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Osteoarthritis (OA) is a normal part of aging. It is a process whereby inside of surfaces of a joint wear away and the cartilage deteriorates. Bony formations can also occur which change the shape of the joint itself. This wearing away of the joint surface can cause symptoms such as pain, swelling and loss of range of motion at the joint. However, these symptoms are not present in all people who have OA. 1 in 13 Australians report having osteoarthritis, with 2/3 of these people being female. The prevalence of osteoarthritis steadily increases with age. Some people will get to a point in their life where a knee or hip replacement is brought up by their health care provider after a period of joint pain that is affecting day-to-day life. Sore knees stopping you from participating in the things that make you happy? Are you unsure about whether to get a hip replacement? Have you tried physiotherapy? In this blog post we address some facts about osteoarthritis and the role physiotherapy can play in helping you manage your knee or hip pain. How do I know if I have OA? A physiotherapist can diagnose your OA using clinical criteria developed by The National Institute for Health and Care Excellence (The NICE guidelines). The Royal Australian College of General Practitioners endorses the use of clinical criteria without the need for imaging. A physiotherapist may request imaging if the presentation of a person’s OA is not typical, such as: · A history of trauma · Rapid worsening of symptoms · A hot or swollen joint · Or suspicion of a more serious pathology What are the risk factors for OA? A traumatic joint injury is one of the strongest risk factors for developing OA. 50% of people will develop OA within a decade after injuring a joint. Obesity also contributes to the development of OA due to the increased mechanical stress applied to joints in the body and through obesity related metabolic factors which can cause pro-inflammatory processes in cartilage and bone. Jobs that require high levels of physical labour (e.g. Brick layer or builder), particularly those that require kneeling or lifting also increase the risk of OA. Everyone experiences OA pain differently. Pain is not simply an ‘alarm’ arising from a damaged part of the body. Pain is a complex emotional response to physical stimulus that is associated with memories, beliefs and social or environmental context. Pain experienced from OA is no different. People may experience OA pain before any structural changes appear on imaging and in contrast those with advanced OA may experience little to no pain at all. Physiotherapists understand the complex nature of pain and will focus less on the imaging of a joint and focus more on the individual and what factors may be influencing your pain such as general physical and psychological health, social and environmental factors and a person’s beliefs about pain. Why not replace the joint sooner? It is a common belief that the only way to ‘cure’ OA is through surgery. Many people do get relief from a joint replacement, however, nearly 20% of people who have a knee replacement are not happy with the outcome and 30% of people still suffer from pain, stiffness and difficulty with activity day to day. 93% of people who have a hip replacement are satisfied with the outcome however the remaining people report having a worse quality 12 months after surgery, worse than compared to pre-surgery. How can Physiotherapy help you with OA? All guidelines for OA recommend that exercise be the first intervention prescribed. It is a common misconception that exercise can make OA worse. Findings from two recent studies that included 1700 participants concluded that exercise does not trigger increased inflammation or damage the surfaces of joints in people with OA. Exercise strengthens the muscles around a joint leading to improve stability and mobility and is essential for joint health as it can stimulate cartilage regeneration. Therefore, a physiotherapist will not recommend rest but encourage you to engage in a guided physical activity program that is also very beneficial for your general health. Physical activity can also help prevent over 30 chronic diseases, many of these are also common in people with OA, especially obesity which as discussed plays a large role in the development of OA. Surgery should be discussed after attempting a thorough high-value care plan with your physiotherapist that includes exercise therapy, education and if required a weight management plan.

Bone is changeable tissue that responds to variables in mechanical loads by altering its mass, structure and/or strength. Today's blog will explore some of the key principles behind exercise for bone health. Principle of Specificity: The way bones change in relation to loading is site-specific and not systemic in nature. In other words, when your physiotherapist prescribes exercises, they must include targeted activities that are known to directly or indirectly load the bones giving trouble. The most common sites of fractures are the hips, the spine and the wrists. Principle of Progressive Overload: The load put on bone, either directly or indirectly, must push a little bit further than what we are used to during everyday activities. Bone is adaptable. If you lift at the same weight session after session, you will be unlikely to see any improvements. If you lift a little bit heavier each time, you will notice changes in lifting capacity and muscle definition. The same happens with bones, if you don’t progressively overload them - nothing will change! Principle of Reversibility: any positive bone adaptations resulting from exercise training will be progressively lost once the exercise is stopped.The findings from a 16-year non-randomized study involving a “multimodal exercise program in early postmenopausal women with osteopenia found that at least two sessions per week was the minimum effective dose to positively influence bone over the long-term”. So… Now you know the importance of exercise for healthy bones, but what can you do? Take a look at our suggestions below of exercises for bone health! Exercises for bone health: It is recommended to have a mix between weight-bearing and resistance based exercises for best bone health. Weight-bearing exercises ● Walking ● Hiking ● Jogging ● Climbing stairs ● Playing tennis ● Dancing. Resistance based exercises: ● Lunges ● Deadlifts ● Squats ● Rows ● Flys ● Overhead pres If you have a bone density deficiency or want to prevent it, check in with a member of our team here at Physio K to see how you put the steps in place to lead a stronger, healthier and happier life!

What the HEEL is going on??? Do you ever experience pain on the bottom of your foot, around your heel or arch while walking or running? You may be experiencing Plantar fasciitis. Most of us who have experienced plantar fasciitis know first-hand how debilitating and frustrating it can be. Every morning resembles being forced to walk on glass and you quickly become annoyed and dissatisfied. The prevalence in the general population is estimated to range from 3.6% to 7% and may account for as much as 8% of all running-related injuries. What is Plantar fasciitis? …. Plantar fasciitis is an inflammation of the fibrous tissue (plantar fascia) along the bottom of your foot that connects your heel bone to your toes. Plantar fasciitis can cause intense heel pain. Ok so, I understand what it is but how did I get it? …. Well, it is not always clear why this happens. You may be more likely to get plantar fasciitis if you: recently started exercising on hard surfaces exercise with a tight calf or heel overstretch the sole of your foot during exercise recently started doing a lot more walking, running, or standing up wear shoes with poor cushioning or support are very overweight While there isn’t just one specific cause of inflammation, it can be difficult to discern the exact cause as there are many reasons that can lead to it. The one thing that all these causes have in common is that they cause a lot of pressure on the plantar fascia tissue, leading to excess stretching or overuse. My GP has told me I have Plantar fasciitis. What should I do next? …. Book in for a session at Physio K! As physiotherapists we can help you to manage your pain, symptoms and mitigate flare ups through a variety of different treatments. Treatment is always individualised to each client we see. We will carry out an assessment so that we can provide the most appropriate treatment based on your level of pain and what stage of rehab you are at. What should I expect from physiotherapy for this? …. We will be able to help guide you through the rehabilitation process; help you understand signs of plantar fasciitis healing and get you back to doing what you love! Some of the treatments you can expect to receive, but are not exclusive to are: Massage or soft tissue work Home exercise programmes for stretching and strengthening Advice and education Dry Needling What should I do while waiting to see my Physiotherapist? …. There are many home practices you can adopt to aid in your recovery from plantar fasciitis. It is always recommended to see a professional. DO DON’T Rest and raise your foot on a stool when you can Do not take ibuprofen for the first 48 hours ​Put an ice pack (or bag of frozen peas) in a towel on the painful area for up to 20 minutes every 2 to 3 hours Do not walk or stand for long periods ​Wear wide comfortable shoes with a low heel and soft sole Do not wear high heels or tight pointy shoes Use soft insoles or heel pads in your shoes Do not wear flip-flops or backless slippers Regular gentle stretching exercises Do not walk barefoot on hard surfaces ​Exercises that do not put pressure on your feet, such as swimming ​ Take paracetamol ​

Having trouble running or walking without foot pain? Have you been told you have a flat foot? Have you been pitched an orthotic insert for your shoe? BUT… Has anyone told you that you can rehabilitate a flat foot with physiotherapy? That you don’t need to rely on an expensive splint that gets lost, doesn’t fit in our new shoes that wears down and must be replaced? Not to mention that an orthotic doesn’t treat the source of your problem. What does ‘flat feet’ mean? Flat foot can be described simply as dropped arch height and an inward roll of the foot, although it can be a little more complicated than that. Other names that you may have heard of are Pes Planus or Pes Planouvalgus. People with symptomatic flat feet will experience foot pain in the base of the heel or along the fascia that spans the arch of the foot. People may also experience pain in the shins, knees or hips due to the altered mechanics of the foot during walking and running. Most people will experience little to no symptoms of flat feet, however the change in foot posture can have upstream affects at the knee, hip and back. The effects of which may not be obvious until they reach a tipping point and either an injury occurs, or a chronic condition develops (tendonitis or shin splints). Why do Orthotics work? The orthotic acts as a bolster and physically pushes the arch of the foot upwards placing it in a better position. This in the short term will improve foot position and reduce the pain associated with flat feet. That’s it. Take the sole away and the arch drops, and the pain returns. This may help with acute episodes of foot pain and can help people with high workloads manage their pain (labourers, soldiers, athletes) but ultimately the orthotic has no lasting change on the condition itself. In fact, becoming reliant on highly structured shoes with or without insoles deconditions the foots intrinsic muscles and sensory nerves further, meaning when you take the insole away you will probably be in more discomfort! So, how can Physiotherapy build the arch in our foot? Physiotherapy aims to build the arch in your foot by training the soft tissues in your foot and lower limb. This can take some time, but it makes lasting changes. These therapies involve strengthening, stretching, mobilisations and activities that redevelop the neural functions in your foot such as proprioception. Modern footwear deconditions the foot and its structures and graded exposure to flat soled shoes and bare foot walking is also incorporated into the rehabilitation program. Our physiotherapists can assess your feet and develop a personalised evidence-based program that involves activity modification, load management, stretching, strengthening of the tissues that support the arch of your foot. Using orthotics can help with your day-to-day function and reduce pain but in our belief treating the source of the problem is more effective than simply treating symptoms.

First, what is a Disc? An intervertebral disc is a soft piece of tissue that sits between the vertebrae in the spine acting as a shock absorber and gives the spine flexibility. The two main parts of a disc are the annulus fibrosus (the outer part) and the nucleus pulposus (the inner part). The annulus fibrosus is the tough outer layer and the nucleus pulposus is the core of the disc and consists of a gel-like fluid with some fibrous structure. The intervertebral disc is also highly innervated and vascularised meaning it gets good blood supply and has lots of sensation. Is a bulging disc the same as a herniated disc? What’s the difference? A herniated disc (ruptured disc) is when the nucleus pulposus of the disc pushes out of the annulus fibrosus and can put pressure on nearby nerves or the spinal cord. This may lead to pain, numbness, pins & needles and/or weakness in parts of the body supplied by the nerve that is being compressed. A bulging disc occurs when the outer layer of the disc (annulus fibrosus) is weakened or damaged and expands outwards, but the core of the disc remains within. The symptoms of a bulging disc are somewhat like a herniated disc but usually less severe. What does it feel like to have a disc injury? The most common symptom of a disc injury is pain. This pain can be felt at the site of the injured disc (most commonly the lower back or neck) but also in the arms or legs depending on which nerves are affected. Another common symptom is a sensation of pins and needles or numbness in the arms or legs. Other more serious signs of a disc injury include weakness of muscles that are controlled by the affected nerve, abnormality in the reflexes in a limb and loss of bowel and bladder control. The common mechanisms that lead to disc injury include age related degeneration, repetitive strain, or acute trauma. How do you know if you have a bulging disc? A physiotherapist can make a clinical diagnosis of disc related injury by taking a detailed history, conducting a thorough physical examination, and observing and monitoring the progression of your symptoms. Imaging is not usually required unless the signs of severe neurological compromise are present such as progressive weakness and loss of bowel and bladder control. Generally imaging is not recommended unless physiotherapy has not improved symptoms after 6 weeks or the signs and symptoms of disc injury are progressively worsening. Why do we wait so long to request imaging? It is proven that many people without any back pain have evidence of disc degeneration, herniation and bulging and display no clinical signs or symptoms. Due to this fact, imaging is only used to confirm a clinical diagnosis or to investigate if conservative back pain treatments are failing to improve pain. Imaging too early can muddy the waters and cause clinicians and patients to focus on something that may really have little to no effect on a person’s pain, delaying recovery and possibly increasing a patient’s stress. Common myths and misconceptions: You cannot ‘slip’ a disc: Although this term gets thrown around a lot, it is impossible to ‘slip’ a disc. The disc is secured to the vertebrae by very strong, thick ligaments. Bulging discs always cause pain: False. Up to 60% of people who have a bulging disc have no pain or symptoms. Bulging discs always require surgery: False. For most people, physiotherapy is effective for treating disc injuries. Surgery is indicated if conservative therapies fail or there is significant nerve compression. Herniated discs do not heal: False. The recovery rate of herniated discs is quite high. Herniated discs can only be treated surgically: False. A large proportion of people with herniated discs can improve their condition with physiotherapy tailored to their specific condition and some adjunct therapies such as anti-inflammatory medications and injections. Herniated discs mean you are in a lot of trouble: Not always. If your imaging shows you have a herniated disc it doesn’t necessarily point to the source of your pain. Discs degenerate as we age and have some degeneration is not a disaster, it's expected. Most people would have some degree of disc herniation somewhere in the later stages of life, although only a small percentage have pain. What options do you have for treatment? Physiotherapy With adherence to a physiotherapy program including specific exercises, manual therapy, and activity modification most people will show improvement in symptoms within a few weeks to a few months. Those who seek treatment earlier are more likely to recover quickly. Corticosteroid injections: Corticosteroid injections can provide short-term pain relief for some people with herniated or bulging discs. Corticosteroid injections provide moderate pain relief for up to 6 weeks, but they aren’t without risks. Some risks associated with Corticosteroid injections include infection, nerve damage and blood sugar complications in those people with diabetes. The benefits of these injections decrease over time with no benefit lasting beyond 3 months. Repeated use of these injections can lead to weight gain, osteoporosis/ fractures, high blood pressure/ heart disease and impaired wound healing amongst other things. Corticosteroids can be a good option for people with herniated or bulging discs, but their use should not be the first line of treatment. Surgery Surgery should be reserved for when conservative therapy has been tried and failed or when there are significant neurological symptoms. Having surgery does not always relieve all the symptoms a person may have and doesn’t prevent the injury from happening again. Surgery should be a last resort as it carries a substantial financial cost and exposes you to risk of infection, nerve damage or other side effects of sedatives, antibiotics and analgesics. If the vertebrae are fused in the process of repairing the disc injury, you will also lose range of motion through the fused levels as well as increase the likelihood of degeneration of the discs above and below the fusion site.

Hopefully my discomfort will just go away….. No. The Power of Early Intervention and Consistent Supervision in Musculoskeletal Rehabilitation. Musculoskeletal conditions can have a profound impact on our daily lives, hindering our ability to move, work, and enjoy activities we love. Whether it's back pain, joint stiffness, or sports injuries, finding effective relief is crucial for restoring functionality and improving overall quality of life. In this blog post, we will explore the importance of early intervention and consistent supervised treatment sessions with a physiotherapist. 1. Early Intervention: A swift path to recovery. Timely intervention is key when it comes to managing musculoskeletal conditions. By seeking professional help from a physiotherapist at the earliest signs of discomfort, you can significantly improve outcomes and accelerate the healing process. Early intervention is backed heavily by research, for instance: a) A study published in the Journal of Orthopaedic & Sports Physical Therapy found that early physiotherapy intervention within the first 14 days of low back pain reduced the risk of chronic disability by 50% compared to delayed treatment. b) Research published in the American Journal of Sports Medicine showed that early physiotherapy intervention for acute ankle sprains led to faster recovery, reduced pain, and improved functional outcomes compared to delayed treatment. These importance of early identification and immediate involvement of a skilled physiotherapist to prevent chronicity and promote a faster return to normal activities. 2. The Benefits of Supervised Treatment Sessions: Unsupervised physiotherapy exercises or home-based interventions, which we do recommended, may not always provide the same level of effectiveness as supervised treatment sessions. Here's why consistent supervision matters: a) Correct Technique and Progression: Proper technique and progression are crucial to optimize healing and prevent further injury. A study published in the Journal of Orthopaedic & Sports Physical Therapy (2020) revealed that supervised exercises for rotator cuff tendinopathy resulted in improved outcomes compared to unsupervised home-based exercises. b) Motivation and Compliance: Consistency is key in rehabilitation, and supervised treatment sessions provide a supportive environment that encourages adherence to prescribed exercises. A study published in the Journal of Back and Musculoskeletal Rehabilitation (2018) demonstrated that patients who attended supervised physiotherapy sessions had higher compliance rates and better treatment outcomes compared to those who relied solely on unsupervised exercises. c) Real-Time Monitoring and Feedback: During supervised sessions, physiotherapists can monitor your progress, modify exercises when necessary, and provide immediate feedback. This personalized attention enhances the effectiveness of treatment and minimizes the risk of incorrect execution, preventing further complications or delaying recovery. Early intervention and consistent supervised treatment sessions with one of our physiotherapist’s can significantly improve your rehabilitation outcomes. By seeking our help promptly, and combining effective manual therapy such as dry needling, joint mobilisations and soft tissue release, with physical reconditioning programs you can mitigate the risk of chronic disability and achieve faster recovery. At PhysioK, we understand the importance of early intervention and consistent supervision. Our team of experienced physiotherapists provides personalized care, evidence-based treatments, and ongoing support throughout your rehabilitation journey. Don't wait for your condition to worsen—contact us today and experience the transformative power of early intervention and supervised treatment sessions.

What is RED-S? Relative Energy Deficiency in Sport (RED-S) refers to a condition in which energy imbalance leads to impaired physiological function of multiple organ systems. RED-S is thought to be primarily caused by low energy availability (LEA) due to low energy diets, be it intentional or unintentional, and is often combined with the harmful aspects of overtraining syndrome and/or excessive exercising; thus, creating a relative negative energy imbalance. What is Low Energy Availability? LEA may be intentional, with the athlete intentionally restricting their dietary intake, or unintentional, in which the athlete's nutrition simply isn’t meeting the demands of their training load. Be it intentional or unintentional, the athlete will suffer the same implications to their health and performance. Intentionally: the athlete is restricting their diet, common in sports such as cross country running and gymnastics where weight effects overall performance. This can be difficult to manage as the athlete must address their complex relationship with food and psychology. Unintentionally: the athlete is not getting the energy availability out of their diet that their sports demand. This can be easier to manage as it may be sufficient to simply educate the patient on the nutritional demands of their training load. Who is most likely at risk of RED-S? Most common in sports that unite the importance of a thin body type and success - gymnastics, figure skating. Sports with frequent weigh ins – boxing, rowing Endurance sports – cycling, marathon running. Regardless of the sport, team culture and coaching staff’s attitudes can contribute to the risk of RED-S in an athlete The understanding of REDS and its symptoms are poorly known by athletes and coaches therefore if often goes undiagnosed and untreated - this stresses the importance of the role of physiotherapists and sports clinicians in identifying the symptoms in their patients. What is the impact of RED-S on my health? Bone Health – LEA causes a chronic state of hypoestrogenism which leads to lone bone density. Endocrine Health – negatively effects thyroid function. Menstrual Health - can range from abnormal bleeding to amenorrhea which is when the female’s period is absent for more than 90 days. Fertility - due to the absence of ovarian follicular development, anovulation, or luteal-phase defects, menstrual dysfunction can further lead to infertility in females. Metabolic Implications Gastrointestinal Implications Psychological – In individuals with REDS, there is an increased prevalence of eating disorders and disordered eating. This has significant implications for psychological well-being, by potentially exacerbating low self-esteem, anxiety and depression. What is the impact of RED-S on my performance? Increased risk of injury – stress reactions, stress fractures due to poor bone health Poor concentration Fatigue and poor recovery Impaired judgement Neuromuscular performance and reaction times are reduced. Impaired co-ordination Negative influence on muscular strength - because of a negative impact on muscle protein synthesis. Negative influence on endurance performance – because of a negative impact on mitochondrial protein synthesis and strength What is the role of the physiotherapist in treating RED-S? Often patients will present to physios with injuries that have been a repercussion of RED-S. Most often this is a bony injury – stress reaction/fracture and/or an overuse injury that has not healed fully. In this case the physio should look out for other red flags such as: Oligomenorrhea/amenorrhea Recent weight loss Restrictive eating and body dysmorphia Recurrent illnesses Cardiac abnormalities It is important for physios to be able to identify RED-S and ensure the patient gets proper screening. A multi-practitioner, patient-centred approach is needed to treat both the physical and psychological health implications. Management strategies should include: Education Optimising energy availability – altering diet. Modification of exercise and training – in some case this means only low impact exercise if BMD is very low or stopping exercise completely for a period of time. Mental health support Physiotherapists can modify and monitor an athlete’s activity levels during recovery, prescribe an appropriate training schedule for the athlete, and develop treatment goals for the patient.

It seems like the whole world has taken up running. As a result, running shoes have soared in price and popularity. With so many options available its hard for new runners to know what shoe to buy. When it comes to shoes the perfect shoe can be the difference between a comfortable run and a painful experience. Having incorrect footwear can lead to poor running techniques and injuries. How do I know my running style? Ideally before buying runners, you should get a gait analysis either from a physio or in a running shop to assess your technique and specific loading patterns. An ideal running technique is a neutral pattern with natural inward rolling of the foot meaning the weight is evenly distributed. Some runners overpronate which is excessive inward rolling of the foot as it hits the ground, meaning most of the load is going through the inside of your foot. And to a lesser extent some runners supinate which is an outward rolling of the foot meaning the weight is transferred to the outer edge of the foot. If this is picked up in an assessment your physio should be able to recommend an ideal shoe or orthotic to help correct this issue and allow the weight to be evenly distributed upon landing. The right shoe will also depend on training load, specific needs and style choice. How often do I change my shoes? This is a common question asked to us by patients. A number of factors like your gait, running style, weight, terrain you’re running on will all contribute to how often you should change your shoes. Typically, if a shoe has a higher stack they tend to last longer as their midsole foam will take longer to break down. A lighter, lower stack shoe has less mileage in them but can be kept for your weekly session or race. As a result, building a shoe rotation can help get the most out of your shoes. To make things easier, Physio K have put together a list of popular and recommended shoes to suit all types of runners for all types of training sessions. Adidas Novablast A neutral shoe which is said to hug the foot with a snug midfoot. FF Blast Plus Eco foam gives a thick stack height allowing for serious bounce. As well as the bounce in the newest version, Novablast 4, there is a toe spring in the forefoot making it ideal for speed sessions. Best for: 5k & 10km races, tempo sessions Brooks Ghost Each variation of the Brooks Ghost offers comfort and durability making them an ideal shoe for winter training. The newest version in the series contains nitrogen-infused DNA LOFT v3 technology, adapting to your stride for a personalized feel. Best for: neutral runners, daily training and long-distance running Nike Air Zoom Pegasus Series A long-standing favourite amongst distance runners, the Nike Air Zoom Pegasus series offers a balance between soft cushioning and responsiveness and features a wider forefoot. The Nike Air Zoom Pegasus Turbo is a lighter shoe built for speedier tempo runs while the Nike Air Zoom Pegasus Trail is more versatile and ideal for trails and varied terrain. Best for: Everyday runners seeking a reliable shoe for daily mileage and workouts Adidas Supernova Rise Ideal for all running needs, the Supernova Rise isn’t overly soft or hard but balances nicely a cushioning feeling with reaction and feedback. Best for: long, easy miles, can manage tempos but a stacked midsole makes cornering at speed difficult. Saucony Ride 17 The newest Saucony Ride model, the 17, features a new engineered mesh which gives support while also giving enough flex to still feel pliable and unrestrained. Like other shoes in this blog the biggest advantage comes in the midsole. The change to Pwrrun+ foam improves the ride by feeling bouncy and soft giving enough liveliness for some faster running. Best for: beginners, half marathon & marathon runners Hoka Arachi 7 The shoe features Hoka’s compression-moulded EVA midsole foam and combats overpronation with a J-frame midsole support. It lacks the springiness of some before mentioned shoes but if security and stability are what you’re looking for then this shoe is perfect for everyday training. Best for: overpronators looking for support What are carbon plated shoes and when should I wear them? Carbon shoes have become more popular over the last few years, allowing athletes to improve their performance and reduce their fatigue. The shoes are designed with carbon plate technology to provide spring-like motion when the foot hits the ground while expending less energy. However, this also makes them more expensive than many of the best running shoes, so they're less suited to daily training and more appropriate when you're racing or looking for a PB. They also have reduced durability. Conventional running shoes typically have about 300-400 miles of racing in them while the carbon shoes have about 120-150 miles before they ‘expire’. They’re popularity amongst fitness influencers, particularly the Nike Alphaflys, have led everyday runners to think they need these shoes for daily training. But given their durability and that they are the most expensive shoe on the market it is advised to keep them for sessions and racing! Most sports brands have now released their own versions of the carbon shoe, two of the best are recommended below. Nike Alphaflys Probably the most recognisable shoe out there at the moment the Alphafly 3 is even lighter than the record breaking Alphfly 2. Its 15% lighter but has a continuous outsole for stability. Built for speed, the ZoomAir pods provide propulsion and response. Best for: performance Hoka Rocket 2 The rockets are thought to be the best carbon fibre plated Hokas available. They have a scooped carbon fibre plate to allow for a fast toe-off. They also feature the classic Hoka’s full Peba midsole foam which surrounds the carbon fibre plates. Important to note that the sizing is unisex, so it is advised to size up if you are in between sizes as the inside cage of the shoe hugs the foot tight. Best for: performance

Subacromial impingement syndrome. It’s quite a mouthful and a diagnosis that will make you fearful of ever using your shoulder and arm again. But what is it and what does it mean? Subacromial impingement is considered to be the most common musculoskeletal condition affecting the shoulder and is estimated to affect at least one in four people at some point in their lifetime. It is based upon the idea of tissues within the shoulder joint undergoing compression during certain functional movements, especially ones that involve the arm being raised above shoulder height. In essence this theory suggests that one of the muscles that contributes to the rotator cuff (supraspinatus) gets pinched underneath the bony roof of your shoulder blade (acromion process) resulting in pain and inflammation of the tendon and its surrounding tissues such as the bursa (a sac of fluid that protects the tendon from abrasion). But is this really the cause of your shoulder pain? After all, up until this point in your life you’ve never had an issue with this bone or this tendon so what’s changed? To answer this, we first must understand what tendons are and how they operate. Tendons are the connective tissues that help connect a muscle to a bone. It is made up of collagen fibres which are closely packed to give a tendon the strength it needs to transmit the forces produced by our muscles into the bones they attach to. In fact, tendons are so robust that gram for gram these tightly packed fibres are stronger than steel! If that’s the case, then you may be wondering how do they get damaged? Well, there are several lifestyle factors that contribute to tendon health and regeneration. Avoiding modifiable factors such as smoking, obesity, high intakes of fatty or processed foods and high cholesterol levels all contribute to maintaining healthy tendons. However, by far the most notable risk factor for tendon injury is SUDDEN CHANGES IN ACTIVTY LEVELS! Tendons do not like a sudden change in activity. If they go through a period of unaccustomed loading, especially above shoulder height, they will end up getting irritated and unhappy. When we work a tendon to fatigue (which happens quite easily when we first start moving after a period of inactivity) it induces swelling within that tendon. This is especially true in the case of the supraspinatus tendon, which is the main tissue implicated in this diagnosis. As a result of this fatigue and swelling there is a decrease in activation of the supraspinatus muscle which plays an important roll in stabilising the shoulder joint and preventing the unwanted rise of the humeral head (top of the arm bone). Therefore, the issue is not actually subacromial impingement but rather tilting more towards an irritation of the tendon due to overuse, also referred to as overuse tendinopathy or as rotator cuff related shoulder pain. So, what can you expect from physiotherapy management? Well typically when dealing with rotator cuff related shoulder pain there should be physiotherapy rehabilitation for the first 12 weeks, followed by self-management or independent rehabilitation from week 12 to 24. After week 24 you can then return to normal activity. Physiotherapy management may often include some manual therapy techniques in addition to a targeted home exercise program or work-related activity program. It is important to note that some of the exercises you will be asked to complete may bring on some discomfort or result in you working through pain. This is completely normal, but it should be tolerable and settle quickly upon completion of the exercise. The reality of the situation is that this theory of shoulder impingement is now considered outdated. The evidence now shows us that decompression surgery, which was and still is the surgical procedure for this injury to date, does not outperform either placebo surgery or physiotherapy treatment in the short-, medium- or long-term outcomes. So, we have to ask, why risk taking the surgical route if in 6-12 months-time the result will be the same with physiotherapy treatment. References Cuff, A., & Littlewood, C. (2018). Subacromial impingement syndrome – What does this mean to and for the patient? A qualitative study. Musculoskeletal Science And Practice, 33, 24-28. doi: 10.1016/j.msksp.2017.10.008 Lewis, J. (2009). Rotator cuff tendinopathy/subacromial impingement syndrome: is it time for a new method of assessment?. British Journal Of Sports Medicine, 43(4), 259-264. doi: 10.1136/bjsm.2008.052183 Lewis, J. (2011). Subacromial impingement syndrome: a musculoskeletal condition or a clinical illusion?. Physical Therapy Reviews, 16(5), 388-398. doi: 10.1179/1743288x11y.0000000027 Lewis, J. (2016). Rotator cuff related shoulder pain: Assessment, management and uncertainties. Manual Therapy, 23, 57-68. doi: 10.1016/j.math.2016.03.009 Lewis, J., McCreesh, K., Roy, J., & Ginn, K. (2015). Rotator Cuff Tendinopathy: Navigating the Diagnosis-Management Conundrum. Journal Of Orthopaedic & Sports Physical Therapy, 45(11), 923-937. doi: 10.2519/jospt.2015.5941 Löscher, S. (2018). 2013 Neer Award: Prädiktoren für das Versagen von nicht operativer Therapie bei chronischen, symptomatischen Rupturen der Rotatorenmanschette. Manuelletherapie, 22(04), 157-159. doi: 10.1055/a-0658-8975

WHAT IS SCIATICA? Sciatica is a term that tends to get thrown around quite a lot especially in reference to any nerve related pain in the lower extremity. Yet despite its common diagnosis, there are many misconceptions surrounding what it really is. It is a vague term used to describe pain that is associated with the compression or irritation of a nerve root located in the lumbosacral region of the spine (lower back). Now grasping that this pain originates from the lower back can be a touch more complicated, especially when factoring in that most symptoms are felt down the leg. However, this begins to make more sense when looking into the major anatomical structures involved. Sciatica derives its name from the condition’s involvement of the sciatic nerve which is the largest and longest nerve in the human body. Starting in the buttock and travelling down to the lower leg, this nerve is formed by a cluster of smaller nerve roots that can be traced back to the sacral plexus within the lower back. If these nerve roots are irritated in any way it can manifest in referring pain down the nerves pathway which can include the buttock, thigh, calf, and foot. HOW CAN THESE NERVE ROOTS BE IRRITATED? To understand how the nerve roots can be irritated we need to look at where these nerve roots are and what structures can influence them. As can be seen in the image below, the nerve roots are the yellow cords exiting either side of the spinal cord. These nerves send and receive information from the brain all the way down to the tips of the toes and are therefore a very important travel route for sensory (feeling) and motor (muscular) control. Another important structure to consider is the discs, depicted as the blue semi-circles. When it comes to nerve root pain there are two primary types: mechanical pressure and chemical irritation. The concept of mechanical pressure is relatively straightforward. It postulates that when a nerve root experiences compression, as can be seen in the image above on the right, this can limit the amount of blood flow to the nerve. Without the appropriate blood flow there is reduced oxygen being delivered meaning the nerve will not be able to perform its functions properly. Furthermore, if this reduced blood supply is prolonged it can lead to nerve degeneration and the development of abnormal impulses within the nerve. This is what can often be experienced as the burning, pins and needles or electric shock type of sensations down the leg. The chemical irritation system is slightly more complicated and has two additional schools of thought. The first is that the discs contain powerful chemicals that when spilled onto the nerve can lead to inflammation making the nerve angry and dysfunctional. Discs are very active tissues within the body. They are constantly laying down new cells and breaking down the old ones to ensure they are always healthy and functional. For the discs to be able to break down old cells they need to have powerful enzymes that can damage and discard them. Therefore, if a disc herniates and some of the chemicals spill onto the nerve roots, they can irritate the nerve and start an inflammatory response from the body. The second is that the disc can cause an autoimmune response which will often catch the nerve in the crossfire. Whilst it is very rare that a tissue in the human body has no nerve or blood supply, this is the case for the discs after the first few months of life (like the inside of the eyeballs!). As a result, the discs are quite foreign to the body’s immune system, to the point where it is unrecognizable. Therefore, when a disc herniates the immune system reacts to this as it would a foreign body, such as an infection or a virus. This means it attacks the disc tissue resulting in an inflammatory reaction which will end up affecting the nerve root given its proximity to the disc. WHAT ARE THE SYMPTOMS OF SCIATICA, WHO DOES IT AFFECT AND FOR HOW LONG? The most common symptoms associated with Sciatica is pain travelling down the back of the leg. Key areas include the buttocks, back of the thigh, calf, and foot. Some people can experience a burning, electric shock or pins and needles type pain or in rare cases a sensation of cold water running down the leg that may be associated with numbness or muscle weakness. The intensity of the symptoms can be quite broad ranging from mild, barely noticeable pain to severe pain, likened in some cases to childbirth. Sciatica can affect people of every age however it is mostly seen in the forties and fifties. Expected timeframes for recovery from a sciatica diagnosis can vary greatly however the pain is generally the worst for the first 2-4 weeks. At the 12-week mark 50% of those with sciatica will have nearly a complete resolution of initial symptoms. For a small group of people, pain may not improve at the rate normally expected however by the 12-month milestone over 75% of patients are asymptomatic. HOW TO MANAGE SCIATICA? When it comes to the management of Sciatica there are a range of treatment options available, including physiotherapy. The most important factor in most of these is allowing the appropriate amount of time for recovery. Other common non-surgical treatments include adjusting lifestyle factors such as smoking cessation and weight loss as well as introducing general exercises or specific spinal/ nerve movements targeted at mobilising the sciatic nerve. In extreme cases medications, specialist nerve injections or surgery may be used as a last resort however for most this is certainly avoidable! If you are unsure about what may work best for you then book an appointment with your health professional who can provide you with an accurate diagnosis and a suitable treatment plan that is built around you and your lifestyle! References Dower, A., Davies, M., & Ghahreman, A. (2019). Pathologic Basis of Lumbar Radicular Pain. World Neurosurgery, 128, 114-121. doi: 10.1016/j.wneu.2019.04.147 Goldsmith, R., Williams, N., & Wood, F. (2019). Understanding sciatica: illness and treatment beliefs in a lumbar radicular pain population. A qualitative interview study. BJGP Open, 3(3), bjgpopen19X101654. doi: 10.3399/bjgpopen19x101654 Jesson, T., Runge, N., & Schmid, A. (2020). Physiotherapy for people with painful peripheral neuropathies: a narrative review of its efficacy and safety. PAIN Reports, 5(5), 1-e834. doi: 10.1097/pr9.0000000000000834 Schmid, A., Hailey, L., & Tampin, B. (2018). Entrapment Neuropathies: Challenging Common Beliefs With Novel Evidence. Journal Of Orthopaedic & Sports Physical Therapy, 48(2), 58-62. doi: 10.2519/jospt.2018.0603. Background photo created by jcomp - www.freepik.com

With the recent spike in lockdown restrictions most people have been advised to return to working from home. As a result, I’m sure the dust has been blown off many home set-ups that were installed during the peak of the pandemic in 2020. For most of us this ‘temporary’ setup consisted of a four-legged chair, kitchen bench and our laptops, or even worse…our beds! But is this really the best idea? What did the home office change? For a majority of the workforce, the COVID 19 health emergency introduced us to remote working for the first time. With the primary goal being to minimize physical contact and potential contamination of the workplace, it was a feat of technological brilliance that allowed most companies to continue to operate despite these restrictions. Yet with this in mind, the shift to a home set up has resulted in a considerable change to the environment in which we work. Among the advantages of this we see reduced time spent commuting to and from work, possible increases in productivity and motivation as well as a better work-life balance. However, not everything has changed for the better. Common struggles such as a lack of separation between work and rest, no personal human interactions or communication problems are the obvious disadvantages that most of us would identify when talking about the harm of working from home. But what if I told you that working from home was also affecting your physical health? Is your home environment detrimental to your health? A study conducted in 2020 (Moretti et al., 2020), targeted the changes in working life that most of the population has experienced since the COVID-19 health emergency. In this it analyses the physical health issues related to remote working. The two major factors identified were the increased periods of inactivity and the adoption of poor posture due to lack of environmental support. It suggested that our home environment is inferior to the workplace, particularly due to the “absence of ergonomic office furniture which may impede the adoption of a healthy posture and promote the onset of musculoskeletal disorders.” SO... WHAT DOES THIS MEAN IN ENGLISH? In simple terms our use of a four-leg dining chair, kitchen bench and laptop are a poor substitute for an office desk with an adjustable chair and height adjustable monitor. In fact, this shows that it can lead to the development or worsening of physical disorders notably lower back and neck pain. It reported that 70.5% of participants had musculoskeletal pain with the lower back being responsible for 41.2% of complaints and the neck accounting for 23.5%. Now given that lower back pain itself is quite complex it would be wrong to suggest that the poor remote working station is the only reason for this spike in pain. However, if we frame the entire working from home lifestyle and take the big picture into consideration, it is quite easy to see how these factors can play together. If we combine the reduced activity levels, with poor body positioning whilst sitting, poor psychosocial factors from time in isolation and the continued stress of repetitive work, it starts to paint quite an ugly picture for our overall spine health. Furthermore, it is well documented that working in the same position for an extended period significantly increases your risk of injury. Considering that the most frequent health problems presented within the working population are spine related, this finding is not too surprising. What can you do to prevent this? Whilst we are going to give you some tips below on how to adapt your workstation, to maintain good health and wellbeing throughout this period of remote working change should not stop there. It is essential that you continue to maintain boundaries with work. If possible, schedule time away from your desk. Try to maintain physical activity throughout this period aiming for at least 30 minutes of moderate physical activity every day. Furthermore, maintaining social relationships during this period will also help alleviate stress and other psychosocial factors that may influence your pain. If you can adjust your home set up it should include the following changes: 1. Adjust your screen height. The ideal screen sits in line with your shoulders so adjust your desktop to this height and if you have a laptop elevate it with a platform or some sturdy books. This will prevent excessive craning of the neck or other less ideal positions. Working with one screen is also preferable as it prevents you rotating your neck repeatedly to one side which can contribute to imbalance. 2. Lumbar support. If you do not have an office chair at home, a rolled up towel positioned at the small of the back can act as a substitute helping to assist you into an ideal position. 3. Keep your keyboard and mouse close to the edge of your desk. This will prevent excessive forward leaning. 4. Keep your feet flat on the floor. If you have a height adjustable chair this would be ideal. If not, using a footstool beneath the feet can offer the same support. 5. Keep moving. Try to avoid being stuck in the same position for long periods of time. Remember, your next position is your best position! Moretti, A., Menna, F., Aulicino, M., Paoletta, M., Liguori, S. and Iolascon, G., 2020. Characterization of Home Working Population during COVID-19 Emergency: A Cross-Sectional Analysis. International Journal of Environmental Research and Public Health, 17(17), p.6284.

Whether you’ve signed up for a local 5K, Sydney fun run or you’re building towards something bigger, following the right running injury prevention tips can make a huge difference to your performance, recovery and long-term progress. Most runners focus only on getting through race day — but how you prepare and recover is what truly keeps you running strong and injury-free. Running Injury Prevention Tips Before Race Day Let’s break it down simply 👇 1. The months before: build, don’t rush 🏃🏼‍♂️ This is where most injuries either develop or are prevented, and the most common mistake we see in clinic is simply doing too much, too soon. If you’re preparing for an event, make sure you: Gradually increase your running volume (not more than ~10% per week) Include strength training (especially glutes, calves and quads) Don’t ignore small niggles—they rarely “just go away”. 💡 If something feels off early, that’s your window to fix it—not push through it. 2. The week before: less is more 📅 By race week, the work is done. Now it’s about arriving fresh to that moment you’ve been preparing for. Focus on: Reducing training volume (tapering) Keeping some light intensity (don’t fully stop) Prioritising sleep and recovery Avoid: Trying new shoes Changing your routine “Testing yourself” with a hard training session 💡 You don’t gain fitness this week—you protect it. 3. The night before: keep it simple 🌙 No need to overcomplicate things, stay within your normal routine and most importantly, don’t stress if you don’t sleep perfectly. One average night won’t ruin your performance. Some things to keep in mind: Eat a familiar meal (nothing new or heavy) Hydrate well throughout the day Prepare everything in advance (shoes, outfit, timing) 4. RACE DAY: warm up, don’t wing it ☀️ Wake up with enough time to avoid rushing, get dressed calmly, and make sure you have everything you need for the race. Once you arrive, give yourself time to settle in and start preparing your body—turning up and “just starting” is one of the fastest ways to pick up a niggle. Before you run you should do a 5-10 minute easy jog Dynamic mobility exercises for hip, calves and ankles Try a few accelerations. This will help you to reduce injury risk, improve performance and get your body ready to absorb load. 5. After the race: recovery starts immediately 🧊 Recovery is active, not passive. From the minutes right after you finish until a few days after when you start building back up to your previous training load or a new goal, active recovery it’s a crucial part to avoid injuries. The first hour after the race: Keep moving (don’t just stop abruptly) Light walk + gentle mobility Hydrate and refuel (protein + carbs) Do not sit for long periods straight away Do not ignore stiffness building up The days after the race: Day 1–2: light movement (walk, cycle, mobility) + try some ice baths Day 3+: gradual return depending on how you feel + get a nice massage Do not rush back into training Do not ignore pain - 💡 Soreness is normal, pain that changes how you move isn’t. This is where many runners go wrong—jumping from soreness to complete rest, then straight back into full training—so instead, build back gradually and pay attention to signs like persistent pain (not just soreness), swelling, or any sharp or localised discomfort. To wrap things up 🧠 Running events are great motivators—but they also tend to expose gaps in preparation. The goal isn’t just to get through your race. It’s to perform well on the day, recover properly afterwards, and be able to keep training consistently without setbacks. Need help preparing or recovering? If you’ve got an event coming up—or something doesn’t feel quite right after one—getting on top of it early can make a big difference. Small issues are much easier to manage before they turn into something that stops your training altogether. At Physio K, we help runners with personalised treatment, recovery strategies and running injury prevention tips to keep you moving consistently and pain-free. 👉 Book in with our team and let’s keep you moving.