Patellofemoral Pain Syndrome (PFPS) is a common complaint we see here in the clinic. This usually presents as a gradual onset of pain in the front of the knee which is generally vague and difficult to pinpoint. This knee pain usually progressively worsens over time and can interfere with your daily activities and overall function. There can be a number of contributing factors to PFPS and therefore it needs a thorough examination to identify the important factors for each individual patient. Factors such as load management, range of motion, strength and control of the hip, knee, ankle and foot can all play a part in the development of PFPS. It is important then, that we identify the contributors and target these factors with an individualised rehabilitation program. Let’s take a look at these factors in some more depth:
Load Management: As with many injuries we see here at Central Performance, the main contributing factor tends to be a sudden increase in activity (running or loading) e.g. getting back to running after a break but trying to do the same distances you were running before you stopped. Although PFPS often affects runners, it can also occur from other repetitive activities such as stair climbing, hiking or hill running as well as excessive compressive activities such as squatting and kneeling. Key to the successful rehabilitation of PFPS is to manage your load in an appropriate and graded way.
Knee Strength and Lateral Tightness: Research shows that people suffering from PFPS tend to have a weakness in the quadriceps muscles. We also see that the structures (eg the ITB) on the outside of the knee and hip are tight and this affects the position of the patella, pulling it laterally and causing increased wear and tear on the cartilage of the knee due to this sub-optimal tracking.
Hip Strength and Control : A lack of hip strength or control, particularly in the gluteal (“glutes”) muscles to the side of your hips, can result in a rolling inwards of the knee during single leg activities (e.g. walking, running, steps etc). This inward rolling (“valgus collapse”) also pulls the patella outwards, which causes further wear and tear on the under surface of the patella itself and on the contact points of the femur.
Ankle and Foot Factors: Stiffness or restriction of the ankle can transfer excess load up the leg and place more stress through the knee. Similarly, if there is a lack of strength in the calf complex, then this can result in an increase in load through the knee joint in order to compensate. Foot posture has also been linked to PFPS, with those people having flat or “pronated” feet more likely to present with patellofemoral pain.
As you can see, managing Patellofemoral Pain Syndrome is as complex as it is to spell it! It requires a thorough assessment and an individualised rehabilitation program addressing the factors that are specific to you and your pain experience – there is no “one size fits all” treatment recipe. So if you are experiencing anterior knee pain our talented team of physio’s can help!
”Every training element has a point of diminishing returns. Our job (the coach’s job) is to find it shift emphasis and cycle back at the optimal point in time.” ~ Derek Hansen
If you’re looking for a great personal trainer in Surry Hills then Central Performance has you covered. Many people know us as a physio or rehab-oriented facility, however you should know that a large part of what we do every day is work with healthy individuals, who are completely free from injury, using tailored exercise programs to improve peoples overall health and sports performance.
Here are some key ingredients that set our exercise services apart;
• it’s all about you. Every exercise program we deliver is specific just for that client and is based on their individual goals, wants, needs, current fitness level and preferences
• exceptional trainers who really care about you. We really make the time and effort to get to know you, your likes and dislikes, what you want to achieve and what might be holding you back. We make sure your time with us is a real highlight of your day, not just just another exercise session.
• a warm and friendly environment where you feel you really belong, amongst a group of people who always want the best for you.
• a dedicated team working hand-in-hand around you to give you everything you need for success. Because our team of trainers and coaches work right alongside our phyiso’s, exercise physiologists and massage therapists, if you do have any injury concerns then help and advice is always on hand.
We work with people at every level of fitness and sports performance, from gym newbies to athletes competing at national and international levels. Whether your goal is weight loss, sports performance, getting your body back to the way you like it, or maybe you just feel sluggish and you know you’ve got to get moving again, we can tailor an exercise program just right for you. Spending too long at the desk and putting on some kilos, or maybe your doctor says you need to get your weight or blood pressure under control with regular exercise? We can help.
One of the most common complaints we see as physio’s is shoulder pain, and it doesn’t just affect athletes. While acute shoulder injuries often happen in collision sports or because of a sporting accident, people performing overhead activities such as lifting in the gym, throwing, racquet sports or swimming are also prone to shoulder pain.
Shoulder Impingement Syndrome is the most common cause of shoulder pain in the general population & with many types of sports activities. It can be very debilitating for people such as swimmers, racquet sports players and gym-goers. Throwing, bowling or pitching sports like cricket, baseball and softball are also common places to find shoulder impingement injuries.
Some occupations that involve lifting, carrying, and other repetitive tasks, especially if they are performed with the arm away from the side of the body, are also common causes of shoulder impingement. Even some common DIY tasks like painting walls or ceilings, repetitive drilling at shoulder height or above, and digging in the garden can bring on the pain.
As the arm is raised, the rotator cuff muscles keep the ball of the humerus tightly in the centre of the socket of the scapula. If this position is not maintained well, the tendons of the rotator cuff may be pinched between the top of the arm bone & the bony “roof” of the scapula. This can cause irritation of the tendon which can lead to inflammation, weakness and pain. Eventually it can lead to more significant problems like tearing of the tendon.
The classic presentation is a painful arc, which is when you feel pain as you lift your arm away from your side and up to your ear. This corresponds with the narrowing of the sub-acromial space, which is where the tendon gets pinched.
Many people also feel pain with twisting movements such as putting on a jacket or when reaching behind your back. When the inflammation is active you may feel pain at night and be unable to sleep comfortably on that side, and your shoulder can ache even when your arm is resting. Sometimes people describe a ‘locking’ sensation in the arm on certain movements.
Initially, avoiding painful activities to help settle your symptoms is important. If you have recently started or significantly increased your exercise regime you may just need to progress more slowly once your pain has resolved. However because most shoulder impingement is caused by an imbalance in muscle length &/or strength around the shoulder, you need to fix the underlying cause of your pain otherwise it is likely to return again in the future. This is especially true if you have had more than one episode of pain because recurrent pain strongly indicates an underlying imbalance within your shoulder, often within the rotator cuff muscles or the muscles that control your shoulder blade.
Keeping correct shoulder alignment relies a lot on keeping the right balance of length and strength within your shoulder muscles. Having a balanced gym program of pulling and pushing exercises is a great way to help achieve this. If you don’t normally go to the gym then you may need to do some extra strengthening for the muscles at the back of your shoulder, especially if you are an office worker and tend to hunch over your desk a lot. Shoulder and pec/chest stretching can also help.
If you have had a significant episode of pain, or several mild-to-moderate episodes recently, then you should get it checked out by a physio because you are very likely to have an underlying imbalance that will keep giving you problems in the future. Treating the pain when it is only recent and relatively mild is usually fairly simple. However, recurrent episodes can lead to more tendon damage requiring prolonged treatment, costly investigations such as an MRI, potentially more invasive management like cortisone, and much more time away from doing the things that you love.
Sydney-siders love a good run! And with the Blackmores running festival coming up, beautiful scenery & awesome weather it’s easy to see why. So today we look at the most common type of knee pain that can affect runners as well as people playing many other sports that involve running and jumping.
The knee is the most common site for pain in runners, but it’s not just “runners” that are at risk. Many other sports that involve running &/or jumping have a relatively high risk of knee injuries. One very common cause of knee pain is Patellofemoral Pain Syndrome, which accounts for up to 40% of all knee problems in sports medicine centres. The pain is felt around or behind the kneecap & occurs when the kneecap (patella) does not align correctly into the groove on the end of the thigh bone (femur). It is common in young people, & affects more women than men.
Pain is either felt around the front part of the knee or along one or both sides of the kneecap. It can sometimes be hard to find a specific spot where the pain is felt the most, especially because sometimes it feels like it is hidden away behind the kneecap. Your knee may be making some grinding or clicking noises, & there may be some swelling.
Often there is no specific cause (eg a fall or twist) of patellofemoral pain. Sometimes you may be able to relate it back to an increase in running or jumping volume, or things like new shoes or more hill running. It often begins as a niggle then gradually gets worse if you continue to exercise on it, eventually stopping you doing your normal training. It usually settles temporarily if you stop exercising but keeps coming back when you return.
Patellofemoral pain is usually made worse with anything that increases the load within your knee, eg taking your weight in a bent-knee position. Examples of painful activities can include;
Some people also get pain from sitting in a bent-knee position for long periods of time, eg working at a desk or sitting in a movie theatre. This is because this position squashes the inflamed back surface the kneecap onto the end of the thigh bone, causing pain after a while.
The main cause of patellofemoral pain is when the kneecap doesn’t “track” properly in the femoral groove when we bend our knee. It can get pulled out to the side of the groove, meaning that it rubs on the wrong places & becomes inflamed. Excessive or rapid increases in loading, usually due to increasing training or running volumes too fast, are also common factors that contribute to patellofemoral pain.
Poor biomechanics (i.e. the way our body controls movement) is the major factor that contributes to incorrect tracking of the kneecap in the femoral groove. Common biomechanical problems include:
Females are more likely to develop patellofemoral pain than males (3:2). This is due to women having a bigger “Q Angle”, which is where the quads muscles have a more outwards pull on the kneecap because women’s hips tend to be wider than mens.
Assessing & correcting your biomechanics is a big part of getting your knee pain resolved. You need to release any tight muscles on your outer thigh & hip, usually by using a foam roller or spikey ball. You will also need to strengthen muscles that are not keeping your leg and knee in the right alignment. The usual problem is that your knee rolls inwards over your big toe too much, so strengthening your glutes muscles to correct this is critical. Making sure that your inner quads muscle (your VMO) is strong enough to balance your outer quads muscle (VL) is also important.
Your foot position also needs to be checked. The most common foot problem is over-pronation, where your inner arch collapses & rotates your shin and knee inwards too much. You will need to ensure that you have the right shoes for your foot type, eg if you are an over-pronator then pronation control shoes or orthotics are likely to help you. However as physio’s we always find that shoe type or orthotics alone are not the full solution – they are only one component. You must correct your other biomechanical factors like hip control as well.
Every day our friendly & experienced physio’s work with runners & athletes at all levels, from weekend warriors to national champions. We can help you with fast relief & get you back out there on the road, track, field or court. We specialise in finding & fixing the underlying cause of your problems so that once we’ve got you feeling good, you stay feeling good.
In Part 2 of this blog post series, we covered the hormone changes that occur in the first phase of the menstrual cycle, the follicular phase. This week we will go into the second phase of the cycle, the luteal phase.
The luteal phase occurs from day 14-28, assuming a 28-day cycle. We know this phase all too well as this is when PMS (pre-menstrual syndrome) symptoms occur! Be aware of food cravings, especially if your symptoms sideline you from your usual workouts.
This phase is the high hormone phase with progesterone at its peak. Progesterone increases the body’s core temperature, lessening tolerance to heat during workouts and increasing sweat which causes the body to lose more sodium. Because of this you need to really make sure you stay on top of your hydration when working out in the hotter months of the year in the second phase of your cycle!
During the luteal phase, the body uses carbohydrate less effectively for energy, instead utilising fat. If you are trying to reach high exercise intensities or need to perform at your best during this time, extra carbohydrates around training sessions may be necessary for you to be able to exercise at your best. Protein breakdown also increases, so its really important to make sure you are recovering adequately with protein sources after a workout.
Examples of high protein snacks to enjoy post-workout includes plain yoghurt with nuts, a fruit smoothie made with milk, yoghurt and fruit, or some boiled eggs.
Try having red meat or salmon for dinner post-workout to aid your recovery and help you get in your essential nutrients during this time of the month.
If you are looking for an effective periodised nutrition plan to suit your cycle and training demands, our sports dietitian Kelsey Hutton can give you everything you need. Your initial assessment with highlight your goals, current nutrition levels & areas to focus on. Your personalised plan gives you a practical & effective way to fuel your body with everything it needs for peak performance.
In part 1 of this blog post series, I talked about the concept of the female athlete triad. Menstrual dysfunction, low energy availability and low bone mass can affect active women without the right nutrition and exercise plan individualised to their needs. Now in part 2 & 3 of this blog post series, I will discuss hormonal changes across the menstrual cycle that can have an effect on exercise and nutrition.
Every females cycle will differ, but assuming a 28-day cycle, there are 2 phases – the follicular phase (day 1 -14) and the luteal phase (day 15 – 28). Day 1 of the cycle is when menstrual bleeding begins.
During the follicular phase (day 1-14), the hormones progesterone and estrogen are at their lowest, with estrogen slowly rising until ovulation occurs on day 14. Testosterone levels are also raised slightly, so muscle building is optimised. Energy levels are at their highest in this phase, and your body is able to effectively use carbohydrates as an energy source in this phase, so you can reach higher exercise intensities during training. As estrogen peaks towards the end of the follicular phase, changes in collagen structure means tendon and ligament tears are more likely to occur, so its important to ensure you are particularly careful with your exercise warm ups and technique.
Increases in strength and energy during the follicular phase means you can take advantage of your body being able to use carbohydrates more effectively as a fuel source and to aid muscle growth and recovery. Think about including carbohydrate foods as a pre-workout meal and including high fibre carbohydrate sources with your meals. Some examples include a banana smoothie before your workout, and brown rice with stir fried chicken and vegetables for dinner. Sleep is also a key consideration during this phase, make sure you are getting enough sleep after your big training sessions to aid recovery!
Stay tuned for Part 3 of this blog series which will go into the hormone changes across the second phase of the cycle and the impacts this can have on exercise performance.
If you are interested in a periodised nutrition plan to suit your cycle and training demands, our sports dietitian can provide individualised guidance. Contact reception on 9280 2322 or head to our online bookings page to book in a chat with Kelsey.
After a long summer it seems the Australian winter is finally upon us; the time of year when cold and flu symptoms are on the rise. It seems as though everyone around you will have advice for how to beat your cold or flu, from drinking honey, ginger and lemon teas, or jumping into a sauna to relieve congestion. It can be hard to separate fact from fiction when it comes to the abundance of remedies, so our dietitian has some simple and reasonable advice for you to follow this winter.
Food can play a really important role in preventing and reducing the severity of colds and flu, which is no surprise because 80% of the immune system is located in the digestive tract. Healthy gut bacteria, proteins and other chemicals are just some of the warriors in the digestive system that help to fight off infections. Before illness comes on, it is important to eat a healthy diet to provide the immune system with these nutrients it needs to fight off infections. Here are just some of the foods that help to protect your immune system and should be included in the everyday diet:
Berries are a great source of Vitamin C which is an antioxidant that has antimicrobial properties, protects immune cells from damage and contributes to maintaining a healthy immune system. Vitamin C can also help to reduce duration and severity of colds. Frozen berries have the same nutrition value as fresh berries, so it doesn’t matter if you buy frozen.
Capsicum contains twice the amount of Vitamin C as citrus fruits. Vitamin C boosts white blood cells to help fight infections. Include capsicum in stir fries or salads.
Broccoli contains Vitamins A, C and E which are antioxidants. Antioxidants assist in preventing cell damage and reduce risk of certain illnesses. Broccoli is best when cooked for the shortest time possible, to keep in the good nutrients
These all have anti-microbial properties, helping to prevent illness. Use these together when cooking stir fries and pasta dishes.
Yoghurt is a good source of probiotics to keep your gut healthy and boost immune function. Choose the unflavoured varieties for benefits e.g. plain Greek yoghurts or plain Chobani/Yo-Pro yoghurts
Salmon is high in Omega-3 (essential fatty acids) which will help to maintain healthy cells and assists with reducing inflammation, particularly important for recovery for those with heavy training loads.
Brazil nuts are high in a nutrient called selenium that helps to protect the body’s cells from oxidative damage. Deficiencies of selenium have been associated with increased risk of illnesses. Incorporate brazil nuts into your diet a few times a week to reap the benefits.
Being sick will often result in a decrease in appetite, so every meal consumed while sick is an opportunity to choose nutrient rich foods that will help to fight off infection and speed up recovery. Some foods that should be included in the diet during a bout of cold or flu includes:
What do citrus fruits, tomatoes, pumpkin, capsicum and sweet potatoes have in common? These foods are all high in Vitamin C, which is an antioxidant that has been found to assist with reducing the severity and longevity of colds by protecting cells from damage. Try a roast vegetable tray with tomato, pumpkin, capsicum and sweet potato, or snack on some oranges or mandarins.
Garlic has antimicrobial properties so acts as an antibiotic that can help to reduce the severity of your cold.
Chicken soup has long been a favourite of Mum’s everywhere to help fight off a cold, but Vietnamese Pho is another great option! This big bowl of warming soup will help to rehydrate you by providing plenty of fluid and electrolytes and provides a source of protein. You can even order extra meat to boost the protein content!
Supplements that reduce the severity and duration of colds can be really useful, particularly when you don’t feel like eating a lot! The following are good quality supplements that I recommend you to use while sick:
Lastly, the most important thing you can do for yourself is to eat a healthy and varied diet to protect your immune system. Make sure you rest and eat well when sick, using supplements if needed to help reduce the longevity and severity of colds and flu. Book in an appointment with our dietitian to find out more about how a healthy diet can positively affect your wellbeing.