Physio Penrith Lower Limb Treatments

Lower Limb Injuries Treated at Sydney Muscle & Joint Physio Penrith

At Sydney Muscle & Joint Physio Penrith common lower limb complaints include femoro-acetabular impingement (FAI), greater trochanteric pain syndrome from gluteal tendinopathy and/or hip bursitis, groin and adductor strains, patellofemoral pain syndrome (PFPS), ACL reconstruction rehabilitation, ankle sprains, Achilles tendinopathy and plantar fasciopathy (fasciitis). These lower limb injuries can be acute and chronic in nature, they can be the result of trauma, a sporting injury or excessive overload. Regardless, a thorough physiotherapy assessment, diagnosis and impairment related management should be at the core of any treatment approach. At Sydney Muscle & Joint Physio Penrith we pride ourselves on an accurate assessment and diagnosis and the application of research supported interventions that includes the very latest in exercise prescription.

Hip FAI impingement

Hip femoroacetabular impingement (FAI) is recognised as a major cause of hip pain and early hip joint osteoarthritis in young adults. The dynamic conflict between the femoral neck and the acetabular rim has been shown to result in labral tears, cartilage lesions, and early osteoarthritis. Common symptoms include anterior or anterolateral hip pain that refers to the groin and occasionally radiates down the anterior thigh. Hip pain, discomfort and “stiffness” can be increased in positions and activities requiring hip flexion and/or internal rotation. If enough intra-articular damage has occurred, such as a labral tear or chondral damage, then mechanical symptoms such as clicking or catching of the hip may be present.

 

On physical examination patients may use the “C sign” and grasp the affected hip with their hand indicating both anterior and posterior hip pain and most often patients will have a positive anterior impingement test, in which the hip is flexed to 90°, internally rotated and adducted (FADIR Test). Read more.

Hip subspine impingement

Subspine impingement is used to denote the collision that may occur between an enlarged or malorientated anterior inferior iliac spine (AIIS) and the distal anterior femoral neck in straight flexion of the hip. Involvement and impingement of soft-tissue structures, such as the direct head of the rectus femoris and the iliocapsularis muscles, or the anterior hip capsule, has been suggested.

New evidence regarding the role of the iliocapsularis muscle in providing stability to the hip joint is providing some specific exercise selections in those with subspine and also those with impingement presentations and no radiographic evidence of changes int he change of the AIIS. Read more.

Lateral hip pain

At Sydney Muscle & Joint Physio Penrith patients presenting with pain on the outside of the hip is very common. Greater trochanteric pain syndrome is a common cause of lateral hip pain and for many years, this condition was believed to be caused by trochanteric bursitis. More recently gluteal tendinopathy/tears have been proposed as potential causes. Localised lateral hip pain with point tenderness over the greater trochanter has for many years been clinically diagnosed as trochanteric bursitis, this may be inappropriate, given that three of the four cardinal signs of inflammation: rubor, erthythema and oedema are uncommon with only pain being the main complaint.

 

Imaging findings for patients with lateral hip pain report variable incidence, with bursitis incidence ranging from 4% to 46% and gluteal tendinopathy ranging from 18% to 50%. Therefore, the preferred clinical term for lateral hip pain is therefore greater trochanteric pain syndrome. At Sydney Muscle & Joint Physio Penrith common symptoms of greater trochanteric pain syndrome include chronic intermittent lateral hip/thigh/buttock pain, aggravated with activity and affected side lying position. The most common examination finding is reproduction of the pain on palpation of the bony prominence on the side of the thigh. Read more.

Hip microinstability

Symptomatic hip microinstability is recognised as a potential cause of pain and disability in young patients. The etiology of hip microinstability includes bony abnormalities, residual laxity after traumatic dislocation, connective tissue disorders resulting in ligamentous laxity, repetitive microtrauma associated with athletic activities, iatrogenic injuries to the hip capsule and idiopathic. In most cases, initial treatment should consist of non-operative management, focusing on strengthening of the intrinsic hip muscles, glut muscles and core muscles. Read more.

Hip labral tear

Hip labral tears are a common source of hip and groin pain, with some research reporting a prevalence of labral tears in patients with hip or groin pain as 22–55%. The cause of many hip labral tears includes trauma, femoroacetabular impingement (FAI), capsular laxity/hip hypermobility, dysplasia, and degeneration. Conservative management for acetabular labral tears usually focuses on physiotherapy-led exercise protocols that aims to optimise the alignment of the hip joint and the precision of joint motion by reducing anteriorly directed forces on the hip and addressing abnormal patterns of recruitment of muscles that control the hip.

Specific strengthening exercises that target the smaller hip muscles that internal and externally rotate the femur bone should be the first line of treatment, followed by the larger more powerful muscles. Stretching should be avoided at all costs. Read more.

ITB syndrome

Iliotibial band (ITB) syndrome is a common knee injury in runners and other long distance athletes caused by inflammation of the distal portion of the iliotibial band (ITB), which results in lateral knee pain or pain on the outside of the knee joint. Most people still think of the IT band as being free to move relative to the femur creating friction at the knee, but the iliotibial band is not free to move relative to the femur. It is anchored to the femur bone between the big muscles of the front and back; it clings to it like a barnacle to a rock, this is why it has been suggested that “the ITB cannot actually create frictional forces by moving forwards and backwards over the epicondyle during flexion and extension of the knee". In actually fact, the IT band has been described as a big tendon and therefore interventions that are proven to work for tendon injuries need to be applied to those individuals with ITB syndrome. Read more.

Patellofemoral knee pain (anterior knee pain)

Patellofemoral pain syndrome (PFPS) is a common painful knee presentation at Sydney Muscle & Joint Physio Penrith and can also be referred to as runners knee, patellofemoral joint syndrome, patellofemeral pain (PFP), and anterior (front) knee pain. Common symtpoms of patellofemoral pain syndrome include pain to be experienced in a diffuse manner at the front, inside and/or outside of the knee joint, as well as around the knee cap- the knee pain is very hard to localise. These symptoms are exacerbated during patellofemoral joint loading activities; eg, squatting, climbing or descending stairs and running or when sitting with the knee bent for a long time (movie sign).

Patellofemoral pain syndrome is a very common complaint and accounts for 25-40% of knee problems that a physiotherapist will manage. Patellofemoral pain will not get better on its own and resting or stretching is often not helpful and can often make the presentation worse when returning to activity. Research shows that up 91% of people still had this problem 20 years after it started (it lasts a long time). Read more.

Knee osteoarthritis

Knee osteoarthritis is a chronic condition affecting the knee joint and the most common form of chronic arthritis. Common symptoms include joint pain, stiffness and swelling. Osteoarthritis most frequently occurs in people aged >55 years, with risk factors including previous joint injury, being overweight or obese, and older age. It is expected that Australians with osteoarthritis is expected to rise from 2.2 million in 2015 to almost 3.1 million by 2030.

 

There is currently no cure for knee osteoarthritis, but there are many non-surgical treatments and approaches to managing the long-term symptoms of this disease. In 2018 the RACGP released an updated version of the Guideline for the management of knee and hip osteoarthritis with advice and recommendations for the management of people with knee and/or hip osteoarthritis. The guideline has a strong focus on self-management and non-surgical treatments to improve the health of people with knee and/or hip osteoarthritis. Read more.

Knee meniscus injury

Knee meniscus injury is a common cause of medial knee pain and can be categorised as an acute injury during a flexion and pivoting movement, or degenerative as part of osteoarthritis. 

Medial and lateral collateral ligament knee injury

Medial collateral ligament (MCL) injury is a common cause of medial knee pain and is a commonly injured ligament, often injured in combination with the ACL ligament and medial meniscus. A tear in the MCL ligament is also known as an MCL strain and is associated with some delayed swelling (6-24hrs), pain on valgus force and pain when bending the knee.

The MCL is injured through contact and non-contact forces. If there is enough force, this will result in the ligament stretching and tearing. Non-contact injuries can also occur, particularly when there are large forces going through the knee resulting in over-stretching and tearing.

 

The symptoms will depend on which grade of injury has occurred:

  • Grade 1 – some pain on the inside of the knee but generally no swelling. There is no instability of the knee.

  • Grade 2 – Much pain on the inside of the knee with some swelling. There will be some instability of the knee.

  • Grade 3 – Much pain on the inside of the knee with large swelling. Gross instability of the knee will be found.

Anterior cruciate ligament (ACL) injury

The Anterior cruciate ligament (ACL) is a supportive ligament located within the knee joint. It stops the shin bone (tibia) sliding forward on the thigh bone (femur). ACL injuries can be the result of contact and non-contact sports. Often they are from non-contact sports that involve side stepping (cutting), jumping and landing, and deceleration (quickly stopping). AFL, soccer and netball would be a good example of sports that involves these movements with high amounts of ACL injuries.

When the ACL is torn an audible ‘pop’ can often be heard and pain and swelling within the knee occur immediately after the injury. The knee can become very swollen. It will be difficult to walk or put weight through the leg and there will be feelings of instability.

The treatment for an ACL tear is generally surgical treatment with 9-12 months of progressive physiotherapy-led exercise rehabilitation. Exercises are designed to improve the knee function to the pre-injury level, ensuring quadricep strength, jumping and landing and good hip stiffness is at its foundation. Read more.

Shin splints - medial tibial stress syndrome

Medial tibial stress syndrome, commonly known as “shin splints,” is a frequent injury of the lower extremity and one of the most common causes of exertional leg pain in athletes. New evidence indicates that a spectrum of tibial stress injuries is likely involved in shin splints, including tendinopathy, periostitis, periosteal remodeling, and stress reaction of the tibia. Dysfunction of the tibialis posterior, tibialis anterior, and soleus muscles are also commonly implicated.

The most common complaint of patients with shin splints is vague, diffuse pain of the lower extremity, along the middle-distal tibia associated with exertion (inside of the shin bone). In the early course of shin splints, pain is worse at the beginning of exercise and gradually subsides during training and within minutes of stopping exercise. As the injury progresses, however, pain presents with less activity and may occur at rest. Read more.