Patellofemoral Pain

Patellofemoral pain is a term used to describe pain around the knee cap, i.e at the front of the knee. There can be clicking at the front of the knee and a sensation of giving away or locking.

It is a common knee injury, especially in runners, cyclists and hill-walkers. It also commonly affects people who are new to exercise, especially when they are rapidly increasing  their activity levels.

The patella is also known as the knee cap. It lies in a grove at the front of the knee. It slides up and down in this grove as the knee bends and straightens. When there is excessive pressure on the knee, for example when we increase our training volumes, increase our speed or go up or down lots of stairs or hills, this puts an increased load on the patella and surrounding structures and can result in pain. Pain can also result from the patella not tracking up and down correctly in it’s grove.

Pain can arise from the highly sensitive fat pad which lies just under the knee cap. Pain can also arise from the tendon that attaches the knee cap to the shin bone (patellofemoral ligament) or from the muscles on the outside of the thigh.

Physiotherapy treatment will initially aim to reduce pain with manual therapy, rest, ice and taping. The most important part of treatment is to identify the cause of the symptoms. The Physiotherapist needs to assess your foot, your biomechanics (ie the way you move), your flexibility and your strength. they will need to look at your training programme and may need to tailor it, aswell as building in some rehabilitation.

Bear in mind that this is just one type of knee pain. There are many other causes, so it is important to get assessed to ensure things are dealt with correctly. If you are suffering from knee pain and would like some help, please do not hesitate to call us at East Coast Physio.



5 Reasons Triathletes Get Injured

Triathlon season is almost upon up us! Avoid an injury at this stage by avoiding these common pitfalls:

1. Too much, too soon

At this time of year, triathletes are increasing the length and intensity of their sessions in preparation for race season. Injuries happen when the load put on our bodies is too much for our tissues to withstand. Before increasing your training load, ask yourself; Is you body ready for this increase? Have you built up steadily over the last few months? If so, increase you mileage or your intensity of sessions in one discipline at a time. 10% a week is a good guide, and this means a 10% increase in either intensity or mileage, not both!

2. Rest/Recovery

I would argue that the rest day is the most important training day!

Triathlon requires high volumes of training. Not only does the triathlete have to find time to train for three very different disciplines, they also need to incorporate endurance, power and skill training into each discipline. Most triathletes are working full time, have family and social commitments. It’s hard to fit it all in!

Many triathletes push themselves until their bodies break down and they get an injury. If you are tired, take a rest day or chose a lighter session for that day. If you are physically or mentally tired, you will not get the benefit from a tough session, and you increase your risk of injury.

3. Nutrition

If you are training hard, you need to consider how you are fuelling your body.  It is important you are well nourished. Otherwise you could find yourself picking up every cold and sore throat going! Choose healthy options, slow release carbohydrates, adequate protein and unsaturated fats. Healthy snacks between meals are important to avoid highs and lows in blood sugar levels during the day. After a training session, you should eat a snack which contains some carbohydrate and protein. Try to eat a proper meal within an hour after training.  And don’t forget to stay hydrated!

 4. Invest in a bike fit!

You spent an open fortune on a bike but shy away from investing in a bike fitting?! It is so important that the bike fits you.

5. Flexibility and strength 

It’s hard to fit it all in, but in my opinion, flexibility and strength are the most important factors in injury prevention. Flexibility is easy! Three times a week (more if you can), grab a mat in front of the TV, and stretch/foam roll all of your major muscles.

Strengthening is in my opinion a little more difficult. It is important to identify where your weaknesses lie. You may need to consult a Physiotherapist to help identify what areas you need to work on. This will allow you to focus on the important areas, which is more effective for injury prevention and also more time efficient!

Good luck! And if you need any assistance or advise, please do not hesitate to contact us at East Coast Physio. 



Operation Transformation – Injury Prevention

Three basic tips for injury prevention:

1. Variety is the spice of life!

Exercising the same muscles in the same way day in day out can lead to muscle breakdown and injury. Factor in a rest day, and if possible vary your exercise. For example, do swimming, cycling or an exercise class for one session instead of walking.

If you have done little or no exercise in the past few months, be careful to start your exercise routine this week gradually (try not to go from zero to hero!!).  Read Zero to Hero to find out how to ease into your new exercise.

2. Footwear

In the clinic we advise clients everyday on correct footwear.  It is so important to have good supportive footwear when you are exercising to avoid injury. Read our Footwear section to find out what would be suitable for your foot.

3. Recover well

For your body to get stronger and fitter, it needs a chance for recovery. Eating and sleeping well and staying well hydrated will help this.

To help your muscles to recover, doing a good cool-down is important – it is important to stretch after exercise to avoid soreness after exercise and to avoid injuries.  We have pictures of all the stretches you should be doing after your Operation Transformation exercise plan (pay particular attention to calf, hip flexor, quad, hamstring and glut stretches). These need to be held for at least 30 seconds to have an effect.

Foam rolling can be a good addition to your routine, to help you self-massage tight muscles. We stock these in the clinic.

Best of luck this week with your new programme!  If you have any injuries or problems with your Operation Transformation exercise plan call us on 0404 49781 or email

Catherine, Fiona, Robert and Ian




Low Back Pain

85% of people will experience back pain at some stage during their lives. Lower back pain is by far the most common condition we see at East Coast Physio.

Five bones (vertebrae) make up the lumbar spine (lower back). Between the vertebrae are discs, which act as shock absorbers. There are two facet joints between each vertebra which allow movement forwards, backwards and side to side. There are many muscles acting on the lumbar spine and a number of strong ligaments which stabilise it.

The most common causes of low back pain are muscle strains, ligament sprains, facet joint issues and disc bulges. Low back pain can come on suddenly, or it can build up gradually over a period of time.The good news is that Physiotherapy is very effective for treating low back pain. Early diagnosis and treatment helps you to recover quickly and prevent a recurrence.
Most common causes of low back pain:
  1. Muscle strains are the most common injury. These can occur if your back is tired or weak, if there is excessive strain put though your back or if you have a poor lifting technique.
  2. Ligament sprains – your ligaments are responsible for restricting the amount of movement at your lower back. They can get strained if you stretch them too far or too quickly. Poor lifting technique, sports injuries and car accidents can all cause ligament sprains.
  3. Disc bulges can occur when there is excessive pressure on a certain area of the disc, causing it to bulge at the edge. Disc bulges vary in severity. A severe disc bulge can cause a nerve irritation, which can result in pain and altered sensation in your leg.
  4. Posture: low back pain which is related to posture tends to creep up on you gradually over time. It often worsens as the day goes on and you may find it difficult to sit or stand for long periods of time

Physiotherapy treatment for low back pain

Stage 1: Protection and pain relief

In the early stages, your physiotherapist will often use soft tissue massage, joint mobilisations and taping to help relieve your pain. We often recommend taking some pain relief at this stage and staying as mobile as possible, as this will help to speed up your recovery. Bed rest is not usually recommended, but it is ok to lie down in your most comfortable position for 30-40 minutes at intervals during the day.

Stage 2:  Mobilisation and strengthening.

Once the initial pain and inflammation has settled, it is time to restore normal movement and strength to your lower back. The sooner you can get your back gently moving, the better. Hands on therapy can be really beneficial at this stage. Your physiotherapist will identify any strength and movement deficits you may have and prescribe you specific exercises to address these deficits.

Stage 3: Return to full function. This third and final stage focuses on restoring your back’s function back to normal, to safely allow you to return to work, sport and general daily activities. Preventing a re-occurrence is top priority, and it is important that you continue to work on some specific strengthening exercises, even after your pain has gone.

How can you prevent lower back pain?

There are no guarantees, but active individuals, who exercise regularly have the best chance of avoiding lower back pain. Safe lifting techniques and correct posture also reduce your risk.


Exercise away those winter blues!

December is busy! It’s cold! We over indulge in food and drink and exercising goes out the window. We plan to start afresh in January!

The World health Organisation recommends adults partake in 30 minutes of moderate intensity exercise, 5 times a week.

Why don’t you make an early New Year’s resolution to stay active now? It will make it so much easier to stay on track come January. You will feel better, have more energy, and you are sure to fit into that party dress or suit!! What you need is some motivation, and here’s how you  find it:

1. Set a goal

It doesn’t matter how big or how small, set yourself a goal for the new year and work towards it. It can help to pick an organised event, like a charity walk or run.  Pick a date. Write it in your diary and on your calendar.  Pay the entry fee. Tell people about it. Get others on board. Now you are committed!

Break down your main goal into smaller goals that are achievable. Tick them off as you achieve them.

2. Exercise in the morning 

It is often easier than trying to drag yourself off the couch after a long day’s work. It also has the added benefit of energising you for the day. You will be more productive and in better form from the off!

3. Preparation is key!

Have a tracksuit and runners in work or in the car if you plan to exercise after work. Have your clothes ready beside your bed if you are exercising first thing in the morning. No excuses to skip your session!

4. Make it social!

Make exercising fun! Catch up over a 30 minutes walk rather than over a coffee! The time will fly by. Arrange a time. Now you have to show up!

5. Keep a record 

There are some great apps that will track your distance and time, and even post them on Facebook or e-mail them to you. Or, if you prefer the more traditional approach, use your calender or diary.


Too cold or wet to go out? Do 10 minutes of stretching. March on the spot. Use a skipping rope. Step up and down onto the first step of your stairs. It all counts!

Are You Sitting Correctly?

Much of the neck and back pain we see at East Coast Physio is due to the way people sit at work. The way we sit can also lead to repetitive strain injuries of the elbow, wrist and hand. We can get away with repetitive movements and poor postures for a while, but after a prolonged period of time these habits can begin to take their toll.


Here are our top 10 tips for sitting correctly at work:

  1. Sit up tall, with your back firmly against the back of your chair. If your back is not well supported, try adjusting your chair, or placing a cushion behind your lower back.
  2. You should be sitting firmly on your seat bones. To check if you are sitting correctly, sit on your hands and feel for the two bony bits. Move around and feel these bony bits moving under your hands. You are sitting correctly when all your weight is on these bones.
  3. Your thighs should be parallel to the floor and should be fully supported by the chair.
  4. The computer monitor should be at eye level.  It should be about an arm’s length away from your body. Try not to allow your chin to poke forwards.
  5. Your feet should be flat on the floor.
  6. Your elbows should rest by your sides. They should be at a 90 degree angle, either resting on the arm rests, or on the desk.
  7. Your wrists should be straight.
  8. Your mouse should be as close to you as possible. A mouse mat with a wrist support may help to keep your wrist straight and avoid awkward bending.
  9. Make objects accessible. Position frequently used objects such as the telephone within easy reach.
  10. Avoid holding the phone between your ear and your shoulder. Use headphones if you spend long periods of time on the phone.

Hamstring Strains

Hamstring strains are one of the most common sports injuries.

The hamstring muscles are found at the back of your thigh. The hamstrings are composed of three main muscles; the biceps femoris muscle, the semimembranosus muscle and the semitendinosus muscle. The biceps femoris muscle is the most commonly injured. Hamstring strains occur when excessive or sudden tension is put through the hamstring muscle fibers.  Hamstring strains vary from simple strains to complete tears.

The hamstrings are responsible for bending the knee and they help to extend the hip. The hamstrings are extremely important in deceleration of your leg as you run. They are most prone to injury just before your foot hits the ground, as this is when they exert their maximum force. Hamstring muscle strains are extremely common in sports involving sudden acceleration and deceleration, such as hurling and camogie or sports that involve kicking. They are very common in sports like hockey that require a low body position.

Hamstring injuries have the highest recurrence rate of all injuries with a recurrence rate of 34% in Australian football and 12% in soccer.  This is often due to hamstrings not being fully rehabilitated and the risk factors (see below) not being addressed.

Risk factors for hamstring strains:

  • Previous injury
  • Poor hamstring flexibility
  • Poor hamstring strength, especially when the hamstring is in a lengthened position
  • Tightness of your sciatic nerve
  • Poor muscular control of your pelvis
  • Lower back issues, including lower back stiffness and weakness
  • Poor running biomechanics;  over-striding and poor hip strength can put your hamstrings in a vulnerable position
  • Increasing age
  • Poor warm up; we would recommend an active and dynamic warm up.
  • Fatigue; tired muscles are able to absorb less energy. It is important to schedule recovery between sessions.  Speed work should be done early in the workout, to avoid hamstring fatigue
  • Slippery playing surfaces

How to treat hamstring injuries:

Initially you will be advised to follow the RICE protocol  (Rest, Ice, Compression, Elevation). The extent of the tear needs to be diagnosed. This will determine how quickly you can progress through the stages of rehabilitation. Gentle pain-free stretching can be useful, but stretching should be avoided if it increases your pain. The hamstrings will need to be strengthened, and strengthening exercises will progress from gentle to more intensive as the hamstring heals. Any lower back, pelvic or hip weakness or lack of flexibility, and any faults in your training program also need to be addressed.  Your rehab should be focused on you as an individual, with a gradual return to your previous sport/activity.

It is important to remember that there are multiple causes of thigh pain. It is advisable to seek professional assessment, diagnosis and guidance for all injuries.

References: Brukner and Khan, Clinical Sports Medicine

Tips for the Marathon!

October 31st is fast approaching. Here are some tips for the final week and for the big day:

1. Don’t panic- as I say time and again, your training is essentially done, so it’s a bad idea to try to make-up lost mileage- you need a fresh body at that start line, that is the reason for the taper.

2. Don’t make any unplanned changes to your training/clothing/footwear/diet etc.- with extra time on your hands and extra time to think, people can end up doing daft things before a marathon- my advice is not to try anything new, or make any changes to your training plan- the plan is designed for your body to peak for race day, and messing around with this is risky.

3. Having a rub-down in the week prior to the marathon (but not within 3 days) can help to keep the muscles feeling loose and fresh.

4. Keep well hydrated.

5. Distract yourself with other activities if you feel the panic setting in!

6. Use balm/Vaseline on areas that are prone to chafing

And after the race (which most people haven’t thought about!):

1. Have something warm to wear.

2. Eat something salty (eg crackers) within 15 mins of finishing, and…

3. Stretch well afterwards- this will help your recovery no end.

4. Recovery bath- some people swear by the ice bath (science is undecided), or a lukewarm bath with epsom salts may be more pleasant. Avoid a hot bath.

5. Take adequate recovery time- I often see injuries months after a marathon, as people didn’t take a break. The jury is out on how long is needed, and of course it varies per person, but guidelines would state not to return to intense training until 26-40 days after the race.

6. Cross-training is a great way of assisting your recovery- a gently cycle/swim/walk in the days after the race can get the blood flowing and ease the leg stiffness.

7. Avoid alcohol after the race! This is obviously going to affect your recovery. If you do decide to go for that pint of Guinness, just make sure its acccompanied by some water.

8. Having a rub-down in the week after the race can help to alleviate muscle soreness.

Best of Luck and Enjoy!

Hip Pain – Gluteal Tendinopathy

Gluteal Tendinopathy

The gluteal muscles are your buttock muscles. Often hip pain can be caused by inflammation of these muscles, where they attach with their tendon onto the outside of the hip bone. The gluteus medius muscle is the most commonly affected muscle.

The gluteus medius muscle is one of our most important hip stabilisers. It has multiple functions. It contracts to move the leg outwards or to turn the hip outwards. When we are standing on one leg, it contracts to hold the pelvis stable. It can also prevent the leg from turning inwards. It is constantly working while we are active.

What does gluteal tendinopathy feel like?

An aching pain on the outside of your hip, which can radiate down the outside of your thigh to your knee. Pain can be worst at night or first thing in the morning. The area can be tender to touch, and it can be painful to lie on that side or to sit for long periods. Pain is usually aggravated by activity, such as running, climbing stairs or walking.


Gluteal tendinopathy often occurs when we have poor hip control and weakness of the buttock muscles. This can lead to over-stressing of the gluteal muscles and tendons. In addition, tightness of surrounding structures such as the iliotibibal band can lead to compression of the gluteal tendons.

An increase in activity, e.g increasing speed/distance, adding hills or changes in terrain, can trigger gluteal tendinopathy. Inappropriate footwear or poor foot biomechanics can also have an influence.


Your physiotherapist will take a detailed history of your condition and carefully examine your symptoms to determine what structures and activities are causing your pain, what muscles are tight and what muscles are weak. Treatment may involve using rest/ice to reduce your symptoms, stretching and massaging tight muscles and strengthening weak muscles. Progressive gluteal, pelvis and core strengthening is essential, with a gradual return to activity.


Foot pain

The warm weather has brought with it a seasonal spike in the amount of foot pain we are seeing in the clinic. We are featuring two of the more common types that we have seen this summer.


“Itis” just means inflammation, so tendonitis is essentially an inflammation of the tendon. Tendons are essentially like elastic bands, and joint our muscles to the bone. We have lots of these in the foot and ankle, as there isn’t much room in the area for big muscles, and any of these tendons can get inflamed and painful. This type of pain is very bad first thing in the morning and often starts out just with this symptom, but as it gets worse it can become painful when you are on your feet, and throb when you are resting.

The important thing about managing tendonitis is that you catch it early and nip it in the bud. This is so important, as after about 2 weeks of tendonitis, the tendon starts to wear down, and more permanent changes happen to the structure of the tendon. This can leave you with a chronic problem, which, while treatable, requires a bit more expertise, time and effort to address.

Heel pain

The most common area for heel pain is shown in the picture above. This type of pain in the heel can often be caused by heel spurs, or a bruised heel. This sort of pain usually comes on gradually and for no obvious reason, and is typically worse in the morning, improves with exercise (only in the early stages), and is aggravated by standing and eventually walking.

Sometimes this can be caused by tightness in the plantar fascia, which is a soft tissue structure on the sole of our foot. This can get tight from exercising either excessively or with poor support for the foot, and this tightness can then pull on the heel and cause pain. It can also be caused by walking on shoes with too hard a heel, which can essentially bruise the bone.

Again, the important thing when treating heel pain is to settle it down quickly. We usually do this in the clinic by providing some form of small insert to take the pressure off the painful part of the heel. Taping the foot can often help it to feel better more quickly, as can ice massage of the area and loosening out any tightness that may have caused it.

So it is very important to catch it early and fix the problem. There are very often obvious explanations for why you got the pain, if this is the case it is important to eliminate the cause so that you don’t keep encouraging the tendon or heel to be inflamed.

Examples of causes of foot pain in summer-time are:

1. Walking or running on the beach -  this is great for working the leg and foot muscles, however if it is something that you are not used too, and you suddenly started doing alot of it, it can just prove to be a bit much for your feet.

2. Walking or being on your feet for long periods barefoot or in bad flip-flops – if you have flat feet, or feet that are used to cushioning and support, and then you suddenly throw away all of that support and spend long periods in poor or no support (either standing, just being active, or exercising), this again can overwork parts of the foot that are not used to it, and eventually cause those structures to start complaining. Likewise if you have a high arch and suddenly start going barefoot this can irritate the foot.

3. Getting out more! Nice weather encourages us to get outdoors, which is just fantastic. But again, if we go too hard too soon, and push our body beyond its limit and keep pushing it, the structures don’t get enough time to recover by the next exercise session, and they get overworked and damaged. So if you are taking up or resuming an activity, make sure you factor in recovery days, and try to build up gradually. Stretching tight muscles will help to keep things moving more smoothly. See examples of leg stretches here:

4. Weight gain over being overweight or obese puts more pressure on our feet.

How do I treat foot pain if I get it?

Catching and managing it early is key. If the pain is less than 2 weeks old:

1. Rest from whatever activity you think may have caused the problem.

2. Ice the area regularly (10 mins on, 10 mins off and repeat regularly).

3. Taking anti-inflammatory medication or gel can be beneficial (once there is no medical reason why you shouldn’t be taking it).

4. Stretch out tight muscles in the area.

5. Think about your footwear- generally trying to wear something with some arch support, good cushioning and a slight lift at the back of the shoe.

If all of the above doesn’t clear the pain within a week, you have the pain longer than that or it is severe, it is wisest to get it seen to, before longer term issues develop in the foot. We can assess the problem and advise a treatment plan to sort it out. The earlier it is managed correctly the quicker and more complete your recovery, so don’t take any chances. Also bear in mind that these are just 2 examples of foot pain, there are many other causes, so it is important to get assessed to ensure things are dealt with correctly.