Runner Lacing Up with Achilles Pain

Achilles Tendon Myths

Achilles Tendon Myths

By Aaron Woolley, Physiotherapist

The Achilles tendon serves as the robust link between the muscles of the calf and the foot. Symptoms of Achilles tendinopathy often include pain in the tendon, stiffness following periods of rest, and sensitivity to touch. This condition is typically a result of excessive strain on the tendon or sudden increases in physical activity. It is seen in 25% of professional athletes and affects approximately 15% of recreational runners. It’s no surprise that this issue is commonly encountered at Robina Physio on the Gold Coast. Despite its prevalence, there are many myths and misconceptions surrounding its causes, treatment, and management. This blog post aims to debunk some of the Achilles Tendon Myths and provide evidence-based information to help individuals better understand Achilles tendinopathy.Achilles pain diagram Achilles myths

Myth 1: Only Athletes Get Achilles Tendinopathy

One of the most pervasive myths is that Achilles tendinopathy only affects athletes, particularly runners. While it’s true that athletes are at a higher risk due to repetitive strain and overuse, anyone can develop the condition. Many factors including poor footwear, excessive pronation, sudden increases in physical activity, and even certain medical conditions can contribute to the development of Achilles tendinopathy in non-athletes.

Myth 2: Complete Rest is the Best Treatment

This is probably the most widespread Achilles Tendon Myths around. Historically, complete rest was prescribed as the primary treatment for Achilles tendinopathy. However, recent evidence suggests that complete rest can actually hinder recovery. While it’s important to minimise activities that exacerbate the pain initially, gentle movement and specific exercises that promote tendon loading and healing are now recommended. Eccentric exercises, which involve lengthening the muscle while contracting it, have been shown to be particularly effective in treating Achilles tendinopathy.

Myth 3: Steroid Injections are a Quick Fix

Steroid injections are often thought of as a quick fix for pain relief in various musculoskeletal conditions, including Achilles tendinopathy. However, research indicates that steroid injections may weaken the tendon over time and increase the risk of tendon rupture. Therefore, this Achilles Tendon Myths has the potential to really set back progress and potentially worsen your tendons integrity. Instead, physiotherapy directed treatment like at Robina Physio on the Gold Coast, including exercises tailored to the individual’s condition and pain management techniques, is the preferred approach.

Myth 4: Surgery is Often Necessary

Surgery is sometimes considered a necessary step for those suffering from Achilles tendinopathy, especially when conservative treatments fail. While surgery can be an option for chronic, non-responsive cases, it’s often seen as a last resort. Many individuals with Achilles tendinopathy can achieve significant improvement or even full recovery with a well-designed physiotherapy program focused on strengthening and flexibility exercises. But bear in mind that an Achilles rupture is different beast and may require surgery more frequently.

Myth 5: Pain Equals Damage

The belief that pain is always indicative of damage is a common misconception. In the context of Achilles tendinopathy, pain does not necessarily correlate with the amount of tendon damage. It’s possible to have significant pain with minimal tissue damage and vice versa. This is why assessing and treating Achilles tendinopathy requires a comprehensive approach that considers pain levels, functional limitations, and individual goals rather than relying solely on imaging findings. When managing Achilles tendinopathy slight pain can sometimes be considered favourable.Runner Lacing Up with Achilles Tendon

Myth 6: All Pain Should be Avoided During Recovery

While it’s important to manage pain and avoid activities that cause significant discomfort, some level of pain is acceptable and even expected during the recovery process. A general guideline is the “24-hour rule,” where exercises that cause pain that returns to baseline within 24 hours are considered safe. This approach encourages gradual loading of the tendon, which is essential for healing.

Myth 7: Only High-Intensity Exercise Benefits Achilles Tendinopathy

While high-intensity exercise can be part of a rehabilitation program for Achilles tendinopathy, it’s not the only beneficial form of exercise. Low to moderate intensity exercises, particularly those focusing on tendon loading and stretching, play a crucial role in the recovery process. These exercises help improve tendon health and function without placing excessive stress on the tendon. The expert physiotherapists at Robina Physio on the Gold Coast can put together the highest quality loading program available to treat your Achilles pain incorporating these forms of loading.

Achilles Physio Gold Coast: Achilles Tendon Myths

Achilles tendinopathy can be a frustrating and debilitating condition, but understanding the facts can empower individuals to seek effective treatment and manage their recovery more effectively. By debunking these myths, we hope to provide a clearer path to recovery for those affected by Achilles tendinopathy.

Remember, a personalised approach to treatment, focusing on gradual progression and addressing individual needs, is key to successful management. If you suspect you have Achilles tendinopathy, consulting a physiotherapist or healthcare professional is the first step towards understanding and overcoming this condition.

At Robina Physio on the Gold Coast, we take a comprehensive approach that extends beyond merely diagnosing your injury and handing you a rehabilitation plan. After a thorough evaluation, our primary goal is to swiftly return you to your favourite sports and activities. Our rehabilitation strategy not only provides direct treatment to alleviate your pain, but also includes a comprehensive exercise regimen and a strategically developed plan for your return to running. Recognising the significance of load management, we continue our support by assisting in the planning of your training sessions, ensuring a safe and gradual increase in your running intensity.

I hope you found this article on Achilles Tendon Myths insightful. If your struggling with Achilles Pain and Tendinopathy visit our expert physiotherapists at Robina Physio on the Gold Coast and getting running pain free again. Don’t hesitate to Contact Us on (07) 5578 7233 or BOOK ONLINE.

Calf Muscle Stretch On Step

Sever’s Disease

Sever’s Disease

By Aaron Woolley, Physiotherapist.

Sever’s disease is the common name for a condition called calcaneal apophysitis. This is a very common condition that affects children/adolescents between the ages of 8-14 and is more common in boys than girls. This injury tends to be more prevalent in sports that involve repetitive activities including running and jumping. However, less active children and adolescents may also experience this condition if they have excessive pronation of their feet and wear unsupportive/flat shoes.

Repetitive overload and pulling on the calcaneal apophysis (C-shaped bone below) causes the growth zone to become inflamed. Sever’s disease presents with pain and tenderness at the back of the heel and/or underneath the heel. The pain typically worsens with activity, although it’s not uncommon for it to feel worse immediately after stopping activity as well. Other traction injuries that a similar to Sever’s disease are Osgood-Schlatter Disease (knee), Sinding-Larsen-Johansson Syndrome (knee), Iliac (Pelvis) and hamstring apophysitis (Pelvis).

Sever's disease anatomy–conditions/severs-disease/

At Robina Physio on the Gold Coast we see this condition quite frequently at the beginning of a sports season. This tends to happen because overuse conditions such as Sever’s disease are very sensitive to changes in activity load. Unfortunately, due to regular stoppages in sports seasons over the last 18 months due to COVID-19 we have seen increased presentations of these injuries. When sport returns again after the latest lockdown, another increase in presentation of this condition is likely for physiotherapists.

The good news is there are some effective ways to treat Sever’s disease and even better completely prevent it. Below are some simple things you can try to help prevent Sever’s disease.

  1. Wear good quality and supportive running shoes and boots when training and at school. Try choosing boots with a slightly elevated heel.
  2. Gradually build the running volume in the lead up to and during the beginning of your sports season.
  3. Of course, warm up and cool down properly. Remember to stretch those leg muscles regularly (especially the calf muscles).

If you’re already suffering from Sever’s disease, you will find some nice tips to help manage your injury below. Combining these tips with treatment from the team at Robina Physio on the Gold Coast should speed your recovery and get you out of pain faster. Although not mentioned below, rest from the aggravating activity is often very helpful but it’s important the return to sport is done correctly otherwise the condition is highly likely to return.

Calf Foam Roller Release: Aim for 30-50 rolls on each leg, especially after training and competition. (Pic from Telehab)

Sever's Disease Roller

Calf Stretching: Hold for 20-30 seconds, repeat 2-3 times. Try to perform most days per week. (Pic from Telehab)

Sever's Disease Stretching


Heel Wedges: I would only try these if the symptoms are severe or not responding to other treatments. A small heel lift can decrease the loading on the calcaneus.

Sever's Disease Wedge

If you need assistance to manage Sever’s disease and want to return to pain free running and sport the team at Robina Physiotherapy on the Gold Coast would love to help. Contact Us on (07)5578 7233 or BOOK ONLINE.

Spine Bending

Scoliosis Physio

Scoliosis Physio

By Aaron Woolley, Physiotherapist.

Continuing with the Robina Physio blog series, we shift our focus to an equally significant but often misunderstood condition: scoliosis. Scoliosis physio presents its unique challenges and more often than not requires a specialised approach of physiotherapy management.

Spinal Anatomy

Before we take the deep dive into scoliosis physio it’s important we understand normal spinal anatomy. The human spinal column is typically composed of 33 vertebrae, categorised into several distinct regions. This structure includes 24 individual vertebrae, along with 9 fused vertebrae forming two separate regions at the base.Spinal Anatomy

Specifically, the spine consists of:

  1. Cervical Vertebrae: The uppermost section, comprising 7 cervical vertebrae.
  2. Thoracic Vertebrae: Following the cervical region, there are 12 thoracic vertebrae.
  3. Lumbar Vertebrae: Below the thoracic region, 5 lumbar vertebrae are located.
  4. Sacrum: This is a fusion of 5 vertebrae, forming a single structure.
  5. Coccyx: Commonly known as the tailbone, typically involving 4 fused vertebrae.

Variations in this structure are possible, including conditions like hemi-vertebrae and fusion of vertebrae in regions outside the sacrum and coccyx.

In terms of spinal curvature, when viewed from the side, the vertebral column in an upright posture reveals five distinct curves:

  1. Cervical Curves: There are two curves in the cervical spine. The upper cervical curve stretches from the base of the skull (occiput) to the second vertebra (axis), curving convexly forward. Conversely, the lower cervical curve, which is lordotic, extends from the axis to the second thoracic vertebra, curving in the opposite direction of the upper curve.
  2. Thoracic Curve: This curve spans from the second to the twelfth thoracic vertebrae (T2 to T12), and is concave forward. This concavity results from the posterior parts of the vertebral bodies being deeper in this region. Additionally, a slight lateral curve is often present in the upper thoracic area, with the convexity directed either to the right or left.
  3. Lumbar Curve: Extending from the first lumbar vertebra (L1) to the junction where the lumbar spine meets the sacrum, this curve is convex forward.
  4. Sacral Curve: This curve, which includes the sacrum, extends from the lumbosacral junction to the coccyx. It is characterised by a forward and downward facing anterior concavity.

Understanding Scoliosis

Scoliosis is a condition characterised by an abnormal lateral (sideways) curvature of the spine. It can occur in children and adults, but it is most commonly identified in adolescents. The curvature can vary in degree, and in some cases, it may be accompanied by a rotation of the spine, leading to a more complex three-dimensional deformity. Scoliosis affects 3% of the population and is more prevalent in females. The severity of the condition ranges from mild to severe, resulting in a diverse array of treatment options. Notably, females have an eightfold increased risk of developing a degree of curvature that requires medical intervention. At Robina Physio on the Gold Coast our Physiotherapists are experts with a deep understanding of the human spine and conditions affecting its function.

Causes and Types of Scoliosis

The exact cause of scoliosis is often unknown (idiopathic), particularly in adolescents. However, some cases are attributed to congenital spinal deformities, neuromuscular conditions, or trauma. Scoliosis can be broadly categorised into three types:

  1. Idiopathic Scoliosis: accounts for approximately 80% of scoliosis diagnoses, identified by the process of excluding other potential causes. The designation ‘idiopathic’ implies that the underlying cause of the condition remains unknown.
  2. Congenital Scoliosis: arises during embryonic development, leading to the malformation of one or more spinal vertebrae. This can happen at any point along the spine and is due to disparities in growth rates within different sections of the spinal column, resulting in curvature and other spinal deformities. Since these irregularities are present from birth, congenital scoliosis is often discovered earlier than idiopathic scoliosis.
  3. Neuromuscular Scoliosis: is a form that develops as a consequence of underlying neurological or muscular disorders, such as spinal muscular atrophy, cerebral palsy, and spina bifida. This variation of scoliosis tends to progress more swiftly than idiopathic scoliosis and frequently necessitates surgical intervention.

Signs and Symptoms

For many scoliosis is more of an aesthetic issue, but it can also lead to physical discomfort and impact overall health. Common signs include:

  • Visible curvature of the spine
  • Uneven shoulders or hips
  • Rib prominence or a prominent shoulder blade
  • Back pain or discomfort
  • Fatigue due to muscle strain

Diagnosis and Assessment

Diagnosis typically involves a physical examination, including the Adam’s Forward Bend Test, and imaging tests like X-rays to determine the curvature’s angle (Cobb Angle). In physiotherapy, a comprehensive assessment is crucial to tailor the treatment effectively. This assessment may include:

  • Evaluating the spine’s range of motion
  • Muscle strength testing
  • Postural analysis
  • Assessing breathing patterns and lung capacityScoliosis Cobb Angle

Physiotherapy Management

The role of physiotherapy in managing scoliosis is pivotal. While severe cases may require more intensive treatments such as bracing or surgery, many individuals with scoliosis benefit significantly from conservative interventions.

  1. Exercise Therapy: Specific exercises are designed to strengthen and stabilise the muscles supporting the spine. This includes strengthening the core, improving posture, and specific stretching exercises to help counter the curvatures pulling.
  2. Manual Therapy: Techniques like soft tissue mobilisation and spinal manipulation can help alleviate pain and improve spinal mobility. Unfortunately, those with scoliosis have a higher prevalence of back pain. This can be managed well expert physio care similar to that provided at Robina Physio on the Gold Coast.
  3. Postural Training: Educating patients on maintaining proper posture during daily activities is crucial in managing scoliosis. It is very common for people with scoliosis to experience other structural/functional changes including winging scapula and forward head posture.
  4. Bracing and Support: In some cases, particularly in growing children and adolescents, bracing might be recommended. Some studies have shown it may help to prevent the future progression of the curve in some patients. The downside is the brace typically needs to be worn 23 hours per day.

The majority of scoliosis cases are only mild with Cobb angles less than 20 degrees and will be managed with observation and physiotherapy. Once angles start to get between 30-40 degrees intervention such as bracing may be considered for some depending on their age. Only once Cobb angles to a more severe level of 40-50 degrees is surgery then considered.

Other than surgery no interventions has been proven to improve a patient’s spinal curvature. But conservative interventions have been shown to be useful in minimising pain and curvature progression. Although it’s important to note that improving the curvature angle doesn’t necessarily mean an improvement of pain and/or function. Therefore, you should take careful consideration when deciding on which treatment path to take.

At Robina Physio on the Gold Coast our Physiotherapists work in conjunction with your GP and Orthopaedic specialist to ensure your and/or your loved get the highest quality care which is guided by the most up to date evidence-based treatments and advice.

Spine Bending

Photo by Inge Poelman

The Good News

While scoliosis cannot always be prevented, early detection and intervention can significantly impact the progression and management of the condition. The vast majority to people with scoliosis have little to no symptoms other than the aesthetic appearance of the spine. Even people with larger curvatures still function normally without limitation, even at an elite sporting level. So overall don’t let a scoliosis diagnosis scare or dishearten you unnecessarily.

Scoliosis, much like TMJ dysfunction, requires a nuanced and specialised approach in physiotherapy. The goal is not just to manage the curvature of the spine but to enhance overall quality of life, ensuring individuals with scoliosis can lead active, healthy lives. At Robina Physio on the Gold Coast, our dedicated team is trained to provide comprehensive care for those dealing with scoliosis, offering support and tailored interventions every step of the way.

If you or someone you know is struggling with scoliosis, don’t hesitate to seek professional help. Early intervention can make a significant difference. Contact Us at Robina Physio on the Gold Coast or BOOK ONLINE to schedule a consultation and take the first step towards effective management of scoliosis.

Achilles Pain

Achilles Pain

Achilles Pain

By Aaron Woolley, Physiotherapist.

Achilles Pain is a common complaint affecting large numbers of people in the community. The most common injury encountered is termed Achilles Tendinopathy. An overuse injury that involves a range of pathological alterations in the Achilles tendon, often resulting from prolonged overuse and chronic excessive strain on the tendon. This condition is observed in both athletes and non-athletes and may occur with or without an accompanying Achilles tendon tear. Reduced flexibility or stiffness in the Achilles tendon can heighten the risk of such injuries.Achilles Pain

What is the Achilles Tendon?

The Achilles tendon holds the title of the largest and most robust tendon in the human body, endowed with the ability to withstand substantial tensile loads. This tendon emerges from the lower union of the gastrocnemius and soleus muscles and anchors into the lower part of the heel bone, known as the calcaneus.

Encasing the Achilles tendon is a structure called the paratendon, functioning like an elastic sheath that grants the tendon the liberty to glide amidst the neighbouring tissues. However, the vascular supply along the tendon’s length is relatively deficient, as evidenced by the scant count of blood vessels per unit of cross-sectional area. This is particularly true for the segment situated 4-6 cm above the heel bone. Such limited blood flow is often associated with longer healing times after sustaining an injury.

What is a Tendinopathy?

Tendinopathy can be depicted as existing on a spectrum. Progressing along this spectrum, one encounters a robust and healthy tendon, which can transition into a reactive tendinopathy stage. This stage further evolves into tendon disrepair and eventually leads to a degenerative tendon. A tendon’s position on this spectrum is influenced by the loads it endures, and this position can fluctuate based on different factors.

Clinically, tendinopathy is often described as a tendon’s unsuccessful attempt at healing. This condition involves abnormal growth in tenocytes (the cells of a tendon), disturbances within these cells, a breakdown in the collagen fibres, and an increase in the non-collagenous substances within the tendon. The term “tendinopathy” is a general term used for conditions linked to tendon overuse, which includes both the experience of pain and pathological changes. Moreover, tendinopathy is marked by pain, reduced functional ability, and a decreased tolerance for exercise.

Achilles Pain (tendinopathy) can be categorised as either insertional or mid-portion, distinguished primarily by the location of the condition. Insertional Achilles tendinopathy occurs at the junction where the Achilles tendon meets the bone, specifically within 2 cm of its insertion point. In contrast, mid-portion Achilles tendinopathy is found in the body of the tendon, more than 2 cm away from where it attaches to the bone.

Causes of Achilles Pain (Tendinopathy)

The precise cause of Achilles Tendinopathy remains unclear. Achilles pain is often thought of as an injury that only affect sports people. But in-fact this injury is also often found in people who do not practice sports. What we do know is that Achilles tendinopathy is caused from both intrinsic and extrinsic factors. The causes and mechanisms include:

Intrinsic factors: Age, sex, metabolic dysfunction, muscle weakness/imbalance, gastrocnemius dysfunction, anatomical variation of the plantaris muscle, tendon vascularization, torsion of the Achilles tendons and lateral instability of the ankle.

Extrinsic factors: Include mechanical overload, constant effort, inadequate equipment, obesity, medications (corticosteroids, anabolic steroids, fluoroquinolones), improper footwear use, insufficient warming or stretching and sharp changes in training loads.

Achilles Pain Presentation and Assessment

Pain experienced in the morning is a signature symptom, as the Achilles tendon is required to endure a complete range of motion, including stretching, right after rising in the morning. Typically, symptoms are concentrated in the tendon itself and the adjacent area. Swelling of the Achilles tendon is not common but in chronic cases the tendon may become thickened at the tendinopathy site.

When assessing Achilles Pain, a thorough subjective examination gives many key clues to the mechanism of injury. On objective examination palpation of the tendon is one of the most useful tests. A positive result would result in pain, +/- thickening of the tendon of the site. Other important examination components include, range of motion, strength testing, anatomical and technique analysis and special tests including the arc sign and Royal London Hospital Test.

Imaging studies are not essential for diagnosing Achilles Pain (Tendinopathy) but can be beneficial for distinguishing it from other conditions. Ultrasound stands out as the preferred imaging method because it clearly reveals the tendon’s dimensions, variations in the tendon’s water content and collagen structure, as well as any swelling in the bursa. If the diagnosis is uncertain or if the symptoms do not follow the typical pattern, an MRI might be recommended.

At Robina Physio on the Gold Coast, we work closely with GP’s, Sports Physicians and Orthopaedic Specialists. This collaboration is especially important in more severe cases that may require more intensive treatments that are available such as PRP injections and in rare cases surgery. Our aim is to provide comprehensive care and support to address your Achilles issues effectively and get you walking and running again pain free.

Achilles Pain (Tendinopathy) Treatments

Treating tendon issues is the bread and butter of any physio. At Robina Physio on the Gold Coast we use highly effective treatment techniques and get fantastic results for managing Achilles pain. Treatment techniques we use includes:

  1. Load Management: As this injury is mostly impacted by over loading of the Achilles, this is perhaps the most important factor when managing Achilles pain. Finding the “sweet spot” of load is important, followed by gradually increasing tendon loads within the Achilles limits.
  2. Strengthening Exercises / Tendon Loading: Used in conjunction with load management, gradually loading the Achilles in a specific manner is key to stimulating a healing response within the tendon. Typically, we start with isometric holds, then progress into isotonic contractions with progressively increasing loads that match the sport specific needs of the tendon.Achilles Pain Calf Raise
  3. Technique Correction: Poor biomechanics are a common problem related to Achilles pain. These poor biomechanics may need shoe adjustments but also often require running technique assessment and correction. At Robina Physio on the Gold Coast we have highly experienced running physios that offer in depth running and footwear analysis.
  4. Soft Tissue Release: Maintaining the balance of muscles in the leg e.g. gastrocnemius and soleus are an important adjunct to managing Achilles pain. Tightness in the lower limb is often present in people with Achilles pain.
  5. Dry Needling: Is another highly effective adjunct treatment Robina Physio on the Gold Coast offers. In many cases a combination dry needling the leg muscles and threading the Achilles tendon to help relieve pain and promote healing is highly effective.Achilles Pain Dry Needling

Achilles Pain Physio Gold Coast

I hope you found this information helpful. The Physiotherapists at Robina Physio are highly experienced and highly trained in the management of Achilles pain. If your struggling with Achilles Pain and Tendinopathy please don’t hesitate to Contact Us on (07) 5578 7233 or BOOK ONLINE.

Runner at Sunshine Coast Marathon

Running Physio

Running Physio

By Aaron Woolley. Gold Coast Physio, Robina Physiotherapy.

Running is an excellent activity that offers numerous health benefits. Not only does it help with cardiovascular fitness, it also is great for building soft tissue strength, bone density and has huge benefits for mental health. Running also has great community engagement and therefore has great social interactions whether you’re just starting out or a seasoned competitor. Almost all runners will experience an injury during their running journey. Thankfully, the majority of running injuries are minor and with good quality physiotherapy rehabilitation like you would receive with a Running Physio at Robina Physio on the Gold Coast these injuries can be treated quickly and effectively.

In this article, we will delve into the common causes of running injuries, signs to watch out for, and tips to help you remain injury-free. We will also highlight the pivotal role a Running Physio at Robina Physio on the Gold Coast can have in both managing and preventing future injuries.Runner at Sunshine Coast Marathon

Common Running Injuries

  • ITB Syndrome: The ITB, running from the hip to the ankle, aids in knee stabilization. However, its structure makes it prone to injuries, especially when there’s excessive tension on the lateral knee. Symptoms include pain on the knee’s outer side, worsening pain during runs, discomfort when ascending or descending stairs, and post-run soreness.
  • Patellofemoral Joint Syndrome: The kneecap endures significant force during runs. An imbalance or excessive force can lead to pain around the kneecap. Symptoms often include a vague, shifting pain that might intensify during a run but occasionally diminishes for some runners.
  • Muscle Tightness and Strains: Muscles tightness and pain is highly common in runners. Muscles in the legs, gluts and lower back are the most common sites for muscle pain. But considering that running involves the entire body, running related muscle pain could affect any muscle in the body. Getting an assessment and soft tissue release from an expert running physio at Robina Physio on the Gold Coast can quickly improve this and get you running again. BOOK ONLINE HERE!
  • Shin Splints: Shin splints are characterised by pain along the inside border of the tibia. Swelling in the area may or may not be present. It is common for shin splint related pain to feel like Be dull and throbbing pain that occurs during and after running. Shin splints is often worse at the beginning of running, gets better as you warm up, then worse again following running.Shin Splints Robina Physio
  • Plantar Fasciitis: This condition affects the thick band beneath the foot, crucial for arch support. Symptoms typically include pain near the heel, which may extend across the foot, exacerbated pain during runs, and post-run soreness. Poor running and foot biomechanics highly impact the likelihood of experiencing plantar fasciitis.
  • Achilles Tendinopathy: Tendons, especially the Achilles, can get injured if they can’t handle the exerted load. Symptoms include pinpointed tenderness, a “warm-up effect” where pain decreases during a run, post-run discomfort, and recurring pain after resuming runs post-rest.
  • Stress Fractures: Stress fractures are caused from multiple factors including training overload and poor technique. A stress fracture is a small crack in the bone and presents with persistent pain which is aggravated by running. The most common sites for stress fractures in runners are the tibia and foot. These injuries can often be mis-diagnosed as shin splints so getting an examination from a running physio at Robina Physio on the Gold Coast is highly recommended if you are experiencing shin or foot pain from running.

Factors Increasing Injury Risk:

  • Mis-managed training loads: Arguably the most significant risk factor, poor load management refers to how much running you undertake. Many who visit our clinic fall into the ‘overtrained’ category. Overtraining happens when your body hasn’t had the chance to adapt to the volume of running you’re doing, leading to injuries. It’s a delicate balance between building endurance and managing your running load. See my previous load management blog HERE.
  • Changes in Footwear and/or Technique: It’s common for runners to experience discomfort after switching to a new pair of shoes. Even if the new pair is of the same model and make, the change can introduce a risk. It’s vital to break in new shoes gradually before committing to long runs. You also need to be careful when adjusting your technique. Small changes can drastically transfer forces to new muscles, tendons and bones. This can easily lead to injury if you don’t also adapt your training loads during this time.
  • Inadequate Strength: Strength training plays a vital role in injury prevention. A strong body can handle more stress and protect itself better as your tissues can improve their tolerance to the high impacts involved with running. Some of our joints and tendons experience upwards of 4 times your body weight every stride. Doing a full body strength session that incorporates running specific lower limb exercises (e.g. lunges and step ups) is a must, and don’t forget that core strength.
  • Excessive Muscle Tightness: Running tends to load specific muscles more than others (e.g. calf, quadriceps, hamstrings, gluts and TFL). Overtime these muscles can easily become pathologically tight leading to imbalance and pain. Making you incorporate some mobility work into your training program either with some stretching, foam rolling and/or massage. Getting some massage and dry needling from a Gold Coast Running Physio at Robina Physio will help considerably with this. Foam Roller Calf Muscle

How to Stay Injury Free:

  • Structured Training Plans: Planning is very important in load management and decreasing overuse injuries. Gradually increasing your volumes and strategically adding intensity will make your training more effective and minimise your injury risk. Try to aim for an increase in volume of approximately 10-15% per week, any higher and your injury risk skyrockets.
  • Add Resistance Training: The age-old debate about whether distance runners should incorporate strength training rages on in some communities. But the evidence is clear that strength training is key to preventing and treating injuries. It has also been shown to improve running performance, so really, it’s a no brainer in my book. Adding strength training 2-3 times per weeks can be a huge boost. Try working your entire body in a session and include some more running specific exercises that use “split type stances” e.g. lunges, step ups and single leg deadlifts.
  • Early Intervention: Early detection and timely professional intervention can hasten recovery. Prolonged neglect only exacerbates the injury, making recovery more challenging. Even if it only feels like a small niggle get in and see our Gold Coast Running Physios at Robina Physio straight away for prompt and effective treatment to keep you running harder and longer.

At Robina Physio on the Gold Coast our mission surpasses mere injury diagnosis and treatment. After a comprehensive assessment, we focus on a swift, effective rehabilitation process to get you back on track. Our multifaceted approach includes hands-on treatments, tailored exercise programs, and structured return-to-running plans.

Remember, as Physiotherapists, our goal isn’t just recovery; it’s prevention. We’re deeply invested in injury prevention, frequently conducting running assessments to help avid runners remain injury-free.

If you’re suffering with an injury or need guidance to prevent injuries and set up a training plan, Contact Us on (07)55787233 or BOOK ONLINE with our expert Physiotherapists today! Stay safe, keep running!

Tendon Pain Gold Coast

Tendon Pain

Tendon Pain

By Aaron Woolley, Physiotherapist – Robina Physio Gold Coast

Why am I Getting Tendon Pain?

Tendinopathy is a condition that affects many tendons in the body and often leads to extensive tendon pain. People who participate in activities that require repetitive high-level loads including running and jumping, gripping with force and heavy lifting often experience tendinopathy related pain. Managing Tendon pain is bread and butter for the Physiotherapists at Robina Physio on the Gold Coast, so don’t hesitate to BOOK ONLINE and receive expert care.Tendon Pain Gold Coast

Tendons play a crucial role in our musculoskeletal system. These tensile structures connect our muscles to the bones, transferring the force produced by muscles, enabling us to move. Similar to muscles, tendons also respond to load. For instance, rigorous strength training at the gym can result in muscle growth. Likewise, when tendons are appropriately loaded, they become stronger and better equipped to handle intense forces.

However, tendons have their limits. If we subject them to sudden and severe forces they may suffer an acute tear but also if load them in an improper and excessive manner over a long period of they, they might not adapt correctly. This can lead to a change in their structure, resulting in a pathological state. Indicators of this pathological change include an increase in water content within the tendon, disturbances in the type and structure of collagen (cells of the tendon), and the growth of nerve and blood vessels in the tendon area. All these changes can result in pain and a feeling of weakness in the affected area.

What is a Tendinopathy?

Tendinopathy can be visualized on a continuum. At one end, you have a mechanically frail tendon. Move along the spectrum, and you find a healthy, robust tendon, which can then shift to a state of reactive tendinopathy, further morphing into tendon disrepair, and ultimately, a degenerative tendon. The position of a tendon on this continuum is determined by the loads it’s subjected to and can oscillate based on varying conditions.

Tendinopathy, in clinical terms, is often defined as a failed healing response of the tendon. This involves irregular growth of tenocytes (tendon cells), intracellular abnormalities within these tenocytes, a disruption in the collagen fibres, and an increase in non-collagenous matrix. The term “tendinopathy” serves as a broad descriptor for clinical conditions associated with tendon overuse, encompassing both pain and pathological attributes. Furthermore, tendinopathy is characterized by pain, diminished function, and intolerance to exercise.

Common sites for tendinopathy include:

  • Lateral Elbow (Tennis Elbow)
  • Medial Elbow (Golfers Elbow)
  • Patella Tendon
  • Achilles Tendon
  • Rotator Cuff
  • Hamstring and Gluteal Tendons

    Tennis Elbow Tendon Pain


Typically, individuals with tendinopathy type tendon pain describe a progressive increase in pain at the affected tendon’s site, often linked to escalated activity levels. The tendon pain is generally associated with the load exerted on the tendon. In early tendinopathy stages, the pain might be present only at the activity’s onset, disappearing during the activity but returning once the activity is concluded.

Tendinopathy Treatment

Thankfully high-quality physiotherapy intervention can fix your pain and with the right loading and management plan even lead to repair of the tendon structure and return to sport. At Robina Physio on the Gold Coast we use a multifaceted approach to tendon management and get great long-lasting results with our patients.

Early intervention can mitigate further damage and expedite recovery. At Robina Physio on the Gold Coast, our skilled physiotherapists will aid in alleviating your tendon pain. Furthermore, we’ll delve deep to identify and address the root causes contributing to your discomfort. Through strengthening exercises, running drills, technique modifications, functional exercises, and/or a comprehensive load management plan, we aim to set you back on the path to pain-free movement.

CONTACT US on (07)55787233 or BOOK ONLINE today and get you tendon pain resolved ASAP.

Neck Pain Physio

Neck Pain

Neck Pain

By Aaron Woolley, Physiotherapist.

Neck pain (NP) is a prevalent condition that affects a significant portion of the global population. Studies suggest that approximately two-thirds of the population will experience neck pain at some point in their lives. The prevalence of NP varies across different studies, with mean reported estimates indicating 7.6% for point prevalence and 48.5% for lifetime prevalence. This condition is more commonly observed among women, individuals suffering from anxiety or depression, and office workers with poor ergonomic positions. To effectively address neck pain, it is crucial to understand its anatomy, potential causes, and available physiotherapy treatments.Neck Pain Physio

Anatomy of the Neck

The neck is a highly complex structure composed of bones, joints, muscles, tendons, ligaments, and nerves. It consists of seven bones, C1 to C7, which make up the cervical vertebrae. These bones articulate with each other with the intervertebral disc at the front and facet joints at the rear.

There are numerous large and powerful muscles supporting the neck, including the trapezius, sternocleidomastoid, levator scapulae, splenius capitis and cervicis and deep neck flexors. These muscles facilitate gross motor movements in the neck as well as provided postural control and support. Any condition involving these muscles and tendons can be a strong pain generator and severely impact cervical spine mobility.

The cervical spine nerves, a set of eight nerves (C1 to C8), provide functional control and sensation to various body parts based on their respective spinal levels. Compression or irritation of these nerves can lead to pain and tingling sensations, often felt in the upper limb or shoulder girdle.

Common Causes of Neck Pain

  1. Muscle Pain: Overuse of neck muscles due to poor posture, prolonged sitting, or incorrect ergonomics is a leading cause of neck pain. Strained neck muscles can be painful and restrict motion.
  2. Muscle Imbalance: Focusing excessively on training the upper trapezius muscles, neglecting the lower and mid traps, may lead to overstimulation of the upper traps, resulting in neck pain.
  3. Osteoarthritis: As we age, the neck’s joints can become worn down, leading to conditions like osteoarthritis. Deterioration of cartilage between vertebrae and the formation of osteophytes can impact range of motion and cause pain.
  4. Nerve Compression: Herniated disks or osteophytes in the vertebrae can press on the nerves branching out from the intervertebral foramen, causing pain and discomfort.
  5. Injuries: Motor vehicle accidents and sporting injuries, especially those resulting in whiplash, can strain the soft tissues of the neck, leading to pain and reduced mobility.
  6. Diseases: Certain diseases like rheumatoid arthritis, meningitis, or cancer can also contribute to neck pain.

Managing Neck Pain

At Robina Physio on the Gold Coast, we offer effective strategies for managing neck pain and improving the overall health of the neck and surrounding structures. Here are some essential physiotherapy techniques:

  1. Therapeutic Exercises: A physiotherapist can design a personalised exercise programs to strengthen weak neck muscles, improve flexibility, and correct muscle imbalances. These exercises may include neck stretches, range of motion exercises, and strengthening routines.
  2. Manual Therapy: Hands-on techniques, such as massage, joint mobilisation, and trigger point therapy, can help alleviate muscle tension and therefore pain and mobility.
  3. Postural Correction: Proper posture can play a crucial role in reducing pain. A physiotherapist can assess your posture and provide guidance on maintaining correct alignment during various activities.
  4. Ergonomic Recommendations: For office workers, optimising workspace ergonomics is essential. A physiotherapist can suggest adjustments to your workstation setup to reduce strain on the neck and promote better posture.
  5. Heat and Cold Therapy: Applying heat or cold packs to the affected area can help reduce inflammation, relieve pain. If you have a spasmed muscle, opt for heat most of the time.
  6. Dry Needling and Acupuncture: Dry needling has been shown by research and in the clinical setting to be highly effective for managing pain. The main aim of this technique is to release your tight muscles and restore pain free range of motion as quick as possible.Neck Pain Robina Physio

Neck pain is a prevalent condition that can significantly impact an individual’s quality of life. With the help of a skilled physiotherapist, like those at Robina Physio on the Gold Coast, you can implement a personalised treatment plan to alleviate your symptoms, improve mobility, and prevent future occurrences of neck pain.

The Physiotherapists at Robina Physio on the Gold Coast are experts with additional training in the management of neck pain and dysfunction. If you’re struggling with neck pain please don’t hesitate to Contact Us on (07) 5578 7233 or BOOK ONLINE.

Tennis Elbow Tendon Pain

Tennis Elbow

Tennis Elbow

By Aaron Woolley, Physiotherapist.

Tennis elbow, also known as lateral epicondylitis, is a condition that affects the tendons in the elbow joint. It is characterised by pain and tenderness on the outer part of the elbow and forearm. This condition is usually caused by overuse of the lateral forearm tendons, resulting in small tears within the tendon that attaches to the lateral epicondyle of the humerus bone (upper arm). Tennis elbow can be debilitating and painful, and can affect everyday activities that involve gripping and lifting. Thankfully, high-quality physiotherapy treatment that is provided at Robina Physio on the Gold Coast can be highly effective at treating this condition and get you functioning again normally without pain.

Tennis Elbow


Symptoms of Tennis Elbow

The primary symptom of tennis elbow is pain and tenderness on the outer part of the elbow, which may radiate down the forearm. The pain is often aggravated by gripping or lifting objects, twisting the forearm, or even by simply shaking hands. Other symptoms of tennis elbow may include stiffness (particularly in the AM), weakness, and difficulty performing everyday tasks.

Treatment for Tennis Elbow

Physiotherapy rehabilitation for tennis elbow can be very effective in reducing pain and improving function. A physiotherapist will work with you to develop an individualised rehabilitation program that may include exercises to strengthen the forearm muscles and tendons, manual therapy techniques including massage and dry needling/acupuncture and some taping and bracing techniques to help reduce pain and improve mobility.

Strengthening exercises for tennis elbow are designed to improve the strength and endurance of the forearm muscles and most importantly gradual load the tendon to restore the tendons tissue tolerance. We typically start with extensor muscles contractions in an isometric nature then progress to contraction through range of motion. From here the physiotherapists at Robina Physio on the Gold Coast will build the functional loading of the muscles and tendons.

Resting your injury is not always the best treatment. Quite often people simply rest and wait for the pain to diminish. Unfortunately, this is not an effective long-term solution as while the tendon is resting the tissue tolerance of the tendons diminishes as well. Meaning once you load it again the pain returns much quicker. The best approach is to slightly decrease your loading of the injured area but not completely stop using it. The physio’s at Robina Physiotherapy on the Gold Coast are experts at training/load modification and can help get your loading patterns right.

The research for physiotherapy treatment is positive and has shown that patients who received physio rehabilitation consisting of manual therapy, stretching exercises, and strengthening exercises experienced significant improvements in pain, function, and grip strength compared to those who received only a corticosteroid injection. Another study published in the Journal of Hand Therapy found that a combination of manual therapy and exercise therapy was more effective in reducing pain and improving function in patients with tennis elbow compared to exercise therapy alone.

If you’re struggling with Tennis Elbow don’t hesitate to get your treatment started as early intervention typically equates to better and quicker outcomes. Our expert Physiotherapists at Robina Physio on the Gold Coast would love to help. Contact Us on (07) 55787233 or BOOK ONLINE.

Dry Needling QL

Dry Needling & Acupuncture

Dry Needling and Acupuncture

By Leigh McCutcheon & Dr Wayne Hing, Physiotherapist.

The effectiveness of western acupuncture and dry needling is seen every day in clinic, so it’s good to see the growing evidence for its use. In the past year since Leigh McCutcheon of Robina Physio on the Gold Coast and Dr Wayne Hing of Bond University on the Gold Coast collaboratively wrote Physio ‘dry needling’ and acupuncture – what’s the difference and what does the evidence say? for The Conversation, almost 400 RCTs in dry needling have been published and almost ten fold of that for acupuncture directly influencing clinical practice and associated outcomes.

Physiotherapists are increasingly offering needling therapies in addition to their standard care. Many Australian physiotherapists in private practice now offer dry needling or Western medical acupuncture as part of a treatment approach.

Is it just a fad or does science support it?

Needling, three ways

Physiotherapists can be trained to use dry needling, Western acupuncture and/or traditional acupuncture.

Dry needling involves penetrating the skin with needles to altered or dysfunctional tissue in order to improve or restore function. This often involves needling muscle trigger points to activate a reflexive relaxation of the muscle.

Western acupuncture uses traditional needling meridians (the ancient idea of energy channels through the body) and trigger points. But these ideas are applied to Western understandings of anatomy. In Western acupuncture, points are stimulated to create local tissue changes, as well as spinal and brain effects. The goal is to trigger pain-relieving chemicals, muscle activation or relaxation.

Even though traditional acupuncture points are used with this style of needling, Western acupuncture is not viewed as traditional Chinese medicine.

Traditional acupuncture uses meridian lines or other points based on traditional Chinese medicine assessment methods and approaches.

Acupuncture chart

A traditional Chinese medicine acupuncture chart from the 1800s. Wellcome Collection, CC BY

All physiotherapists trained in either acupuncture or dry needling meet safety standards which are viewed as within scope by the Australian Health Practitioners Regulatory Agency and the Physiotherapy Registration Board. These standards cover the level of training required, registration to practice and safety standards that include needle safety and hygiene to protect the public.

Minor reported side effects related to acupuncture including pain and bleeding or bruising from needle insertion are fairly common. But major adverse events – pneumothorax (collapsed lung), excessive bleeding, prolonged aggravation – are rare.

What’s needling good for?

Research into the effectiveness of acupuncture and dry needling is variable. Some studies show comparable results between dry needling and acupuncture, while others show more favourable results for one or the other depending on the condition being treated.

review that assessed the effects of acupuncture and dry needling for the treatment of low-back pain found that it is a useful add-on therapy when combined with manual therapy, activity modification and exercise prescription.

For migraine and tension headaches, experts say acupuncture seems to reduce the frequency and intensity of attacks – though more research is needed to compare it to other treatments.

Acupuncture and dry needling may reduce pain and improve function for people with neck pain. A systematic review found significant differences between acupuncture and “sham acupuncture” (which is performed away from acupuncture points) when used to treat certain types of chronic pain. However, some research only shows small and temporary relief for neck pain with dry needling.

Dry Needling QL

Results from randomised control trials support the use of needling for shoulder paintennis elbow and osteo arthritic knee pain. But a recent systemic review of research reported only weak evidence to support needling to treat plantarfasciitis and chronic ankle instability.

Not just for sporting injuries

Similarly, small randomised control trials have shown acupuncture and dry needling might reduce problematic jaw pain (temporo mandibular disorder) and improve mouth opening.Dry Needling of TMJ

Systematic reviews have reported needling and acupuncture were safe and effective recommendations for the treatment of broad conditions of tendinopathy (the breakdown of collagen in tendons) and fibromyalgia (chronic pain in the muscles and bones).

For women’s health, acupuncture has been shown to be effective for reducing pain with periods, compared to no treatment or non-steroidal pain relief medications – but the research had design limitations.

Though widely used in pregnancy, research into the use of acupuncture to induce labour reports it may increase satisfaction with pain management and reduce pain intensity. But it may have little to no effect on the rates of caesarean or assisted vaginal birth.

In summary, it appears needling techniques – whether dry needling or acupuncture – generally show positive effects over no treatment or “sham” treatments, but more research and high quality trials are needed.

Just one part of a treatment program

Needling may be useful as part of multimodal care – that is, when more than one treatment is used in conjunction to treat a problem.

Physiotherapists may combine needling therapies with exercise prescription, hands-on care including massage, mobilisations and manipulations, and taping techniques. They may also employ therapies that apply external energy such as ultrasound, laser, transcutaneous (under the skin) electrical nerve stimulation and biofeedback.Dry Needling Scapula

Finally, while the various needling techniques all use a filiform needle (with a solid filament as opposed to a hollow bore needle), the styles with each can be quite different. Ask what style of needling is being employed to treat you, and if you have a history of finding one style works better for you, discuss this with your practitioner.

Are you struggling with pain and ready to try adding Dry Needling and Acupuncture to your treatment? The Physiotherapists at Robina Physio on the Gold Coast are industry leaders in providing Dry Needling and Western Acupuncture treatments as well as training other health professionals in it use clinically. Please don’t hesitate to Contact Us on (07) 5578 7233 or BOOK ONLINE.

Hamstring Strains Soccer

Hamstring Strains

Hamstring Strains

By Yona Dorzaun, Physiotherapist.

We have decided to add a refresher article about hamstring strains and tears to the Robina Physio blog. This is series due to the high recurrence of hamstring strains that occur when sporting seasons start back on the Gold Coast. In athletic populations hamstring strains account for over 15% of all injuries, with re-injury rates being reported between 12-63% in some studies.

Hamstring Strains Soccer

Hamstring strains are caused by a rapid extensive contraction or a violent stretch of the hamstring muscle group which causes high mechanical stress. These injuries are common in dynamic sports like sprinting, jumping or contact sports such as Australian Rules football (AFL), Rugby and Soccer where quick eccentric contractions are regular. Hamstring injuries can also occur during recreational movements where the knee is forcefully fully extended.Hamstring Strains


The hamstrings consist of three muscles:

  • The Biceps Femoris
  • The Semitendinosus and
  • The Semimembranosus.

Causes and Risk Factors

There are various proposed risk factors which may play a role in hamstring injuries including older age, limited or excessive flexibility, fatigue, poor core stability, and strength imbalances.

During activities like running and kicking, hamstring will lengthen while the hip flexes and the knee extends, this lengthening reaches the mechanical limits of the muscle and can lead to the accumulation of muscle damage. One possibility for a hamstring strain is that the quadriceps (the opposing thigh muscles) do not contract in a coordinated fashion while we lengthen the hamstrings. Another reason might be differences in anatomy between individuals, e.g. differences in where the hamstrings attach on the femur and pelvic girdle.

How do Hamstring Tears / Strains Present?

Hamstring strains and/or tears present with a sudden pain in the posterior thigh ranging from minimal to severe intensity. People also often describe a “popping” sound or tearing impression. Depending on the degree you can expect bruising and swelling but these may not happen straight away. Alongside pain and tenderness hamstring strains cause loss of range of motion and loss of the ability to contract those muscles to different degrees.

Rehab at Robina Physio

At Robina Physiotherapy in the Gold Coast one of our physios will first take a detailed history and thorough physical examination including your gait, range of motion and strength. A lot can be deducted from the mechanism of these injuries, including what structures may be involved and the severity of the injury. This also helps you physio determine the best rehab strategy for you injury.

Hamstring strains are categorised in 3 groups, according to the amount of pain, weakness, and loss of motion. Hamstring Strains Grades

Grade 1 (mild)

  • Just a few fibres of the muscle are damaged / strained. This rarely influences the muscle’s power and endurance but can limit range of motion. Apart from feeling some pain and stiffness on their posterior tight.

Grade 2 (medium):

  • Approximately half of the fibres are torn. The symptoms we recognise at Robina physio are acute pain, swelling and a mild case of function loss. The patient’s gait will be influenced due to lack of ability to fully stretch the muscle, and the physio will be able to reproduce the pain by applying pressure on the hamstring muscle or bending the knee against resistance.

Grade 3 (severe):

  • Ranging from more than half of the fibres ruptured to complete rupture of the muscle. Both the muscle belly and the tendon can suffer from this injury. It typically causes large amounts swelling and pain. The function of the hamstring muscle is greatly impacted showing significant weakness.

Regardless of the degree of muscle strain, the primary aim of the rehabilitation program provided by the Physiotherapist’s at Robina Physio on the Gold Coast will aim to restore your function to the highest degree and to return to your daily or sporting activities at the same level as before the injury.

You can expect the highest level of clinical care using evidence-based rehabilitation protocols that have been proven to get you moving pain free again. With the right care from our expert Physio’s recovery times and re-injury rates are drastically reduced. Using a peer reviewed and renowned rehabilitation protocol that has been shown to reduce re-injury rates to a mere 0.53% we will aim to minimise pain, regain function, and enable you to achieve your goals and return to your usual activities.

The Physiotherapist’s at Robina Physio on the Gold Coast are here to help with any of your muscle injuries. CONTACT US on (07) 5578 7233 or BOOK ONLINE.