misunderstood. Neither is actually a disease in the scary sense of the word, both are very manageable, and the good news is that with the right approach most kids get through it without missing more sport than necessary.

Here's what's actually going on, and what to do about it.

Firstly, what are these conditions?

Both Osgood-Schlatter and Sever' s fall into a category called apophyseal injuries. That's a technical term for irritation at a growth plate, a specific area of developing bone where a tendon or ligament attaches. During childhood and adolescence, these growth plates are softer and more vulnerable than the surrounding bone, which makes them susceptible to irritation when they're loaded repeatedly during sport.

Think of it this way: your child's bones are actively growing, the tendons attached to those bones are being pulled on constantly during running, jumping, and kicking, and sometimes the load exceeds what that developing tissue can comfortably handle. The result is localised pain and tenderness at the growth plate site, not because anything is seriously wrong, but because the area is being asked to do more than it's ready for right now.

It's not a structural failure. It's a load management problem. And that matters because it means the solution is about managing the load, not necessarily stopping sport altogether.

Osgood-Schlatter: the sore bump below the knee

Sever's: the sore heel

Why do some kids get it and others don't?

A few factors tend to contribute. Rapid growth spurts are the biggest one, when bones lengthen quickly, the muscles and tendons attached to them can temporarily become relatively tight, increasing the pull on the growth plate.

A sudden increase in training load is another common trigger. The start of a new season, making a rep team, or adding an extra training session can push a growth plate that was coping adequately over the edge. This is particularly common when kids are playing multiple sports simultaneously with overlapping seasons.

Tighter calf and quad muscles increase the tension through the relevant tendons and growth plates, which is why flexibility tends to be part of the management picture. And there's likely a component of individual variation in growth plate sensitivity that we can't fully control for.

Should they rest completely?

This is the question we get asked most often, and the honest answer is: usually not completely, but load does need to come down.

Complete rest rarely helps and is almost never necessary. In fact, extended rest followed by a sudden return to full training is a reliable way to reproduce the problem. What does help is reducing the load to a level the growth plate can tolerate, maintaining fitness and conditioning in ways that don't aggravate symptoms, and gradually building back up as the irritation settles.

In practice this might mean dropping from five training sessions a week to two or three, avoiding the specific activities that aggravate symptoms most such as heavy plyometrics, hard sprinting, hill running, while continuing lower-impact activity, and modifying rather than stopping sport participation where possible.

A useful rule of thumb : pain during activity that stays below a four out of ten and returns to baseline within 24 hours is generally okay to train through with modified load. Pain above that level, or pain that's still present the following day, is a sign to back off further.

What actually helps?

Load management is the most important thing, as described above. Getting the training volume to a level the growth plate can tolerate gives the irritation a chance to settle.

Stretching the relevant muscle groups consistently can make a genuine difference. For Osgood-Schlatter, regular quad and hip flexor stretching can reduce the tension through the patella tendon. For Sever's, calf stretching, both with a straight knee targeting the gastrocnemius, and with a bent knee targeting the soleus, is important and often underestimated.

Strengthening the surrounding muscles helps the growth plate handle load more efficiently. For knee pain, hip and glute strengthening reduces demand on the quads. For heel pain, progressive calf strengthening, done carefully and within pain limits, helps build the capacity of the Achilles attachment over time.

Heel raises inside shoes can offload the Achilles attachment significantly in Sever's and are worth trying as a short-term measure. Proper footwear matters too, worn-out shoes with poor heel cushioning are a common aggravating factor.

Ice after activity can help manage localised soreness in the short term, though it's a symptomatic measure rather than a fix.

When to see a physio

If your child has been limping for more than a week or two, if they're in pain at rest as well as during activity, if the pain is getting progressively worse despite reduced load, or if you're genuinely not sure whether what you're dealing with is Osgood-Schlatter or Sever's, it's worth coming in.

A physio assessment can confirm the diagnosis, rule out anything that needs further investigation (there are other causes of knee and heel pain in kids that present similarly and are managed differently), and give you a specific plan rather than a generic "rest and see" approach.

We also see parents who've been told by well-meaning coaches or other parents that their child just has to put up with it until they stop growing. That's not quite right. You can't always eliminate the symptoms entirely while a growth plate is actively developing, but you can almost always reduce them meaningfully and keep kids participating in the sport they love while it runs its course.

A note for the coaches reading this

Apophyseal injuries in young athletes are a load management issue at their core, which means coaches play a significant role in prevention and management. Being aware of which kids are in growth spurts, monitoring training loads across a full week rather than just your sessions in isolation, and being willing to modify rather than exclude when a child is symptomatic can make a real difference.

We're always happy to communicate directly with coaches and sporting clubs when we're managing a young athlete, to make sure everyone is on the same page about what they can and can't do.

Julia Flett — Physiotherapist (BPhysio Hons, Dip Pilates), Active Balance Physio & Wellness

If your child has been dealing with knee or heel pain that won't settle, book an assessment online,

or call us on (08) 7123 4148.

Everyone has VALD testing now. But is it actually worth anything?

Sat, 06 Jun 2026 00:21:23 GMT

Everyone has VALD testing now. But is it actually worth anything?

What we have and what it does (in plain English)

At Active Balance we use two VALD devices: the ForceDecks and the Dynamo.

The ForceDecks are two plates that sit on the floor. Think of them as very sophisticated scales that measure not just how much weight you're putting through each leg, but how you're moving, how quickly you're producing force, and how evenly you're sharing load between your left and right side. We use them during tasks like squats, jumps, and single leg movements. They capture data a thousand times per second, which means they pick up things that are completely invisible to even the most experienced eye.

The Dynamo is a handheld device that measures muscle strength objectively. Rather than a physio using their hands to estimate how strong a muscle group is, which is subjective and affected by the clinician's own strength, the Dynamo gives us an actual number. That number can be compared between your left and right side, tracked over time, and measured against research-based benchmarks for your age, weight, and activity level.

Not long ago, this kind of technology lived exclusively in the performance labs of professional sporting clubs and university research facilities. AFL teams, NRL clubs, Olympic programmes, the kind of environments where marginal gains matter enormously and the budget exists to pursue them. The fact that it's now accessible in everyday clinical settings is genuinely a good thing. It means the tools that were once reserved for elite athletes are now available to the weekend runner, the person recovering from a knee reconstruction, the tradie trying to get back to work, and the 60-year-old wanting to know where their strength is really at.

But that shift also comes with a risk. When a technology moves from elite sport into mainstream clinical practice quickly, it doesn't always bring the expertise along with it. And that's the part worth having a conversation about.

The gimmick risk is real…

Something the industry doesn't talk about enough: owning this equipment and using it well are two completely different things.

Any clinic can purchase force plates, run someone through a few tests, and produce a report full of graphs and percentages in fifteen minutes. It looks impressive. But if the clinician on the other side of the desk can't explain what those numbers mean for your specific situation, your injury history, your goals, your body, your sport or job, then it's an expensive PDF.

We've had patients come to us after testing elsewhere, printout in hand, with no real understanding of what it showed or how it was going to affect their treatment. That's not clinical testing. That's theatre.

The data is only as good as what happens with it. Which brings us to what we actually use it for.

Where it genuinely makes a difference..

Finding out why you keep getting niggles - running assessments

One of the areas we find the ForceDecks and Dynamo most valuable is in running assessments, and it's one that surprises people.

When a runner comes in with a recurring issue (e.g. ITB syndrome that keeps flaring, a calf that goes every few months, a knee that grumbles on longer runs etc) the question isn't just what is sore. It's why it keeps happening. And the answer is often in how load is being distributed.

The ForceDecks can show us during a squat or a single leg task whether you're consistently overloading one side, whether your landing mechanics are putting excessive stress through a particular structure, or whether one hip or quad is doing significantly less work than it should. The Dynamo can identify strength deficits that feel normal to you because they've always been there, but that are quietly driving the problem.

Combined with a full running assessment looking at your technique, training load, and history, this gives us a much more complete picture than observation alone. We're not just treating the sore spot. We're identifying why it became sore in the first place, which is really the only way to actually stop it coming back.

Injury prevention and performance screening

You don't have to be injured to benefit from this kind of testing. For athletes heading into a pre-season, people ramping up training for an event, or anyone who wants to understand where their body is at before something goes wrong, a strength and movement screen using the ForceDecks and Dynamo can identify asymmetries and deficits that are risk factors for injury.

Think of it like a warrant of fitness. Everything might feel fine, but if one leg is producing significantly less force than the other, or if your landing mechanics are consistently putting stress through a structure that isn't conditioned for it, that's worth knowing before it becomes a problem rather than after.

For coaches and strength and conditioning staff working with athletes, this data is particularly useful. We can provide detailed reports that give an objective picture of where an athlete is at, not just a clinical opinion, but numbers that can inform programming and load management decisions.

Rehabilitation - tracking what you can't feel

During rehabilitation, people often feel like they're progressing well before their body has actually restored the capacity needed to return to what they were doing. Pain settles. Movement improves. Things feel pretty normal. And then they go back to training and something goes wrong again.

The ForceDecks and Dynamo give us an objective check on that perceived progress. If your strength symmetry between legs is at 74%, we can see it, even if you feel fine. If your landing mechanics are still showing a significant asymmetry at four months post-surgery, we can address it specifically rather than assuming things have sorted themselves out.

This is particularly important for people returning from significant injuries where the stakes of going back too early are high.

Return to sport and return to work

Deciding when someone is ready to return to sport after a significant injury is one of the most important calls in rehabilitation, and historically it's been made on a combination of time elapsed, how someone feels, and clinical observation. None of those three things are sufficient on their own.

The research on ACL re-injury rates, for example, is sobering. Athletes who return before meeting objective strength and symmetry criteria have significantly higher re-injury rates than those who do. The nine-to-twelve month timeframe you'll often hear quoted is a guide, not a guarantee, and without objective data, it's genuinely difficult to know which side of the line someone is on.

Using the ForceDecks and Dynamo, we can assess quadriceps and hamstring strength symmetry, single leg power output, landing mechanics, and force production, all benchmarked against research-supported return-to-sport thresholds. That gives both the clinician and the patient something concrete to work toward, and a defensible basis for the clearance decision.

The same principle applies to return to work. For someone in a physically demanding job, a tradie, a nurse, someone who works on their feet, returning before their body is genuinely ready creates real risk. Objective data from a Dynamo strength assessment and ForceDecks movement testing gives a clear picture of functional capacity that goes well beyond "feels okay."

Reports that actually mean something to the people who need them

Who is this testing actually for?

To be direct about it, not everyone needs this, and we'll tell you honestly if you don't. But these are the people where it genuinely changes what we do and what we know:

Runners and athletes with recurring injuries that haven't fully resolved with standard treatment. If something keeps coming back, the answer is usually in the data.
Anyone returning to sport after ACL reconstruction, knee or hip surgery, or a significant muscle injury. Criteria-based return to sport using objective testing is the current best-practice standard, and the ForceDecks and Dynamo are among the best tools available for it.
People preparing for a season, an event, or a significant increase in training load who want to know where their body is at before committing.
Anyone in a physically demanding job navigating a return to work after injury — particularly where there's a WorkCover or insurance component and objective evidence of capacity is required.
Coaches, S&C staff, or sporting clubs wanting objective athlete screening data that can feed directly into programming.
Older adults where tracking genuine strength progress matters both for motivation and for making good clinical decisions about what to do next.

For a straightforward presentation that doesn't involve any of these questions, you generally don't need force plates or advanced data. Knowing when not to use a tool is as important as knowing how to use it well.

The honest version

We’ve invested in the ForceDecks and Dynamo because the data makes us better clinicians for the right patients, not because it looks good on the website. The technology has made its way from elite sport into everyday clinical practice, and that's a really positive development. But it only delivers on its potential when the clinician using it knows what they're looking for, why it matters, and what to do about it.

If you're considering testing anywhere, the questions worth asking aren't about which devices the clinic owns. They're about what the clinician will actually do with the results, how the testing fits into your overall management, and whether the person interpreting your data has the experience to make it genuinely useful.

We'd like to think we can answer those questions well. If you'd like to find out whether testing makes sense for your situation, come in and have a conversation first.

Alexander Muscat — Physiotherapist (BPhysio Hons), Active Balance Physio & Wellness

Menopause and Back Pain - Is There a Connection?

Sun, 17 May 2026 13:01:15 GMT

Menopause and Back Pain - Is There a Connection?

How Menopause Affects the Spine and Back

The hormonal changes of menopause — particularly the decline in oestrogen — have a direct impact on several structures involved in back pain:

Bone density Oestrogen plays a key role in maintaining bone density. As levels fall during perimenopause and menopause, bone loss accelerates. In the spine, this can lead to reduced density in the vertebrae — increasing the risk of compression fractures, particularly in the thoracic spine, and contributing to postural changes like increased kyphosis (rounding of the upper back).
Disc health The intervertebral discs — the cushioning structures between each vertebra — are partly maintained by oestrogen. Research suggests that oestrogen decline is associated with accelerated disc degeneration, reduced disc hydration and increased susceptibility to disc-related back pain.
Joint inflammation Oestrogen has significant anti-inflammatory properties. Its decline is associated with increased systemic inflammation, which can manifest as greater joint pain and stiffness throughout the body — including the lumbar and thoracic spine and the sacroiliac joints.
Muscle mass and support The accelerated muscle loss associated with menopause affects the muscles that support the spine — including the deep core, the erector spinae and the gluteal muscles. Reduced muscular support places greater demand on passive structures like joints and ligaments, increasing the likelihood of pain.
Pain sensitivity Oestrogen influences how the nervous system processes pain signals. Lower oestrogen levels are associated with increased central sensitisation — meaning the nervous system becomes more reactive and pain thresholds lower. This can make existing back pain feel worse or make new pain develop more easily.
Sleep disruption Night sweats, insomnia and disrupted sleep are common during menopause — and poor sleep is one of the strongest drivers of increased pain sensitivity. Many women find their back pain is significantly worse when they've slept poorly, which creates a difficult cycle.

Common Presentations We See

At Active Balance, we see several patterns of back pain that are particularly common in perimenopausal and menopausal women:

Thoracic pain and stiffness — mid and upper back pain often related to postural changes, reduced bone density and increased joint sensitivity
Lumbar pain — lower back pain that may be more persistent or harder to settle than it was previously
Sacroiliac joint pain — particularly common during hormonal transitions due to changes in ligament laxity and pelvic stability
Generalised spinal stiffness — a feeling of the whole spine being tighter and less mobile, often worst in the morning

What Actually Helps

The good news is that back pain during menopause responds well to the same evidence-based physiotherapy approaches that work at any stage of life — and some interventions are particularly well suited to this phase:

Strength training Progressive resistance training is arguably the most important intervention. Building and maintaining the muscles that support the spine — core, glutes, hip stabilisers — reduces load on passive structures and significantly improves pain and function. The research is clear that strength training is safe and beneficial for women in midlife and beyond.
Manual therapy and hands-on treatment Joint mobilisation, soft tissue therapy, dry needling and myofascial release can all help reduce pain, improve mobility and settle acute flare-ups — creating the window needed to engage effectively with rehabilitation.
Clinical Pilates and exercise classes Physio-led exercise that builds deep core control, spinal mobility and hip strength is particularly valuable. Our Clinical Pilates and Move Well classes are designed to be progressive and individually tailored — making them excellent for women managing menopause-related back pain.
Sleep and stress management Addressing sleep quality and stress levels — whether through lifestyle changes, relaxation strategies, massage or other means — has a meaningful impact on pain sensitivity and recovery.
Load management and education Understanding what's driving your back pain, how hormonal changes are contributing, and what you can do about it is one of the most empowering parts of treatment. Knowledge reduces fear, and reduced fear genuinely reduces pain.

When to Get Assessed

If you're experiencing back pain during perimenopause or menopause — whether it's new, worsening or just more persistent than before — it's worth getting a proper assessment. A physiotherapist can identify the contributing factors, rule out anything that needs medical attention, and put together a plan that addresses the whole picture.

Book online or call us on (08) 7123 4148. Our team understands the specific musculoskeletal challenges of menopause and would love to help.

Written by Julia Flett, Physiotherapist at Active Balance Physio & Wellness, St Marys Adelaide. Julia holds a Bachelor of Physiotherapy (Honours) and a Diploma of Polestar Pilates Comprehensive Instruction Method, with a special interest in musculoskeletal conditions, women's health and paediatrics.

Exercise During Menopause - What the Evidence Actually Says

Sun, 17 May 2026 12:52:18 GMT

Exercise During Menopause — What the Evidence Actually Says

What Happens to the Body During Menopause?

To understand why exercise recommendations need to change, it helps to understand what's happening physiologically.

As oestrogen levels decline during perimenopause and menopause, several significant changes occur:

Accelerated muscle loss (sarcopenia) — oestrogen has a protective effect on muscle mass. As levels fall, muscle loss accelerates, particularly in the lower limbs
Reduced bone density — oestrogen plays a key role in bone metabolism. Declining levels increase the rate of bone resorption, raising the risk of osteopenia and osteoporosis
Increased visceral fat accumulation — body composition shifts, with a tendency toward increased fat storage around the abdomen even without changes in diet or activity
Changes in joint health — oestrogen has anti-inflammatory properties. Its decline is associated with increased joint pain and stiffness, particularly in the hands, knees and hips
Cardiovascular changes — the protective effect of oestrogen on the cardiovascular system reduces, increasing risk factors for heart disease
Sleep disruption and mood changes — which in turn affect recovery, motivation and energy for exercise

These changes don't happen overnight and they don't affect every woman equally — but they do shift the landscape of what the body needs from exercise.

What the Research Tells Us:

Resistance Training Is the Highest Priority

The evidence for resistance training during menopause is stronger than for any other exercise modality. A growing body of research — including systematic reviews and randomised controlled trials — consistently shows that progressive resistance training:

Significantly slows and partially reverses age and menopause related muscle loss
Improves bone density or slows its decline, particularly when combined with impact loading
Reduces visceral fat accumulation and improves body composition
Improves insulin sensitivity and metabolic health
Reduces joint pain and improves functional capacity
Has meaningful positive effects on mood, sleep quality and cognitive function

The LIFTMOR trial, conducted at Griffith University, demonstrated that high intensity progressive resistance and impact training produced significant improvements in bone density, muscle strength and functional performance in postmenopausal women with low bone mass — safely and without adverse effects. This was a landmark study that shifted the conversation from "be careful" to "load up."

For women who have avoided weights for fear of injury or becoming "bulky" — the evidence is clear that neither is a realistic concern with appropriate programming. What is realistic is becoming stronger, more resilient, and genuinely healthier.

Cardiovascular Exercise Still Matters — But It's Not Enough on Its Own

Aerobic exercise remains important for cardiovascular health, mood regulation and maintaining a healthy weight. Walking, swimming, cycling and group fitness all contribute meaningfully to overall health.

However research consistently shows that cardiovascular exercise alone does not adequately address the muscle loss, bone density decline or metabolic changes associated with menopause. Women who rely on cardio alone without resistance training are missing the most impactful intervention available to them.

The current consensus from sports medicine and exercise physiology bodies recommends a combination of:

At least two resistance training sessions per week targeting all major muscle groups
150 or more minutes of moderate intensity aerobic activity per week
Balance and coordination work to reduce falls risk

High Intensity Training Is Safe and Effective

There is a common misconception that women in midlife should scale back the intensity of their exercise. The research doesn't support this. Studies show that higher intensity training — including heavy resistance training and high impact activities — produces superior outcomes for bone density, muscle mass and metabolic health compared to lower intensity alternatives, when performed with appropriate technique and progressive programming.

The caveat is individualisation — what counts as high intensity varies between people, and a structured program designed around your current capacity and goals will always outperform generic advice.

Mind-Body Exercise Has a Supportive Role

Yoga, Pilates and tai chi have good evidence for improving flexibility, balance, core strength and stress management during menopause. These modalities are particularly valuable for:

Reducing falls risk through improved balance and proprioception
Managing stress and cortisol, which affects sleep, mood and body composition
Improving posture and addressing the musculoskeletal changes that come with midlife
Providing a sustainable, enjoyable movement practice that supports long term adherence

Clinical Pilates in particular — which is physiotherapist-led and individually tailored — bridges the gap between rehabilitation and strength training, making it an excellent option for women building back into exercise or managing pain alongside their menopause transition.

What This Means in Practice

The evidence points clearly toward a few key principles for exercise during menopause:

Lift weights — progressively and consistently. This is the single most impactful thing most women can add to their routine
Don't just walk — walking is wonderful for overall health but won't address muscle and bone loss on its own
Embrace intensity — with appropriate guidance, working harder produces better outcomes
Prioritise consistency over perfection — two well-structured sessions per week done consistently will always outperform the perfect program done occasionally
Get professional guidance — a program designed around your body, your history and your goals will be far more effective than a generic one

How We Can Help

At Active Balance, our physiotherapists and exercise physiologist can design an individualised exercise program that meets you where you are and builds toward where you want to be. Whether you're new to strength training, returning after a break or wanting to optimise what you're already doing, we can help.

Our Clinical Mat Pilates and Move Well classes are also particularly well suited to women going through menopause — small groups, physiotherapist-led, and tailored to individual needs.

Book online or call us on (08) 7123 4148 to chat with our team about the best approach for you.

Corticosteroid Injections: Benefits & Risks

Sat, 16 May 2026 14:12:51 GMT

Corticosteroid Injections: Benefits, Risks and How They Fit Into Rehab

What Are Corticosteroids?

Corticosteroids are synthetic medications that closely mimic cortisol, a hormone naturally produced by the adrenal glands. When injected directly into an affected area — a joint, bursa, or tendon — they work to reduce inflammation, suppress the local immune response, and relieve pain.

They are not the same as anabolic steroids used in sport. Corticosteroids are anti-inflammatory medications used in legitimate medical management.

When Are They Used?

Corticosteroid injections are commonly considered for:

Osteoarthritis — particularly of the knee, hip or shoulder, where joint inflammation is contributing to pain
Tendinopathies — such as lateral elbow tendinopathy (tennis elbow) or rotator cuff related shoulder pain, particularly when conservative management has plateaued
Bursitis — inflammation of the fluid-filled sacs that cushion joints, such as hip bursitis or shoulder bursitis
Other inflammatory conditions — including carpal tunnel syndrome and certain soft tissue disorders

They are generally considered when pain is significant, when it's limiting your ability to participate in rehabilitation, or when a period of conservative management hasn't produced enough improvement.

The Benefits

The main advantage of a corticosteroid injection is speed. Most people notice a meaningful reduction in pain and inflammation within a few days, which can be genuinely useful when:

Pain levels are making rehabilitation exercises too difficult to perform properly
Significant inflammation is slowing healing
You need to maintain function at work or in daily life while recovering

When used strategically alongside a structured rehabilitation program, a corticosteroid injection can create a window of opportunity — pain settles enough to allow meaningful exercise and strengthening, which addresses the underlying cause of the problem.

The Risks and Limitations

Corticosteroid injections are a useful tool, but they come with important caveats worth understanding before deciding:

They don't fix the underlying problem. An injection reduces inflammation and pain — it doesn't address the weakness, movement dysfunction, or loading issues that caused the problem in the first place. Without rehabilitation alongside or after the injection, symptoms often return.
The duration of relief varies significantly. Some people experience relief for months. Others feel little to no benefit. This variability can be frustrating and is worth factoring into your expectations.
They're limited in frequency. To minimise side effects, injections are typically limited to three or four per year in any one area. Overuse can lead to tissue weakening and joint damage over time.
Side effects exist. Common short-term effects include temporary pain at the injection site and some localised bruising. Longer-term or repeated use can contribute to tendon weakening, cartilage changes, and in some cases systemic effects including impacts on blood sugar and bone density.
Tendon caution. Repeated corticosteroid injections into or near tendons (such as the Achilles or patellar tendon) can increase the risk of tendon rupture. This is an important consideration for tendinopathy management specifically.

How We Approach This at Active Balance

As physiotherapists, we don't administer corticosteroid injections — that's done by your GP or a specialist. But we play an important role in helping you decide whether one is appropriate, and in making sure you get the most out of it if you proceed.

Our typical approach:

1. Thorough assessment first We assess your condition, pain levels, functional limitations and response to treatment. In most cases we work through a period of conservative physiotherapy management first to see how much improvement is achievable without an injection.

2. Honest conversation If progress has plateaued and we think an injection might help create the window needed for rehabilitation to be more effective, we'll discuss that with you and refer to your GP with a clear clinical rationale.

3. Post-injection rehabilitation This is the critical part that's often skipped. The injection settles symptoms — but the rehabilitation that follows is what produces lasting results. We'll have a structured plan ready to go so you can make the most of the pain-free window the injection provides.

4. Ongoing monitoring We track your response and adjust the plan based on how you're progressing. The injection is one piece of the puzzle, not the whole strategy.

Should You Get One?

Ultimately that's a decision for you, your GP and your allied health team together. Corticosteroid injections can be genuinely valuable in the right situation — particularly for significant, persistent inflammation that's limiting your ability to rehabilitate effectively.

But they work best as part of a broader plan, not as a standalone fix. The research consistently shows that injections combined with structured rehabilitation produce better long-term outcomes than injections alone.

If you're dealing with a persistent injury and wondering whether a corticosteroid injection might be appropriate for your situation, book an assessment with our team or call us on (08) 7123 4148. We're happy to talk it through with you and help you understand your options.

Written by Alexander Muscat, Physiotherapist at Active Balance Physio & Wellness, St Marys Adelaide. Alex holds a Bachelor of Physiotherapy (Honours) and has experience treating sports injuries, complex pain, rehabilitation and joint conditions. He brings an extensive athletic background to his practice including competitive soccer and futsal.

Don't Hibernate This Winter: Why keeping moving matters

Fri, 01 May 2026 10:16:50 GMT

Don’t Hibernate This Winter: Why Keeping Moving Matters More Than Ever

As the weather cools down, it’s completely normal to feel less motivated to exercise. The mornings are darker, the couch is warmer, and suddenly staying still feels a lot more appealing than getting up and moving. But here’s the catch, winter is actually when your body needs movement the most.

When we become less active, even for a few weeks, we often start to notice:

Increased joint & muscle stiffness (especially in the mornings)
More aches and pains creeping in
Reduced strength and energy
Old injuries or niggles starting to flare up again

The good news? You don’t need to suddenly become ultra-fit or spend hours exercising.

Small, consistent movement can make a huge difference.

Why movement matters in winter

Regular movement helps to:

Keep your joints mobile and less stiff
Maintain strength (which supports your joints and reduces pain)
Improve circulation and energy levels
Support balance and reduce fall risk
Keep those small issues from turning into bigger injuries

Even just 10–20 minutes a few times a week can help you stay on track.

The key is to choose something realistic (and enjoyable)

One of the biggest mistakes people make is setting the bar too high.

If your plan relies on motivation alone, winter usually wins.

Instead, focus on something that feels:

Achievable
Structured
Supported

That’s where a lot of people find group exercise, especially when guided by a coach or physio, can make all the difference.

How we can help you stay moving this winter

We offer a range of physiotherapist-led classes designed to meet you where you’re at, whether you're just getting started, returning after injury, or ready to build strength long-term.

Check out our classes here

Clinical Mat Pilates

Focused, guided movement with purpose.

This is more than a standard Pilates class, it’s physiotherapist-led, meaning every exercise is chosen with your body in mind.

With small group sizes, we can tailor movements to:

Work around injuries
Improve movement quality
Build strength safely
Reduce pain and prevent flare-ups

It’s a great option if you want a bit more guidance and individual attention while still enjoying a group setting.

Move Well for Life

Strength, confidence, and long-term health.

If you’re ready to build real strength, this class uses gym equipment in a highly supervised, small-group environment.

It’s especially helpful if you:

Have osteoarthritis or joint concerns
Are recovering from surgery
Want to improve bone density
Are worried about balance or falls
Want to feel stronger and more confident long-term

Each participant completes an initial assessment so your program is tailored specifically to you — and progresses as you do.

Move Well Express 30

A short, accessible starting point.

These 30-minute mat-based sessions are low-impact but still effective, focusing on core strength, mobility, and overall conditioning.
They’re ideal if you:

Feel stiff or tight
Are returning to exercise
Want something simple and manageable
Prefer a low-pressure environment

No assessment is required, and everything can be adapted on the spot by your physio

A simple goal for May

Instead of aiming for perfection, aim for consistency.

Your goal this month:
Move your body 2–3 times per week in a way that feels manageable.

That might be:

A short walk
A quick stretch session
Or joining a class where everything is guided for you

Not sure where to start?

That’s completely okay! Most people aren’t. If you’re unsure which class suits you, or you’ve been dealing with pain or stiffness, our team is always happy to guide you in the right direction.

The hardest part is getting started, once you do, your body will thank you for it.

Why “Just Resting” an Injury Usually Isn’t Enough

Fri, 20 Mar 2026 00:17:40 GMT

Why "Just Resting" an Injury Usually Isn't Enough

Rest Addresses the Symptom, Not the Cause

Rest is very good at reducing pain. It is much less good at addressing why the pain developed in the first place.

Most injuries don't occur because a tissue was suddenly damaged out of nowhere. They develop because the load placed on a tissue exceeded what that tissue could tolerate — either through a sudden spike, repetitive accumulation, a strength deficit, a movement pattern problem, or some combination of these.

Rest removes the load. But it doesn't improve the tissue's capacity to handle load when you return. The underlying vulnerability that caused the injury is still there — and often worse, because the tissue has deconditioned during the rest period.

This is why the same injury keeps coming back for so many people. The pain settles, activity resumes, the tissue gets loaded again — and without the capacity to handle it, symptoms return.

What Happens to the Body During Rest

Strength and tissue capacity decline rapidly

Muscle begins to weaken within days of disuse. Tendons become less tolerant to load. Joint support decreases as the muscles that actively stabilise the joint lose their conditioning.

This is particularly significant for tendon-related injuries — Achilles tendinopathy, patellar tendinopathy, tennis elbow, rotator cuff related pain. These conditions actually require progressive loading as a key component of recovery. The tendon needs to be gradually stressed to stimulate the collagen remodelling that restores its structural capacity. Rest alone produces no such stimulus and in the medium term leaves the tendon less prepared for activity than before the injury.

Movement patterns and neuromuscular control deteriorate

Injuries and rest don't just affect strength — they affect how your body moves. Pain causes the nervous system to alter movement patterns to protect the affected area. Coordination changes, joint control reduces and compensatory patterns develop as the body finds ways to offload the painful structure.

These altered patterns don't automatically reverse when pain settles. Without specific rehabilitation addressing movement quality, the compensatory patterns persist — often placing increased load on other structures and setting the stage for secondary injuries.

Confidence and psychological readiness are affected

This is an underappreciated component of recovery. After a period of rest, an area can feel unreliable even when the tissue has healed. The nervous system has been in protection mode and the person has been avoiding the movement — rebuilding the confidence to use the area normally requires gradual, progressive exposure, not just waiting until it feels better.

The Boom-Bust Cycle

There's a pattern we see in clinic regularly that illustrates exactly how rest-only management fails:

Rest → pain settles → resume activity → feels okay initially → load increases → pain returns → back to rest.

This cycle can continue for months or years. Each time the pain returns, the person rests again — and each time, the underlying capacity problem remains unaddressed. The tissue never gets the progressive loading stimulus it needs to build genuine resilience.

Breaking this cycle requires addressing what's actually driving the injury — not just managing the symptom of pain.

What to Do Instead

The evidence is clear and consistent: for the vast majority of musculoskeletal injuries, a guided, gradual return to movement and progressive loading produces better outcomes than rest alone. The goal is not to avoid loading the injury — it's to load it in the right amount, at the right time, with the right progression.

Hands-on treatment — creating a starting point

Manual therapy, soft tissue work and dry needling can settle pain and improve movement quality in the early stages — creating the window needed to begin rehabilitation. This isn't the end goal, but reducing pain to a manageable level makes the rehabilitation process more effective and accessible.

Progressive loading — the cornerstone of recovery

Targeted strengthening exercises that gradually reintroduce stress to the injured tissue, rebuild capacity and address the strength deficits that contributed to the injury in the first place. The key principle is progression — not too much too soon, but enough stimulus to drive adaptation.

For tendon injuries this might mean isometric loading initially, progressing to isotonic strengthening, then heavier loading and eventually sport-specific demands. For joint injuries it might mean range of motion work progressing to stability exercises and then functional loading. The specific program depends entirely on the injury and the individual.

Load management — finding the middle ground

Complete rest is rarely necessary or helpful. But neither is pushing through pain. The clinical skill is finding the level of activity that the injury can tolerate while rehabilitation progresses — what can be continued, what needs to be modified and how to gradually build back up without triggering flare-ups.

Addressing contributing factors

Rehabilitation that only treats the site of pain without identifying why the injury occurred is incomplete. Movement patterns and technique, training load history, strength imbalances, workplace demands and lifestyle factors all contribute to injury development and need to be addressed to reduce the risk of recurrence.

The Goal Is Capacity, Not Just Pain Relief

This is the most important reframe for understanding why rest alone isn't enough.

Pain relief is a necessary step in recovery — but it is not the destination. The destination is building the body's capacity to handle the demands being placed on it without breaking down.

An Achilles tendon that no longer hurts but has the same load tolerance as when it was injured will fail again as soon as training resumes. A shoulder that is pain-free but has the same rotator cuff weakness that allowed impingement to develop will become symptomatic again under load.

The goal of rehabilitation is not to rest until pain goes away. It is to systematically build the tissue's capacity — strength, load tolerance, movement quality, neuromuscular control — to a level that matches or exceeds the demands of your daily life and activity.

If you've been stuck in the rest and flare-up cycle and are ready to actually address what's driving the problem, book online or call us on (08) 7123 4148. This is exactly what we do every day — and there's almost always a way through it.

Written by Alexander Muscat, Physiotherapist at Active Balance Physio & Wellness, St Marys Adelaide. Alex holds a Bachelor of Physiotherapy (Honours) and has experience treating sports injuries, complex pain management, rehabilitation and joint conditions. He brings an extensive athletic background to his practice including competitive soccer and futsal.

Creatine — More Than a Gym Supplement

Tue, 03 Mar 2026 04:51:32 GMT

Creatine: More Than a Gym Supplement

What Is Creatine and How Does It Work?

Creatine is a naturally occurring compound that is stored primarily in your muscles, with smaller amounts in your brain. You can also gain small amounts through foods like red meat and fish.

Its main role is to support the production of ATP (adenosine triphosphate), which is the body’s primary energy currency. During short bursts of effort (like lifting weights, sprinting, or even standing up from a chair), ATP is used quickly. Creatine helps regenerate ATP more quickly, allowing you to sustain force production for slightly longer.

That might sound minor, but those extra repetitions or slightly improved power outputs accumulate over time to big results.

With consistent supplementation (typically 3–5g daily), muscle creatine stores increase, which may lead to:

Improved strength output
Increased training capacity
Better recovery between sets
Greater long-term adaptation to resistance training

Creatine does not build muscle on its own (sorry ��), but it does enhance your response to training.

So, who can benefit from creatine supplementation?

Creatine can benefit a wide range of people in number ways. From high level athletes, to everyday gym goers, to women navigating peri/menopause, creatine can have positive effects on muscle health, bulk and power output.

Athletes

Creatine is one of the most evidence-backed supplements in sports nutrition.

Meta-analyses consistently show that when combined with resistance training, creatine can help improve:

Maximal strength
Power output
Lean muscle mass
Training volume

For athletes, this can mean better adaptation to structured training programs and improved performance potential.

The Everyday Person

You don’t need to be an athlete to benefit from creatine.

For someone who:

Strength trains a few times per week
Wants to build or maintain muscle
Is working on body composition
Feels fatigued from busy work or family life
Simply wants to stay strong and capable long-term

Creatine can be helpful in enhancing the positive effects of training.

Even small improvements in training output can compound over months and years. If creatine allows you to perform one or two extra quality repetitions per set, that may seem small, but over time, that can contribute to greater strength and muscle preservation.

Muscle plays a critical role in:

Metabolic health
Blood sugar regulation
Joint support
Injury resilience
Long-term independence

Current research also suggests that creatine may support cognitive performance during periods of stress or sleep restriction — something many everyday adults experience!

It’s not a magic supplement. But for someone already exercising and prioritising their health, it can provide a meaningful edge.

Women

Creatine has historically been marketed toward men, but research shows women respond just as well, if not better, as they generally have lower baseline creatine stores than men.

Studies demonstrate that women supplementing with creatine alongside strength training experience:

Improved strength
Increased lean muscle mass
No adverse hormonal effects

Importantly:

Creatine does not cause fat gain
It does not automatically make you “bulky”
It is not a steroid

For Perimenopause and Menopause

This is an area of growing interest, and understandably so.

During perimenopause and menopause, declining oestrogen levels are associated with:

Accelerated muscle loss
Reduced strength
Increased visceral fat accumulation
Reduced bone density
Changes in energy and cognitive function

Oestrogen has a protective role in muscle and bone metabolism. As levels decline, maintaining muscle mass becomes more challenging. Resistance training is one of the most powerful interventions during this stage of life, and creatine may help enhance the muscle-building response to that training.

Research in midlife and older women suggests that creatine combined with progressive resistance training can:

Improve strength gains beyond training alone
Increase lean muscle mass
Improve functional performance
Potentially support bone health indirectly through increased mechanical loading

There is also emerging research into creatine’s role in brain energy metabolism, as the brain is highly energy-dependent and influenced by hormonal shifts.

It’s important to be clear:

Creatine is not hormone therapy and does not “treat” menopause. But as part of a structured strength-based approach, it may be a helpful adjunct.

Healthy Ageing

Age-related muscle loss (sarcopenia) contributes to:

Falls risk
Reduced independence
Slower metabolism
Increased chronic disease risk

Studies in older adults show that creatine supplementation alongside resistance training improves:

Lean body mass
Strength
Functional capacity

Preserving muscle is one of the most powerful strategies for maintaining long-term health and resilience.

Safety and Dosage

Creatine monohydrate is the most studied form and is considered safe for healthy individuals.

Typical dose: 3–5 grams daily
There is no need to “load.”
Long-term research shows no harmful effects on kidney function in healthy individuals. Anyone with existing kidney disease or significant medical conditions should consult their GP first.

Common myths

It does not damage healthy kidneys when used appropriately
It is not a steroid
It does not cause dehydration when used appropriately

The most common side effect is mild gastrointestinal discomfort, which is usually resolved by taking it with food.

Frequently Asked Questions

Will creatine make me gain weight?

Some people notice a small increase in body weight in the first 1–2 weeks due to water being stored inside muscle cells. This is not fat gain and typically stabilises.

Do I need a loading phase?

No. A consistent 3–5g daily dose is effective.

When should I take it?

Timing is not critical. Consistency matters more.

Who shouldn’t take creatine?

Individuals with kidney disease, significant medical conditions, or who are pregnant or breastfeeding should consult their GP first.

What We Recommend at Active Balance

At Active Balance, we stock ATP NOWAY!® Creatine Monohydrate, a high-quality, pharmaceutical-grade creatine monohydrate with no unnecessary additives.

If you’re strength training, whether as an athlete, navigating midlife changes, or simply wanting to stay strong and capable, creatine may be a simple, evidence-based addition to your routine.

As always, supplementation works best alongside:

Progressive resistance training
Adequate protein intake
Sleep and recovery
A well-structured program

If you’re unsure whether creatine is appropriate for you, our team is happy to guide you ��

Some of the evidence base…

• Kreider RB et al. (2017). International Society of Sports Nutrition position stand: safety and efficacy of creatine supplementation. JISSN.

• Chilibeck PD et al. (2017). Creatine supplementation and resistance training in older adults: a meta-analysis.

• Devries MC & Phillips SM. (2014). Creatine supplementation in older adults. Medicine & Science in Sports & Exercise.

• Smith-Ryan AE et al. (2021). Creatine supplementation in women’s health. Nutrients.

• Forbes SC et al. (2021). Creatine supplementation in females: review of literature. Nutrients.

• Avgerinos KI et al. (2018). Creatine and cognitive function: systematic review. Experimental Gerontology.

Written by Emily Clements, Senior Physiotherapist at Active Balance Physio & Wellness, St Marys Adelaide. Emily holds a Bachelor of Physiotherapy and a Bachelor of Psychology (Honours) and has a special interest in shoulder rehabilitation, strength and conditioning, and helping active people manage and overcome injury.

Is Manual Therapy Useless? A Balanced Perspective

Wed, 25 Feb 2026 08:10:37 GMT

Is Manual Therapy Useless? A Balanced Perspective

You may have heard (probably from Instagram physios ��) that manual therapy is useless and shouldn’t be used in physiotherapy.

We respectfully disagree...

Is it a magic fix?

No.

Does it break up scar tissue, “realign” your spine, or release fascia permanently?

Also no.

But can it reduce pain and help you move better so rehab is more comfortable and effective?

Absolutely.

What Is Manual Therapy?

Manual therapy refers to skilled, hands-on techniques performed by a physiotherapist (or other manual therapists such as massage therapists, osteopaths, chiros and myotherapists). These may include:

Joint mobilisations
Soft tissue techniques
Trigger point therapy
Muscle energy techniques
Joint mobilisation

These techniques are generally chosen based on your presentation and goals. They are not random, they are applied with a clear purpose: usually to reduce pain, improve movement, and make rehab & recovery more achievable.

What Manual Therapy Doesn’t Do

There are some persistent myths around hands-on treatment.

Current research tells us that manual therapy does not:

Physically break up adhesions
Permanently “release” fascia
Push joints back into place
Structurally remodel tissue in a short session

Your connective tissue is strong and resilient. It is not being reshaped in 30 minutes of treatment.

So if it’s not mechanically changing tissue, what is happening?

It Influences the Nervous System

Pain does not always mean damage. It is often a protective response created by your nervous system.

When an area becomes irritated or overloaded, the nervous system may increase sensitivity. This can lead to:

Muscle guarding
Stiffness
Reduced range of motion
Increased pain with movement

Manual therapy can provide sensory input to the body. Research suggests that this input can help change how the nervous system processes pain signals.

In simple terms, it can:

Reduce pain sensitivity
Decrease muscle tension
Improve short-term movement tolerance
Help you feel more comfortable moving

Rather than “fixing” injured or tight tissues, manual therapy often works by calming a sensitised nervous system.

When the system is calmer, movement becomes easier — and that’s where progress begins.

It Can Improve Circulation and Tissue Health

Hands-on therapy can also increase local blood flow.

Improved circulation may support:

Oxygen delivery
Nutrient exchange
Removal of metabolic waste
Overall tissue health

This doesn’t mean instant healing, but healthy circulation supports the body’s natural recovery processes.

Creating a Window for Rehabilitation

This is where manual therapy becomes particularly useful, and where we see a huge benefit.

If pain levels are high, exercise can feel:

Too uncomfortable
Too threatening
Hard to perform properly

If we can reduce your pain with some hands on treatment (even temporarily) that reduction can create a window of opportunity.

During that window, we can:

Introduce strengthening & rehab movements
Improve joint mobility
Retrain movement patterns
Gradually increase load & tolerance
Build confidence

Long-term recovery for most musculoskeletal conditions relies on progressive strengthening and improved load tolerance.

Manual therapy doesn’t replace exercise.

It helps make exercise possible.

What Does the Evidence Say?

Clinical guidelines for conditions such as low back pain, neck pain, and some shoulder conditions suggest manual therapy can be helpful, especially when combined with exercise.

Research generally shows:

Manual therapy can reduce pain in the short term
It can improve short-term range of motion
Outcomes are better when combined with active rehabilitation

On its own, manual therapy tends to produce temporary effects. But when paired with strengthening, mobility work, and education, results are typically more meaningful and longer lasting. This reflects modern physiotherapy practice: use hands-on treatment strategically, not exclusively.

What About “Maintenance” Treatments?

Work, sport & life in general can place repeated demands on the body.

If you do things like:

Work in a physically repetitive job
Sit at a desk for long hours
Play regular sport
Lift and carry children
Train intensely

You are regularly placing load on your tissues, and even strong, healthy tissues can become temporarily overloaded.

For some people, regular hands on treatments can:

Settle flare-ups early
Reduce accumulated muscle tension
Improve movement quality
Help manage symptom build-up

Importantly, this should not replace strength, recovery strategies, and load management. It works best as part of a broader plan that includes:

Appropriate exercise
Good training progression
Rest and recovery
Self-management strategies

The goal of “maintenance” care is not dependency. It’s about supporting a body that is regularly exposed to high or repetitive demands. Think of it less as “fixing something broken” and more as helping your system stay adaptable and resilient.

A Balanced Approach

Physiotherapy is not “hands-on versus exercise.” It shouldn’t be an either/or decision.

At our clinic, manual therapy is:

A tool
Used when clinically appropriate
More often than not, combined with strengthening and mobility work
Generally phased out as independence improves

Our goal is never to make you reliant on treatment.

Our goal is to:

Reduce pain
Improve movement
Build strength
Increase confidence
Help you manage your condition independently

The Bottom Line

Manual therapy does not:

Permanently change tissue structure
Realign your body
Act as a stand-alone cure

But it can:

Reduce pain
Calm a sensitive nervous system
Improve short-term mobility
Support circulation
Create a window for effective rehabilitation

When combined with tailored, progressive exercise, it can be a very useful part of your recovery.

If you’re unsure whether manual therapy is appropriate for your condition, our physios can assess you and design a plan that supports both short-term comfort and long-term goals.

Can AI running apps replace your physio or running coach?

Wed, 28 Jan 2026 07:42:47 GMT

Can AI Running Apps Replace Your Physio or Running Coach?

Why Running Injuries Happen

Before we look at apps specifically, it helps to understand why runners get injured in the first place.

Your bones, tendons, muscles and ligaments adapt to load over time — but they need adequate time and recovery to do so. When training load increases faster than your tissues can adapt, the result is injury. It's not complicated in principle, but it's surprisingly easy to get wrong in practice.

The most common triggers we see in clinic are:

Increasing mileage or intensity too quickly — jumping from 20km to 35km per week over a fortnight might feel manageable cardiovascularly, but your tendons and bones are adapting on a much slower timeline
Insufficient recovery — rest days aren't optional extras, they're when adaptation actually happens. Without them, micro-damage accumulates faster than it can repair
Ignoring early warning signs — pain is your body's early warning system, not something to push through. Apps can't feel what you feel
Neglecting strength work — runners who only run, without complementary strength training, are significantly more vulnerable to tendon and bone stress injuries

What AI Apps Can and Can't Do

AI running apps have genuine strengths. They're convenient, motivating, increasingly sophisticated, and for many runners they provide structure that simply didn't exist before. That's genuinely valuable.

But there are things no app can currently account for, no matter how good the algorithm...

What apps don't know about you:

Your injury history — that Achilles niggle from six months ago, the stress fracture two years back
Your biomechanics — how your foot strikes, your hip drop, your cadence and how these interact with your injury risk
Your running shoes — whether they're appropriate for your gait and worn to the point of needing replacement
The surface you run on — road, trail, track and treadmill all load your body quite differently
Your lifestyle context — sleep quality, stress levels, nutrition, how physically demanding your job is
Current niggles — that tightness in your calf that's been there for a week

These factors matter enormously when it comes to injury risk. A training plan that looks perfectly progressive on paper can be a recipe for injury if the person following it is sleeping poorly, works on their feet all day, and hasn't done a strength session in months.

How to Use AI Running Apps More Safely

None of this means you should delete your running app. Used well, they can genuinely support your training. Here's how to get the most out of them while keeping your injury risk low:

Treat the plan as a guide, not a rulebook. The app doesn't know how you feel today. If you're fatigued, sore, or something feels off — adjust. A missed session or reduced session is far less costly than six weeks on the sideline with a stress fracture.
Respect the 10% rule. As a general principle, avoid increasing your weekly mileage by more than 10% from one week to the next. It's a conservative rule of thumb but it exists for good reason — tendons and bones adapt more slowly than your cardiovascular system.
Prioritise recovery as much as training. Rest days, sleep and nutrition aren't soft add-ons to your program — they're when adaptation actually occurs. An app that pushes you to train every day without adequate recovery is not working in your best interests.
Add strength training. Calves, glutes, hip abductors and core all play a role in protecting your joints and tendons when you run. Two strength sessions per week alongside your running program significantly reduces injury risk and improves performance over time.
Pay attention to pain. There's a difference between normal training fatigue and pain that's telling you something is wrong. Persistent localised pain — especially over a tendon or bone — warrants a rest day and, if it continues, a professional assessment. Don't let an app tell you to push through.
Know when to get professional input. If you're returning from injury, building toward your first marathon, dealing with a recurring issue, or just not sure whether your training is appropriate for your body — a physio or running coach can give you something no app can: genuinely individualised advice based on your specific body, history and goals.

The Bottom Line

AI running apps are exciting tools and they're only going to get more sophisticated. Used sensibly, they can provide structure, motivation and useful data that helps you train consistently. But, they are not a replacement for understanding your own body, respecting the principles of load management, or seeking professional guidance when something isn't right. The runners who stay injury-free long term are the ones who combine smart training tools with body awareness, adequate recovery, and a willingness to ask for help when they need it.

If you're dealing with a running injury, concerned about your training load, or want a running assessment to identify your injury risk before it becomes a problem — we'd love to help. Book online or call us on (08) 7123 4148.

Understanding Stress Fractures

Wed, 31 Dec 2025 03:52:31 GMT

Understanding stress fractures

Unfortunately, we are seeing an increase in stress fracture presentations at the moment, particularly in young females, which seems to be linked to the growing popularity of endurance sports such as Hyrox, long-distance running, and other high-volume training programs.

What are stress fractures?

Stress fractures are tiny cracks in the bone, often caused by repetitive force rather than a single traumatic event. They are common in athletes, active individuals, and even people who suddenly increase their activity levels. Understanding why they occur, the risk factors, and how to prevent them is key to keeping your bones strong and staying active safely.

Why Stress Fractures Occur

Unlike acute fractures caused by sudden trauma, stress fractures develop over time. They happen when the load on a bone exceeds its ability to repair and adapt. Every time we run, jump, or engage in high-impact activity, our bones experience tiny amounts of stress. Normally, bones remodel and strengthen in response. However, if the stress is too frequent or intense without enough recovery, damage can accumulate and eventually result in a stress fracture.

Common sites include:

• Lower leg: tibia (shin), fibula

• Foot: metatarsals

• Hip: femoral neck

• Ankle: talus

Risk Factors

Several factors can increase the risk of developing a stress fracture, but some of the most significant in today’s sports culture include:

1. Training and activity-related factors

• Rapid increases in training volume or intensity, such as going from running 5km to a full marathon in 3 months

• Repetitive high-impact activities (running, jumping, dance, military training, endurance sports)

• Overtraining or poor load management, without enough rest and recovery

• Poor footwear or inappropriate training surfaces

2. Physiological and health-related factors

• Underfueling or inadequate nutrition, leading to low energy availability & deficiencies

• Low bone density (osteopenia or osteoporosis)

• Hormonal imbalances (e.g., low estrogen in women, low testosterone in men)

• Nutritional deficiencies (low calcium, vitamin D, or overall energy intake)

• Previous injuries or existing biomechanical issues

3. Biomechanical factors

• Abnormal gait or foot alignment

• Muscle weakness leading to poor shock absorption

Important to note: A huge percentage of stress fractures are preventable with proper load management, realistic training progression, and attention to nutrition. Unrealistic expectations such as trying to increase distance, intensity, or frequency too fast significantly increase the risk.

Signs and Symptoms

Stress fractures typically start with gradual pain at a specific spot that worsens with activity and improves with rest. Other signs include:

• Localised tenderness (you can usually pinpoint it)

• Swelling & heat in the area (not always though)

• Bruising (less common)

• Pain when tapping on the bone

If left untreated, symptoms can worsen and lead to a complete fracture.

Prevention and Load Management

As physios, we recommend a proactive approach to prevent stress fractures. Key strategies include:

1. Gradual progression

• Increase training volume, intensity, or impact gradually (e.g., no more than 10% per week).

• Incorporate rest days to allow bones to adapt.

2. Strength and conditioning

• Build lower limb and trunk strength to improve shock absorption.

• Focus on hip, glute, calf, and foot muscles.

3. Biomechanical assessment

• Correct muscle imbalances, poor gait patterns, or foot mechanics with physio exercises, orthotics, or footwear adjustments.

4. Nutrition and bone health

• Ensure adequate calcium and vitamin D intake.

• Maintain sufficient overall energy intake (including fats and carbohydrates), especially for athletes in high-volume training.

5. Cross-training

• Reduce repetitive impact by alternating running with cycling, swimming, or resistance training.

6. Early recognition

• Don’t ignore persistent pain during activity. Early detection and modified activity can prevent progression.

Load Management in Practice

Load management is crucial for both preventing and recovering from stress fractures:

• Acute phase: Reduce or stop the activity causing pain. Use low-impact alternatives.

• Recovery phase: Gradually reintroduce weight-bearing activity under a structured program.

• Maintenance phase: Focus on strength, conditioning, and gradual increases in training load.

Our physios can design a tailored program to help manage load, correct biomechanics, and safely guide return to sport or activity.

Bottom Line:

Stress fractures are generally preventable with proper training, nutrition, and attention to biomechanics. With the rise of endurance sports, we’re seeing more cases, particularly in young females. Unrealistic training goals, underfueling, and overtraining are major risk factors. Listening to your body and managing your load wisely is the best way to stay active without setbacks.

If you experience persistent pain or suspect a stress fracture, early assessment by one of our physios can help prevent further injury and ensure a safe return to activity.

Physiotherapy for Hip Bursitis: Relieving Pain and Restoring Movement

Wed, 08 Oct 2025 10:29:04 GMT

Physiotherapy for Hip Bursitis: Relieving Pain and Restoring Movement

If you’ve ever experienced a sharp, aching pain on the outside of your hip, especially when lying on your side or after a long walk, you may be dealing with a condition called hip bursitis. Also known as greater trochanteric pain syndrome (GTPS), this condition can be frustrating and disruptive, but with the right management, recovery is very achievable.

Physio can offer safe, effective strategies to reduce pain, restore strength, and get you back to moving comfortably.

What is Hip Bursitis?

Your hip has small fluid-filled sacs called bursae that sit between tendons, muscles, and bones to reduce friction. The main one affected in hip bursitis is the trochanteric bursa, located on the outer side of your hip.

When this bursa or the surrounding tendons (like the gluteal tendons) become irritated, inflamed, or overloaded, pain develops. This is why many practitioners now use the broader term greater trochanteric pain syndrome, since the problem often involves both the bursa and the nearby tendons.

Common Symptoms

• Pain over the outer hip, sometimes radiating down the thigh

• Tenderness when pressing on the bony point of the hip (greater trochanter)

• Pain lying on the affected side, especially at night

• Discomfort with walking, climbing stairs, or prolonged standing

• Stiffness after sitting for long periods

What Causes Hip Bursitis?

Hip bursitis often occurs due to overload or irritation rather than a single traumatic event. Contributing factors can include:

• Weakness or imbalance in the hip and gluteal muscles

• Tightness/tension in the iliotibial band (ITB) or surrounding muscles

• Repetitive movements like running, walking long distances, or stair climbing

• Postural habits (e.g., crossing legs, standing with weight on one side)

• Biomechanical factors like leg length differences or altered gait patterns

It’s more common in women, particularly between ages 40–60, but can affect anyone.

How Physiotherapy Can Help

When you see one of our physios, the first step is a comprehensive assessment. We’ll look at your history, daily activities, posture, muscle strength, and movement patterns. This allows us to put together a tailored plan that addresses not just the pain, but also the underlying cause.

Hands-On Treatments for Pain Relief

In the early stages, our goal is to calm down irritation and reduce pain. We may use:

• Soft tissue release or massage for tight muscles around the hip and thigh to help relive pressure on the affected structures

• Myofascial release or cupping to ease tension and improve flexibility

• Trigger point therapy or dry needling for overactive glute/TFL muscles & ITB.

• Electrotherapy to help with pain relief and muscle activation

These treatments help settle discomfort so you can move & feel better, but the real long-term fix comes from targeted exercise.

Exercise Rehabilitation

Research shows that progressive strengthening of the hip and gluteal muscles is the most effective treatment for hip bursitis. Your physio will guide you through a program that may include:

• Isometric exercises for early pain management (e.g., static glute contractions)

• Glute strengthening (bridges, resistance band walks, deadlifts, hip thrusts etc)

• Hip stabilisation work to improve control during walking and running

• Functional strengthening (squats, step-ups, single-leg work) to restore load tolerance

Over time, we’ll progress your exercises to restore full strength and reduce the risk of recurrence.

Education and Lifestyle Advice

We’ll also talk through simple changes that make a big difference, such as:

• Avoiding sleeping directly on the sore hip until it settles (a pillow between the knees can help)

• Reducing prolonged standing or sitting with legs crossed

• Adjusting training loads to prevent flare-ups

• Choosing supportive footwear to improve biomechanics

What the Evidence Says

• Exercise is key: Research strongly supports targeted hip strengthening as the most effective long-term treatment for hip bursitis/GTPS.

• Manual therapy helps short term: Soft tissue techniques, needling, and cupping can reduce pain, but work best when paired with strengthening. Basically, it can give us a window of opportunity – where symptoms are reduced so strengthening and rehab exercises can be done with less discomfort & pain.

• Corticosteroid injections may help in acute or stubborn cases, but are less effective long-term compared to physiotherapy-led exercise programs.

• Surgery is rarely required and only considered if conservative management fails.

A systematic review in the British Journal of Sports Medicine highlights that exercise programs provide superior long-term outcomes compared with injections alone.

A Partner in Your Recovery

Hip bursitis can be stubborn, especially if it’s been hanging around for months. We will take the time to understand your unique situation, reduce your pain, and build a tailored strengthening and lifestyle plan to get you moving freely again.

We’ll be with you every step of the way — from early pain relief to regaining strength, confidence, and independence in your daily activities.

Key Takeaways

• Hip bursitis (or greater trochanteric pain syndrome) causes outer hip pain, especially when lying on your side, walking, or climbing stairs.

• Physiotherapy can help with pain relief, targeted strengthening, and practical advice for daily activities.

• Research shows that exercise-based rehab is the most effective long-term solution.

• With the right plan, most people can return to normal activities without ongoing pain.

If you’ve been struggling with hip pain, book a time with our physios to get you back on track & feeling great!

Physiotherapy for Patellar Tendinopathy: Reducing Pain and Restoring Jumping and Running Performance

Wed, 08 Oct 2025 10:19:32 GMT

Physiotherapy for Patella Tendinopathy: Getting You Back on Track

If you’ve ever had pain just below your kneecap, especially during sport or exercise, you may have experienced something called patella tendinopathy. Often called “jumper’s knee”, this condition is common in people who play sports involving running, jumping, or sudden changes of direction, but it can affect anyone for a number of reasons.

While it can be frustrating and sometimes stubborn, the good news is that physiotherapy is often highly effective for managing patella tendinopathy and helping you get back to the activities you love.

What is Patella Tendinopathy?

The patella tendon connects your kneecap (patella) to your shin bone (tibia). Its main job is to transfer the force of your quadriceps (thigh muscles) so you can straighten your knee when walking, running, or jumping.

With patella tendinopathy, this tendon becomes painful and sometimes thickened due to overuse and overload. Unlike an acute “tear” or “strain,” tendinopathy develops gradually when the tendon is stressed more than it can adapt to.

Common signs and symptoms:

• Pain just below the kneecap, especially with jumping, running, or squatting

• Stiffness or ache after exercise, sometimes the next morning

• Pain that warms up with activity but can worsen if you keep pushing through

• Reduced performance — difficulty with explosive movements or keeping up with training volume

Why Does Patella Tendinopathy Happen?

It usually develops due to a combination of:

• Sudden increases in training load (e.g., more jumping, hill running, or gym work)

• Poor movement mechanics (landing technique, hip/knee alignment)

• Weakness or tightness in surrounding muscles like the quads, glutes, and calves

• Not enough recovery between sessions

It’s especially common in sports like basketball, volleyball, netball, football, and athletics — hence the nickname jumper’s knee.

How Physiotherapy Can Help

When you come to see one of our physios, we’ll start with a full assessment. This includes looking at your pain history, activity levels, biomechanics, strength, and training loads. From there, we’ll put together a tailored plan to not just help reduce pain, but also restore tendon health and prevent recurrences.

Hands-On Treatment
In the short term, we can use manual techniques to help reduce pain and help you move more freely. These may include:
Soft tissue release or massage for tight quads, hamstrings, or calves
Trigger point therapy or dry needling to release overloaded muscles around the knee
Myofascial release or cupping to improve flexibility and reduce tension
Electrotherapy to help with pain relief in acute cases
While these treatments can provide quick relief, the long-term solution comes from exercise, rehab & training smart.
Targeted Exercise Therapy
This is the gold standard for patella tendinopathy. Research consistently shows that a structured strengthening program can help restore tendon capacity and function better than rest or passive treatments alone.
Your physio will guide you through a progressive exercise plan that may include:
Isometric exercises (like static wall sits) for early pain relief
Slow, heavy strength training (such as squats, leg presses, split squats) to rebuild tendon tolerance
Eccentric loading (controlled lowering movements) to stimulate tendon repair
Plyometric drills to retrain jumping mechanics once pain is under control
Education and Load Management
One of the most important roles we play is helping you understand how to manage training loads. Tendons don’t like sudden spikes in activity, so we’ll help you find the right balance between exercise, sport, and recovery.
We’ll also give you practical advice on warm-ups, footwear, and movement patterns to reduce strain on the tendon.

What the research says

• Exercise therapy is the cornerstone: The strongest evidence supports progressive loading exercises as the most effective treatment. (British Journal of Sports Medicine reviews highlight heavy slow resistance training as highly effective.)

• Manual therapy & adjuncts (needling, cupping, massage) are helpful for pain relief and short-term function, but must be paired with exercise for long-term success.

• Education & load management are essential — athletes who understand and adjust their training recover more successfully.

• Surgery is rarely needed: Most cases respond well to conservative physiotherapy when managed properly.

A Partner in Your Recovery

Patella tendinopathy can be very frustrating, especially when it lingers or flares up every time you return to sport or try to increase your training. We don’t just treat the symptoms — we aim to help you understand why the problem developed, give you the right tools to rebuild tendon health, and support you step by step until you’re confident and pain-free.

Whether you’re an elite athlete or someone who just wants to enjoy movement & exercise without knee pain, we’ll work with you to create a treatment plan that works for your lifestyle and goals.

Key Takeaways

• Patella tendinopathy (jumper’s knee) is an overuse injury affecting the tendon below your kneecap.

• Physiotherapy helps by combining hands-on pain relief, progressive strengthening exercises, and education.

• Evidence shows exercise-based rehab is the most effective long-term solution.

• With the right plan, most people return to sport and activity without ongoing pain.

If knee pain is holding you back, don’t wait until it becomes a bigger issue. Book an appointment with one of our physiotherapists, and we can help you find relief now, and get back to doing what you love.

Brazilian Lymphatic Drainage and Fertility: Supporting Your Reproductive Health

Wed, 08 Oct 2025 10:08:24 GMT

Brazilian Lymphatic Drainage and Fertility: Supporting Your Reproductive Health

Trying to conceive can be an emotional and physical journey. Many people explore ways to support their reproductive health beyond medical interventions, looking for gentle therapies that can improve overall wellbeing and optimise the chances of conception. One therapy gaining recognition for its supportive role is Brazilian Lymphatic Drainage (BLD).

BLD is a specialised massage technique that uses gentle, rhythmic movements to stimulate lymphatic flow, improve circulation, and reduce congestion in the pelvic and abdominal areas. While it does not directly treat infertility, it can create a more optimal environment for reproductive health, ease discomfort, and reduce stress — all important factors in fertility.

Understanding the lymphatic system and its role in fertility

The lymphatic system is the body’s natural drainage network. It works closely with the circulatory system to:

Remove excess fluid and toxins from tissues
Maintain fluid balance
Support immune function
Reduce inflammation

When lymphatic flow slows, fluid can accumulate in tissues, creating congestion. In the pelvic area, congestion can contribute to discomfort, bloating, and poor circulation around the uterus, ovaries, and fallopian tubes. This is where BLD can be particularly beneficial. By gently stimulating the lymphatic system, BLD encourages fluid movement, supports tissue health, and helps the body maintain a balanced internal environment — all of which may contribute to reproductive wellbeing.

How Brazilian Lymphatic Drainage supports fertility

Help improve circulation to reproductive organs

BLD uses gentle, sweeping strokes to enhance lymphatic and blood flow in the pelvic and abdominal regions. Improved circulation ensures that the ovaries, uterus, and surrounding tissues receive oxygen and nutrients while metabolic waste products are removed more efficiently. This supports tissue health, making the reproductive system more receptive and functional.

Helps reduce pelvic congestion

Stagnant fluid in the pelvic area can lead to feelings of heaviness, bloating, and discomfort. BLD gently encourages the movement of lymph and fluid from congested tissues back into circulation, helping to ease these sensations. Many people report feeling lighter, more comfortable, and less bloated after a session.

Helps support hormonal balance indirectly

While BLD does not directly regulate hormones, improved lymphatic and circulatory function can support the organs responsible for hormone production and balance. Reduced inflammation, better nutrient delivery, and efficient waste removal create an environment that allows hormonal systems to function more effectively.

Reduces inflammation

Inflammation in the pelvic region can impact fertility. BLD helps the lymphatic system clear inflammatory by-products from tissues, which may reduce swelling and discomfort. For individuals with conditions such as endometriosis, polycystic ovary syndrome (PCOS), or pelvic congestion, BLD can be particularly supportive.

Helps to promote relaxation and reduces stress

Trying to conceive can be stressful, and elevated stress hormones like cortisol can interfere with ovulation and reproductive function. The gentle, rhythmic nature of BLD activates the parasympathetic nervous system, promoting relaxation, reducing stress, and supporting the body’s natural restorative processes. Many people feel deeply relaxed and lighter both physically and emotionally after a session.

What a Brazilian Lymphatic Drainage session for fertility involves

A BLD session focused on fertility typically lasts 60-90 minutes. During the session:

• The therapist uses gentle, sweeping strokes to encourage lymphatic flow in the abdomen, pelvis, legs, and arms.

• The focus is on promoting pelvic circulation and reducing congestion without causing discomfort.

• The massage is light and soothing — not deep or forceful — as lymph vessels lie just beneath the skin.

• Many people notice a sense of lightness and relaxation during the session, and some may feel an urge to urinate afterwards as excess fluid moves through the system.

When and how often to have BLD

While one session may provide immediate relief and a sense of lightness, regular sessions are often recommended for ongoing support. For fertility purposes, some individuals choose weekly or biweekly sessions, depending on their circumstances and under the guidance of a qualified therapist.

Consistency helps:

• Maintain optimal lymphatic flow

• Reduce pelvic congestion over time

• Support hormonal and reproductive function indirectly

• Promote overall relaxation and stress reduction

Complementary lifestyle strategies

Brazilian Lymphatic Drainage is most effective when combined with healthy lifestyle choices that support fertility:

• Hydration: Drinking adequate water helps lymphatic flow and enhances the body’s natural detox processes.

• Movement: Gentle exercise like walking, yoga, or swimming supports circulation and lymphatic function.

• Balanced nutrition: Nutrient-dense foods, healthy fats, and adequate protein support reproductive health.

• Stress management: Techniques such as meditation, breathing exercises, or mindfulness complement the relaxation benefits of BLD.

Who may benefit from BLD for fertility

Brazilian Lymphatic Drainage may be beneficial for:

• Individuals experiencing pelvic congestion or bloating

• Those with reproductive conditions such as endometriosis, adenomyosis, or PCOS

• People seeking a gentle, supportive therapy alongside medical fertility treatment

• Anyone wanting to reduce stress, improve circulation, and support overall reproductive health

It’s important to note that BLD is complementary, not a replacement for medical fertility care. Always consult your healthcare provider when exploring therapies to support conception.

Final thoughts...

While fertility involves many complex factors, supporting the body’s natural processes can make a meaningful difference. Brazilian Lymphatic Drainage offers a gentle, non-invasive way to improve pelvic circulation, reduce congestion, ease discomfort, and promote relaxation.

For those trying to conceive, BLD can be a valuable part of a holistic approach that combines medical care, lifestyle strategies, and gentle therapies. Regular sessions may not only support physical wellbeing but also provide emotional relief and a sense of control during the fertility journey.

By helping the lymphatic system function efficiently, BLD encourages the body to maintain balance, optimise reproductive organ health, and feel lighter and more comfortable overall.

Brazilian Lymphatic Drainage for Lipoedema and Lymphoedema: Managing Swelling and Supporting Comfort

Wed, 08 Oct 2025 10:01:10 GMT

Brazilian Lymphatic Drainage for Lipoedema and Lymphoedema: Managing Swelling and Supporting Comfort

Lipoedema and lymphoedema are conditions that can significantly affect daily comfort, mobility, and self-confidence. Both involve abnormal fluid accumulation, but for different reasons:

Lipoedema is a chronic condition characterised by abnormal fat and fluid deposition, usually in the legs and sometimes arms, causing heaviness, tenderness, and disproportionate limb size.
Lymphoedema is caused by impaired lymphatic flow, leading to fluid retention, swelling, and tissue changes, often after surgery, trauma, or as a primary condition.

While medical management is essential, complementary therapies can help reduce discomfort, improve mobility, and support lymphatic function. One such effective therapy is Brazilian Lymphatic Drainage (BLD).

Unlike traditional lymphatic drainage, BLD is firm, continuous, and dynamic, specifically designed to move stagnant fluid, reduce tissue congestion, and improve circulation. It also provides sculpting and contouring effects, helping limbs feel lighter and more comfortable.

How Brazilian Lymphatic Drainage works

The lymphatic system is the body’s natural drainage network, responsible for removing fluid, toxins, and metabolic waste from tissues. In lipoedema and lymphoedema, fluid can accumulate due to tissue changes or impaired lymphatic flow, causing heaviness, swelling, and discomfort.

BLD works by:

• Using firm, wave-like, continuous movements to mobilise fluid from congested tissues

• Directing fluid toward lymph nodes where it can be efficiently cleared

• Reducing tissue congestion while improving circulation to affected areas

• Supporting detoxification and tissue health

• Promoting sculpting and contouring effects, especially in the legs, arms, and abdomen

Unlike light lymphatic massages, BLD applies dynamic pressure that encourages deep fluid movement and tissue mobilisation, making it especially effective for chronic conditions like lipoedema and lymphoedema.

Benefits of BLD for lipoedema and lymphoedema

Helps reduce swelling and heaviness

BLD’s firm, continuous strokes help move fluid from congested areas toward the lymph nodes, reducing swelling in the legs, arms, and glutes. Many clients notice a measurable reduction in heaviness and limb circumference after a few sessions, making mobility easier and daily tasks more comfortable.

Helps to improve circulation and tissue function

Enhanced lymphatic and blood flow ensures that tissues receive oxygen and nutrients while waste products are cleared. For individuals with lipoedema or lymphoedema, this can reduce discomfort, tenderness, and inflammation while supporting tissue health.

Helps support lymphatic and fluid clearance

BLD helps reactivate lymphatic flow in areas affected by impaired drainage. This is especially important for lymphoedema patients, whose lymphatic systems may struggle to clear excess fluid effectively. Regular sessions help maintain consistent fluid movement and reduce the risk of fluid build-up.

Provides sculpting and contouring effects

BLD’s firm, flowing strokes target affected areas, helping limbs feel lighter and more contoured. For lipoedema, where fat deposition can be uneven, BLD assists in mobilising fluid and easing tissue tension, which can improve overall limb shape and comfort.

Helps reduce discomfort and tenderness

Both lipoedema and lymphoedema can cause pain, tenderness, and a heavy sensation. BLD helps relieve pressure in congested tissues, reduces tightness, and promotes a sense of lightness in the limbs, making daily movement easier.

Helps enhance overall wellbeing

Beyond physical relief, BLD promotes a sense of comfort and relaxation. While it is firm and dynamic, clients often feel energised, lighter, and more in control of their bodies after a session. This can improve confidence and quality of life, particularly for individuals managing chronic swelling.

What a Brazilian Lymphatic Drainage session involves

A typical BLD session for lipoedema or lymphoedema lasts 45–60 minutes and includes:

Firm, continuous, wave-like movements on the affected limbs, glutes, abdomen, and sometimes the arms
Focus on mobilising fluid toward key lymph nodes, including inguinal, axillary, and cervical nodes
Dynamic pressure designed to move stagnant fluid effectively, not just superficially
Particular attention to areas prone to congestion, such as thighs, calves, or forearms
Clients may notice lightness, reduced swelling, and improved mobility

After a session, many people experience increased urination as the body clears excess fluid, a lighter sensation in the limbs, and reduced tension or tenderness.

Frequency and consistency

For best results, regular BLD sessions are recommended:

Weekly or biweekly sessions can help maintain lymphatic flow and reduce recurrent swelling
Consistent treatment supports tissue health, fluid balance, and mobility
Over time, regular BLD can improve the long-term appearance, feel, and function of affected limbs

Consistency is especially important for lipoedema and lymphoedema, as these are chronic conditions where fluid retention can return without ongoing support.

Complementary strategies

BLD works best alongside supportive lifestyle measures:

Hydration: Adequate water intake supports lymphatic clearance
Movement: Gentle exercises like walking, swimming, or cycling improve circulation and reduce congestion
Compression garments: For lymphoedema, these may be recommended to support fluid control after sessions
Balanced nutrition: Anti-inflammatory and nutrient-rich foods support tissue health and minimise fluid retention
Stress management: Techniques such as meditation, deep breathing, or yoga complement BLD’s benefits

Who may benefit

BLD can help:

Individuals with lipoedema or lymphoedema seeking relief from swelling and heaviness
People who experience tenderness or discomfort in congested areas
Those wanting dynamic, effective therapy to support lymphatic function and body contouring
Anyone looking for improved mobility, comfort, and confidence while managing chronic swelling

BLD is complementary and should be used alongside medical management for lipoedema or lymphoedema. Always consult a healthcare provider for personalised care.

Final thoughts...

Living with lipoedema or lymphoedema can affect comfort, mobility, and confidence. Brazilian Lymphatic Drainage offers a firm, dynamic, and highly effective way to mobilise fluid, reduce swelling, ease tenderness, and support lymphatic function.

Regular BLD sessions, combined with hydration, movement, and appropriate medical support, provide a holistic approach to managing these chronic conditions. Beyond physical relief, clients often experience increased energy, improved mobility, and a renewed sense of control over their bodies.

By targeting the abdomen, pelvis, glutes, and limbs, Brazilian Lymphatic Drainage addresses fluid congestion at its source, promoting long-term comfort, balance, and wellbeing.

Brazilian Lymphatic Drainage for Post-Surgical Recovery: Supporting Healing and Comfort

Wed, 08 Oct 2025 09:53:47 GMT

Brazilian Lymphatic Drainage for Post-Surgical Recovery: Supporting Healing and Comfort

Recovering from surgery can be challenging, both physically and emotionally. Swelling, bruising, fluid retention, stiffness, and discomfort are common after many procedures, whether they are cosmetic, abdominal, pelvic, or orthopaedic. While medical care and physiotherapy are often essential, complementary therapies such as Brazilian Lymphatic Drainage (BLD) can play a valuable role in supporting recovery and enhancing comfort.

Brazilian Lymphatic Drainage is a firm, dynamic, and continuous massage technique designed to mobilise fluid, reduce tissue congestion, improve circulation, and support the body’s natural healing processes. Unlike traditional lymphatic massage, BLD uses wave-like movements with specific pressure, often targeting the surgical area, surrounding tissues, and key lymphatic pathways, helping to reduce swelling, bruising, and tension.

Understanding post-surgical fluid accumulation

After surgery, the body responds with inflammation and fluid accumulation as part of the healing process. Lymphatic flow can be temporarily impaired due to tissue trauma, incisions, or reduced mobility, leading to:

Swelling in the operated area and surrounding tissues
Bruising and discolouration
Tightness or stiffness in muscles and connective tissue
Discomfort or a heavy sensation in affected limbs or torso

Excess fluid can slow recovery, prolong discomfort, and contribute to a feeling of heaviness. Brazilian Lymphatic Drainage helps target these issues by mobilising stagnant fluid, promoting lymphatic flow, and supporting tissue healing.

How Brazilian Lymphatic Drainage supports post-surgical recovery

Reduces swelling and oedema
BLD uses firm, continuous, wave-like movements to move excess fluid from the surgical site and surrounding tissues toward lymph nodes for clearance. This helps reduce post-operative swelling, making the affected area feel lighter and more comfortable.
Helps reduce bruising faster
Bruising occurs when blood leaks into surrounding tissues after surgery. By stimulating lymphatic and circulatory flow, BLD encourages efficient removal of these by-products, potentially reducing the duration and intensity of bruising.
Enhances circulation and tissue oxygenation
Improved lymphatic and blood circulation ensures that tissues around the surgical site receive oxygen and nutrients essential for healing. This can support collagen production, tissue repair, and overall recovery.
Promotes scar and tissue flexibility
Post-surgical adhesions, stiffness, or tightness can develop around the incision site. BLD’s dynamic, firm strokes gently mobilise tissues, helping to maintain flexibility, improve mobility, and reduce discomfort in the early stages of healing.
Supports detoxification
Surgery generates metabolic by-products as part of tissue repair. BLD helps move stagnant fluid away from the area, allowing the lymphatic system to efficiently eliminate toxins, which supports overall recovery and reduces systemic fatigue.
Encourages relaxation and reduces stress
While BLD is firm and dynamic, many patients report a sense of deep relaxation and relief during and after treatment. This reduction in stress hormones can complement healing by supporting immune function and encouraging overall wellbeing.

What to expect during a post-surgical BLD session

A typical session lasts 45–60 minutes, tailored to the individual’s surgical site and stage of recovery. During the session:

The therapist applies firm, continuous wave-like movements to the surgical area and surrounding tissues
Fluid is mobilised toward key lymph nodes (inguinal, axillary, and cervical)
Pressure is adjusted to the patient’s comfort level, always firm enough to move fluid effectively without causing harm
Sessions may also target limbs or torso if swelling extends beyond the surgical site

Clients often notice immediate lightness, reduced swelling, and improved mobility after a session. Some may experience increased urination, which is a natural response as fluid is cleared from tissues.

Timing and frequency

The timing and frequency of BLD after surgery depend on the type of procedure and the person's healing progress. This can be discussed with your massage therapist as you progress.

Generally:

Early intervention: Once cleared by your surgeon, BLD can be started to manage early swelling and bruising.
Regular sessions: Weekly or biweekly sessions may be recommended to maintain lymphatic flow, reduce oedema, and support ongoing tissue healing.
Tailored approach: Each session is customised to the patient’s surgical area, comfort level, and stage of recovery.
Consistency is key, as regular BLD can accelerate recovery, reduce complications from fluid accumulation, and help restore comfort and mobility.

Complementary post-surgical care strategies

BLD is most effective when combined with other supportive measures:

Hydration: Adequate water intake helps maintain lymphatic flow and reduce swelling.
Gentle movement: Light walking or physiotherapy-approved exercises enhance circulation and prevent stiffness.
Balanced nutrition: Protein-rich, nutrient-dense foods support tissue repair and collagen formation.
Compression garments: If prescribed, these support lymphatic drainage and prevent fluid accumulation between sessions.
Stress management: Relaxation techniques complement BLD’s effects and support overall healing.

Who may benefit

BLD can benefit individuals recovering from a variety of surgical procedures, including:

Cosmetic surgeries (abdominoplasty, liposuction, breast surgery)
Orthopaedic procedures (joint replacements, ligament repairs)
Abdominal or pelvic surgeries (hysterectomy, C-section, hernia repair)
Any surgery where swelling, bruising, or tissue tightness is present

It is important to note that BLD is complementary and should always be performed with clearance from the treating surgeon &/or medical practitioner.

Final thoughts...

Post-surgical recovery can be uncomfortable and slow, particularly when fluid retention, bruising, or tissue tightness is present. Brazilian Lymphatic Drainage offers a firm, dynamic, and highly effective approach to support healing, reduce swelling, and improve overall comfort.

Regular BLD sessions, combined with hydration, gentle movement, balanced nutrition, and appropriate medical care, provide a holistic approach to recovery. By targeting the surgical area, surrounding tissues, and key lymphatic pathways, BLD helps mobilise fluid, improve circulation, and enhance tissue repair, leaving patients feeling lighter, more mobile, and more comfortable as they heal.

Like to Book for post surgical Lymphatic Drainage? Please get in touch & we can discuss the best treatment plan for you ��

Brazilian Lymphatic Drainage for Bloating and Food Intolerances: Supporting Digestive Comfort

Wed, 08 Oct 2025 09:42:43 GMT

Brazilian Lymphatic Drainage for Bloating and Food Intolerances: Supporting Digestive Comfort

Bloating and digestive discomfort are common issues for many people, often linked to food intolerances, sensitivities, or slow digestion. Abdominal fullness, discomfort, or a “heavy” feeling can affect daily comfort, energy levels, and overall wellbeing. While dietary management is essential for addressing food intolerances, Brazilian Lymphatic Drainage (BLD) can be a valuable complementary therapy for improving digestion, reducing bloating, and supporting overall abdominal comfort.

What is Brazilian Lymphatic Drainage?

Unlike traditional lymphatic drainage, BLD is firm, dynamic, and continuous, using wave-like movements along the abdomen, pelvis, and surrounding areas. This technique helps mobilise fluid, support digestive organs, and improve lymphatic flow, reducing bloating and promoting a lighter, more comfortable feeling in the body.

Understanding bloating and food intolerances

Bloating occurs when the digestive system becomes congested with fluid, gas, or inflammation, causing a full, tight, or heavy feeling in the abdomen. It can be triggered by:

Food intolerances or sensitivities (e.g., dairy, gluten, FODMAPs)
Slow digestion or impaired gut motility
Fluid retention in the abdominal tissues
Stress, which can affect gut function

Food intolerances can exacerbate bloating by creating inflammation and fluid retention in the digestive tract and surrounding tissues. Brazilian Lymphatic Drainage works to support the body’s natural drainage system, encouraging the removal of excess fluid, inflammatory by-products, and metabolic waste. This helps relieve abdominal pressure and support overall digestive comfort.

How Brazilian Lymphatic Drainage helps to:

Reduce abdominal bloating

BLD applies firm, continuous, wave-like movements to the abdomen, pelvis, and surrounding areas, actively mobilising stagnant fluid and relieving pressure. This helps ease bloating, distension, and the “heavy” feeling that often accompanies food intolerances

Support digestive flow and organ function

Firm, dynamic abdominal movements stimulate lymphatic flow and circulation around the digestive organs, including the stomach, intestines, and liver. Improved fluid and blood flow supports nutrient delivery, waste removal, and digestive efficiency, reducing discomfort and promoting regularity.

Mobilise fluid and reduces tissue congestion

Bloating is often accompanied by localized fluid retention in the abdominal and pelvic tissues. BLD’s firm, continuous strokes encourage the movement of this fluid toward the lymph nodes, helping to reduce pressure, swelling, and overall abdominal heaviness.

Enhance detoxification and tissue health

BLD helps support the body’s natural detoxification processes by moving lymph and waste products away from the digestive organs. This can reduce inflammation, relieve tissue tension, and promote healthier cellular function, complementing dietary strategies for managing food intolerances.

Promote relaxation and reduces stress-related digestive issues

While BLD is firm and dynamic, many clients report a deep sense of relief and relaxation during and after treatment. Stress can exacerbate bloating and digestive discomfort, so supporting the parasympathetic nervous system can indirectly improve digestive function and fluid balance.

Provide contouring and abdominal toning benefits

A unique aspect of BLD is its sculpting effect. Firm, flowing abdominal and pelvic movements not only reduce fluid and bloating but also support a toned, lighter feeling in the torso. Clients often notice an immediate difference in abdominal softness and comfort.

What to expect during a BLD session for bloating

A typical session lasts 45–60 minutes and focuses on the abdomen, pelvis, and surrounding tissues:
Firm, continuous, wave-like strokes mobilise fluid and support lymphatic drainage
Movements target the abdominal organs and surrounding tissues to improve circulation and digestive comfort
Fluid is directed toward key lymph nodes, including the inguinal and cervical nodes
Sessions may also include the glutes and lower limbs if fluid retention extends beyond the abdomen

After a session, clients often notice:

Immediate relief from abdominal bloating
A lighter, more comfortable feeling in the torso
Increased urination as excess fluid is cleared
Improved energy and digestive comfort

Frequency and consistency

For occasional bloating, a single session can provide noticeable relief. For chronic bloating related to food intolerances, regular sessions are recommended:

Weekly or biweekly sessions help maintain abdominal drainage and digestive comfort
Consistency supports fluid balance, tissue health, and organ function
Over time, regular BLD can reduce the frequency and severity of bloating and improve overall abdominal comfort

Complementary strategies

Brazilian Lymphatic Drainage works best alongside supportive lifestyle and dietary strategies:

Hydration: Adequate water intake supports lymphatic and digestive flow
Dietary management: Identifying and reducing trigger foods can reduce inflammation and bloating
Gentle movement: Walking, yoga, or stretching improves circulation and digestive motility
Stress management: Relaxation techniques complement BLD by reducing stress-related digestive tension
Gut-supporting nutrition: Prebiotics, probiotics, and nutrient-dense foods help optimise digestive health

Who may benefit :

People experiencing chronic or occasional abdominal bloating
People with food intolerances or sensitivities causing fluid retention and digestive discomfort
Anyone seeking a dynamic, effective therapy to support lymphatic and digestive function
Those looking for abdominal comfort, reduced pressure, and a sculpted feeling

It is important to note that BLD is a complementary therapy. Persistent digestive issues should always be discussed with a healthcare provider to identify and manage underlying causes.

Final thoughts...

Bloating and discomfort from food intolerances can impact daily life and overall wellbeing. Brazilian Lymphatic Drainage offers a firm, dynamic, and effective approach to supporting fluid movement, reducing abdominal pressure, and improving digestive comfort.

When combined with hydration, dietary management, gentle movement, and stress reduction, BLD can provide a holistic strategy for managing bloating and supporting digestive health. By targeting the abdomen, pelvis, and surrounding tissues, Brazilian Lymphatic Drainage not only helps alleviate bloating but also promotes a lighter, more comfortable, and energised feeling throughout the body.

Shoulder Impingement — Is the Diagnosis Actually Correct?

Sat, 27 Sep 2025 01:55:05 GMT

Shoulder Impingement — Is the Diagnosis Actually Correct?

The Traditional Impingement Model

The classic shoulder impingement theory — introduced by orthopaedic surgeon Charles Neer in the 1970s — described a mechanical process where the rotator cuff tendons and subacromial bursa become physically compressed, or "pinched," in the space between the humeral head and the acromion (the bony roof of the shoulder) during arm elevation.

This model drove decades of treatment focused on creating more space in the subacromial region — through corticosteroid injections, postural correction to "open up" the shoulder, and ultimately subacromial decompression surgery, which involved shaving away bone to physically enlarge the space.

It seemed logical. And for a long time it was largely accepted without serious challenge.

Why the Model Has Been Questioned

Several lines of evidence have significantly undermined the traditional impingement model:

The surgery evidence

A landmark randomised controlled trial published in the British Medical Journal in 2018 — the CSAW trial — compared three groups: subacromial decompression surgery, diagnostic arthroscopy only (going in but doing nothing), and physiotherapy alone. The surgical groups showed no better outcomes than the sham surgery group, and neither surgical group showed meaningfully better outcomes than physiotherapy.

If physically removing the impingement through surgery produces the same result as not removing it, the mechanical impingement model doesn't hold up.

Imaging doesn't predict symptoms

Rotator cuff changes, bursal thickening and reduced subacromial space are found on imaging in large proportions of asymptomatic people — people with no shoulder pain whatsoever. If impingement were a purely mechanical phenomenon driven by structural narrowing, people with these findings should reliably have pain. They often don't.

Movement patterns, not anatomy, drive symptoms

Research consistently shows that the way the shoulder moves — scapular kinematics, rotator cuff activation patterns, movement timing — is more strongly associated with symptoms than the structural dimensions of the subacromial space.

What Is Actually Happening?

The term now preferred by many researchers and clinicians is rotator cuff related shoulder pain — a broader, more accurate description that acknowledges the rotator cuff tendons and bursa are involved without committing to a specific mechanical mechanism that the evidence doesn't fully support.

What does appear to be happening in most presentations:

Rotator cuff tendon overload or tendinopathy — the tendons become irritated and reactive when loaded beyond their current capacity. This is fundamentally a load management and tendon health issue rather than a structural compression problem.
Subacromial bursitis — the bursa becomes inflamed in response to irritation, contributing to pain and restricting movement. This is often secondary to rotator cuff dysfunction rather than primary.
Altered movement patterns — changes in how the scapula moves, how the rotator cuff activates and how forces are distributed through the shoulder joint create loading patterns that stress the tendon and bursa. These altered patterns are often driven by muscle weakness and imbalance rather than structural anatomy.
Nervous system sensitisation — in persistent cases, the nervous system becomes sensitised and amplifies pain signals beyond what the tissue state alone would explain. This is why shoulder pain can persist long after the initial irritation has settled.

This reframing matters because it directs treatment toward load management, rotator cuff strengthening and movement retraining — the interventions with the best evidence — rather than trying to create more physical space in the shoulder.

What Actually Works — The Evidence

Progressive rotator cuff and scapular strengthening
This is the cornerstone of treatment and the intervention with the strongest evidence base. The rotator cuff muscles — supraspinatus, infraspinatus, teres minor and subscapularis — work together to dynamically centre the humeral head in the socket during movement. When they are weak or poorly coordinated, the humeral head migrates upward during arm elevation, compressing the subacromial contents.
Strengthening these muscles restores the dynamic centering mechanism, reduces compressive forces during movement and addresses the fundamental driver of symptoms for most people.
The scapular stabilisers — serratus anterior, lower and middle trapezius — are equally important. The scapula is the platform from which the rotator cuff operates, and poor scapular control during arm elevation is consistently associated with shoulder pain. Addressing scapular weakness and movement patterns is a non-negotiable part of rehabilitation.
Manual therapy
Hands-on treatment — joint mobilisation of the glenohumeral and acromioclavicular joints, soft tissue therapy for the rotator cuff, posterior capsule and periscapular muscles, and dry needling for trigger points — reduces pain and improves movement quality in the short term. This creates the window needed to engage effectively with strengthening and movement retraining.
Joint mobilisation of the cervical and thoracic spine is also valuable — the shoulder does not work in isolation from the neck and upper back, and restrictions in these regions directly affect shoulder movement patterns and symptom levels.
Movement retraining and posture
Rounded shoulders and forward head posture alter scapular position and rotator cuff length-tension relationships, contributing to the altered movement patterns that drive shoulder pain. Addressing habitual posture — at the desk, during sport, during sleep — is part of the treatment picture. Small changes in how you position your shoulder during daily activities can make a significant difference to symptom levels while rehabilitation progresses.
Load management
Understanding which activities are loading the shoulder beyond its current capacity and modifying them intelligently — reducing overhead volume temporarily, adjusting training, modifying workplace tasks — allows symptoms to settle while strength is being rebuilt. The goal is never to stop all activity, but to find a level that the shoulder can tolerate while rehabilitation progresses.
Corticosteroid injection
For presentations where pain is severe enough to prevent meaningful rehabilitation, a corticosteroid injection can provide short-term relief that creates the window for exercise to be effective. The evidence supports injection as an adjunct to physiotherapy rather than a standalone treatment — without the rehabilitation component, pain typically returns within months.
Surgery
Based on the current evidence, subacromial decompression surgery should not be a first-line treatment for rotator cuff related shoulder pain. A genuine trial of structured physiotherapy — not just a few generic exercises — is the appropriate first step for most presentations. Surgery may have a role in specific situations where conservative management has genuinely failed, but it is far less routinely indicated than it was a decade ago.

What to Expect at Active Balance

Our approach to shoulder pain starts with a thorough assessment of the entire shoulder complex — rotator cuff strength, scapular control, glenohumeral mobility, cervical and thoracic contribution, and the specific loading pattern driving your symptoms. This assessment drives a specific treatment plan rather than a generic shoulder program.

Treatment typically combines hands-on work to settle symptoms and restore movement with a progressive strengthening program built around your specific weakness pattern. The program is progressed systematically over weeks and months — meaningful rotator cuff and scapular strength improvements take time, and the most common reason shoulder pain recurs is stopping rehabilitation before adequate strength has been developed.

For people with shoulder pain related to sport — throwing, swimming, overhead lifting, racket sports — rehabilitation includes sport-specific loading and movement retraining to ensure the shoulder is genuinely ready for the demands being placed on it.

If shoulder pain is limiting your daily life or sport, book online or call us on (08) 7123 4148. We would love to help you understand what's actually driving your symptoms and get your shoulder moving comfortably again.

Written by E mily Clements , Senior Physiotherapist at Active Balance Physio & Wellness, St Marys Adelaide. Emily holds a Bachelor of Physiotherapy and a Bachelor of Psychology (Honours) and has a special interest in shoulder rehabilitation, strength and conditioning, and helping active people manage and overcome injury.

Physiotherapy Techniques for Neck Pain — What Actually Works

Sat, 27 Sep 2025 01:35:40 GMT

The Physiotherapy Techniques We Use for Neck Pain

First — Why Neck Pain Is Rarely Simple

Before getting into techniques , it's worth understanding why neck pain can be so persistent. The cervical spine is an extraordinarily complex structure — seven vertebrae, multiple joints at each level, a dense network of muscles, the spinal cord and nerve roots, and blood vessels supplying the brain all occupying a relatively small space.

Pain can originate from any of these structures — joints, discs, muscles, nerves — and the pattern of symptoms varies significantly depending on the source. What feels like "just a stiff neck" might involve joint restriction, muscle guarding, disc irritation, nerve sensitisation or a combination of all of these. This is why a thorough assessment before treatment is essential rather than applying the same approach to everyone.

Joint Mobilisation — Restoring Movement at the Source

Joint mobilisation involves applying controlled, graded movement to specific cervical joints to restore normal range of motion, reduce stiffness and modulate pain.

The facet joints of the cervical spine are a primary source of neck pain and stiffness — particularly the upper cervical joints at C1 and C2 which are involved in rotation, and the mid-cervical joints which are commonly restricted in people with desk-related neck pain. When these joints become stiff or irritated, the surrounding muscles guard and tighten in response, creating a cycle of restricted movement and pain that can be difficult to break with exercise alone.

Mobilisation directly addresses the joint restriction driving this cycle. Research consistently supports cervical joint mobilisation for reducing pain and improving range of motion in both acute and chronic neck pain — and it produces faster improvement in range of motion than exercise alone in the early stages of treatment.

At Active Balance we use graded mobilisation techniques — starting gently and progressing based on your response — to restore movement without aggravating symptoms.

Soft Tissue Therapy and Trigger Point Release

The muscles of the neck and upper back — the upper trapezius, levator scapulae, suboccipitals, scalenes and sternocleidomastoid — are almost universally involved in neck pain presentations regardless of the primary source. They tighten in response to pain, sustained postures and stress, and they develop trigger points that refer pain to the head, shoulder and arm.

Hands-on soft tissue work targeting these muscles reduces the muscular component of pain and stiffness, improves blood flow to the area and directly addresses the trigger points that contribute to headaches and referred symptoms.

This is particularly valuable for people whose neck pain is significantly driven by stress and sustained postures — the muscles are responding to inputs from the nervous system as much as to any structural problem, and direct manual work is one of the most effective ways to interrupt that pattern.

Dry Needling

Dry needling uses fine acupuncture needles inserted into trigger points within the neck and upper back muscles to release muscle tension, reduce pain and improve movement.

For persistent or deep trigger points that are difficult to reach effectively with surface massage — particularly the suboccipital muscles at the base of the skull, the deep cervical muscles and the trigger points that refer into the shoulder and arm — dry needling can produce results that hands-on soft tissue work alone cannot easily achieve.

The mechanism involves both a local response in the trigger point itself and a broader effect on the nervous system's processing of pain signals. Research supports dry needling as an effective adjunct for cervicogenic headache and chronic neck pain when combined with exercise and mobilisation.

Electro Dry Needling

Electro dry needling combines standard dry needling with low-level electrical stimulation through the needles. The electrical current enhances the response of the nervous system, promotes blood flow and can reduce pain sensitivity more effectively than dry needling alone for some presentations.

It is particularly useful for people with significant nervous system sensitisation — where the pain response has become amplified beyond what the tissue damage or restriction alone would explain — and for chronic presentations where the pain pattern has become well established and difficult to shift with manual therapy alone.

Myofascial Cupping

Myofascial cupping uses suction cups applied to the skin to lift and separate layers of fascia and muscle, improving circulation and reducing tension through the upper back, shoulders and neck. It is particularly effective for the dense, layered muscle tension that accumulates in the upper trapezius and periscapular muscles with prolonged desk work or repetitive upper limb activity.

Many people find cupping provides a distinctive type of relief that feels different to massage — a sense of decompression and space in the tissues rather than pressure being applied. The temporary skin marking that can follow cupping is normal and fades within a few days.

Cervical Proprioception Training

This is one of the more specialised techniques used for neck pain and one that is often overlooked in general practice. The cervical spine has an exceptionally high density of proprioceptive receptors — sensory organs that tell the brain where the head and neck are in space. Chronic neck pain, whiplash and prolonged postural stress all disrupt the accuracy of these receptors, contributing to symptoms like dizziness, unsteadiness, difficulty concentrating and a vague sense that the neck doesn't feel right even when pain levels are low.

Cervical proprioception training uses specific head and eye movement exercises — including laser pointer targeting, gaze stabilisation and head repositioning tasks — to retrain the cervical proprioceptive system. At Active Balance we have dedicated cervical proprioception training available, which is particularly valuable for people with whiplash-associated disorders, chronic neck pain with dizziness, or persistent symptoms that haven't fully resolved with manual therapy and exercise alone.

Targeted Strengthening — The Long-Term Solution

Hands-on techniques settle symptoms and restore movement — but the evidence is clear that the best long-term outcomes come from combining manual therapy with targeted exercise. Strengthening the deep neck flexors, the deep cervical stabilisers and the scapular stabilisers addresses the muscular weakness and postural dysfunction that drives most persistent neck pain.

Deep neck flexor strengthening in particular — targeting the longus colli and longus capitis muscles that provide stability to the cervical spine — is one of the most evidence-supported interventions for chronic neck pain and cervicogenic headache. These muscles are almost universally inhibited in people with neck pain and their weakness places greater demand on the superficial muscles that then become overloaded and painful.

Your exercise program is progressed from gentle activation work to more challenging strengthening as your symptoms allow — and is always designed around your specific weakness pattern rather than a generic neck exercise routine.

Putting It Together

The most effective approach to neck pain combines several of these techniques in a sequence that makes sense for your specific presentation:

For most people the sequence looks something like this — manual therapy and dry needling to settle symptoms and restore movement, soft tissue work to address muscle tension and trigger points, then progressive strengthening to build the capacity that prevents symptoms from returning.

For people with more complex presentations — chronic pain, significant nervous system sensitisation, whiplash-associated disorders — the approach is more nuanced and may incorporate electro dry needling, cervical proprioception training and a more gradual progression.

The common thread is that treatment is built around your assessment findings — not a standard protocol applied to everyone with neck pain.

If you're dealing with neck pain that isn't responding to basic management, book online or call us on (08) 7123 4148. We'll assess what's actually driving your symptoms and put together a treatment plan that addresses the cause rather than just managing the symptoms.

Anterior Hip Pain in Runners — Is It Really Your Hip Flexor?

Wed, 03 Sep 2025 04:59:42 GMT

Is Your Hip Flexor Really the Problem? A Closer Look at Anterior Hip Pain in Runners

Why the Hip Flexor Gets Blamed

The logic seems straightforward — you have pain at the front of the hip, the hip flexors live at the front of the hip, therefore the hip flexors are the problem. But this reasoning ignores a fundamental aspect of running biomechanics.

During the stance phase of running — when your foot is in contact with the ground and you're loading through the leg — the hip flexors are not the primary active muscles. They are most active during the early swing phase, when the leg is moving forward and off the ground.

This means that if your anterior hip pain is triggered during foot strike, during the loading phase, or during activities that compress or load the hip joint — rather than during the swing phase of running — the hip flexors are unlikely to be the primary driver.

For sprinters, the picture is different. The hip flexors work at much higher intensity and velocity during sprinting, and hip flexor strain is a genuine and common presentation in that population. But for the recreational 5km runner, the half-marathoner or the Hyrox athlete — who makes up the vast majority of the runners we see — the hip flexor explanation often doesn't fit the clinical picture.

What Else Could Be Causing It?

When a runner presents with anterior hip pain and the story doesn't fit a hip flexor strain, several other diagnoses need to be considered carefully.

Femoral neck stress reaction or stress fracture

This is the one that matters most to get right — and the one most likely to be missed if the assessment stops at "hip flexor strain."

The femoral neck is one of the most common sites for bone stress injury in endurance runners. A stress reaction or stress fracture in this area can irritate the surrounding soft tissues — including the hip flexor tendon — producing anterior hip pain that feels exactly like a muscle or tendon problem. The key distinction is that the pain is bone-related, not muscle-related.

This matters enormously for management. A hip flexor strain can continue to be loaded with appropriate modification. A femoral neck stress fracture requires a very different — and much more conservative — approach. Missing this diagnosis and continuing to run on a femoral neck stress fracture can result in complete fracture, which is a serious injury requiring surgery.

Red flags that increase suspicion for bone stress injury include:

Pain that worsens progressively with running rather than warming up and settling
Pain that persists at rest or disturbs sleep
A recent significant increase in training volume or intensity
Young female athletes — the female athlete triad increases stress fracture risk significantly
Pain on single leg hop testing

If any of these features are present, imaging is warranted before a return to running is advised.

Femoroacetabular Impingement (FAI)

FAI occurs when the ball and socket of the hip joint make abnormal contact due to bony morphology — either extra bone on the femoral head (cam impingement), the acetabulum (pincer impingement) or both. This impingement can cause anterior hip or groin pain, particularly with hip flexion activities, and is often aggravated by the repeated hip flexion of running.

FAI is increasingly recognised as a contributor to anterior hip pain in active people and is worth considering when pain is deep, difficult to localise and associated with hip flexion loading.

Labral pathology

The acetabular labrum — the cartilage ring that deepens the hip socket — can be torn or degenerated, often in association with FAI. Labral tears can produce anterior hip pain, clicking or a catching sensation, and groin pain that is difficult to pinpoint. They are often found in runners and athletes doing high volumes of hip flexion activity.

Iliopsoas bursitis

The iliopsoas bursa sits between the hip flexor tendon and the hip joint. Inflammation of this bursa can produce anterior hip pain that mimics hip flexor tendinopathy but has a different treatment approach. It is often associated with repetitive hip flexion loading and can occur alongside FAI or labral pathology.

Referred pain from the lumbar spine or pelvis

The hip flexors and anterior hip receive nerve supply from the lumbar plexus — nerve roots that originate in the lower back. Disc pathology, nerve root irritation or sacroiliac joint dysfunction can all refer pain into the anterior hip and groin in patterns that closely mimic local hip pathology. A runner who has anterior hip pain but also has lower back stiffness or tightness worth assessing for a lumbar contribution.

Why This Matters for Treatment

The reason getting the diagnosis right matters so much is that these conditions have very different management pathways.

Hip flexor strain — relative rest, progressive loading, return to running.
Femoral neck stress fracture — immediate cessation of running, possible non-weight bearing, lengthy rehabilitation before return to impact.
FAI — movement modification, hip strengthening, possible surgical referral for significant impingement.
Labral tear — rehabilitation focused on hip stability and joint centration, possible surgical referral for significant tears.
Lumbar referred pain — treatment directed at the lumbar spine rather than the hip.

Treating a femoral neck stress fracture as a hip flexor strain — which unfortunately does happen — can have serious consequences. Getting a proper assessment before committing to a treatment approach is not overcautious. It's essential.

What Assessment Should Include

A thorough assessment of anterior hip pain in a runner should include:

A detailed history — when did it start, what makes it worse, how does it respond to running, has training load changed recently, any history of previous stress injuries.
Provocation testing — specific clinical tests to reproduce the pain and identify the likely structure involved. The FADIR test for FAI and labral pathology, the hop test for bone stress injury, resisted hip flexion testing for the hip flexors and psoas.
Strength assessment — hip flexor, abductor, external rotator and posterior chain strength. Weakness patterns can point toward the underlying diagnosis and are essential for rehabilitation planning.
Movement assessment — how the hip moves during squatting, single leg stance and running-specific tasks.
Imaging consideration — where bone stress injury is suspected, MRI is the most sensitive imaging modality and should be pursued promptly. X-ray misses early stress reactions. For FAI and labral pathology, X-ray and MRI are both relevant.

The Takeaway

Anterior hip pain in runners is not always — or even usually — a hip flexor problem. The differential diagnosis is broad, includes some conditions that require urgent management, and benefits enormously from a careful clinical assessment rather than a default explanation.

If you're a runner with persistent anterior hip pain that isn't responding to rest and basic management, don't keep assuming it's your hip flexor. Get it properly assessed.

Book online or call us on (08) 7123 4148 to get a thorough assessment and a clear diagnosis — not just a label that fits the location of your pain.

Written by Alexander Muscat, Physiotherapist at Active Balance Physio & Wellness, St Marys Adelaide. Alex holds a Bachelor of Physiotherapy (Honours) and has experience treating sports injuries, complex pain management, rehabilitation and joint conditions. He brings an extensive athletic background to his practice including competitive soccer and futsal.

Runner's Knee — Why Your Kneecap Pain Isn't Just a Knee Problem

Wed, 11 Jun 2025 09:26:13 GMT

Runner's Knee — Why Your Kneecap Pain Isn't Just a Knee Problem

What Is Patellofemoral Pain Syndrome?

Patellofemoral pain syndrome describes pain at the front of the knee — typically felt under or around the kneecap (patella) — that develops as a result of altered loading of the patellofemoral joint. This is the joint between the kneecap and the femur (thigh bone) through which the kneecap glides during knee flexion and extension.

PFPS is extremely common in active people — particularly runners, cyclists, and anyone who squats, jumps or climbs stairs regularly. It's called runner's knee because of its prevalence in the running population, but it affects gym goers, team sport athletes and people whose jobs involve prolonged kneeling or stair climbing equally.

Common symptoms include:

Pain under or around the kneecap, particularly with running, squatting, going downstairs or sitting for prolonged periods
A dull ache that builds during activity and lingers afterwards
Occasional clicking, grinding or a grating sensation around the kneecap
Pain that is aggravated by pressing directly on the kneecap
Stiffness after prolonged sitting — the "theatre sign" where symptoms are worst after sitting still for a period and ease with initial movement

Why PFPS Is Rarely Just a Knee Problem

This is the most important thing to understand about patellofemoral pain — and the reason many people spend months managing symptoms without actually getting better.

The patellofemoral joint is a passive structure. The kneecap itself has no muscle attachments that directly control how it tracks through the femoral groove. Its position and movement are determined entirely by the forces acting on it from the surrounding muscles — and those muscles extend well above and below the knee.

The hip connection

Hip abductor and external rotator weakness — particularly gluteus medius — allows the femur to internally rotate and adduct during weight bearing activities. This changes the angle between the quadriceps and the patellar tendon, altering how the kneecap tracks through the groove and increasing compressive and shear forces on the patellofemoral joint.

In practical terms: when your glutes are weak, your knee collapses inward when you run, squat or land from a jump. This is one of the most consistent findings in people with PFPS and one of the most important things to address in rehabilitation.

The ankle connection

Reduced ankle dorsiflexion — the ability to bring the shin forward over the foot — forces compensatory movement patterns up the chain. When the ankle can't move adequately, the knee takes on additional load and often moves into positions that increase patellofemoral stress.

This is why someone can have front knee pain driven primarily by ankle stiffness, with the knee itself being the symptom rather than the source. Treating the knee alone in this situation produces limited results.

The quadriceps connection

Quadriceps weakness and imbalance — particularly weakness of the VMO (vastus medialis oblique, the teardrop muscle on the inner side of the knee) relative to the lateral quad — alters patellar tracking. The kneecap gets pulled laterally rather than tracking centrally through the groove.

Tightness in the lateral structures — the ITB, lateral retinaculum and TFL — compounds this by physically pulling the kneecap outward.

How We Assess PFPS at Active Balance

Because PFPS is driven by factors at multiple levels of the lower limb, assessment needs to look at the whole picture rather than just the knee.

At Active Balance, our assessment for PFPS includes:

Lower limb strength testing — we use VALD ForceDecks and handheld dynamometry to objectively measure quadriceps, hamstring and hip strength, identify side-to-side asymmetries and compare against normative data. This removes the subjectivity from strength assessment and gives us real data to drive rehabilitation targets.
Movement assessment — watching how you squat, lunge, step down and run provides direct insight into the movement patterns driving your symptoms. Hip drop, knee cave, foot pronation and trunk deviation are all assessed and quantified where possible.
Ankle mobility — restricted dorsiflexion is assessed and addressed if it's contributing to the loading pattern.
Patellar tracking and mobility — assessing how the kneecap moves and whether tightness in the lateral structures is contributing to altered tracking.
Training load review — understanding what changed in your training before symptoms appeared is essential for identifying the load management component.

This comprehensive picture is what allows us to target rehabilitation at what's actually driving your pain rather than applying a generic knee program.

What Treatment Looks Like

Treatment for PFPS is highly individual because the drivers vary significantly between people. The general components include:

Load management Temporarily modifying the activities that most aggravate the patellofemoral joint while rehabilitation begins. This rarely means stopping all activity — it means making intelligent adjustments. Running volume may be reduced, hills avoided, squatting depth modified. The goal is to find a level of activity that allows symptoms to settle while strength work progresses.
McConnell taping Taping the kneecap to improve its tracking during activities can provide immediate symptom relief and allow rehabilitation exercises to be performed with less pain. It's a useful short-term tool while strength and movement patterns are being corrected.
Hip strengthening Progressive strengthening of the hip abductors and external rotators — targeting the gluteus medius specifically — is the most important and most evidence-supported intervention for PFPS. This takes time to produce meaningful strength changes but consistently produces lasting improvement.
Quadriceps rehabilitation Targeted strengthening of the quadriceps through a range that is comfortable — starting with isometric work and progressing to closed chain exercises like leg press, step-ups and eventually squats — rebuilds the capacity of the patellofemoral joint to handle load.
Ankle mobility work Where restricted dorsiflexion is contributing, targeted ankle mobility exercises and joint mobilisation address this component of the problem.
Manual therapy Soft tissue release of the lateral quad, ITB and TFL, combined with patellar mobilisation, reduces the lateral pull on the kneecap and provides symptom relief that makes rehabilitation exercises more comfortable and effective.
Gait retraining For runners with clear gait contributors — significant hip drop, crossover stride, excessive foot pronation — specific gait cues can meaningfully reduce patellofemoral loading during running. This is most effective when combined with the strength work rather than used in isolation.

How Long Does It Take to Resolve?

PFPS that is caught early and managed properly typically shows meaningful improvement within four to six weeks, with full resolution in eight to twelve weeks. Cases that have been present longer, or where rehabilitation has focused only on the knee without addressing hip and ankle contributors, take longer.

The most common reason PFPS becomes chronic is inadequate hip strengthening — symptoms settle, activity resumes at full load before the hip is strong enough to protect the knee, and the cycle restarts.

If front knee pain is affecting your training or daily life, book online or call us on (08) 7123 4148. We'll assess the full picture — not just your knee — and give you a clear plan to address what's actually driving your pain.

Written by Alexander Muscat, Physiotherapist at Active Balance Physio & Wellness, St Marys Adelaide. Alex holds a Bachelor of Physiotherapy and has experience treating sports injuries, complex pain management, rehabilitation and joint conditions. He brings an extensive athletic background to his practice including competitive soccer and futsal.

Why You Feel Worse After Myotherapy Before You Feel Better

Wed, 26 Mar 2025 07:41:56 GMT

Why You Might Feel Worse Before You Feel Better After Myotherapy

What Happens During Treatment

During a myotherapy session, several things are happening simultaneously in the tissues being treated.

In the early part of a session, hands-on work produces pain inhibition and improved movement — the nervous system responds to the sensory input of treatment by reducing its protective guarding response. This is why many people experience an immediate improvement in range of motion and a reduction in pain during or immediately after treatment. It feels good, movement feels freer and the area feels less tense.

As treatment continues, deeper physiological responses occur. The autonomic nervous system shifts toward a parasympathetic state — the rest and recovery mode. Muscle tension reduces, blood flow to the treated tissues increases through vasodilation and the body enters a state of genuine relaxation. This is why many people feel drowsy, heavy or deeply relaxed after treatment — and why some describe it as feeling "floaty" or unusually calm.

The skin may redden in treated areas and some people notice increased perspiration during or after treatment. These are normal signs of increased circulation and autonomic nervous system response — not cause for concern.

The 12 to 72 Hour Response

Here's where it gets interesting — and where most people's questions arise.

In the 12 to 72 hours following myotherapy treatment, it's common to experience muscular aching that feels similar to delayed onset muscle soreness — the kind of soreness you feel a day or two after a hard gym session. This can range from mild tenderness to more significant aching depending on several factors.

Why does this happen?

When myotherapy works into chronically tight or dysfunctional muscle tissue — particularly trigger points and areas of deep muscle hardening — it creates a localised inflammatory response as part of the healing process. The body is essentially treating the area as if it has experienced a new, controlled stimulus for repair. The soreness you feel is the tissue responding to this stimulus, not evidence of damage.

Think of it as the treatment starting a conversation with tissues that have been stuck in a dysfunctional pattern for a long time. That conversation isn't always comfortable initially.

The more chronic the condition, the more pronounced the response

This is an important pattern to understand. If you have had muscle tension, pain or dysfunction for weeks, months or years, the tissue response to treatment tends to be more intense and longer lasting than for someone with a recent, acute issue. Chronically tight and fibrotic muscle tissue has a bigger response to being worked through than recently overloaded but otherwise healthy tissue.

This means that if you've been dealing with something long-standing and your post-treatment soreness is significant, it's actually reflecting the chronicity of the problem — not that anything went wrong.

Symptoms may temporarily return or intensify

One of the more disconcerting post-treatment experiences is when symptoms that had been absent — referred pain, tingling, numbness or aching in other areas — return briefly after treatment. This happens when trigger points that have been contributing to referred symptoms are directly treated. Reproducing and then releasing a trigger point can temporarily activate its referral pattern before it settles.

This is actually a positive sign — it confirms the trigger point was contributing to your symptoms and that it has been directly addressed. It typically settles within 24 to 48 hours.

What to Do in the Days After Treatment

Hydrate well — increased circulation and the physiological response to treatment means your body benefits from good hydration in the days following a session. Drink water consistently rather than waiting until you're thirsty.
Move gently — light movement and gentle stretching in the days after treatment supports the healing response and prevents the treated areas from stiffening back up. Avoid intense training for 24 to 48 hours after a significant treatment session.
Stretch through the chain, not just the sore muscle — if you're doing stretching after myotherapy, focus on movements that take the whole muscular chain through range rather than isolated muscle stretches. Stretching the entire posterior chain — rather than just the hamstring or just the calf — is more effective because muscle groups work together and restricting one part of the chain limits the others.
Apply heat if needed — gentle heat to sore areas can help with the post-treatment aching. Avoid ice unless there is significant swelling from an acute injury.
Don't judge the treatment by how you feel the next day — the 24 to 48 hour window is not a good measure of whether the treatment worked. How you feel after the soreness resolves — typically three to five days post-treatment — is the more meaningful indicator.

Why Treatment Spacing Matters

A common question is how frequently to come in for myotherapy — and the post-treatment response is part of why the answer matters.

Treatment every 10 to 14 days allows the body to complete the acute healing processes initiated by each session before the next one begins. Treating too frequently before the tissue has had time to respond and recover can mean the body never fully processes the changes from each session.

As treatment progresses and the post-treatment soreness decreases, it's a sign that the superficial layers of muscle tension are resolving and treatment is reaching the deeper layers of dysfunction. This is the process working as intended.

Over successive treatments, the interval between sessions typically increases — from weekly or fortnightly to monthly and eventually to maintenance sessions as needed. The goal is always progressive improvement toward independence, not ongoing dependency on treatment.

When to Be Concerned

Post-treatment soreness that follows the pattern described above — appearing 12 to 48 hours after treatment, feeling like muscle soreness, and resolving within two to three days — is normal and expected.

You should contact your therapist if:

Pain is severe or significantly worsening beyond 48 hours
You notice unusual swelling, bruising or skin changes that weren't there before
You experience chest pain, difficulty breathing or other systemic symptoms
Post-treatment soreness is not improving with subsequent treatments over time

If you have questions about what to expect from your myotherapy treatment or want to discuss whether your post-treatment response is normal, call us on (08) 7123 4148 or raise it at your next appointment. We're always happy to talk through what's happening in your body.

Written by Thomas McCarthy, Myotherapist and Athletic Rehabilitation Therapist at Active Balance Physio & Wellness, St Marys Adelaide. Tom holds a Bachelor of Science in Sport Rehabilitation and Athletic Therapy and has a special interest in lower back pain and manual therapy.

Is High Intensity Exercise Safe for Osteoporosis?

Wed, 26 Mar 2025 07:39:42 GMT

Is High Intensity Exercise Safe for Osteoporosis? The Evidence Might Surprise You

Why the "Gentle Exercise Only" Advice Falls Short

The logic behind recommending only low impact, gentle exercise for osteoporosis is understandable: bones are fragile, fracture risk is elevated, therefore avoid anything that might stress the skeleton.

The problem is that this approach fundamentally misunderstands how bone responds to loading.

Bone is not static tissue. It is constantly remodelling — being broken down by osteoclasts and rebuilt by osteoblasts in a continuous cycle. The stimulus for bone formation is mechanical stress. When bone is loaded — through impact, resistance training, or the pull of muscles on their bony attachments — it responds by laying down new bone tissue, increasing density and structural strength.

When bone is not loaded — when activity is reduced to gentle walking and chair-based exercises — the remodelling stimulus is insufficient to counter the bone loss driven by declining oestrogen. The result is continued bone density decline and no meaningful improvement in the bone's ability to withstand the forces it will encounter in real life.

Walking is beneficial for general health. It is not sufficient to meaningfully improve bone density in people with osteoporosis.

The LIFTMOR Trial — What It Found

The LIFTMOR trial — Lifting Intervention For Training Muscle and Osteoporosis Rehabilitation — was conducted at Griffith University and published in the Journal of Bone and Mineral Research in 2017. It is one of the most significant studies in the field of bone health and exercise.

The study specifically recruited postmenopausal women with low bone mass — the population typically told to avoid high intensity exercise. Participants were randomised to either a high intensity progressive resistance and impact training program (HiPRT) or a low intensity home exercise program.

The HiPRT program was genuinely high intensity. It included:

Deadlifts
Overhead press
Squats
Drop landings — jumping off a box and landing with high impact force

These are exercises that most practitioners would have been cautious about prescribing in this population. Yet the results were striking.

The HiPRT group showed significant improvements in:

Lumbar spine bone density
Femoral neck bone density — the hip, one of the most fracture-vulnerable sites in osteoporosis
Functional performance including balance and muscle strength

The low intensity group showed no significant improvement in bone density.

Critically — and this is the finding that changed the conversation — there were no fractures, no serious adverse events and no significant injuries in the high intensity group across the entire trial period. The intervention was not just effective. It was safe.

Why High Intensity Works and Low Intensity Doesn't

The bone-loading stimulus from exercise needs to exceed a certain threshold to trigger meaningful bone formation. This threshold is substantially higher than what gentle walking or low resistance exercise provides.

Impact loading — landing from jumps, stepping down stairs, activities that create significant ground reaction forces — provides the kind of brief, high magnitude mechanical stimulus that most effectively drives bone remodelling. This is why impact sports like running and basketball are associated with better bone density than swimming or cycling.

Progressive resistance training creates mechanical stress on bone through the direct compressive forces of loaded exercises and the pull of muscles on their bony attachments during contraction. Deadlifts, squats and overhead press all load the spine and hip — the two sites most clinically important in osteoporosis — under significant force.

The key variables are magnitude and progression. Light loads produce light stimulus. Heavy, progressive loads produce the stimulus needed for bone adaptation.

The Role of Supervision

The LIFTMOR trial did not simply hand participants a program and send them to the gym. All sessions were supervised by exercise professionals who could ensure correct technique, appropriate load progression and safety monitoring.

This is an important caveat. High intensity training for osteoporosis is not something to start independently based on a blog post. The risks are real if technique is poor, loads are progressed too quickly or underlying conditions are not accounted for.

What supervised exercise provides:

Thorough initial assessment — understanding your bone density levels, fracture history, other health conditions, current fitness and movement capacity before designing a program.
Individualised programming — the appropriate starting loads, exercise selection and progression rate vary significantly between individuals. A 65-year-old with T-score of -2.0 and good baseline fitness needs a different starting point than a 75-year-old with T-score of -3.0 and limited movement experience.
Technique coaching — correct form on deadlifts, squats and overhead press is essential both for safety and effectiveness. Poor technique under load creates injury risk regardless of bone density status.
Progressive overload — systematically increasing loads over time as strength and capacity improve. This is what drives ongoing bone adaptation rather than a plateau.
Regular review — monitoring response to training and adjusting the program as fitness, strength and bone density change over time.

Who This Is For

High intensity resistance and impact training for bone health is appropriate for most people with osteoporosis or osteopenia — but should be introduced thoughtfully and with professional guidance.

It is particularly valuable for:

Postmenopausal women with low bone density who want to take proactive steps beyond medication
People who have been told to exercise but given only generic low intensity advice
Anyone wanting to reduce long-term fracture risk through a sustainable, evidence-based approach
People who are already strength training and want to ensure their program is actually adequate for bone health

Certain presentations require additional medical input before starting — including recent fragility fractures, very low T-scores, significant cardiovascular conditions or other health factors that affect exercise tolerance. Your GP and exercise professional can guide this assessment collaboratively.

How We Can Help

At Active Balance, our physiotherapists work with people managing osteoporosis and low bone density regularly. We can conduct a thorough assessment, design an individualised high intensity program appropriate to your current capacity and health status, and supervise your training to ensure you're getting the bone stimulus you need safely.

Our supervised rehabilitation gym provides the environment and equipment for this kind of structured training, and our team has the clinical background to manage the complexity that comes with osteoporosis alongside other health conditions.

Book online or call us on (08) 7123 4148 to discuss how we can help you build stronger bones.

ITB Syndrome — Why Outer Knee Pain Keeps Coming Back

Wed, 26 Mar 2025 07:29:06 GMT

ITB Syndrome - Why Outer Knee Pain Is More Complicated Than You Think

What Is the ITB?

The iliotibial band is a thick band of connective tissue that runs along the outside of the thigh from the pelvis down to just below the knee. It's not a muscle — it has no ability to contract — but it plays an important role in lateral knee stability and is under significant tension during running and cycling.

ITB syndrome is one of the most common running injuries, accounting for around 12% of all running-related injuries. It's particularly prevalent in distance runners and cyclists, though it also appears in basketball players, skiers, hockey players and soccer players.

The Old Explanation — and Why It's Been Updated

For years ITB syndrome was explained as a friction injury — the ITB rubbing back and forth over the lateral femoral epicondyle (the bony prominence on the outside of the knee) as the knee flexes and extends during running. This became known as the "friction syndrome" model and drove treatment approaches focused on stretching the ITB, foam rolling the IT band itself and reducing friction.

More recent research has challenged this explanation. The ITB is structurally attached to the underlying tissue and doesn't actually slide back and forth the way the friction model suggested. What appears to happen instead is compression of a layer of fat and connective tissue beneath the ITB at the lateral knee — a compression rather than a friction phenomenon.

This matters for treatment because it means:

Stretching the ITB itself is unlikely to be the most useful intervention — the ITB doesn't stretch meaningfully due to its dense connective tissue structure
Aggressive foam rolling directly on the ITB may provide temporary relief but doesn't address the underlying cause
The focus should be on why the ITB is under excessive tension — which is almost always a load and strength issue

What Causes ITB Syndrome?

The ITB becomes symptomatic when it is under excessive tension during repetitive knee flexion and extension. Several factors contribute to this:

Hip abductor and glute weakness This is the most consistently identified contributor to ITB syndrome in runners. When the hip abductors — particularly gluteus medius — are weak, the pelvis drops on the swing leg side during the stance phase of running. This creates an adduction moment at the hip that increases tension through the ITB. Weak glutes are not just associated with ITB syndrome — they are arguably the primary driver in most cases.
Training load — too much too soon A sudden increase in weekly mileage, adding hill work without preparation, or returning to running after a break at previous volumes are all common triggers. ITB syndrome is fundamentally a load management problem in most presentations.
Running downhill Downhill running increases the knee flexion angle at which the ITB is most compressed and places significantly greater eccentric demand on the hip and knee stabilisers. Many runners notice their ITB symptoms are specifically triggered by downhill sections.
Foot pronation and gait factors Excessive foot pronation increases tibial internal rotation which can increase ITB tension. However this is generally a contributing factor rather than a primary cause — addressing hip weakness and load management typically produces better results than focusing primarily on foot mechanics.
Worn out footwear Running shoes that have lost their cushioning and support increase impact forces and can contribute to altered biomechanics. If your shoes have more than 600 to 800 kilometres on them, it's worth considering whether they need replacing.

Symptoms

ITB syndrome has a characteristic presentation that most runners recognise immediately once they've had it:

Sharp or burning pain on the outside of the knee
Pain that typically comes on at a predictable point in a run — often around the 10 to 15 minute mark — and worsens as running continues
Pain that settles quickly with rest but returns as soon as running resumes
A dull ache after activity that can persist for hours
Occasional clicking or snapping sensation at the outer knee
Hip pain in some presentations where the ITB is irritated at its proximal attachment

The "10 minute rule" — where symptoms appear at a consistent point in every run — is one of the most characteristic features of ITB syndrome and helps distinguish it from other causes of lateral knee pain.

What Actually Works

Load management — the foundation
Reducing running volume to a level the ITB can tolerate is the essential first step. This doesn't necessarily mean complete rest — for many people a significant reduction in mileage, avoiding hills and running on softer surfaces is sufficient to allow the irritation to settle while rehabilitation begins.
Completely stopping running for 3 to 6 weeks while doing nothing else is not the most effective approach and is rarely necessary. The goal is to find a load that is manageable while you address the underlying causes.
Hip strengthening — the most important intervention
Progressive strengthening of the hip abductors and external rotators is the cornerstone of ITB syndrome rehabilitation and the intervention with the strongest evidence base. This is not a quick fix — meaningful strength improvements take 6 to 8 weeks of consistent training — but it addresses the primary mechanical driver of the condition.
Key exercises include:
Clamshells and side-lying hip abduction — early stage, low load
Resistance band walks — lateral and forward
Single leg squats — identifying and addressing the hip drop that loads the ITB
Deadlifts and hip thrusts — building overall glute and posterior chain capacity
Step-downs — specifically loading the glutes eccentrically in the position most relevant to running
Manual therapy and soft tissue work
Hands-on treatment targeting the TFL, gluteus medius, vastus lateralis and biceps femoris can reduce pain and improve tissue quality in the acute phase — creating the window needed to engage effectively with rehabilitation. Dry needling and myofascial cupping are particularly effective for the deep hip and lateral thigh muscles that contribute to ITB tension.
Foam rolling directly on the ITB itself provides temporary relief for some people but as noted above doesn't address the compression mechanism. Foam rolling the TFL — the muscle at the top of the ITB — and the glutes is generally more productive.
Gait retraining
For runners with clear gait contributors — significant hip drop, excessive crossover stride, heavy heel striking — gait retraining can meaningfully reduce ITB load. This is best done with a physio who can assess your running pattern and give specific, evidence-based cues rather than generic advice.
Return to running
A graduated return to running program — progressively increasing volume and reintroducing hills — should be built around your strength progression rather than a fixed timeline. Returning to previous volumes before adequate hip strength has been restored is the most common reason ITB syndrome recurs.

How Long Does Recovery Take?

ITB syndrome has a reputation for being slow to resolve, and this is often because it's managed with rest alone rather than addressing the hip weakness that drives it. With a proper rehabilitation program, most people see meaningful improvement within 4 to 8 weeks and return to full running within 8 to 12 weeks.

Cases that have been present for longer, have involved repeated cycles of rest and return, or where load management has not been addressed, may take longer.

If outer knee pain is affecting your running or training, book online or call us on (08) 7123 4148. We can assess your hip strength, running mechanics and training load and put together a specific plan to get you back to running without the 10-minute countdown.

Written by Alexander Muscat, Physiotherapist at Active Balance Physio & Wellness, St Marys Adelaide. Alex holds a Bachelor of Physiotherapy (Honours) and has experience treating sports injuries, complex pain management, rehabilitation and joint conditions. He brings an extensive athletic background to his practice including competitive soccer and futsal.

Why Your Ankle Keeps Giving Way | Chronic Ankle Instability | Active Balance

Sun, 23 Feb 2025 04:13:37 GMT

Chronic Ankle Instability - Why Your Ankle Keeps Giving Way And What to Actually Do About It

What Actually Happens When You Sprain Your Ankle

An ankle sprain stretches or tears the ligaments on the outside of the ankle. The pain and swelling settle within a few weeks, and most people feel well enough to return to activity well before the underlying problems have been resolved.

Here's what most people don't realise: embedded within the ligaments of the ankle are specialised nerve receptors called mechanoreceptors. These receptors are responsible for proprioception — your ankle's ability to sense its position in space and respond quickly to perturbations. When the ligament is damaged, these receptors are damaged too.

When you walk on even ground, you probably won't notice. But put yourself on uneven terrain, ask your ankle to react quickly to an unexpected movement, or load it under sport-specific demands — and the deficit becomes apparent. The ankle doesn't react fast enough. It gives way.

Pain and swelling resolve relatively quickly. Proprioception, muscle reaction time and strength take much longer to restore — and they don't restore on their own with rest. They need to be actively rehabilitated.

How Chronic Ankle Instability Develops

Chronic ankle instability develops when the deficits from an ankle sprain — reduced proprioception, calf weakness, poor balance and altered movement patterns — are never properly addressed.

The typical pattern looks like this: ankle gets rolled, it's sore for a few weeks, pain settles, activity resumes. Feels okay until the next awkward step, landing or change of direction — at which point the ankle gives way again. Another sprain. More rest. Back to activity. Repeat.

Each subsequent sprain causes further ligament damage and further proprioceptive deficit. Over time the ankle becomes progressively less stable, and people start adapting their behaviour around it — avoiding uneven ground, relying on bracing for sport, avoiding certain activities altogether.

You may have chronic ankle instability if you:

Have a history of multiple ankle sprains on the same side
Feel like your ankle is unreliable or likely to give way
Have done little or no formal rehabilitation after your sprains
Depend on bracing or strapping to feel safe during sport
Notice stiffness or aching after loading the ankle
Have reduced confidence on uneven ground or during cutting movements

What We Typically See in Assessment

When we assess someone with chronic ankle instability, the findings are remarkably consistent regardless of how many sprains they've had or how long the instability has been present:

Calf weakness — the calf muscles are the primary active stabilisers of the ankle. Weakness here is almost universal in chronic ankle instability and contributes directly to the feeling of giving way.
Reduced proprioception — balance testing on the affected side shows clear deficits compared to the unaffected side, particularly on dynamic tasks.
Poor hip control — this one surprises people, but hip abductor and external rotator weakness allows the knee to collapse inward during landing and cutting, which changes how load is distributed through the ankle and significantly increases instability risk.
Reduced ability to hop and land — single leg hopping and landing tasks — the movements most likely to cause a re-sprain — are often avoided or performed with clear compensation patterns.
Fear of movement — after multiple sprains, many people develop a guarded relationship with their ankle. They move differently, they anticipate the give and they avoid loading it. This avoidance, while understandable, actually perpetuates the problem by preventing the ankle from being trained.

What Rehabilitation Actually Looks Like

The good news is that chronic ankle instability responds very well to a structured rehabilitation program. The deficits are real but they are addressable — and most people can return to full activity including high-demand sport with the right program.

Rehabilitation progresses through several phases:

Balance and proprioception retraining This is the foundation. Single leg balance work — starting on stable surfaces and progressing to unstable surfaces — begins retraining the nervous system's ability to sense and respond to ankle position. The goal is not just to be able to stand on one leg, but to react quickly and automatically when the ankle is challenged.
Calf and hip strengthening Progressive calf strengthening — starting with double leg calf raises and building to single leg, weighted, and eventually explosive variations — restores the primary active stabiliser of the ankle. Hip strengthening addresses the proximal control deficit that contributes to instability during dynamic movements.
Progressive loading and impact work Once strength and balance are restored, the rehabilitation introduces more challenging tasks — hopping, bounding, lateral movements, cutting and change of direction. This phase trains the ankle to handle the specific demands of your sport or activity.
Bracing and taping — useful but not the answer A brace or tape job can provide support and confidence during return to sport, and is a reasonable short-term strategy while strength and proprioception are being rebuilt. But relying on a brace long-term without addressing the underlying deficits is not a solution — it's a workaround that leaves the underlying problem unaddressed.
Return to sport testing Before returning to high-risk sport, objective testing — including single leg hop tests and balance assessment — can confirm that the ankle has the capacity to handle the demands it will face. This removes the guesswork from the return to sport decision.

Is Surgery Ever Needed?

For the vast majority of people with chronic ankle instability, surgery is not necessary. Conservative management — physiotherapy and structured rehabilitation — produces good outcomes for most presentations.

Surgery becomes a consideration when conservative management has genuinely failed after an adequate trial, when there is significant mechanical laxity that isn't responding to strengthening, or when there are associated structural issues such as osteochondral damage that require intervention.

If you've been told you might need surgery for your ankle, it's worth having a thorough physiotherapy assessment first to confirm that conservative management has been properly completed rather than just attempted briefly.

If your ankle keeps giving way and you're ready to actually fix it rather than just manage it, book online or call us on (08) 7123 4148. We can assess exactly what's driving your instability and put together a specific plan to address it.

Written by Christian Rees, Physiotherapist at Active Balance Physio & Wellness, St Marys Adelaide. Chris holds a Bachelor of Physiotherapy (Honours) and has a special interest in sports physiotherapy, acute injuries and spinal conditions. He is undertaking his Masters in Sports Physiotherapy in 2026.

Are You Overtraining? How to Tell and What to Do | Active Balance

Mon, 17 Feb 2025 01:24:27 GMT

Are You Overtraining?

How to Tell — and How Manual Therapy Can Help

What Is Overtraining Syndrome?

Overtraining syndrome occurs when training stress consistently exceeds the body's capacity to recover. It's not just having a hard week — it's a sustained imbalance between load and recovery that accumulates over time until the system starts to break down.

The distinction between productive training stress and overtraining is important. Some fatigue is normal and necessary — it's the stimulus that drives adaptation. The problem is when fatigue accumulates faster than it can be cleared, and the body never fully recovers between sessions.

How to Tell If You're Overtraining

The early signs of overtraining are easy to dismiss. Here's what to watch for:

Performance decline despite continued effort This is the hallmark sign. You're training the same or harder but getting slower, weaker or less explosive. Times are going backwards. Weights that felt manageable feel heavy. If your performance is consistently declining despite consistent training, something is wrong.
Persistent fatigue that doesn't resolve with rest Normal training fatigue settles with a good night's sleep or a rest day. Overtraining fatigue is different — it's there in the morning, it doesn't lift through the day and a single rest day doesn't touch it.
Elevated resting heart rate Your resting heart rate is a sensitive marker of recovery status. If you track it regularly, a consistently elevated resting heart rate — particularly first thing in the morning — is a reliable early warning sign of accumulated fatigue and potential overtraining.
Mood disturbances and irritability The relationship between overtraining and mood is well established. Overreaching and overtraining are associated with increased anxiety, depression, irritability and reduced motivation. If training starts to feel like a chore rather than something you want to do, and your mood is consistently lower than normal, pay attention.
Sleep disruption Paradoxically, overtraining can disrupt sleep despite the fatigue it causes — elevated cortisol and sympathetic nervous system activation interfere with sleep quality and onset. Difficulty falling asleep or waking through the night during periods of heavy training is a warning sign worth taking seriously.
Increased susceptibility to illness and injury Chronic overtraining suppresses immune function. If you're picking up every cold going around, getting repeated minor infections or noticing that small niggles aren't resolving the way they normally would, your immune and recovery systems are likely compromised.
Persistent muscle soreness and heaviness Muscle soreness that extends well beyond the normal 24 to 72 hour post-training window, or a constant feeling of heaviness and stiffness in the legs or arms that doesn't clear between sessions, suggests inadequate tissue recovery.

Why Manual Therapy Helps

The primary treatment for overtraining syndrome is reduced training load and improved recovery — there's no getting around that. But manual therapy plays a genuinely useful role in both the prevention and management of overtraining, and here's how.

Physiotherapy — managing the load before it becomes a problem

A physiotherapist can help you identify the biomechanical and structural factors that make your body more susceptible to overtraining injury. Muscle imbalances, movement compensations and training program design all contribute to how efficiently your body handles load. Regular check-ins during heavy training blocks — not just when something hurts — allow adjustments to be made before the system fails.

Load management advice from a physio isn't about training less. It's about training smarter — understanding the relationship between your acute training load and your chronic training capacity, and keeping that ratio in a range your body can handle.

Remedial massage — accelerating recovery between sessions

Remedial massage directly addresses the muscular fatigue and tension that accumulates during heavy training. Improved blood flow speeds the clearance of metabolic waste products, reduces muscle tension and promotes the parasympathetic nervous system activity that is essential for tissue repair.

For athletes in high training blocks, regular massage isn't a luxury — it's a recovery tool with genuine physiological benefits. Research consistently shows that massage reduces delayed onset muscle soreness, improves subjective recovery and reduces cortisol levels — all directly relevant to overtraining prevention.

The stress reduction effect is worth emphasising. Overtraining has both physical and psychological components. The cortisol reduction and parasympathetic activation produced by massage therapy address the nervous system dysregulation that characterises overtraining syndrome, not just the muscular fatigue.

Myotherapy — addressing the deeper drivers

Myotherapy goes beyond surface muscle tension to address trigger points, nerve irritation and the deeper muscular dysfunction that develops with sustained overtraining. Repetitive training patterns create predictable trigger point activity in specific muscles — the calves and peroneals in runners, the pecs and lats in swimmers and lifters, the hip flexors and TFL in cyclists.

Left unaddressed, these trigger points create compensatory movement patterns that increase load on other structures and set the stage for injury. Regular myotherapy during heavy training periods keeps these patterns from becoming established, maintaining the muscle balance that underpins both performance and injury resilience.

Nerve mobilisation is another valuable tool — overtraining can cause nerve irritation and entrapment through chronically tight and overworked muscles. Addressing this early prevents the numbness, tingling and referred pain that can halt training entirely.

How to Integrate Manual Therapy Into Your Training

The most common mistake is using manual therapy reactively — booking a massage when something hurts rather than as a regular part of training management. By the time pain appears, the underlying problem is usually well established.

A more effective approach:

During heavy training blocks — weekly or fortnightly sessions to manage accumulating tension, address trigger points early and monitor recovery status. Your therapist will notice changes in tissue quality that you may not be aware of.
After competitions or intense training blocks — a session within 48 to 72 hours after a major event or training camp accelerates recovery and reduces the recovery debt carried into the next training phase.
During deload periods — a deeper treatment session during a planned deload allows thorough work on accumulated tension without the concern of being sore before a hard session.
As a monitoring tool — regular sessions with a therapist who knows your body provide an ongoing assessment of your recovery status. Changes in tissue quality, tension patterns and pain sensitivity are early indicators of overreaching that can prompt adjustments to training before they become overtraining.

The Bottom Line

Overtraining isn't just a problem for elite athletes pushing huge training volumes. It affects recreational runners building toward their first marathon, CrossFit athletes competing in the open, team sport players navigating a long season and gym goers who simply love training and find it hard to hold back.

The goal isn't to train less. It's to recover better — so the training you do actually produces the adaptation you're working toward rather than digging a hole you can't get out of.

Manual therapy is one of the most practical tools available for keeping that balance in check. Combined with adequate sleep, nutrition, load management and a willingness to listen to your body, it can make the difference between a training career that lasts decades and one that keeps getting derailed by the same preventable problems.

Book online or call us on (08) 7123 4148 to discuss how regular manual therapy can fit into your training program.

Sprain vs Strain: What's the Difference?

Wed, 12 Feb 2025 08:03:46 GMT

Sprain vs Strain: What's the Difference?

What Is a Strain?

A strain is an injury to a muscle or tendon — the fibrous tissue that connects muscle to bone. Strains happen when the muscle or tendon is stretched beyond its capacity or placed under excessive load too quickly.

Common mechanisms include sprinting, kicking, heavy lifting, or any sudden explosive movement that the tissue isn't prepared for.

Symptoms of a strain:

Pain in the affected muscle or tendon
Swelling and bruising around the injury site
Muscle weakness
Limited range of motion
Muscle spasms

Grades of muscle strain:

Grade 1 — a small number of muscle fibres are affected. Pain is localised but strength is maintained. Recovery is usually straightforward with appropriate management.
Grade 2 — a significant number of fibres are involved, with associated pain, swelling and bruising. Activating the muscle reproduces pain, and both strength and range of motion are reduced.
Grade 3 — a complete tear of the muscle or tendon. This is a serious injury that may require surgical assessment and a lengthy rehabilitation process.

What Is a Sprain?

A sprain is an injury to a ligament — the connective tissue that holds bones together and provides joint stability. Sprains occur when a joint is forced beyond its normal range of motion, overstretching or tearing the ligament in the process.

Common mechanisms include rolling your ankle, landing awkwardly from a jump, a sudden twisting motion, or contact from another player during sport.

Symptoms of a sprain:

Pain around the affected joint
Swelling and bruising
Reduced mobility and difficulty moving the joint
A feeling of instability or the joint "giving way" in more severe cases

Grades of ligament sprain:

Grade 1 — stretching of a small number of ligament fibres with no significant laxity. Pain and swelling are mild and recovery is usually quick with good management.
Grade 2 — a partial tear involving a considerable proportion of fibres, resulting in some joint laxity. More significant swelling, bruising and instability.
Grade 3 — a complete rupture of the ligament. The joint may feel grossly unstable. Depending on the location, surgical assessment may be required.

Key Differences

Strain:

Affects muscle or tendon
Caused by overstretching or overloading a muscle
Common locations include hamstring, calf, quadriceps and rotator cuff
Main symptoms are muscle pain and weakness

Sprain:

Affects ligament
Caused by a joint being forced beyond its normal range
Common locations include ankle, knee, wrist and thumb
Main symptoms are joint pain and instability

How Physiotherapy Helps

For both sprains and strains, physiotherapy plays a key role in recovery — from the acute stage right through to full return to activity.

In the early stages we focus on accurate diagnosis, understanding the grade of injury, and applying the PEACE & LOVE principles to manage pain and swelling (see our blog post on this).

From there, rehabilitation typically includes:

Restoring range of motion — gentle mobility work to prevent stiffness and maintain joint health
Strengthening — targeted exercises to rebuild muscle and tendon capacity, or to restrengthen the muscles that support an injured joint
Balance and proprioception training — particularly important for ligament injuries where joint position sense is disrupted
Manual therapy — hands-on treatment to reduce pain and improve movement quality
Load management — a structured return to activity that matches what your tissue can handle at each stage of recovery
Education — understanding your injury, your recovery timeline, and what to do (and avoid) at each stage

One of the most common mistakes we see is stopping rehabilitation as soon as pain settles. Pain reduction is a great sign — but it doesn't mean the tissue is fully healed or that strength and stability have returned. Completing the full rehabilitation process is what prevents the injury from recurring.

If you've had a strain or sprain and aren't sure where you're at in your recovery, book online or call us on (08) 7123 4148. We'd love to help you get back to full function safely.

Written by Emily Clements, Senior Physiotherapist at Active Balance Physio & Wellness, St Marys Adelaide. Emily holds a Bachelor of Physiotherapy and has a special interest in shoulder rehabilitation, strength and conditioning, and helping active people manage and overcome injury.

Injury Prevention Tips & Tricks

Wed, 04 Sep 2024 07:12:22 GMT

What Is the Best Form of Injury Prevention? A Physio's View

Everyone who trains regularly has been injured at some point. And most people, after the injury settles, go straight back to doing exactly what they were doing before — and wonder why it happens again.

Injury prevention is one of those topics that gets a lot of lip service but rarely gets implemented properly. People know they should warm up. They know they should manage their load. They know they should do their rehab exercises. They just don't do it consistently — usually because nobody has explained why it actually matters or what it practically looks like.

Here's our honest take on the most effective injury prevention strategies, in order of importance.

1. Finish Your Rehabilitation Properly

This is the most underrated injury prevention strategy available — and the most commonly skipped.

The single biggest predictor of future injury is a history of the same injury. A previously injured ankle, knee, hamstring or shoulder is significantly more likely to be reinjured than one that has never been hurt. This is not bad luck. It's the predictable consequence of incomplete rehabilitation.

Here's what happens: you get injured, you rest, the pain settles, you feel better, you return to sport or activity. But pain settling is not the same as the tissue being fully healed, the muscle being fully strong, or the neuromuscular control being fully restored. The injury feels fine — until you ask it to perform at the level that caused the problem in the first place.

Completing rehabilitation properly means continuing with your exercises until you've restored:

Full range of motion
Symmetrical strength compared to the other side
Normal balance and proprioception
The ability to perform sport-specific movements at full speed and load without compensation

This often means continuing rehabilitation exercises for weeks or months after pain has resolved. It's the unglamorous part of recovery that makes the difference between a one-off injury and a recurring one.

2. Manage Your Load

Load management is the most evidence-based injury prevention strategy we have — and it's the one most commonly violated by enthusiastic athletes and gym goers.

Every tissue in your body — muscle, tendon, bone, cartilage — adapts to the stress placed on it, but on its own timeline. Cardiovascular fitness improves relatively quickly. Tendons and bones adapt slowly — weeks to months of consistent loading are required before meaningful structural change occurs.

The problem is that cardiovascular fitness often outpaces tissue capacity. You feel fit enough to run further, train harder or increase your weights — but your tendons and bones haven't caught up yet. The result is overuse injury.

Practical load management principles:

The 10% rule — as a general guideline, avoid increasing weekly training volume by more than 10% from one week to the next. It's conservative but it exists because tendons and bones genuinely need that gradual progression.
Monitor acute to chronic workload ratio — this is a concept used in elite sport but applicable to anyone. If your training load this week is significantly higher than your average load over the past month, injury risk increases. Spikes in load — a big weekend of sport after a quiet week — are a common injury trigger.
Don't return to pre-injury loads immediately after time off — whether you've had a week of illness, a holiday or a period of reduced training, your tissue capacity has decreased. Coming back at your previous level is a load spike even if it doesn't feel like one.

3. Build Strength Consistently

Strength training is the most versatile and evidence-backed tool in injury prevention. Strong muscles protect joints, absorb impact forces, improve movement quality and reduce the load placed on passive structures like ligaments and tendons.

This is not just for athletes. For desk workers, older adults, recreational gym goers and elite sportspeople alike, adequate strength reduces injury risk across virtually every context.

Key areas worth prioritising for most people:

Hip and glute strength — weakness here contributes to knee, hip and lower back injuries across almost every sport and activity. Single leg work — split squats, single leg deadlifts, step-ups — is particularly valuable.
Calf and ankle strength — the calves absorb enormous loads during running and jumping. Calf weakness is associated with Achilles tendinopathy, plantar fasciitis and ankle sprains. Calf raises — particularly single leg and with progressive load — are one of the highest value exercises for lower limb injury prevention.
Posterior chain — hamstrings, glutes and lower back working together. Nordic hamstring curls in particular have the strongest evidence base of any single exercise for hamstring injury prevention.
Rotator cuff and scapular stabilisers — for anyone doing overhead sport or significant upper body training, shoulder stability work reduces injury risk meaningfully.

Functional training — movements that replicate the demands of your sport or activity — builds capacity in the specific patterns most likely to be stressed. Balance and proprioception training, particularly single leg work, has direct evidence for reducing ankle sprain rates.

If you want objective data on where your strength deficits are, our VALD ForceDecks and Dynamo testing can compare your strength against normative data and identify asymmetries that put you at risk before they cause problems.

4. Warm Up Properly

A good warm up does three things: raises core temperature, increases range of motion and prepares the nervous system for the demands ahead. It does not need to be elaborate or time-consuming — 10 to 15 minutes of progressively more intense movement that mirrors what you're about to do is sufficient for most people.

What it should include:

General movement to raise heart rate and temperature — light jogging, skipping, cycling
Dynamic mobility work for the joints most involved in your activity — hip circles, ankle rotations, thoracic rotation
Progressively more sport-specific movement — walking lunges to running lunges, slow jogging to striding, light throws before full intensity throwing

What it should not include as the primary focus:

Long duration static stretching immediately before activity — research consistently shows this reduces power output and does not reduce acute injury risk when performed immediately before training

Save static stretching for after training or as a separate mobility session.

5. Prioritise Recovery

Recovery is where adaptation actually happens. Training is the stimulus — sleep, nutrition and rest are where your body responds to that stimulus and becomes stronger and more resilient.

The most important recovery strategies, in order of evidence:

Sleep — the single most impactful recovery tool available and the most neglected. Seven to nine hours per night is associated with significantly lower injury rates in athletes. Sleep deprivation impairs reaction time, decision-making, tissue repair and pain sensitivity. No recovery strategy compensates for chronic poor sleep.
Nutrition — adequate calories, sufficient protein distributed through the day, and anti-inflammatory food choices all support tissue repair and adaptation. Chronic underfueling is a significant risk factor for bone and tendon injuries.
Hydration — dehydration impairs performance, increases perceived effort and reduces tissue resilience. Staying well hydrated throughout the day — not just during training — supports recovery.
Active recovery and adjuncts — compression, cold water immersion, massage and infrared sauna all have evidence for reducing muscle soreness and supporting recovery between sessions. At Active Balance our recovery room includes infrared saunas and NormaTec compression boots, available as a standalone session or as a treatment add-on for just $10. These tools work best as complements to the fundamentals above, not replacements for them.

The Takeaway

Injury prevention isn't a single intervention — it's a combination of habits that compound over time. The most effective approach is:

Finish your rehabilitation completely before returning to full activity
Progress your training load gradually and consistently
Build strength in the areas most relevant to your sport and lifestyle
Warm up with purpose before training
Prioritise sleep, nutrition and recovery

None of this is complicated. What makes the difference is consistency — doing these things week after week rather than sporadically when you feel like it.

If you want a specific injury prevention assessment — looking at your movement, strength, training load and history — our team can give you a clear picture of your individual risk factors and a practical plan to address them.

Book online or call us on (08) 7123 4148.

Written by Alexander Muscat, Physiotherapist at Active Balance Physio & Wellness, St Marys Adelaide. Alex holds a Bachelor of Physiotherapy (Honours) and has experience treating sports injuries, complex pain management, rehabilitation and joint conditions. He brings an extensive athletic background to his practice including competitive soccer and futsal.

What Running Shoes Are Best? A Physio's Honest Take | Active Balance

Thu, 13 Jun 2024 01:02:43 GMT

What Running Shoes Are Best? A Physio's Honest Take

The Honest Answer Nobody Wants to Hear

The best running shoe is the one that fits well, feels comfortable and that you can run in without pain. That's it. That's the short answer.

The evidence on running shoe prescription is genuinely humbling. Decades of research trying to match shoe type to foot type — the idea that flat feet need stability shoes, high arches need cushioned shoes, overpronators need motion control — has not held up particularly well under scrutiny. Large prospective studies have repeatedly failed to show that prescribing shoes based on arch height or pronation pattern reduces injury rates.

What does seem to matter is comfort. Research from the Swiss Federal Laboratories for Materials Testing showed that runners who selected shoes based on comfort showed lower injury rates than those who selected based on prescribed criteria. The body is surprisingly good at telling you what works for it — if a shoe feels right, that's meaningful information.

This doesn't mean all shoes are equal or that shoe choice doesn't matter at all. It means the elaborate categorisation system the industry has built around foot type is less evidence-based than most people assume.

What Actually Matters When Choosing Running Shoes

Fit

This is the most important factor and the one that overrides everything else. A shoe that doesn't fit well will cause problems regardless of its cushioning, stability or price tag.

Key fit considerations:

Approximately a thumb's width of space between your longest toe and the end of the shoe — your foot expands when you run and with heat and fatigue
No pinching or pressure across the midfoot or forefoot — the shoe should feel secure without feeling constricted
No heel slipping — the heel counter should hold your heel firmly without creating pressure points
Try shoes on later in the day when your feet are at their largest, and always try them with the socks you run in

Comfort from the first wear

A running shoe should feel good immediately. The idea that shoes need to be "broken in" is largely outdated with modern footwear construction. If a shoe feels stiff, tight or awkward in the store, it's unlikely to feel dramatically better after 50 kilometres.

The right stack height for your running

Stack height — the thickness of the midsole — has become one of the more evidence-influenced areas of shoe design. Higher stack shoes (more cushioning) reduce impact forces and are associated with lower rates of bone stress injury in some research. Lower stack shoes and minimalist footwear can be beneficial for developing foot strength but require a gradual transition — moving from a high stack to a minimal shoe too quickly is a genuine injury risk.

For most recreational runners, a moderate stack height of 20 to 35mm is a reasonable starting point. Carbon fibre plated "super shoes" — the technology that has revolutionised elite marathon times — are now widely available but are designed for race day performance, not everyday training. Using them for all your running removes the training stimulus that builds the foot and calf strength they effectively bypass.

Surface appropriateness

Road shoes and trail shoes serve genuinely different purposes. Trail shoes have outsoles designed for grip on uneven, loose or wet terrain. Running road shoes on trails regularly will wear them faster and provide less traction than you need. Road shoes on trails can increase ankle sprain risk. If you run off-road regularly, dedicated trail shoes are worth the investment.

Replace them regularly

Most running shoes have a lifespan of 600 to 800 kilometres depending on your weight, running surface and gait. Running in worn-out shoes — where the midsole has compressed and lost its cushioning — is associated with increased injury risk. The upper often looks fine long after the midsole has deteriorated. If your shoes are over 12 months old and you run regularly, they're probably due for replacement.

A Note on Pronation and Gait Analysis

Pronation — the inward rolling of the foot during the stance phase of running — is normal and necessary. The foot is designed to pronate as part of its natural shock absorption mechanism. Overpronation becomes a concern when it's excessive and contributing to symptoms — but the presence of pronation on a treadmill analysis alone is not a reason to prescribe a motion control shoe.

Gait analysis in a shoe store is useful but has limitations. A two-minute treadmill assessment captures one small sample of how you move in a specific shoe in a non-fatigued state. It doesn't account for how your gait changes over a long run, your training load, your strength deficits or your injury history.

If you're having recurring running injuries, a running assessment with a physiotherapist is significantly more informative than a shoe store gait analysis. We can look at the whole picture — hip strength, ankle mobility, cadence, foot strike, training load — and give you specific, evidence-based advice rather than a shoe category recommendation.

What We Suggest in Practice

For most recreational runners, here's a practical framework:

Go to a specialty running store with knowledgeable staff — not a general sports store
Try several pairs across different categories rather than going in with a fixed idea
Run in each pair — most stores have a treadmill or will let you run outside
Choose based on comfort, fit and feel — not brand loyalty or what a friend recommended
Consider having two pairs and rotating them — different shoes create slightly different load patterns, which some research suggests reduces overuse injury risk
If you keep getting injured despite good shoes, the shoes probably aren't the problem — get a running assessment

When to See a Physio About Your Running Shoes

If you're experiencing recurring pain with running — particularly in the heel, arch, shin, knee or hip — a physiotherapy running assessment is a better investment than a new pair of shoes. Footwear is one part of a complex picture that also includes training load, strength, mobility, running technique and recovery.

We offer running assessments at Active Balance that look at the full picture and give you specific, practical recommendations — including whether footwear is likely contributing to your symptoms.

Book online or call us on (08) 7123 4148.

Blood Flow Restriction Training — What It Is and Why It Works | Active Balance

Mon, 11 Mar 2024 02:07:10 GMT

Blood Flow Restriction Training - What It Is and Why It's Useful in Rehab

What Is Blood Flow Restriction Training?

Blood flow restriction training involves wrapping an inflatable cuff or tourniquet around the top of a limb — the upper arm or upper thigh — and partially restricting blood flow during exercise. The restriction is applied to venous return (blood leaving the muscle) while arterial flow (blood entering the muscle) is maintained.

The result is that blood and metabolic by-products accumulate in the working muscle, creating an environment that triggers significant muscle adaptation — at loads far lower than what would normally be required.

In traditional resistance training, meaningful muscle hypertrophy generally requires working at loads above 65% of your one rep maximum. With BFR, similar adaptations can be achieved at just 20 to 30% of one rep max. For someone who cannot safely load a joint or limb heavily — due to surgery, injury, tendon irritation or pain — this is a significant practical advantage.

How Does It Actually Work?

The physiology behind BFR is genuinely interesting and worth understanding if you're considering using it.

Under normal training conditions, heavy loading causes an inflammatory response in muscle tissue that drives adaptation — bigger, stronger muscle fibres. This is also what causes delayed onset muscle soreness (DOMS) and limits the ability to train again the next day at high intensity.

BFR bypasses the need for heavy loading by exploiting the relationship between oxygen availability and muscle fibre recruitment. Here's the simplified version:

Oxygen is required for the development of Type 1 (slow twitch) muscle fibres — the endurance fibres that are recruited first during low-intensity exercise. Type 2 (fast twitch) fibres — the larger, more powerful fibres that drive strength and hypertrophy — are normally only recruited at high loads or intensities.

By restricting blood flow and reducing oxygen delivery to the muscle, BFR forces early recruitment of Type 2 fibres even at low loads. The metabolic by-products that accumulate — particularly lactate — act as cellular signals that stimulate muscle protein synthesis and growth hormone release.

Research has shown that BFR training can increase growth hormone secretion by up to 170% compared to traditional exercise — without the inflammatory effects of heavy loading. This has protective effects on tendons and muscle collagen, which is particularly relevant in the rehabilitation setting.

Where BFR Is Most Useful in Rehab

BFR is not a replacement for traditional strength training in most circumstances. But it fills a genuinely important gap for people who cannot train at the loads required for conventional hypertrophy and strength gains.

Post-surgical rehabilitation

After ACL reconstruction, joint replacement or other orthopaedic procedures, the affected limb is typically restricted in how much load it can handle. Muscle atrophy begins almost immediately after surgery and is one of the primary barriers to full recovery. BFR allows meaningful muscle stimulus at the low loads that post-surgical protocols permit, reducing the extent of atrophy and speeding up the return to higher load training.

Injury and reduced weight bearing

For someone managing a stress fracture, tendon injury or other condition requiring load reduction, BFR allows continued muscle training during the relative rest period. Maintaining muscle mass and strength during forced rest significantly improves outcomes when full training resumes.

Tendinopathy management

Heavy loading is a key component of tendinopathy rehabilitation — but in the acute or irritable phase, the tendon may not tolerate the loads required. BFR can provide a meaningful training stimulus at loads the tendon can handle, maintaining muscle capacity while the tendon settles.

Deloading phases

For athletes in structured periodisation programs, deload periods are important for recovery but can involve significant reductions in training load. BFR can help maintain muscle stimulus during deload phases without the systemic fatigue of heavy training.

Older adults and clinical populations

For people who cannot safely perform high load exercise due to cardiovascular conditions, joint pathology or general deconditioning, BFR offers a lower-load pathway to meaningful strength gains that would otherwise be inaccessible.

What a BFR Session Looks Like

A typical BFR session involves applying a cuff to the upper arm or thigh at an appropriate occlusion pressure — which should be individually determined rather than guessed. Too little restriction produces minimal effect. Too much can be unsafe.

Exercise is then performed at low load — typically 20 to 30% of one rep max — for higher repetition sets (commonly 30 repetitions, then three sets of 15 repetitions) with short rest periods of 30 to 60 seconds between sets. The short rest is important — it maintains the metabolic accumulation that drives the adaptation.

The session typically feels more challenging than the load would suggest — the metabolic accumulation creates a significant burning sensation in the working muscle. This is normal and expected.

Who Should Not Use BFR

As with any training modality, BFR is not appropriate for everyone. Contraindications include:

Known circulatory issues or clot risk including DVT history
Heart disease or cardiac insufficiency
Severe uncontrolled hypertension
Diabetes with vascular complications
Sickle cell anaemia
Varicose veins
Pregnancy
Open wounds, incisions or active infection in the affected limb
Active cancer
Lymphoedema
Under 12 years of age

If you have any of these conditions or are unsure, discuss with your physiotherapist or GP before attempting BFR training.

Getting Started

The occlusion pressure, load, repetition scheme and exercise selection for BFR should be individually prescribed rather than self-directed — particularly in a rehabilitation context. Getting the pressure wrong can reduce effectiveness or, at the extremes, create safety issues.

At Active Balance, our physiotherapists can assess whether BFR is appropriate for your situation, prescribe the right parameters and supervise your initial sessions to ensure you're getting the most out of it safely. Book online or call us on (08) 7123 4148 to find out whether BFR training could be useful for you.

Back Squat vs Front Squat — Which Should You Be Doing? | Active Balance

Fri, 05 Jan 2024 01:40:49 GMT

Back Squat vs Front Squat — Which One Should You Be Doing?

If you've spent any time in a gym or CrossFit box, you've done both. But if someone asked you why you were doing one versus the other — or which one is actually better for your goals — could you answer confidently?

Most people default to the back squat because it's what they learned first and they can usually lift more weight. The front squat gets programmed occasionally and feels awkward. But understanding the actual differences between these two movements can meaningfully improve how you train and help you get more out of both.

The Fundamental Difference

Both the back squat and front squat are lower body compound movements that build strength in the quads, hamstrings, glutes and back. The fundamental difference between them is torso position — and everything else flows from that.

In the back squat , the barbell sits on the upper back in either a high bar or low bar position. To maintain balance with the load behind your centre of mass, you lean your torso forward as you descend. The hips travel back significantly and the movement has a more hip-dominant feel.

In the front squat , the barbell sits on the front rack — across the shoulders with elbows high and upper arms parallel to the floor. This position demands an upright torso throughout the entire movement. The hips still travel back but the knees come further forward, and the movement has a distinctly more quad-dominant feel.

That single difference in bar position creates a cascade of technical and physiological differences worth understanding.

Mobility Requirements

Ankle mobility

The front squat demands significantly more ankle dorsiflexion — the ability to bring your shin forward over your foot — than the back squat. This is because the upright torso position requires your ankles to do more of the work to keep you balanced. If ankle mobility is limited in a front squat, the torso pitches forward to compensate, the elbows drop and the whole movement breaks down.

In the back squat, a forward torso lean naturally reduces the ankle dorsiflexion demand, meaning tighter ankles are less of a limiting factor.

Hip mobility

The back squat moves through a larger range of hip flexion, particularly in the low bar variation. Athletes with good hip mobility and stronger posterior chains often find the back squat more natural and comfortable. Those with restricted hips may find depth harder to achieve and are more prone to the "butt wink" — posterior pelvic tilt at the bottom — which increases lumbar load.

The front squat actually requires less hip mobility to hit depth, which is one reason some people find it more comfortable to squat deep in the front rack position despite the increased ankle demand.

Upper body mobility

The front rack position is the most commonly cited barrier to front squatting — and for good reason. Maintaining a front rack requires adequate wrist, elbow, shoulder and thoracic mobility. For athletes coming from a primarily gym-based background without exposure to Olympic lifting or CrossFit, the front rack can feel extremely restrictive initially.

This is worth working on rather than avoiding. The mobility demands of the front rack are not just useful for squatting — they carry over to pressing movements, overhead work and general upper body health.

Muscle Activation — What Are You Actually Training?

Quadriceps

The front squat is more quad dominant. Because the knees travel further forward over the toes during the descent, the quads are taken through a larger range of motion and placed under greater load. If quad development or knee rehab is a priority, front squats are a valuable tool.

Posterior chain — hamstrings and glutes

The back squat, particularly the low bar variation, involves more hip travel and greater hip extension demand — making it more posterior chain dominant. For athletes focused on hamstring and glute development, or those training for sports requiring powerful hip extension, the back squat provides a stronger stimulus for the posterior chain.

Upper back and thoracic extensors

This is where the front squat has a clear advantage that's often overlooked. Maintaining an upright torso under load in the front rack position demands significant upper back strength — the thoracic extensors, rhomboids and mid-traps work hard to prevent the forward collapse that kills front squat technique. This makes the front squat an excellent tool for developing upper back strength and thoracic endurance, which carries over to posture, overhead pressing and Olympic lifting.

Athletes with weak thoracic extensors will often look fine in the back squat but collapse forward the moment they front squat — a useful diagnostic in itself.

Which One Is Better?

Neither. This is the genuinely honest answer.

Both movements build lower body and back strength effectively. Both have a place in a well-rounded strength program. The differences between them are real but not so significant that one is clearly superior for most training goals.

What the front squat does better: quad development, upper back strength, ankle mobility development, transferability to Olympic lifts and catching positions.

What the back squat does better: overall load capacity (most people can back squat significantly more than they can front squat), posterior chain development, and accessibility for athletes without a front rack.

For most people doing general strength training — incorporate both. Use the back squat as your primary strength movement where you're looking to add load progressively, and use the front squat as a complementary movement that addresses the quad and upper back demands the back squat underloads.
For CrossFit athletes — both are essential. The front squat is foundational to the clean and should be trained with as much attention as the back squat.
For rehabilitation — the front squat can be useful for knee rehabilitation because the increased quad demand and more upright torso position loads the knee in a controlled way. The back squat may be more appropriate for hip and posterior chain rehabilitation. Your physio or exercise physiologist can advise which is most appropriate for your specific presentation.

A Note on Technique

The most common front squat error is dropping the elbows — which causes the torso to tip forward, turns it into a back squat with bad mechanics, and defeats the purpose of the movement. If you can't keep your elbows high and torso upright at a given load, the weight is too heavy. Strip the bar and build the movement correctly before adding load.

The most common back squat error is the knee cave — allowing the knees to collapse inward under load. This is typically driven by hip abductor weakness and is worth addressing both for performance and injury prevention.

If you're unsure about your squat mechanics or want a technical assessment, our physios and exercise physiologist can assess your movement and give you specific feedback — including objective strength testing through our VALD system.

Book online or call us on (08) 7123 4148 to chat with our team about your training program or to book a strength assessment.

Do You Need to Be Injured to See a Physio? | Active Balance

Mon, 04 Dec 2023 00:12:23 GMT

Do You Need to Be Injured to See a Physio? No — and Here's Why

1. Identifying Problems Before They Become Injuries

One of the most valuable things a physiotherapist can do is assess your movement, strength, balance and flexibility to identify vulnerabilities before they cause problems.

Most injuries don't come from nowhere. They develop from a combination of factors — muscle weakness, movement asymmetries, restricted range of motion, poor load management — that accumulate over time until the system fails. By the time pain appears, the underlying problem has often been building for weeks or months.

A movement screen and strength assessment can identify these contributing factors while they're still silent and manageable. For someone returning to sport after time off, ramping up training for an event, or with a history of recurring injuries, this kind of proactive assessment is genuinely valuable.

Think of it less like visiting a mechanic after your car breaks down and more like getting a service before a long road trip.

2. Optimising Sports Performance

Physiotherapy isn't just about keeping you healthy — it's about helping you perform better. Regular check-ins with a physio who knows your body and your baseline measures mean that small changes in movement quality, strength or flexibility are noticed and addressed before they affect your training.

For athletes this might involve:

Identifying strength imbalances between limbs that affect running efficiency or injury risk
Addressing mobility restrictions that limit technique in the gym or on the field
Managing accumulated tightness and fatigue during heavy training blocks so it doesn't compound into injury
Designing prehabilitation programs for known vulnerable areas based on your sport's specific demands

You don't need to be a professional athlete for this to be relevant. Weekend runners, gym goers, recreational team sport players and anyone who takes their physical activity seriously can benefit from having a physio in their corner rather than just calling on one when something goes wrong.

3. Workplace and Lifestyle Ergonomics

Pain doesn't only come from sport and exercise. For many people the biggest physical stressor in their life is their job — whether that's sitting at a desk for eight hours, performing repetitive manual tasks, standing on hard floors or driving long distances.

A physiotherapist can assess your workplace setup, identify the postural and movement habits that are loading your body throughout the day, and give you practical strategies to reduce that load. This might include workstation adjustments, movement breaks, targeted exercises for commonly overloaded areas or advice on footwear and seating.

Addressing these factors proactively is significantly more effective than waiting for neck pain, lower back pain or shoulder issues to develop and then trying to manage them while continuing to work in the same environment that caused them.

4. Better Recovery When Injuries Do Happen

Nobody can prevent injuries entirely. Life happens — awkward landings, unexpected collisions, moments of inattention. But having an established relationship with a physio who knows your body means that when something does go wrong, you're not starting from zero.

Your physio already knows your movement patterns, your history, your strengths and your vulnerabilities. Assessment is faster, treatment is better targeted and rehabilitation is built on a foundation that already exists. Recovery tends to be quicker and more complete for people who have been working with a physio proactively compared to those presenting for the first time after an acute injury.

There's also a conditioning component — people who have been doing regular strength and mobility work tend to sustain less severe injuries when they do occur, because their tissues are more resilient and their bodies are better conditioned to absorb unexpected loads.

5. Falls Prevention and Healthy Ageing

For older adults, physiotherapy has a particularly important preventative role. Falls are one of the leading causes of hospitalisation in people over 65 — and the consequences of a fall-related fracture, particularly a hip fracture, can be life-altering.

The factors that contribute to falls risk — reduced muscle strength, poor balance and proprioception, reduced reaction time, pain that alters gait — are all things physiotherapy directly addresses. A targeted program of strength and balance training, combined with management of any pain or movement issues, can meaningfully reduce falls risk and the fear of falling that often limits activity in older adults.

Staying active, strong and confident in movement as you age is one of the most important investments in long-term independence and quality of life — and physiotherapy plays a direct role in supporting that.

What a Proactive Physio Appointment Looks Like

If you come in without an acute injury, the appointment is less about treatment and more about assessment and planning. Your physiotherapist will look at:

How you move — posture, gait, functional movement patterns
Strength and flexibility — identifying any asymmetries or restrictions
Your activity history and goals — what you're doing, what you want to do, what might be in the way
Any areas of previous injury or ongoing niggles — even things that feel minor

From there you'll get a clear picture of where your body is at and a practical plan — whether that's a home exercise program, regular check-in appointments, or simply some advice and reassurance that everything looks good.

How Often Should You Come In?

This varies enormously depending on your age, activity level, history and goals. Some people benefit from monthly check-ins during heavy training periods. Others find quarterly appointments sufficient for general maintenance. Some people come in once, get a program, and check back in every six months.

There's no formula — your physio will give you an honest recommendation based on your individual situation rather than a one-size-fits-all schedule.

If you're curious about what a proactive physio assessment might identify for you, book online or call us on (08) 7123 4148. You don't have to wait until something hurts.

Plantar Fasciitis — Why Your Heel Hurts and How to Fix It | Active Balance

Fri, 24 Nov 2023 23:52:11 GMT

Plantar Fasciitis — Why Your Heel Hurts and How to Fix It

What Is Plantar Fasciitis?

Running along the bottom of your foot is a thick band of connective tissue called the plantar fascia. It connects your heel bone to the base of your toes and plays a crucial role in absorbing the load placed on your foot during walking, running and everyday activity.

Plantar fasciitis occurs when this band becomes irritated and inflamed — and in more persistent cases, small tears can develop within the tissue. It's one of the most common causes of heel pain, affecting around 10% of people at some point in their lives.

What Does It Feel Like?

Plantar fasciitis has a very characteristic presentation:

A sharp, stabbing pain at the bottom of the heel — often described as stepping on a stone or piece of glass
Pain that is worst with the first few steps in the morning or after sitting for a long period
An ache that typically eases after 5 to 10 minutes of walking as the tissue warms up
Pain that can return later in the day as the foot fatigues
Occasional arch pain along the sole of the foot
Pain that tends to be worse after activity rather than during it

In the early stages symptoms are usually limited to that morning pain and settle quickly through the day. As the condition becomes more established, the pain and stiffness can intensify — making those first minutes out of bed genuinely difficult — and the window of relief through the day can shorten.

What Causes Plantar Fasciitis?

Plantar fasciitis develops when the load placed on the plantar fascia exceeds what it can tolerate and recover from. Several factors can contribute:

Training and activity related:

A sudden increase in running volume, distance or intensity
Starting a new activity involving prolonged time on your feet
Increasing any weight-bearing activity too quickly without adequate recovery
Prolonged standing on hard surfaces — particularly common in nurses, teachers, retail and factory workers

Biomechanical factors:

Tight calf muscles and restricted ankle mobility — one of the most common contributors
High arches or flat feet affecting how load is distributed through the foot
Weakness in the foot intrinsic muscles, calves or hip stabilisers
Poor footwear — flat shoes with minimal support, worn out runners, or prolonged use of thongs or heels

Other factors:

Age — plantar fasciitis is most common between 40 and 60 years old
Higher body weight — increases the load through the plantar fascia with every step
Previous lower limb injuries that have altered your gait or loading patterns

What Can You Do at Home?

If you've noticed symptoms early, these strategies can help settle things down:

Invest in supportive footwear — avoid flat shoes, old worn-out runners and prolonged barefoot walking on hard floors
Modify your activity — shorter runs or walks with adequate rest between sessions. You don't need to stop completely but reducing load temporarily helps
Calf stretching — tight calves are a major contributing factor. Regular calf and Achilles stretching throughout the day, particularly before getting out of bed in the morning
Calf and foot strengthening — strengthening the calf complex and foot intrinsic muscles helps build the capacity to handle load
Frozen water bottle rolling — rolling the bottom of your foot over a frozen water bottle for 5 to 10 minutes provides symptomatic relief and gentle tissue mobilisation
Foam rolling the calf — reducing tension through the calf and Achilles reduces the pull on the plantar fascia

When to Seek Help

If symptoms haven't improved within a week of self-management, or keep returning every time you try to resume normal activity, it's time to get a proper assessment.

Plantar fasciitis is often multifactorial — meaning several things are contributing at once — and without identifying and addressing the underlying drivers, it has a habit of coming back. This is one of the most common patterns we see: symptoms settle with rest, activity resumes, pain returns.

How We Treat Plantar Fasciitis at Active Balance

When you come in with plantar fasciitis we start with a thorough assessment of your foot, calf, ankle mobility, foot posture, footwear and training history. Treatment is tailored to what's actually driving your symptoms and may include:

Load management — identifying the right level of activity to allow healing while keeping you as mobile as possible. Complete rest is rarely the answer and can actually allow the tissue to decondition.
Hands-on treatment — soft tissue massage and trigger point release through the calf and plantar fascia, dry needling for persistent muscular contributors, and joint mobilisation to improve ankle and foot mobility.
Strengthening program — progressive calf and foot strengthening is the cornerstone of plantar fasciitis rehabilitation. Heavy slow resistance calf training has the strongest evidence base for long-term recovery. The program starts gently and builds systematically to restore the tissue's capacity to handle load.
Taping — low-dye taping or plantar fascia taping can provide significant short-term symptom relief and support while rehabilitation progresses.
Footwear assessment and advice — reviewing your current footwear and making specific recommendations based on your foot type and activity level.
Orthotics — in some cases heel cups or custom orthotics can help offload the plantar fascia during recovery. We'll let you know if this is something we think would help and can refer to podiatry where appropriate.

How Long Does Recovery Take?

This depends on how long symptoms have been present and how consistently the rehabilitation program is followed. Mild early cases can resolve in 4 to 6 weeks. More established or chronic presentations can take 3 to 6 months.

The most important thing is not to stop rehabilitation as soon as pain settles — the tissue needs time to build genuine load tolerance before returning to full activity, otherwise recurrence is very likely.

If heel pain is affecting your mornings or limiting your activity, book online or call us on (08) 7123 4148. We'd love to help you get back on your feet.

ACL Tears: Surgery vs Conservative Management

talt@activebalancephysio.com.au (Talia Alt) — Wed, 22 Nov 2023 06:53:27 GMT

ACL Tears: Surgery vs Conservative Management — What Does the Evidence Say?

The Traditional View — Surgery as Default

For many years, the standard advice for a complete ACL rupture — particularly in active people and athletes — was clear: you need surgery. This was based on two key assumptions:

The ACL cannot heal on its own
ACL reconstruction prevents the development of knee osteoarthritis long term

Both of these assumptions have been significantly challenged by recent research.

What the Evidence Now Shows

ACLs can heal without surgery

The KANON trial — Knee Anterior Cruciate Ligament Nonsurgical vs Surgical Treatment — is one of the most important studies in this area. A secondary analysis by Filbay and colleagues published in the BMJ in 2022 examined MRI evidence of ACL healing across participants who had either rehabilitation alone or rehabilitation with optional delayed reconstruction.

The findings were striking. At the two year follow up, 53% of participants in the rehabilitation alone group showed evidence of ACL healing on MRI — rising to 58% at five years. This directly contradicts the long-held belief that the ACL is incapable of natural healing.

More importantly, participants who showed evidence of ACL healing reported better sport and recreational function and better knee-related quality of life at two years compared to those who had early or delayed reconstruction. The ligament was healing — and people were doing well because of it.

Surgery doesn't prevent osteoarthritis

One of the primary arguments for ACL reconstruction has historically been that it protects the knee from developing osteoarthritis. A 20-year follow-up study by Yperen and colleagues published in the American Journal of Sports Medicine found no significant difference in the rate of knee osteoarthritis between operative and non-operative groups.

Interestingly, while the surgical group demonstrated greater objective knee stability on testing, their subjective and functional outcomes were actually poorer than the non-operative group. Greater stability on a clinical test did not translate to better real-world function.

This doesn't mean surgery is wrong — but it does mean the osteoarthritis prevention argument for reconstruction is weaker than previously thought.

So Should You Have Surgery or Not?

This is the question everyone wants a simple answer to — and the honest answer is that it depends. There is no universal right answer for ACL rupture, and anyone telling you otherwise isn't giving you the full picture.

Factors that favour conservative management (rehabilitation without surgery):

Willingness to commit to a structured, long-term rehabilitation program
Lower demand sports or activities that don't involve heavy pivoting and cutting
Older age or lower activity level
Absence of significant associated injuries (meniscus, cartilage)
Good knee stability on clinical assessment despite the ACL tear
Preference to avoid surgery and its associated risks and recovery time
The "coper" profile — some people adapt remarkably well to ACL deficiency through neuromuscular compensation

Factors that may favour surgical reconstruction:

High level competitive sport involving heavy pivoting, cutting and change of direction — particularly at elite or semi-elite level
Significant associated injuries, particularly unstable meniscus tears requiring surgical repair
Persistent instability despite adequate rehabilitation
Young age with a very high activity level and many years of sport ahead
Previous ACL reconstruction on the other knee
Failure of conservative management — the "optional delayed surgery" pathway

The KANON trial approach

What the research supports is a treatment decision framework rather than a default pathway. The KANON trial used a "rehabilitation plus optional delayed surgery" model — participants started with structured rehabilitation, and surgery was only performed if conservative management failed to produce adequate knee function. This approach produced good outcomes and meant many people avoided surgery entirely.

This is increasingly being adopted as best practice — try rehabilitation first, assess the response, and make a more informed surgical decision with real data rather than defaulting to reconstruction on diagnosis.

What Rehabilitation Looks Like

Whether you pursue conservative management or elect for surgery, rehabilitation is the cornerstone of ACL recovery. For reconstruction, pre-operative rehabilitation ("prehab") improves surgical outcomes. Post-operatively, rehabilitation is the primary determinant of return to sport success. For conservative management, rehabilitation is the entire treatment.

A comprehensive ACL rehabilitation program progresses through several phases:

Acute phase — managing swelling, restoring range of motion, maintaining strength and beginning neuromuscular training. Goals: full range of motion, minimal swelling, normal walking pattern.
Strength and neuromuscular phase — progressive strengthening of the quadriceps, hamstrings, glutes and hip stabilisers. Single leg strength and control. Balance and proprioception training. Goals: symmetrical strength, good single leg control.
Running and loading phase — return to straight line running, progressive plyometric loading, sports-specific movement patterns. Goals: running without compensation, ability to perform sport-specific movements confidently.
Return to sport phase — high intensity sport-specific training, agility, reactive drills and psychological readiness assessment. Return to sport testing using objective strength and performance measures. Goals: symmetrical performance on objective testing, confidence and readiness for return to competition.
The timeline
ACL rehabilitation takes time — typically nine to twelve months minimum for return to competitive sport, regardless of whether surgery is involved. Research consistently shows that returning before nine months significantly increases re-injury risk. Objective return to sport criteria — not just time — should guide the decision to return.

Return to Sport Testing

At Active Balance, we use VALD performance testing — including ForceDecks force plates and Dynamo handheld dynamometry — to objectively measure strength symmetry and functional performance as part of return to sport assessment. This removes the guesswork from the return to sport decision and gives athletes, coaches and surgeons real data to work with.

A limb symmetry index of 90% or greater across key measures is the standard used in current return to sport guidelines — meaning the injured leg needs to be performing at 90% or more of the uninjured leg before return to competitive sport is considered safe.

An Important Caveat

This post specifically addresses isolated ACL ruptures. The picture changes when the ACL tear is accompanied by significant meniscus injury, cartilage damage or multiligament involvement — these associated injuries often require surgical management regardless of the ACL decision.

Every ACL injury is different. The right pathway for you depends on your specific anatomy, injury profile, sport, age, goals and personal preferences. The decision should be made collaboratively with your physiotherapist, GP and orthopaedic surgeon if surgery is being considered — with a full understanding of the evidence on both sides.

If you've injured your ACL and want an evidence-based assessment of your options, book online or call us on (08) 7123 4148. We can help you understand your injury, discuss the research and design a rehabilitation plan whether you're pursuing conservative management or preparing for surgery.

Why New Mums Get Wrist Pain — De Quervain's Explained | Active Balance

Mon, 30 Oct 2023 00:17:03 GMT

Why New Mums Get Wrist Pain — And What to Do About It

What Is De Quervain's Tenosynovitis?

On the thumb side of your wrist, two tendons run through a narrow tunnel of tissue called a sheath. These tendons — the abductor pollicis longus and extensor pollicis brevis — control the movement of lifting and extending the thumb. Their job is to help you grip, pinch, and position your thumb for the thousand small tasks your hands perform every day.

De Quervain's tenosynovitis occurs when these tendons become irritated and inflamed — either from overuse, or from the sheath that surrounds them becoming thickened and constricted. The result is pain, swelling and that characteristic catching or sticking sensation when you move the thumb.

The Finkelstein test — wrapping your fingers over your thumb and bending the wrist downward — is the classic clinical test. If that movement reproduces your pain sharply, De Quervain's is very likely what you're dealing with.

Why New Mothers Are So Vulnerable

The connection between new motherhood and De Quervain's is well established in the literature — and makes complete sense when you think about what new mothers actually do with their hands all day.

The lifting position

The single biggest contributor is the way babies are lifted. When you scoop a baby up with your thumbs pointing upward and fingers spread beneath — which is the natural, instinctive way most people pick up an infant — the thumb tendons are placed under significant load in a lengthened position. Do this repeatedly across dozens of lifts a day, every day, and the cumulative load on those tendons is enormous.

Hormonal factors

Oestrogen and relaxin — hormones that are significantly elevated during pregnancy and the postpartum period — affect the laxity of tendons and ligaments throughout the body. This increased laxity can make tendons more susceptible to irritation and inflammation when placed under load. It's thought to be one of the reasons De Quervain's is so much more common in women than men generally, and why the postpartum period is a particularly vulnerable window.

Breastfeeding positions

Sustained wrist and thumb positions during feeding — particularly supporting the baby's head for extended periods — add further cumulative load to the thumb tendons. Poor feeding ergonomics, which most new mothers have never been shown, can significantly contribute.

Sleep deprivation and recovery capacity

Chronic sleep deprivation affects tissue recovery and pain sensitivity. A tendon that might recover overnight from a day of load doesn't get that opportunity when sleep is fragmented and insufficient. The body's ability to repair accumulating microtrauma is reduced at exactly the time the load on the tendons is highest.

It's often misattributed

New mothers frequently assume wrist pain is from the weight of carrying the baby or from an awkward movement during birth. By the time they seek help it can be weeks or months after onset — by which point the condition has often become well established and takes longer to resolve.

What Actually Helps

Load modification — not load elimination
The first instinct is to rest completely — but with a newborn that's simply not realistic, and it's also not necessary. The goal is load modification, not elimination. That means:
Changing how you lift — scooping with the wrists in a more neutral position rather than thumbs-up reduces tendon strain significantly. Your physiotherapist can show you the specific adjustment, which takes about 30 seconds to learn and makes an immediate difference.
Breaking up prolonged positions — rather than sustaining the same wrist position for an entire feed, small position changes and gentle movement during feeding reduce cumulative load.
Distributing load — using a feeding pillow, a pram rather than a carrier for longer walks, and enlisting a partner or support person for some lifts during the acute phase can all reduce daily tendon load without compromising care for your baby.
Physiotherapy — hands-on treatment and rehabilitation
Manual therapy targeting the thumb, wrist and forearm — including soft tissue release, joint mobilisation and dry needling where appropriate — can significantly reduce pain and inflammation. Importantly, treating the wrist in isolation often misses the picture — the forearm muscles, elbow and even the neck can all contribute to thumb tendon loading and are assessed as part of a thorough evaluation.
Exercise-based rehabilitation addresses any weakness in the thumb and wrist muscles, builds tendon tolerance to load and helps prevent recurrence once symptoms settle.
Taping and splinting

A thumb spica splint — a support that holds the thumb and wrist in a neutral position — can provide meaningful pain relief, particularly overnight and during feeding when sustained positions are unavoidable. Your physiotherapist can fit one and advise when and how to use it without creating dependency.

Corticosteroid injection

For more established or stubborn cases, a corticosteroid injection administered by a GP or specialist can provide rapid pain relief that allows rehabilitation to progress more effectively. The evidence for injection in De Quervain's is reasonably good for short-term relief — though it works best when combined with physiotherapy rather than used as a standalone treatment.

Surgery

Surgery for De Quervain's — which involves releasing the constricted tendon sheath — is rarely necessary and generally only considered after extended conservative management has failed. The vast majority of cases resolve with physiotherapy, load modification and in some cases injection.

A Note on Timing

De Quervain's that is caught and treated early tends to resolve significantly faster than cases that have been present for months. If you're a new mother with thumb or wrist pain, don't put it in the "things to deal with later" pile. A single physiotherapy appointment can confirm the diagnosis, give you immediate practical strategies for load modification and set up a simple home program.

The lifting technique adjustment alone — which takes minutes to learn — can make a meaningful difference to symptoms within days.

It's Not Just New Mums

While new mothers are the most commonly affected group, De Quervain's affects anyone whose work or lifestyle involves repetitive thumb and wrist movements — gardeners, tradespeople, hairdressers, musicians, gamers, and anyone who spends significant time scrolling on a phone with one thumb. If the symptoms described in this post sound familiar regardless of whether you've recently had a baby, the same principles apply.

If you're dealing with thumb or wrist pain and think it might be De Quervain's, book online or call us on (08) 7123 4148. We can assess your wrist, confirm the diagnosis and put together a practical plan that works around the reality of your daily life — not a textbook that assumes you can rest.

SLAP Tear — Do You Actually Need Surgery? | Active Balance

Mon, 30 Oct 2023 00:13:44 GMT

SLAP Tears - Do You Actually Need Surgery?

The Case Against Rushing to Surgery

Surgical repair of SLAP tears — typically performed arthroscopically — has historically been presented as the definitive fix, particularly for athletes wanting to return to overhead sport. But the outcomes data tells a more complicated story.

Return to sport rates after SLAP surgery are lower than expected

A systematic review published in the American Journal of Sports Medicine found that overall return to pre-injury level of sport after SLAP repair surgery was around 63% — lower than many people are told when they consent to the procedure. For overhead athletes specifically, return to the same level of throwing performance is even less predictable.

Complications and re-operation rates are not insignificant

SLAP repair surgery carries risks including stiffness, biceps tendon issues, anchor failure and the need for revision surgery. SLAP tenodesis — an alternative surgical procedure that reattaches the biceps tendon rather than repairing the labrum — has shown better outcomes in some populations, particularly older athletes, but adds another layer of decision-making complexity.

Many SLAP tears do well without surgery

A growing body of evidence supports conservative management — structured physiotherapy — as a first-line approach for the majority of SLAP tears. Studies have shown that a significant proportion of athletes, including overhead athletes, achieve satisfactory outcomes with rehabilitation alone and do not require surgery.

The key insight from the research is that the labrum itself may not need to be structurally repaired for the shoulder to function well. What matters is restoring the dynamic stability of the joint — the strength, coordination and neuromuscular control of the rotator cuff, scapular stabilisers and surrounding musculature — so the shoulder can handle the demands placed on it.

What Conservative Management Actually Involves

The goal of physiotherapy for a SLAP tear is to restore the dynamic stability that the damaged labrum can no longer fully provide passively. This is a structured, progressive process that takes time but produces genuine results for most people.

At Active Balance, rehabilitation for a SLAP tear typically progresses through several phases:

Acute phase — settling symptoms and restoring movement Managing pain and inflammation, restoring full range of motion and beginning gentle rotator cuff and scapular activation. Goals: pain-free range of motion, normal resting muscle tone.
Strength and stability phase — rebuilding the foundation Progressive strengthening of the rotator cuff — particularly the posterior cuff muscles infraspinatus and teres minor which are critical for throwing — alongside scapular stabiliser strengthening (serratus anterior, lower and middle trapezius) and deep cervical and thoracic mobility work. This is the phase that most directly addresses the mechanical demands of overhead sport.
Neuromuscular control phase — training the shoulder to react Proprioception and dynamic stability training, closed chain shoulder exercises and the beginning of sport-specific loading. For throwers, this phase introduces the movement patterns of throwing in a graduated, controlled way before returning to full throwing.
Return to throwing phase — the graduated throwing program A structured return to throwing that progressively increases distance, intensity and velocity. This phase is critical and should not be rushed — the shoulder needs to adapt to throwing load over weeks and months, not days. Return to full competitive throwing typically takes 3 to 6 months or more depending on severity.

When Surgery Might Be the Right Call

Conservative management doesn't work for everyone. Surgery becomes a more reasonable consideration when:

Structured rehabilitation over a meaningful period (typically 3 to 6 months) has failed to produce adequate improvement
There is significant labral instability that is mechanically limiting function regardless of muscle strength
There are associated injuries — such as significant rotator cuff tears or glenohumeral instability — that require surgical management
The athlete is at a high level, the competitive window is narrow and the timeline for conservative management is not viable
The SLAP tear is an acute traumatic injury with complete detachment of the biceps anchor

Even in these situations, prehabilitation — completing a structured physiotherapy program before surgery — consistently produces better surgical outcomes and faster post-operative recovery. We always recommend at minimum a trial of rehabilitation before committing to an operation.

A Note on Diagnosis

It's worth knowing that SLAP tears are notoriously difficult to diagnose accurately — even on MRI. False positive rates on shoulder MRI for SLAP tears are well documented, meaning the imaging may show a tear that isn't clinically significant or isn't actually causing your symptoms.

This is particularly relevant for older athletes, where degenerative labral changes on imaging are common and may be incidental rather than the true source of pain. A thorough clinical assessment — looking at how your shoulder moves, where symptoms are provoked and what you can and can't do — is essential alongside imaging to determine whether a SLAP tear is genuinely what's driving your presentation.

Our Approach at Active Balance

When we see a throwing athlete with suspected or confirmed SLAP tear, our first step is always a thorough assessment — not just of the shoulder but of the entire kinetic chain, from hip rotation through thoracic mobility to scapular control to rotator cuff strength. Throwing is a whole-body movement and shoulder injuries in throwers are rarely just a shoulder problem.

From there we work through a structured rehabilitation program built around the demands of your specific sport, your competitive timeline and your goals. For baseball players in particular we understand the specific demands of pitching and fielding, and program accordingly.

If after a genuine rehabilitation trial you're not making the progress you need, we'll have an honest conversation about surgical options and can refer you to an appropriate orthopaedic surgeon.

Book online or call us on (08) 7123 4148 to get a proper assessment of your shoulder and a clear plan for recovery.

Written by Emily Clements, Physiotherapist at Active Balance Physio & Wellness, St Marys Adelaide. Emily holds a Bachelor of Physiotherapy and has a special interest in shoulder rehabilitation, strength and conditioning, and helping active people manage and overcome injury.

Neck-Related Headaches | Active Balance Physio

Sun, 29 Oct 2023 23:46:05 GMT

Why Your Neck Might Be Causing Your Headaches...

What Does It Actually Feel Like?

Cervicogenic headaches tend to have a pretty recognisable pattern once you know what to look for:

Pain on one side of the head (it usually doesn't switch sides)
A headache that starts or worsens with neck movement or after holding the same position for a while
Stiffness or tenderness at the base of the skull or top of the neck
Tightness through the shoulders and upper back
Sometimes, pain behind the eye on the same side

If any of that sounds familiar, it's worth considering your neck as the source — especially if your headaches never fully respond to pain medication.

Who Gets Them?

Honestly — a lot of different people, but there are some patterns we see regularly in clinic.

Desk workers and remote workers are probably the most common. Hours at a screen, a less-than-ideal setup at home, and not enough movement throughout the day puts sustained load through the upper neck. Over time, that adds up.

Drivers — whether that's long-haul, rideshare, or just long commutes — are another group. Holding your head in one position for extended periods, combined with the vibration and tension of driving, is a recipe for cervicogenic symptoms.

People who've had a neck injury, even an old one, are also more susceptible. Whiplash in particular is a common predecessor — the trauma can leave lasting changes in joint mobility and muscle function that set the stage for these headaches years later.

And sometimes there's no dramatic cause at all. Just accumulated stress, poor sleep posture, or a gradual build-up of tension that eventually tips over into headaches.

What Actually Helps

This is important: cervicogenic headaches are a mechanical problem, which means pain medication alone won't fix them. It can take the edge off, but it doesn't address what's driving the headache in the first place.

Physiotherapy is considered the first-line treatment — and the evidence behind it is solid. A physio will typically work on restoring movement in the joints of the upper cervical spine through hands-on mobilisation or manipulation, and pair that with targeted exercises to strengthen the deep neck flexor muscles that support your head. Postural assessment and ergonomic advice often comes into it too, particularly for desk workers.

Most people start to notice a real difference within a handful of sessions, especially when they're also doing the home exercises.

At home, things that can help in the short term include heat packs or a hot shower to ease muscle tension, gentle self-massage at the base of the skull, and over-the-counter anti-inflammatories as directed. These won't resolve the underlying issue, but they can make the day more manageable while you're working on the root cause.

When to Get It Checked

If you're getting headaches regularly — more than once or twice a week, or headaches that are affecting your work, sleep, or quality of life — it's worth getting a proper assessment. A physio can examine your cervical spine, identify the structures involved, and give you a clear picture of what's going on and how to address it.

Cervicogenic headaches are very treatable. Most people don't have to just live with them. If you think your headaches might be coming from your neck, get in touch with the team at Active Balance Physio &Wellness, and we can help you figure out what's going on.

Infrared Sauna Benefits — What the Evidence Actually Shows

Sun, 29 Oct 2023 23:44:18 GMT

Infrared Sauna — What It Actually Does and Why It's Worth Trying

What the Evidence Actually Shows

Cardiovascular health

One of the strongest areas of evidence for infrared sauna is cardiovascular health. Research — including a large cohort study from Finland following over 2000 men for more than 20 years — found that regular sauna use was associated with significantly reduced risk of cardiovascular disease, sudden cardiac death and all-cause mortality.

The mechanism is well understood. The cardiovascular response to sauna — increased heart rate, cardiac output and peripheral vasodilation — mimics moderate intensity aerobic exercise. For people who cannot exercise at high intensity due to pain, injury or health conditions, sauna provides a meaningful cardiovascular stimulus. Blood pressure reduction with regular use has also been documented in multiple studies.

Pain relief and muscle recovery

Infrared heat penetrates deeply into muscle and connective tissue — more so than surface heat from a hot pack or traditional sauna. This promotes circulation, reduces muscle tension and has been shown to reduce pain in conditions including fibromyalgia, rheumatoid arthritis and chronic musculoskeletal pain.

For athletic recovery, infrared sauna helps clear metabolic waste from muscle tissue, reduces delayed onset muscle soreness and promotes faster recovery between training sessions. This is why it's widely used in professional sport settings.

Stress reduction and nervous system regulation

Regular infrared sauna use activates the parasympathetic nervous system — the body's rest and recovery system — and is associated with measurable reductions in cortisol, the primary stress hormone. Heart rate variability, a marker of nervous system resilience, has been shown to improve with regular sauna use.

For people dealing with chronic stress, anxiety or the kind of nervous system dysregulation that comes with persistent pain or poor sleep, this is a genuine therapeutic benefit rather than just a feeling of relaxation.

Sleep quality

The drop in core body temperature that follows a sauna session mimics the natural temperature change that initiates sleep. Several studies have found that sauna use — particularly in the evening — improves both sleep onset and sleep quality. This makes it a useful tool for people dealing with insomnia or disrupted sleep alongside other health issues.

Immune function

The mild heat stress of sauna stimulates the production of heat shock proteins — cellular proteins that play a role in immune defence and tissue repair. Regular sauna use has been associated with reduced frequency of common illnesses like colds and flu in some studies, though the evidence here is less robust than for cardiovascular and pain outcomes.

Skin health

The increased circulation and sweating associated with infrared sauna promotes blood flow to the skin, supports nutrient delivery and may help with skin tone and appearance. Regular use is associated with improved skin elasticity and a reduction in some skin conditions in observational studies. This is a real benefit, though the evidence is less strong than for the cardiovascular and pain outcomes above.

A Note on "Detoxification"

The claim that saunas detoxify the body — and particularly that infrared sauna eliminates "seven times more toxins" than traditional sauna — is one that circulates widely in wellness spaces but isn't well supported by evidence.

The liver and kidneys are the body's primary detoxification organs, and they do this job continuously and very effectively. Sweat does contain small amounts of some compounds, but the contribution of sweating to overall detoxification is minor compared to hepatic and renal function.

This doesn't mean sauna isn't beneficial — the cardiovascular, recovery and stress-reduction evidence is genuinely compelling. But the detox framing overstates what's actually happening and we prefer to be honest about where the evidence is strong and where it isn't.

A Note on Weight Loss

Sauna sessions do burn some calories — roughly comparable to a gentle walk — due to the elevated heart rate and metabolic response. However the majority of weight lost during a sauna session is fluid loss through sweating, which is replaced when you rehydrate.

Infrared sauna can be a useful complement to an active lifestyle and healthy diet, but it's not a meaningful weight loss tool on its own. This is another area where the wellness marketing around sauna tends to overstate the evidence.

Who Benefits Most

Infrared sauna is particularly useful for:

People recovering from training or competition — accelerated muscle recovery and reduced soreness
Those with chronic pain conditions — fibromyalgia, osteoarthritis, chronic back pain, general musculoskeletal pain
People dealing with high stress or sleep issues — nervous system regulation and sleep quality benefits
Those with cardiovascular risk factors — blood pressure reduction and cardiovascular conditioning benefits, particularly for people who can't exercise intensively
Anyone wanting a genuine recovery and wellness tool — the combination of relaxation, circulation and nervous system benefits makes it a genuinely useful addition to a healthy lifestyle

Practical Guidance

How long and how often? Sessions of 20 to 40 minutes are typical. Most of the research on health benefits involves regular use — two to four sessions per week — rather than occasional use. Consistency produces better results than sporadic sessions.
Hydration Significant fluid is lost during a sauna session. Hydrate well before, during and after. Avoid alcohol before or during sauna use.
When to be cautious Check with your GP before using an infrared sauna if you have significant cardiovascular conditions, are pregnant, have uncontrolled blood pressure, or are taking medications that affect heat tolerance or sweating.
Combining with treatment Many clients at Active Balance add a sauna session before or after their treatment appointment — the warmth before treatment can help relax muscles and improve response to hands-on therapy, while post-treatment sauna supports recovery. Sessions can be added to any appointment for just $10.

Our Recovery Zone

At Active Balance our recovery room is completely private — the space is yours for the duration of your booking. No sharing, no interruptions. You're welcome to bring a friend to use the space with you.

Sessions can be booked as a standalone appointment or added to any treatment booking. We also offer a weekly subscription for unlimited access.

Book online or call us on (08) 7123 4148 to find out more or to add a recovery session to your next appointment.

Strength Training for Osteoarthritis — Why It Works

Sun, 29 Oct 2023 23:42:27 GMT

Strength Training for Osteoarthritis - Why Moving More Is the Answer

What Is Osteoarthritis?

Osteoarthritis is a degenerative joint condition characterised by the breakdown of cartilage — the smooth tissue that cushions the ends of bones within a joint. As cartilage wears, the joint can become painful, stiff and swollen. It most commonly affects the knees, hips, hands and spine, and becomes increasingly common with age.

It's important to understand what osteoarthritis is not. It is not simply "wear and tear" that worsens inevitably with movement. It is not a death sentence for the joint. And — critically — the severity of changes on imaging does not reliably predict the level of pain or disability a person experiences. Many people with significant osteoarthritis on an X-ray have minimal symptoms. Many people with significant pain have relatively mild imaging findings.

This disconnect between structure and symptoms is important because it means that improving how the joint functions — not fixing what it looks like on a scan — is the goal of treatment.

Why Strength Training Works

The muscles surrounding a joint are its primary shock absorbers and stabilisers. When they are strong and functioning well, they absorb load, distribute force evenly across the joint surface and reduce the stress placed on the cartilage and underlying bone.

When they are weak — which is almost universally the case in people with osteoarthritis, partly due to pain-related disuse — the joint is under-supported, load is distributed unevenly and pain and damage can worsen.

Strengthening these muscles doesn't just reduce pain in the short term. It addresses one of the primary mechanical drivers of osteoarthritis symptoms, producing lasting improvements in function and quality of life.

What the research shows

The evidence base for exercise and strength training in osteoarthritis is one of the strongest in musculoskeletal medicine. Major systematic reviews and clinical guidelines consistently show that:

Progressive resistance training significantly reduces pain in knee and hip osteoarthritis
Exercise produces comparable pain relief to anti-inflammatory medications in many people — without the side effects
Strength training improves functional capacity — the ability to walk, climb stairs, stand up from a chair and perform daily activities
Exercise reduces the risk of requiring joint replacement surgery, or delays the need for it
The benefits are maintained long-term with consistent training

The American College of Rheumatology, Arthritis Australia and virtually every major musculoskeletal health body now lists exercise as a first-line treatment for osteoarthritis — above medication and well ahead of surgery for most people.

The Specific Benefits

Increased muscle strength

Progressive resistance training builds the muscles around the affected joint — quadriceps and hamstrings for knee OA, gluteals and hip muscles for hip OA. Stronger muscles mean better joint support, more even load distribution and reduced pain with activity.

Improved joint stability

Osteoarthritis often produces a sense of instability or the joint "giving way" — particularly in the knee. Strengthening the surrounding musculature restores the dynamic stability that passive structures like cartilage and ligaments can no longer provide as reliably.

Increased range of motion

Stiffness is one of the most common and limiting symptoms of osteoarthritis. Progressive exercise — particularly through a full range of motion — maintains and often improves joint mobility by reducing the muscular tightness and guarding that accompanies pain, and by stimulating synovial fluid production which lubricates the joint.

Reduced pain and inflammation

This is perhaps the most counterintuitive benefit for people who assume that loading an arthritic joint will make it worse. Exercise has well-documented anti-inflammatory effects — reducing systemic inflammatory markers and producing local adaptations in the joint environment that reduce pain over time. Many people notice that consistent exercise actually reduces their baseline pain level, even if individual sessions feel challenging initially.

Improved balance and coordination

Osteoarthritis — and the pain-related disuse that comes with it — reduces proprioception, the joint's ability to sense its own position and respond quickly to unexpected perturbations. This increases falls risk, which is a significant concern particularly in older adults. Strengthening exercises, particularly those performed on one leg or in unstable positions, restore proprioceptive function and meaningfully reduce falls risk.

Improved quality of life

All of the above combine to produce what ultimately matters most — the ability to do what you want and need to do with less pain and more confidence. Getting up from the floor to play with grandchildren, walking the dog without dreading the return journey, climbing stairs without holding the rail, continuing to work, garden or exercise — these are the outcomes that matter, and they are consistently achieved through progressive strength training in people with osteoarthritis.

Addressing the Fear of Making It Worse

The most common barrier to exercise in people with osteoarthritis is fear — fear of pain, fear of damaging the joint further, fear that movement is harmful.

This fear is understandable but largely unfounded. The research is clear that appropriately dosed exercise does not accelerate joint damage in osteoarthritis. Some discomfort during or after exercise is normal and expected — the body is adapting to a new load. The rule of thumb used in clinical practice is that mild discomfort during exercise that settles within 24 hours is acceptable and doesn't indicate harm.

What does cause harm is avoiding movement altogether — which leads to progressive muscle weakness, further joint instability and a worsening cycle of pain, disuse and decline.

What a Good Program Looks Like

For someone with osteoarthritis, a well-designed strength program should:

Start conservatively and progress gradually — the joint and surrounding muscles need time to adapt
Target the specific muscle groups most relevant to the affected joint — quadriceps, hamstrings and glutes for knee OA; glutes, hip abductors and hip flexors for hip OA
Include both strengthening and functional movements — exercises that translate to the activities you want to get back to
Be progressive — regularly increasing load, volume or complexity as capacity improves
Be individualised — accounting for current strength level, any other health conditions and personal goals

This is where working with a physiotherapist or exercise physiologist is valuable. A program designed around your body, your joint and your goals will produce better and safer results than a generic online program.

How We Can Help

At Active Balance, our physiotherapists regularly work with people managing osteoarthritis — in the knee, hip, spine and elsewhere. We can assess your current strength and function, design a progressive program tailored to your joint and goals, and support you through the early stages when getting started can feel daunting.

Our supervised rehabilitation gym, Move Well classes and Clinical Pilates are all well suited to people with osteoarthritis who want a guided, progressive environment to build strength safely.

Book online or call us on (08) 7123 4148 to get started.

Written by Alexander Muscat, Physiotherapist at Active Balance Physio & Wellness, St Marys Adelaide. Alex holds a Bachelor of Physiotherapy (Honours) and has experience treating sports injuries, complex pain management, rehabilitation and joint conditions. He brings an extensive athletic background to his practice including competitive soccer and futsal.

Piriformis Syndrome - Does it actually exist?

Sun, 29 Oct 2023 23:25:25 GMT

Piriformis Syndrome - Does It Actually Exist?

The Traditional Piriformis Syndrome Diagnosis

Piriformis syndrome has traditionally been described as a condition where the piriformis muscle compresses or irritates the sciatic nerve, producing buttock pain and sciatica-like symptoms radiating down the leg.

The classic presentation includes:

Deep aching pain in the buttock, often felt as a tender spot deep in the glute
Pain that radiates down the back of the leg — similar to but often distinct from disc-related sciatica
Tingling or numbness in the buttock or leg
Pain that is worse with prolonged sitting, particularly on hard surfaces
Pain when walking up stairs or hills
Discomfort with hip internal rotation or crossing the legs
Tenderness on direct pressure over the piriformis muscle

Does Piriformis Syndrome Actually Exist? The Clinical Debate

Here's where things get interesting — and where this condition differs from most others you'll read about.

The existence of piriformis syndrome as a distinct clinical entity is genuinely contested in the medical and physiotherapy literature. Some clinicians and researchers argue that it is overdiagnosed, poorly defined, and that the evidence for the piriformis muscle directly compressing the sciatic nerve as a primary pain generator is weak.

The main criticisms are:

Lack of a reliable diagnostic test — there is no imaging finding, blood test or clinical test that definitively confirms piriformis syndrome. Diagnosis is based on symptom pattern and ruling out other causes, which makes it inherently imprecise.
Overlap with other conditions — the symptoms attributed to piriformis syndrome overlap significantly with lumbar disc pathology, sacroiliac joint dysfunction, proximal hamstring tendinopathy, deep gluteal syndrome and referred pain from the hip joint. Many cases labelled as piriformis syndrome may actually be one of these other conditions.
The "deep gluteal syndrome" reframe — many clinicians now prefer the broader term deep gluteal syndrome, which describes sciatic nerve irritation in the deep gluteal space that may involve the piriformis but may also involve other structures — including the gemelli, obturator internus, hamstring origin and surrounding fascia. This framing acknowledges that the piriformis is one potential contributor rather than the definitive cause.

What this means for treatment

The debate matters clinically because it changes the focus of treatment. If you assume the piriformis muscle is the sole problem and treat it in isolation — stretching it, releasing it, needling it — you may get temporary relief but miss the broader picture.

A more useful clinical approach is to assess the whole region — the lumbar spine, sacroiliac joint, hip, proximal hamstring and the deep gluteal space collectively — and treat what's actually contributing, whether or not you call it piriformis syndrome.

At Active Balance, this is how we approach deep buttock and leg pain presentations. The label is less important than understanding what's driving the symptoms.

What Actually Causes Deep Buttock and Sciatic Pain?

Whether or not piriformis syndrome is the right label, deep buttock pain with or without leg radiation is a real and common presentation with several potential drivers:

Piriformis muscle tightness or hypertrophy — particularly in runners and cyclists who accumulate significant hip rotation load
Sciatic nerve irritation in the deep gluteal space — from any of the structures in that region, not just the piriformis
Lumbar disc pathology — a disc bulge or herniation at L4/5 or L5/S1 can produce identical buttock and leg symptoms
Sacroiliac joint dysfunction — SI joint irritation frequently refers into the buttock and upper thigh
Proximal hamstring tendinopathy — pain at the sitting bone that can refer down the posterior thigh
Hip joint pathology — including labral tears and femoroacetabular impingement, which can produce deep buttock pain
Muscle imbalances — weakness in the hip abductors and external rotators places greater demand on the piriformis, potentially overloading it

A thorough assessment that considers all of these is essential for getting the diagnosis — and therefore the treatment — right.

How Physiotherapy Helps

Regardless of which structure is primarily responsible for your symptoms, physiotherapy is the most appropriate first-line treatment for deep buttock and sciatic-type pain. Surgery is rarely indicated and is generally only considered after extended conservative management has failed.

At Active Balance, treatment is tailored to your specific assessment findings and may include:

Manual therapy and soft tissue work Hands-on treatment targeting the deep gluteal muscles — piriformis, gemelli, obturator internus — to reduce muscle tension and improve tissue mobility. Myofascial release and trigger point therapy are particularly effective for the deep glute region.
Dry needling Fine needles into the piriformis and surrounding deep gluteal muscles can provide significant relief from muscular pain and trigger point activity. This is one of the more effective tools for deep buttock muscle tightness that is difficult to reach with surface massage.
Neural mobilisation If the sciatic nerve is sensitised and contributing to symptoms, gentle neural mobilisation techniques can reduce nerve irritability and improve the nerve's ability to move freely through surrounding tissues.
Strengthening and rehabilitation This is where lasting improvement comes from. Strengthening the hip abductors, external rotators, glutes and deep hip stabilisers reduces the load on the piriformis and addresses the underlying muscle imbalances that are often driving the condition. A progressive loading program is the cornerstone of long-term recovery.
Lumbar spine assessment and treatment Because lumbar disc and joint pathology can mimic piriformis syndrome exactly, the lumbar spine is always assessed as part of this presentation. If a lumbar contributor is identified, this is treated alongside the local hip work.
Postural and movement assessment Running gait, sitting habits, hip mobility and movement patterns all contribute to how much load the deep gluteal region accumulates. Identifying and addressing these factors reduces the likelihood of recurrence.
Activity modification For runners and cyclists in particular, adjusting training load, surface, intensity and technique can significantly reduce the stress on the piriformis and surrounding structures during recovery.

Stretching — Helpful But Not the Whole Answer

The piriformis stretch — crossing one ankle over the opposite knee and pressing the knee away — is widely recommended and can provide symptomatic relief. There's nothing wrong with using it.

However as with tight hamstrings, the sensation of tightness in the piriformis is not always a flexibility problem. It can be a sign that the muscle is overloaded and under-supported by the surrounding hip musculature. In this case, stretching provides temporary relief but doesn't address the underlying cause. Strengthening the hip — not just stretching the piriformis — is what produces lasting improvement for most people.

When to Get Assessed

Deep buttock pain is worth getting properly assessed rather than self-treating indefinitely. The overlap between piriformis syndrome, lumbar disc pathology, SI joint dysfunction and other conditions means that without a clear diagnosis, you may be treating the wrong thing.

Seek assessment if:

Buttock pain has been present for more than a few weeks despite self-management
Symptoms are radiating significantly down the leg or into the foot
You have associated numbness, tingling or weakness in the leg
Symptoms are worsening rather than settling
Pain is severe enough to significantly limit sitting, walking or daily activities

Book online or call us on (08) 7123 4148. We'll assess the full picture and give you a clear explanation of what's driving your symptoms and how to address it properly.

Written by Alexander Muscat, Physiotherapist at Active Balance Physio & Wellness, St Marys Adelaide. Alex holds a Bachelor of Physiotherapy (Honours) and has experience treating sports injuries, complex pain management, rehabilitation and joint conditions. He brings an extensive athletic background to his practice including competitive soccer and futsal.

When Should You See a Physiotherapist?

Sun, 29 Oct 2023 23:23:28 GMT

When Should You See a Physiotherapist?

Signs It's Time to See a Physio

Your injury or pain keeps coming back

This is one of the most telling signs that something needs proper attention. If you've had the same shoulder, knee, back or ankle problem flare up repeatedly — settles for a while, returns when you do something active, settles again — the underlying cause hasn't been addressed.

Recurring pain and injury almost never resolves with rest alone. Rest removes the stress but doesn't improve your capacity to handle it. A physiotherapist can identify what's actually driving the recurrence — whether that's a strength deficit, a movement pattern, a load management issue or something else — and give you a plan that breaks the cycle.

Pain or injury is stopping you from doing something you value

This is probably the most important indicator of all. It doesn't matter whether what you're being stopped from doing is running a marathon or hanging the washing out — if pain or injury is limiting your participation in something that matters to you, that's reason enough to seek help.

Knee pain stopping you from walking the dog. Shoulder pain interrupting your sleep. Back pain making it hard to sit at your desk. Hip pain preventing you from picking up your grandchildren. Neck pain affecting your ability to drive. These things affect quality of life in ways that accumulate — and physiotherapy exists specifically to help with them.

You have a long-term condition like arthritis

There's a widespread and genuinely harmful misconception that arthritis means you should rest, move less and wait for a joint replacement. For the vast majority of people with osteoarthritis, this is not true.

Physiotherapy is one of the most evidence-supported treatments for osteoarthritis — not because it reverses the joint changes, but because building strength and stability around the joint significantly reduces pain and improves function. The muscles that support the joint are the key variable, and they can always be improved regardless of what a scan shows.

The "bone on bone" diagnosis that frightens so many people into inactivity is often not the whole story. Many people with severe arthritic changes on imaging function very well with minimal pain — and many people in significant pain have relatively mild imaging findings. Building capacity around the joint, not protecting it from all movement, is the path forward for most people.

You have a work-related injury or pain

Some jobs place specific and repetitive demands on the body that increase injury risk. Nurses, trades workers and anyone doing physical labour are at higher risk of lower back injuries. Desk workers, drivers and anyone spending long hours in sustained postures are at higher risk of neck, shoulder and upper limb pain.

These conditions are particularly worth addressing early — both because they're often preventable with the right advice, and because continued exposure to the same demands makes recovery harder the longer treatment is delayed. A physiotherapist can help you manage pain, address contributing factors and advise on workplace modifications to reduce ongoing risk.

You're returning to exercise after a break

Starting or returning to exercise after a period of inactivity — whether that's post-injury, post-surgery, post-pregnancy or simply after time away — carries a higher injury risk if load is increased too quickly. A physiotherapy assessment before or early in the return to exercise process can identify any weaknesses or movement issues worth addressing, and help you build back in a way that's progressive and safe.

You're not injured but want to stay that way

You don't need to be in pain to benefit from physiotherapy. A movement screen and strength assessment can identify vulnerabilities before they become problems — particularly useful for athletes, active people building toward a specific goal, and anyone who has had previous injuries they want to avoid repeating.

What to Expect at Your First Appointment

If you've never seen a physio before, knowing what to expect can make the decision to book a lot easier.

Your first appointment will typically run longer than follow-up sessions — usually 45 to 60 minutes. It starts with a conversation about your history, what's been happening, when it started, what makes it better or worse, and what you want to get back to. Your physiotherapist will then assess how you move — this might involve watching you walk, squat, reach or perform specific movements depending on what you're presenting with.

From there you'll get a clear explanation of what's going on, why it started and what's maintaining it. You'll leave with an understanding of your condition and a plan — which might include hands-on treatment during the session, exercises to do at home and guidance on activity modification.

The goal of a good first appointment isn't just to treat the symptom — it's to understand the whole picture so that treatment actually addresses the cause.

A Note on Timing

Earlier is almost always better. Most musculoskeletal conditions respond more quickly and completely when addressed early — before compensatory movement patterns become established, before strength deficits worsen, and before pain becomes chronic.

If you're on the fence about whether something is worth getting checked, the answer is almost always yes. A single assessment appointment that gives you clarity and a clear direction is never wasted — even if the conclusion is that you don't need ongoing treatment.

If you're dealing with pain, a recurring injury, or something that's been limiting your life longer than it should have, book online or call us on (08) 7123 4148. Our team would love to help you work out what's going on and get you moving well again.

Written by Alexander Muscat, Physiotherapist at Active Balance Physio & Wellness, St Marys Adelaide. Alex holds a Bachelor of Physiotherapy (Honours) and has experience treating sports injuries, complex pain management, rehabilitation and joint conditions. He brings an extensive athletic background to his practice including competitive soccer and futsal.

Nutrition and Injury Recovery — What You Need to Know

Sun, 29 Oct 2023 23:21:28 GMT

Nutrition and Injury — The Missing Piece of Your Recovery

Underfueling — A Bigger Problem Than You Think

Before looking at specific nutrients, it's worth addressing the most fundamental issue: not eating enough.

Underfueling — consuming insufficient calories for your activity level — is a significant risk factor for both bone and tendon injuries. When energy availability is chronically low, the body prioritises essential functions over tissue maintenance and repair. Bones become more susceptible to stress injuries, tendons lose their tolerance to load, and recovery from training slows significantly.

This is particularly relevant for active people who are consciously restricting calories for body composition goals while maintaining a high training load. The combination of high output and low intake creates a physiological environment that is genuinely hostile to tissue health.

The counterintuitive truth about injury and calories

One of the most common mistakes after an injury is reducing food intake because activity has been reduced. This seems logical — less movement, less fuel needed — but the research tells a different story.

Tissue repair is metabolically demanding. Depending on the nature and severity of the injury, the body may require up to 20% more calories above normal maintenance levels to support the healing process. Cutting intake at exactly the time the body needs more resources to repair is a mistake that significantly slows recovery.

The Role of Macronutrients

Protein

Protein is the primary building block of muscle, tendon, ligament and bone. It plays a central role in tissue synthesis and repair — making adequate intake essential both for preventing injury and recovering from it.

For active individuals, research supports a protein intake of around 1.4 to 2.0 grams per kilogram of body weight per day. During injury recovery, aiming toward the higher end of this range helps minimise muscle loss and support tissue healing.

Equally important is how protein is distributed through the day. Consuming protein evenly across three to four meals is significantly more effective for muscle protein synthesis than consuming the same total amount in one or two large servings. Spreading intake — a protein source at breakfast, lunch, dinner and a post-training snack — maximises the anabolic stimulus for tissue repair.

Carbohydrates

Carbohydrates are the primary fuel source for moderate to high intensity exercise. Muscle glycogen — the stored form of carbohydrate in muscle — is depleted during training and needs to be replenished for subsequent sessions.

Chronic glycogen depletion is associated with fatigue, reduced performance and increased injury risk. When the muscles are running low on fuel, movement quality deteriorates and protective reflexes slow — a combination that increases vulnerability to both acute and overuse injuries.

Beyond energy, carbohydrates influence the central nervous system through their effect on neurotransmitter synthesis. Inadequate carbohydrate intake can impair sleep quality, cognitive function and mood — all of which affect recovery capacity and injury risk.

For most active people, carbohydrates should make up a significant proportion of daily intake, with timing around training prioritised for performance and recovery.

Fats — particularly the type

Total fat intake is less important than the quality and type of fats consumed. This is particularly relevant for managing inflammation — a key component of both acute injury and chronic pain.

Highly processed foods — seed oils, fast food, refined snacks — promote a pro-inflammatory environment in the body. For someone with a recent injury or chronic pain, a diet high in these foods can contribute to prolonged inflammation and increased pain.

Conversely, anti-inflammatory fats and foods can help modulate the inflammatory response and support recovery. Foods with good evidence for anti-inflammatory effects include:

Olive oil and avocado — rich in monounsaturated fats and polyphenols
Oily fish (salmon, sardines, mackerel) — high in omega-3 fatty acids
Flaxseed, chia seeds and walnuts — plant-based omega-3 sources
Nuts and seeds generally — mixed anti-inflammatory compounds
Turmeric, ginger and garlic — well-studied anti-inflammatory properties
Pineapple — contains bromelain, which has evidence for reducing inflammation and bruising

This doesn't mean avoiding all processed food forever — but being mindful of the inflammatory load of your diet during periods of injury or flare-up is a practical and evidence-supported strategy.

The Role of Micronutrients

Micronutrients — vitamins and minerals obtained from whole foods and supplements — play specific and important roles in tissue repair and injury prevention. Key ones to be aware of:

Vitamin C — essential for collagen synthesis, which is critical for the repair of tendons, ligaments and cartilage. Also supports immune function and acts as an antioxidant during the inflammatory phase of healing. Found in citrus, kiwi, capsicum and leafy greens.
Vitamin A — supports the early inflammatory phase of healing and immune function. Found in liver, eggs, dairy and orange and yellow vegetables.
Zinc — involved in over 300 enzymatic reactions in the body, including those governing tissue repair and immune function. Found in meat, shellfish, legumes and seeds.
Calcium — the primary mineral in bone. Adequate calcium intake is essential for bone health and fracture healing. Found in dairy products, leafy greens, almonds and fortified foods.
Iron — essential for haemoglobin synthesis and oxygen delivery to healing tissues. Iron deficiency is common in active women and can significantly impair recovery. Found in red meat, legumes, leafy greens and fortified cereals.
Copper — works with Vitamin C to form elastin and supports red blood cell formation. Found in shellfish, nuts, seeds and wholegrains.
Vitamin D — increasingly recognised for its role in musculoskeletal health, immune function and muscle strength. Deficiency is common in Australia despite our sun exposure. Worth checking with your GP if you haven't had your levels tested.

Overall Energy Availability

Underpinning all of the above is a simple principle — you need to eat enough. Chronic underfueling slows every bodily process, impairs tissue maintenance, compromises immune function and reduces the body's ability to adapt to training stress.

This doesn't mean eating without awareness — it means ensuring that your calorie intake is genuinely sufficient to support your activity level, training load and recovery demands. For most active people, this is more food than they think — particularly on training days and during periods of injury recovery.

A Note on Scope

Nutrition for injury prevention and recovery is a topic that sits at the intersection of physiotherapy and dietetics. At Active Balance, we can discuss the general principles outlined in this post and help you understand how nutrition might be affecting your recovery.

For personalised dietary advice — particularly if you have complex health needs, a significant injury, or are an athlete with specific performance goals — we'd recommend working with an accredited practising dietitian (APD). We're happy to refer you to the right person if that's what you need.

If you're dealing with an injury that isn't progressing as expected, or want to understand what else you can do to support your recovery, book online or call us on (08) 7123 4148.

Jaw Pain & TMD Treatment Adelaide

Sun, 29 Oct 2023 23:19:00 GMT

Jaw Pain and TMD - How Physiotherapy and Myotherapy Can Help

What Is TMD?

Temporomandibular disorder — TMD — is an umbrella term for problems affecting the temporomandibular joints (TMJ), the jaw muscles, and the surrounding nerves. The TMJ is the joint on each side of your face that connects your lower jaw to your skull. It's one of the most complex and frequently used joints in the body — involved in every bite, word and yawn.

When this system isn't working properly, the effects ripple outward — into the neck, shoulders, head and ears — which is why TMD often presents as headaches or neck pain rather than obvious jaw pain.

There are three main categories of TMD:

Myofascial pain — the most common type, involving tightness, tension and pain in the jaw, neck and shoulder muscles. Around 80 to 90% of TMD presentations are primarily muscle-related rather than structural joint problems.
Internal joint dysfunction — problems within the joint itself, such as disc displacement, joint clicking or locking, or injury to the joint structures.
Degenerative joint disease — conditions like osteoarthritis affecting the TMJ, more common in older adults and associated with wear and breakdown of the joint surfaces.

Many people experience more than one type simultaneously, which is why a thorough assessment is important before starting treatment.

What Causes TMD?

TMD rarely has a single cause. It typically develops from a combination of factors that place excessive or sustained load on the jaw muscles and joint:

Teeth grinding or clenching (bruxism) — one of the most common contributors, often happening at night without awareness. The forces generated during grinding can be significant and sustained muscle contraction leads to pain and fatigue
Stress — which drives both bruxism and general muscle tension through the jaw, neck and shoulders
Neck pain and tightness — the muscles of the jaw and neck are intimately connected. Chronic neck tension frequently contributes to or perpetuates jaw pain, which is why treating TMD without addressing the neck often produces incomplete results
Postural habits — forward head posture, prolonged screen use and jaw-forward positioning all increase load on the TMJ and surrounding muscles
Previous jaw or facial injury — trauma to the jaw, face or neck can alter joint mechanics and muscle function
Disc displacement or dysfunction — the cartilage disc within the TMJ can shift out of its normal position, causing clicking, locking or pain
Dental factors — bite changes from dental work, missing teeth or tooth wear can alter how the jaw loads
Degenerative changes — osteoarthritis and other joint conditions affecting the TMJ over time

Symptoms of TMD

TMD presents differently in different people. Common symptoms include:

Clicking, popping or grinding sounds when opening or closing the mouth
Jaw pain or aching — often worse in the morning after nighttime grinding, or late in the day after prolonged use
Difficulty opening the mouth fully or pain with wide opening
Pain with chewing, talking or yawning
A feeling of the jaw locking or catching
Referred pain into the face, ear, neck or shoulders
Tension-type headaches — particularly across the forehead and temples or at the base of the skull
Ear pain or a feeling of fullness in the ear without infection
Awareness of clenching or grinding, sometimes only noticed on waking

One of the most common patterns we see is the person who has been treated repeatedly for headaches or neck pain without resolution — and whose jaw has never been assessed. TMD is a frequently missed contributor to chronic head and neck pain.

How Physiotherapy and Myotherapy Help

The good news is that the majority of TMD cases — particularly those that are primarily muscle-related — respond very well to manual therapy and a targeted self-management program. You don't have to just live with it.

At Active Balance, treatment for TMD may include:

Soft tissue therapy and myofascial release: Hands-on treatment targeting the muscles of the jaw, face, neck and shoulders. The masseter, temporalis, pterygoids and suboccipital muscles are common areas of tension that contribute directly to jaw pain and headaches. Releasing these muscles reduces the load on the TMJ and provides significant symptomatic relief.
Trigger point therapy: Targeted pressure into specific trigger points within the jaw and neck muscles can release stubborn areas of tension and reduce referred pain patterns — including the headaches and ear pain that often accompany TMD.
Dry needling: Fine needles placed into trigger points within the jaw and surrounding muscles can provide significant relief from muscle spasm and pain, and reduce the frequency of tension headaches linked to jaw tension.
Joint mobilisation Gentle manual techniques to restore normal movement in the TMJ, improve joint mechanics and reduce pain with opening and closing.
Neck assessment and treatment: Because the neck and jaw are so closely connected, we always assess the cervical spine as part of a TMD presentation. Addressing stiffness, tension and movement dysfunction in the neck frequently produces meaningful improvement in jaw symptoms — even when the neck doesn't seem to be the primary problem.
Education and self-management strategies: Understanding your TMD — what's driving it, what aggravates it and what helps — is a key part of treatment. We'll help you identify habits like jaw clenching, teeth touching at rest and postural patterns that may be perpetuating your symptoms, and give you practical strategies to manage them.
This might include:
Jaw relaxation exercises and awareness techniques
Postural correction for screen use and desk work
Sleep position advice if nighttime grinding is a factor
Self-massage techniques for the jaw and neck
Referral to a dentist or oral health specialist for a night splint if appropriate

When to Get Help

TMD is worth treating early. Left unmanaged, the muscle tension and joint loading that drives symptoms tends to compound over time — making treatment more complex and recovery slower.

You should consider seeking assessment if you experience:

Jaw pain or clicking that has been present for more than a few weeks
Headaches that seem to be linked to jaw tension or morning grinding
Difficulty opening your mouth fully or pain with eating
Neck pain that hasn't resolved with standard treatment
Any combination of jaw, head, neck and ear symptoms that hasn't been properly assessed

Working With Your Dental Team

For some people with significant bruxism or bite-related contributors to TMD, we work in collaboration with dentists and oral health specialists. A custom night splint — designed to reduce the forces of grinding during sleep — can be a valuable adjunct to manual therapy for people whose symptoms are significantly driven by nocturnal bruxism.

If we feel a dental referral would benefit your management, we'll discuss this with you as part of your treatment plan.

If you've been putting up with jaw pain, clicking or tension headaches, book online or call us on (08) 7123 4148. Our team can assess your jaw, neck and surrounding muscles and put together a clear plan to get you moving, eating and talking comfortably again.

Ankle Sprains: Not Just a Rolled Ankle

Sun, 29 Oct 2023 23:17:00 GMT

Ankle Sprains: Not "Just a Rolled Ankle"

What Actually Happens When You Sprain Your Ankle?

An ankle sprain occurs when the ligaments that stabilise the joint are overstretched or torn — most commonly the lateral ligaments on the outside of the ankle. This typically happens when landing awkwardly from a jump, changing direction suddenly, or stepping on uneven ground.

Sprains are graded by severity:

Grade 1 — mild stretching of the ligament with no significant tearing. Some tenderness and swelling, but weight bearing is usually possible.
Grade 2 — partial tear of the ligament. More significant swelling, bruising and pain. Weight bearing is painful and the ankle may feel unstable.
Grade 3 — complete rupture of the ligament. Substantial swelling, bruising and instability. Weight bearing may be impossible in the acute phase.

Beyond the ligaments themselves, other structures can also be affected during a sprain — cartilage damage, tendon involvement, and even small fractures can occur alongside ligament injury. This is one of the reasons an accurate assessment matters rather than just assuming it's a straightforward sprain.

Why Ankle Sprains Are More Serious Than They Look

The statistic that surprises most people: up to 70% of people who sprain their ankle will re-injure it if they don't complete proper rehabilitation . That's not bad luck — it's a predictable consequence of what happens to the ankle after a sprain.

When ligaments are injured, the tiny nerve receptors within them that provide proprioception — your body's sense of joint position and movement — are also damaged. Even after the pain and swelling have settled, this proprioceptive deficit often remains. The result is an ankle that doesn't react quickly enough to protect itself when you step awkwardly, leading to repeated sprains and eventually chronic ankle instability.

Ligaments also don't always return to their original strength and length after a sprain. Without targeted rehabilitation to rebuild strength and retrain the neuromuscular system, the joint is left weaker and more vulnerable than it was before the injury.

Symptoms to Watch For

Common signs of an ankle sprain include:

Pain and swelling around the ankle joint, particularly on the outer side
Bruising that may spread into the foot or track up the leg
Stiffness and difficulty bearing weight
A feeling of instability or the ankle "giving way"
Reduced range of motion

If your pain is severe, you cannot bear weight at all, or there is significant bony tenderness, it's worth getting assessed promptly to rule out a fracture. The Ottawa Ankle Rules are a clinical tool physios and doctors use to guide whether imaging is needed — your physio can apply these at your initial assessment.

What Proper Rehabilitation Looks Like

The goal of ankle sprain rehabilitation isn't just to get the swelling down — it's to restore full strength, mobility, stability and confidence in the joint so that you can return to your activities without fear of re-injury.

At Active Balance, rehabilitation typically progresses through several phases:

Acute phase — first 48 to 72 hours Managing swelling and pain through the PEACE & LOVE principles (see our blog post on this), gentle range of motion work and protected weight bearing as tolerated.
Restoration phase Hands-on therapy to address stiffness and swelling, progressive exercises to rebuild ankle strength and mobility, and early balance work to begin retraining proprioception.
Strengthening and neuromuscular phase Progressive loading of the ankle and surrounding muscles — calves, peroneals, tibialis anterior and hip stabilisers all play a role in ankle stability. Balance and coordination exercises become more challenging as strength improves.
Return to sport or activity phase Sport-specific movement patterns, agility work and high-level testing to confirm the ankle is genuinely ready for the demands of your activity. This phase is where many people cut corners — and where re-injury most often occurs.

When to Seek Assessment

If you've recently sprained your ankle, we'd recommend getting it assessed even if it feels relatively minor. Early guidance on loading, movement and rehabilitation sets you up for a much smoother recovery than waiting to see how it feels.

You should seek prompt assessment if:

You cannot bear weight on the ankle
There is significant bony tenderness over the ankle or foot
The swelling or bruising is severe
The ankle feels grossly unstable
Symptoms are not improving after a few days of basic management

The Bottom Line

A rolled ankle deserves the same respect as any other injury. With the right assessment and rehabilitation, most people make a full recovery and return to everything they were doing before — often with a stronger, more resilient ankle than they had previously.

Don't just walk it off. Book online or call us on (08) 7123 4148 and let us help you get back on your feet properly.

Physiotherapy

Return to Sport Testing

Hamstring Health — Why It's More Important Than You Think

Sun, 29 Oct 2023 23:15:01 GMT

Hamstring health – Why is it important?

Injury Prevention

The hamstrings play a key role in stabilising the knee joint, as well as maintaining the hip and torso positioning.
If the hamstrings are under-developed and quadriceps over-developed, there will be an increased injury risk to both the hamstrings directly and the knee joint.
The hamstrings play a role in deceleration ability, which for anybody involved in high speed running sports or change of direction, this is important.

Performance

Due to their role in hip extension and knee flexion, they are among the muscles responsible for our ability to run fast. With the glutes, they help propel you forward and also play a large role in deceleration. This means the stronger your hamstrings, the greater your ability to stop and change direction – key aspects of sports performance.
Everyday life and activities
Whilst we understand not everyone is interested in boosting performance for sports, greater hamstring strength offers improvements in overall posture, and makes tasks such as standing up from sitting, climbing stairs or bending down to pick things up easier.

A common complaint in the majority of the adult population are “tight, inflexible” hamstrings.

Whilst it can feel like the hamstrings are tight and need to be stretched – often this is your brain’s way of protecting the hamstrings or other joints as the muscle is not strong enough to support it in the range you want it to be (i.e lengthened). Therefore it will give the notion of “tightness”. Whilst static stretching can have it’s place, this will ultimately not build strength through range of motion and the body will continue to protect against putting your body in a vulnerable position. Therefore it is often simply weakness and instability that gives this feeling of “tightness”.

To then reduce this, instead of doing countless stretches, a more effective intervention is to strengthen these.

Because the hamstrings cross both the knee and hip joint, it is important to train it in different ways.

Some effective exercises that you can typically complete at home with little equipment:

Nordic hamstring (knee flexion)
Exercise ball hamstring curls – (knee flexion with hip extension)
These can be done with cables, theraband or also sliders.
This exercise adds an element of stability and core.
Heel slides
Romanian deadlifts (hip extension)
Lying banded hamstring curl

There are a multitude of exercises that you can do to strengthen the hamstring, but here are just a few that load it in different ways.

If you have ongoing tight hamstrings or constantly getting hamstring strains and not sure where to start on your journey, at Active Balance we can help! Contact us for further direction!

RICE vs PEACE & LOVE: New Injury Recovery Protocol

Sun, 29 Oct 2023 23:13:02 GMT

RICE vs PEACE & LOVE: The New Protocol for Injury Recovery

The Problem With RICE

Dr Gabe Mirkin introduced the RICE protocol in 1978. For over 40 years it became the default response to acute injury — taught in first aid courses, handed out in emergency departments, and repeated by coaches and parents everywhere.

Then in 2012, Dr Mirkin publicly revised his own position. His conclusion, supported by a growing body of research, was that ice and prolonged rest may actually delay healing rather than help it.

Here's why: when you injure soft tissue, your body triggers an inflammatory response. This inflammation — the swelling, warmth and redness you see after an injury — is not your enemy. It's your body's repair system activating. Immune cells flood the area, clearing damaged tissue and initiating the healing process.

When we apply ice or take anti-inflammatory medications, we're suppressing exactly the response the body needs to heal efficiently. Swelling is uncomfortable and should be managed, but eliminating inflammation entirely slows the repair process down.

Prolonged rest has similar problems. While protecting an injury in the acute phase is important, extended immobilisation leads to muscle weakness, reduced blood flow and slower recovery.

Introducing PEACE & LOVE

The PEACE & LOVE framework was developed to replace RICE with a more evidence-based approach — one that works with the body's natural healing processes rather than against them.

It's split into two phases: PEACE for the immediate management period, and LOVE for the rehabilitation phase that follows.

PEACE — Immediate Management (First 48–72 Hours)

P - Protection Avoid movements and activities that increase pain in the first 48 to 72 hours. This doesn't mean complete rest — it means protecting the injured area from further aggravation while the initial healing response gets underway.
E - Elevation Elevate the injured limb above heart level as much as possible. Gravity helps drain excess fluid from the area, reducing swelling and discomfort.
A - Avoid anti-inflammatories This is the part that surprises most people. Anti-inflammatory medications like ibuprofen interfere with the body's natural inflammatory healing response. In the early stages of injury, this can slow tissue repair. Ice has a similar effect. Unless pain is severe and unmanageable, it's worth reconsidering reaching for both automatically.
C - Compression Use an elastic bandage or taping to compress the injured area. This helps manage excessive swelling and provides some structural support without suppressing the healing process entirely.
E - Education Trust your body's ability to heal. Seek appropriate professional guidance, but avoid the trap of over-medicalising a straightforward soft tissue injury. Unnecessary passive treatments, excessive imaging and high levels of anxiety about an injury can all slow recovery. Understanding what's happening and having a clear plan helps enormously.

LOVE — The Rehabilitation Phase

L - Load Once the acute phase has settled, gradually reintroduce load to the injured area. Let pain guide you — some discomfort during rehabilitation is normal and expected, but sharp pain or significant increases in swelling are signs to back off. Progressive loading stimulates tissue repair and builds strength.
O - Optimism This one is backed by solid research. A positive, confident mindset genuinely influences recovery outcomes. People who catastrophise their injury or expect the worst tend to recover more slowly. This isn't about dismissing pain — it's about approaching recovery with realistic confidence that you will get better.
V - Vascularisation Get blood moving to the injured area through pain-free cardiovascular activity. This doesn't have to be intense — even gentle cycling, swimming or walking promotes circulation, delivers nutrients to healing tissue and maintains fitness during recovery.
E - Exercise Active rehabilitation — not passive rest — is how you restore full function. Appropriate exercises rebuild strength, restore mobility and improve proprioception (your body's sense of position and movement), which is particularly important for joint injuries like ankle sprains where instability can become a longer-term problem.

What This Means in Practice...

If you roll your ankle at training tonight, here's what the evidence now suggests:

Compress and elevate it, don't ice it for extended periods
Keep moving as much as pain allows — don't just sit on the couch
Avoid anti-inflammatories for the first few days if you can manage without them
Get assessed by a physio to understand what you're dealing with and get a clear rehabilitation plan
Start gentle loading and movement early, progressing gradually

This approach consistently leads to faster, more complete recoveries than prolonged rest and ice.

A Note on Serious Injuries

PEACE & LOVE applies to acute soft tissue injuries — muscle strains, ligament sprains, contusions and similar. If you suspect a fracture, complete tendon rupture, significant joint injury or you're in severe pain, seek medical assessment promptly. Some injuries require imaging and specialist management that goes beyond what any self-management protocol can address.

We're Here to Help

Understanding the best approach to injury recovery has changed significantly in recent years — and it will keep evolving as research develops. At Active Balance we stay current with the evidence so that the advice we give you is always grounded in what actually works.

If you've had a recent injury and want to know the best way to manage it, or you're stuck in a recovery that isn't progressing the way it should, book online or call us on (08) 7123 4148.

Physiotherapy

Shin splints

Sun, 29 Oct 2023 23:10:33 GMT

Shin Splints: Causes, Types, Symptoms and How to Recover

Where Is Your Pain?

The location of your shin pain can give important clues about what's actually going on:

Pain on the inside of the shin (medial shin pain) This is the most common presentation and is usually Medial Tibial Stress Syndrome. It feels like a dull ache or soreness along the inner edge of the shin bone, caused by irritation where muscles attach to the tibia. Common in runners and anyone who has recently increased their training load.
Pain on the front of the shin (anterior shin pain) This can come from several different causes and is worth getting assessed carefully:
Tibialis anterior overload or tendinopathy — pain along the outer front of the shin, often worse when lifting the foot during running or walking uphill
Stress reaction or stress fracture — sharp, pinpoint pain on the front of the shin bone that worsens with impact and may linger at rest
Chronic Exertional Compartment Syndrome (CECS) — cramping, tightness or pressure at the front of the shin during exercise that eases with rest, sometimes accompanied by numbness or weakness in the foot

In short: inside shin pain is usually muscle and tissue overload. Front shin pain can involve muscle, bone or compartment-related issues and warrants careful assessment.

The Different Types of Shin Splints

Because shin splints is a general term rather than a specific diagnosis, it can include several distinct conditions:

Medial Tibial Stress Syndrome (MTSS) The most common type. Pain along the inner shin bone caused by repetitive stress on the tibia and surrounding tissues. Responds well to load management and rehabilitation.
Stress reactions and stress fractures When overload continues without adequate recovery, the shin bone itself can develop tiny cracks. Pain is usually sharper, more localised, and worsens progressively with activity. Stress fractures require a longer, more carefully managed recovery.
Chronic Exertional Compartment Syndrome (CECS) A less common condition where muscle swelling during exercise is restricted by the surrounding tissue, causing cramping, pain or tightness that consistently eases with rest.
Other causes Tibialis anterior tendinopathy, nerve irritation and vascular issues can also present as shin pain. This is why a proper assessment matters — the right diagnosis drives the right treatment.

What Causes Shin Splints?

The common thread across almost all shin pain presentations is doing too much too soon. Specifically:

A sudden increase in training volume, intensity or duration
Returning to training after a break and jumping back to previous levels too quickly
Starting a new high-impact activity like running, jumping or dance
Changes in terrain — moving from flat to hilly, soft to hard, or road to trail
Inadequate or worn out footwear
Training on hard surfaces like concrete without adequate variation
Insufficient recovery between sessions

Biomechanical and physical factors also play a significant role:

Weakness in the calf, glute and hip muscles that support the lower limb during impact
Poor hip and knee stability affecting how load is distributed through the leg
Tight calf muscles or restricted ankle mobility
Running gait issues — overstriding, excessive foot pronation, or low cadence all increase tibial stress
Flat feet or high arches affecting load distribution

When to Worry About a Stress Fracture

Most shin splints will settle with proper management, but some presentations warrant prompt assessment. Seek professional advice if you notice:

Sharp, pinpoint pain at one specific spot on the shin
Pain that worsens the more you exercise rather than easing as you warm up
Pain that lingers at rest or at night
Swelling or tenderness directly over the bone

Stress fractures require a longer period of rest, medical imaging and a carefully guided return to sport. The sooner they're identified the better.

How We Treat Shin Splints at Active Balance

Because shin pain can come from several different sources, treatment starts with a thorough assessment to identify what's actually driving your symptoms. From there, your management plan may include:

Load management — the foundation of shin splint recovery. We'll help you find the right training level to allow healing while keeping you as active as possible. Complete rest is rarely necessary — swapping running for cycling or swimming maintains fitness while reducing tibial stress.
Strengthening exercises — targeting the calf, tibialis posterior, glutes and hip stabilisers to build the capacity your lower limb needs to handle training load.
Manual therapy — massage, dry needling, cupping and joint mobilisation to ease muscle tightness, improve blood flow and reduce pain.
Gait retraining — if your running mechanics are contributing to the problem, small adjustments to technique can significantly reduce tibial stress.
Footwear and surface advice — making sure your shoes are appropriate and that your training environment isn't adding unnecessary load. Where possible, mixing in softer surfaces like grass or trail reduces repetitive impact stress.
Taping — for symptomatic relief and support during the return to activity phase.

Getting Back to Full Training

Our goal isn't just to get you out of pain — it's to get you back to the training you love and give you the tools to stay there. Most people who go through a proper shin splint rehabilitation program come back stronger and more resilient than before.

If you're dealing with shin pain or want to get on top of it before it becomes a bigger problem, book online or call us on (08) 7123 4148. We'd love to help.

Services related to shin splints:

Running Assessment

Manual Therapies

Athlete Tune Up

What Does Muscle Tightness Actually Mean? | Active Balance

Sun, 29 Oct 2023 23:05:07 GMT

Muscle Tightness — What Does It Actually Mean?

The Two Main Types of Muscle Tightness

1. Reduced flexibility This is what most people think of when they think of a tight muscle — a muscle that has genuinely shortened and lost range of motion over time. This is often related to posture and movement habits, and stretching can genuinely help here when done consistently and correctly.

2. Hypertonicity A hypertonic muscle has excessive resting tension — it's in a state of higher than normal activity even when you're not using it. People often describe this as a muscle that feels "wound up" or never fully relaxes. You might also hear the terms spasm, contracture, or cramp used to describe variations of this.

Hypertonicity can be global — affecting an entire muscle or muscle group — or it can present as a myofascial trigger point, which is a concentrated area of tension within the muscle that can also refer pain to other areas of the body.

The key point is that a hypertonic muscle doesn't necessarily need more stretching — and in some cases, stretching can actually aggravate it.

Why Does Muscle Tightness Happen?

There are several common causes we see in clinic, and often more than one is contributing at the same time:

Adaptive shortening — not moving enough When you hold the same position for extended periods — sitting at a desk, looking at a screen, driving — your muscles gradually adapt to that shortened position. Reduced movement also means reduced blood flow to the tissues, which contributes to that sense of tightness and discomfort. This is one of the most common causes we see, particularly in desk workers.
Muscle weakness This one surprises a lot of people. A weak muscle that is being overloaded will often respond by increasing its resting tension — essentially bracing itself. What feels like tightness is actually the muscle struggling under load. It's also worth noting that the muscle you feel as tight isn't always the weak one. A classic example is the hamstrings — they frequently feel tight when the real problem is weakness in the glutes or hip flexors above them. Stretching the hamstrings in this situation provides temporary relief at best.
Psychological factors and general wellbeing Sleep, stress, nutrition and general mental load all influence how your nervous system processes sensation — including the sensation of tightness. People going through periods of high stress or poor sleep often notice their muscles feel significantly tighter, even without any change in their physical activity. This isn't imagined — it reflects real changes in tissue sensitisation driven by the nervous system.

Why Stretching Alone Often Isn't Enough

Stretching is a useful tool — but it's only addressing one piece of a more complex picture. If your tightness is driven by weakness, postural habits, nervous system sensitisation, or a combination of all three, stretching will provide temporary relief without addressing the root cause.

This is why the same areas of tightness keep coming back despite regular stretching — the underlying driver hasn't changed.

How We Can Help

At Active Balance, when you present with muscle tightness we don't just treat the symptom — we work to understand why it's there in the first place.

That starts with a thorough assessment covering your movement patterns, strength, posture, lifestyle and history. From there we develop an individualised treatment plan that might include:

Manual therapy — hands-on treatment to address hypertonicity and restore movement
Dry needling or cupping — effective for releasing stubborn trigger points
Exercise prescription — targeted strengthening to address the underlying weakness driving the tension
Progressive loading — gradually building the capacity of the affected muscles so they're no longer overwhelmed
Education and habit changes — helping you understand what's driving your tightness and what to change in your day-to-day life

Because not all tight muscles are the same — and they don't all need the same solution.

If you've been dealing with persistent muscle tightness that stretching just isn't fixing, book an appointment online or call us on (08) 7123 4148. Our team would love to help you get to the bottom of it.

Written by Tom McCarthy, Myotherapist at Active Balance Physio & Wellness, St Marys Adelaide. Tom holds a Bachelor of Science in Sport Rehabilitation and Athletic Therapy and has a special interest in lower back pain and sports injury rehabilitation.

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