Whiplash
Whiplash describes the neck injury (strain/sprain) following the exertion of great force on the neck through an abrupt back and forth motion, similar to that of a cracking whip. The most common cause is a rear-end car accident, though it can also occur in sports and other trauma such as being jerked back suddenly and forcefully by the shoulders. This can damage various structures including bones, muscles, soft tissues and intervertebral discs. The result is a variation in symptoms that commonly involve pain and stiffness in the neck as well as tenderness in the shoulders, back and arms, fatigue, dizziness, headaches, numbness or tingling in the arms. In more severe cases, symptoms can include vision and sleep disturbances, memory and concentration difficulties, stress, anxiety and more. There may be a delay of up to 24 hours before symptoms present. Because of the varying nature of whiplash with regard to the structures involved, it is important to have your health care professional accurately identify the damaged structures and construct a treatment plan as in some cases pain may continue for months or years following injury. Due to the sensitive nature of the neck closely packed with small ligaments, bones and nerves, it is important when having treatment to advise your therapist if the force they are using feels to firm or you experience any worsening of your symptoms during the treatment.

Upper Trapezius Muscle Strain/Sprain
The upper trapezius is a large muscle situated triangularly between the neck, shoulder and the middle area of your back. Injury to this muscle causes significant pain and discomfort to the shoulder, arm and neck regions and can make moving the head, neck and shoulders painful and uncomfortable. It often presents with swelling and associated muscular weakness and stiffness. Strains on the upper trapezius are caused by abnormal stress on the muscle past what it can handle such as in repetitive overhead and push/pull movements as well as trauma.

Facet Joint Injury (Syndrome/Disease/Pain)
Facet joints are located in pairs between the spinal vertebrae and work to control the movement in the spine. Disturbances to the facet joints can cause them to have limited movement (stiffness), excess movement or become locked or jammed. Causes of stiffness in the facet joints is typically due to degenerative changes and changes to the associated musculature and soft tissues. Causes of excess movement include fractures, dislocation, excess movement in the surrounding soft tissues and some systemic diseases such as Rheumatoid Arthritis. Facet joints can also lock following abrupt movements, twists and trauma. Symptoms vary depending on which facet joints are injured (thoracic, lumbar or cervical) but typically involve pain, tenderness and stiffness in the affected area that can radiate down to the upper back leg or up to the shoulders and arms. Repetitive problems with the facet joints can indicate weakness in the muscles that serve to stabilise the spine, so a thorough assessment is required to develop a treatment programme that both resolves symptoms and prevents future re-injury.

Shoulder Impingement Syndrome (Bursitis/Rotator Cuff)
Shoulder impingement syndrome typically describes the repetitive compression on the rotator cuff tendons that causes a general impingement and injury to these tendons or associated bursa producing pain and limitations in motion of the shoulder. The compression may occur over time (overuse) as seen in repetitive overhead motions of the shoulder such as throwing, reaching or lifting movements, or following an acute trauma such as a fall onto the shoulder. Other causes include bony abnormalities, damage to the joint and the soft tissue structures in the region, muscle damage and arthritic changes. This result is either rotator cuff tendinitis whereby the tendons are damaged or inflamed, or bursitis whereby the bursa (fluid-filled cushion-like sac) between the acromion (bone at the top of your shoulder) and the rotator cuff tendon becomes inflamed. Symptoms include painful and restricted shoulder movements and associated weakness. The pain is exacerbated by throwing, lifting and reaching movements and may radiate down the arm. This injury can present long term symptoms and it is therefore important to see an experienced practitioner for an accurate diagnosis and treatment plan to reduce the risk of recurrence and accelerate healing, as well as differentiating between a soft tissue injury and any joint abnormalities that may cause ongoing problems.

Acromioclavicular (AC) Joint Injury
The AC joint forms part of the shoulder and can be felt at the bony bump at the top of the shoulder (acromion process) where it meets the collarbone (clavicle). The joint is supported by ligaments (acromioclavicular and coracoclavicular ligaments) and it is these ligaments that are typically affected in an AC joint injury. Injury commonly occurs in active young adults from impact to the AC joint that pushes it beneath the clavicle causing a sprain or joint separation, and in severe cases, complete ligament tears. It often occurs in high impact contact sports and throwing sports as well as in trauma such as falls onto the shoulder, bicycle and car accidents. Following impact, swelling, pain and tenderness is felt at the collar bone that can radiate throughout the shoulder, the shoulder may stiffen, pain is exacerbated by moving the shoulder in most directions, especially when trying to raise the arm. A lump at the injury site may also be present. Because there are numerous structures that can be affected in shoulder injuries, it is important to have your shoulder thoroughly checked by your health professional to ensure you get the best treatment and care advice to get you back to full function.

Shoulder Instability
Shoulder instability describes the condition whereby the humerus (upper arm bone) is displaced out of the shoulder socket. While the shoulder is a ball-and-socket joint with a strong joint capsule and supporting ligament system, injury or repetitive strain can disrupt the joint and cause painful subluxation (the ball of the humerus partially comes out of the joint) or dislocation (the ball of the humerus comes completely out of the socket). Repetitive injury and dislocation can lead to chronic instability whereby the tissues of the shoulder joint are weakened and stretched and are therefore unable to control and prevent further dislocations. Alongside a history of injury and overuse to the shoulder, some connective tissue disorders can also result in loose and unstable shoulder joints.

Frozen Shoulder (Adhesive Capsulitis)
Frozen shoulder describes the swelling and stiffening of the shoulder joint capsule and the surrounding ligaments. While the exact cause is not completely understood, there’s a tendency for occurrence following injury and thereby immobility. Frozen shoulder has a higher prevalence in females over 40 years old and in endocrine conditions such as diabetes and thyroid disturbances. Typically a frozen shoulder will present with stiffness in all directions and pain on movement that can worsen at night. With tissue stiffening, scar tissue forms which can also greatly reduce the movement available at the shoulder joint, a process that occurs slowly over time. This condition can last anywhere between 1-3 years so it is important to seek treatment from a health professional in order to optimise your overall rehabilitation time.

Lower Back Pain
While lower back pain may be common, its wide variety of causes mean it needs to be accurately diagnosed and treated appropriately to reduce the risk of ongoing problems and pain. The cause of lower back pain and discomfort varies but is most often of musculoskeletal origin and results from abnormal stress and strain to muscles, ligaments and joints. This is called ‘non-specific lower back pain’. This pain may develop following a trauma such as lifting a heavy object or may occur over time from daily routines such as poor posture at work. Different mechanisms each require different treatments specific to the pathological nature of the injury that has occurred, reinforcing the importance of seeking a thorough assessment and treatment in order to optimise your rehabilitation. Pain can be sharp or dull and can be localised over a small or large region of your back. In rare cases, causes of back pain can include fractures, cancer, infections and systemic conditions.

Causes of non-specific lower back pain can include:

Poor Posture
Poor posture places excess stress on the muscles, ligaments, joints and the inter-vertebral discs of your spine. Prolonged poor postures can cause strain, fatigue and pressure on spinal structures that can result in lower back pain. It is important to be mindful of posture not only at work but when standing, sitting and lifting objects too.

Bulging Disc
A bulging or prolapsed disc describes the outward bulging of an inter-vertebral disc - a spongy cushion-like structure that sits between the vertebrae of the spine and acts as a shock absorber. This may cause it to push against a nerve and produce neurological symptoms including pain, numbness, tingling and cramps. Common symptoms of a bulging disc are both localised lower back pain and referred pain usually travelling down the leg or into the groin.

Sprains/Strains
Muscular and ligamentous sprains and strains occur from increased stress on the tissues such as through heavy lifting, twisting, reaching, sport and car accidents. Muscles fatigue and can tear resulting in pain and swelling.

Lateral Epicondylitis (Tennis Elbow)
Otherwise known as ‘Tennis Elbow’, lateral epicondylitis describes the inflammation on the tendons that connect the muscles of your lower arm to a bony prominence on the outside of the elbow called the lateral epicondyle. Damage occurs due to repetitive overuse of the tendons that places them under more stress than they can normally handle which causes micro-tears to the tendon, much like a rope that slowly frays with excessive use. The main contributing movements aren’t limited to tennis but any activities involving gripping and extending your wrist backwards that increase stress on the musculature of the arm. These activities can range from racket sports and weightlifting to painting and knitting where there is a repetitive extension grip on an object. Symptoms include pain and swelling at the elbow that can radiate down the arm and generally there is no pain at rest, only on movement. It is important for treatment that this be differentiated from medial epicondylitis.

Medial Epicondylitis (Golfers Elbow)
In contrast to tennis elbow that affects the tendons on the outside of the elbow, golfers elbow (medial epicondylitis) affects the tendons on the inside of your elbow that insert into a bony bump called the medial epicondyle. Because the musculature affected works to control flexion of your wrist and fingers, causes are often associated with activities that put strain on hand movements ranging from golf, racket and ball sports that require repetitive flexion and gripping to painting and using tools. The pain and swelling presents on the inside of the elbow which may radiate down the arm and can be exacerbated by movements that require squeezing, gripping, rotating your arm and flexing your wrist. Pain may also be felt when stretching and extending the arm. It is important to differential this from chronic golfer’s elbow which involves degenerative changes to the musculature.

Carpal Tunnel Syndrome
Carpal tunnel syndrome describes an irritation to the median nerve in the wrist within the ‘carpal tunnel’ – a small tunnel in the palm side of the central wrist. Because this nerve moves down the arm to innervate the fingers (except your fifth little finger), symptoms include pain, numbness and tingling in the hand, particularly the thumb, index and middle fingers. While there is no main cause of carpal tunnel syndrome, any activity or condition that places pressure on this nerve or reduces the space within the carpal tunnel contribute to its development including inflammatory conditions such as arthritis, wrist injuries, endocrine disorders such as diabetes and hypothyroidism, as well as pregnancy. Repetitive wrist movements that bend the wrist may also contribute as well as prolonged compression of this part of the wrist during movements such as resting your wrists against the desk or computer while you type.

Ganglion Cyst
A ganglion cyst describes a cushion-like lump that develops at a joint or tendon. They vary in size from 8 – 25mm and are typically rounded with a thick fluid centre. They commonly occur around the wrist, particularly at the back-hand side and can protrude on flexing the wrist. Other areas they can present include the fingers, knee, ankle and foot. While the exact cause remains unclear, it is suggested to be associated with the breakdown of joint tissue as well as irregularities to the joint capsule and surrounding tendons. While some ganglion cysts remain asymptomatic, they can cause pain that is worsened by moving the associated joint, swelling, tendon weakness where a ganglion is connected to a tendon and neurological symptoms such as tingling, numbness and pain where a ganglion impinges on a nearby nerve. Symptoms vary in severity and your health professional will inform you of the best treatment option.

Trochanteric Bursitis
Trochanteric bursitis, otherwise known as ‘Greater Trochanteric Pain Syndrome’ describes the painful inflammation of a small cushion-like sac called a bursa that sits over a bony prominence called the greater trochanter on the side of the hip on the femur (thigh bone). Because bursae function to reduce friction between muscles/tendons and bone and facilitate movement, inflammation occurs when these tissues rub against the bursa and cause friction. This can occur through sporting injuries or falls, or may occur with repeated stress over time such as through walking, running and cycling. Symptoms include pain at the hip that may radiate down the thigh, swelling at the side of the hip, pain on standing after prolonged sitting and increased pain on prolonged repetitive movement such as walking. Typically pain is felt on pressing on the outside of the affected hip.

Hip Labral Tear/Impingement
A hip labral tear describes a tear in the cartilaginous ring surrounding the socket of your hip joint that otherwise functions in cushioning and stabilising the hip socket. Various causes include sporting and accidental trauma that results in displacement of the hip into an abnormal position, repetitive abnormal hip rotation such as during hockey, ballet, soccer and golf, and structural abnormalities within the joint. Occasionally no pain is felt from a labral tear but when symptoms are present they include pain in the outer hip and groin regions, a catching or clicking feeling in the hip joint, stiffness and limited movement at the joint.

A hip labral impingement, otherwise known as ‘Femoroacetabular Impingement’ (FAI), describes an irregularity in the shape of the bones of the hip joint due to bone spurs which causes abnormal rubbing and friction during movement as a result of the imperfect shape. This occurs either from birth or from irregular development of the hip bones in childhood and adolescence and causes pain, swelling and poses an increased risk of early hip osteoarthritis.

The Knee
Our knees take on an enormous load during every day - because of the dynamics of acceleration, the forces and moments created and numerous muscular contractions, regular walking can exert a force of two to three times our body weight across our knee joint. As such, there are many tissues within the knee that play important roles in knee stability and are susceptible to injury. Because of the large impact that knee injuries have on an individual's quality of life, this is a key focus and area of expertise by our podiatrists at Physio Connect that are dedicated to bringing you the best, most effective and advanced solutions to the following knee injuries and more:

• Anterior Cruciate Ligament (ACL) - the ACL is located inside the knee and attaches anteriorly to the tibia to stop the tibia from sliding forwards from the femur while providing some rotational stability to the knee. Injuries to the ACL commonly occurs in the form of sprains or tears. These injuries range from a mild strain where the ACL is still able to maintain its fun in supporting the knee while experiencing some pain, swelling and a decreased range of motion, to the ligament being torn completely, rendering the knee joint unstable. This may be associated a “pop” and the knee giving out resulting in a fall. Injuries may arise from physical activities that involve sudden stops and changes of direction, irregular landing on your feet or direct impact trauma to the knee. It is often seen in sports including basketball, soccer and skiing.
• Medial Collateral Ligament (MCL) - The MCL is located on the inner side of the knee, connecting the femur (thigh bone) to the tibia (shin bone) and helps to stabilise the knee from abnormal sideways motion. Injury commonly occurs when through an impact force to the outside of the knee that pushes inward, straining and potentially tearing the MCL. This can be from a ball hitting the outside of the knee or a side tackle as examples. Pain and swelling present at the inside of the knee, the knee can feel unstable and a popping sound may be heard on impact with the knee potentially catching or locking during movement.
• Lateral Collateral Ligament (LCL) - The LCL is located on the outer side of the knee, connecting the femur to the fibula, and helps to stabilise the knee against abnormal sideways motion. Similar but opposite to the MCL, the LCL is injured when an impact force is exerted on the inside of the knee that pushes the knee outwards, though these injuries are significantly less common. LCL injuries often occur in conjunction with damage to other structures at the lateral knee joint so an examination and correct diagnosis is important. Pain and swelling present at the outside of the knee and the knee can feel unstable.
• Patella Tendon - The Patella Tendon runs from the patella (knee bone) to the tibial tuberosity (bump on the front of the upper shin bone) and works with the quadriceps to straighten the knee. Injury to the patella tendon can come in the form of a partial or complete tear, or a tendonitis. A partial tear describes some damage to the tendon fibres without complete disruption so it remains in one piece. A complete tear means there is no longer a tendinous attachment between the patella and the tibia. Tears occur as a result of a strong force exerted on the tendon, such as the impact from falls or jumping. Tears can be more likely in individuals with patella tendonitis, some chronic diseases that affect the blood supply the tendon, steroid use and previous corticosteroid injections. Tendonitis refers to the inflammation of the tendon from repetitive overloading, such as in jumping, so is often referred to as ‘Jumper’s Knee’. It can also occur as degenerative damage over time in the older population, as well as insufficient healing following an acute tendon injury. Symptoms of patella tendon injury include anterior knee pain, swelling, bruising, difficulty in moving the joint and walking, displacement of the patella and an irregular indent where the tendon may have torn. Because adequate knee motion is essential for daily activities and keeping you on your feet, our Podiatrists here at Physio Connect are highly skilled in this area and ensure to be up to date with the clinical latest research and advanced treatments to be able to work with you to ensure the best clinical outcomes.

Patellofemoral Pain Syndrome (PFS)
broadly describes anterior knee pain in the region of the patella (kneecap) that can involve soft tissue damage to the tendons and ligaments surrounding the knee, the infrapatellar fat pad (fat pad beneath the kneecap) or the synovial tissue at the knee joint that works to facilitate smooth knee motion and reduce friction. There can be many causes of PFS including overuse from an increase in repetitive high-impact physical activities, unsupported translocation of force from the foot, a higher BMI, irregular bony alignments or muscular imbalances that cause the patella to shift outside of its normal tracking path, knee injuries leading to ligamentous laxity and potentially faulty foot biomechanics that result in abnormal compensations at the knee and its tissues. Pain tends to come and go, is localised around and behind the knee cap, and exacerbated by activity that bends the weight bearing knee and compresses the patella. Swelling may occur that can result stiffness and difficulty in bending the knee. Crepitus (a creaking sound associated with a grinding feeling when the knee moves) may also be occur.

Medial Tibial Stress Syndrome (MTSS)
is commonly referred to as shin splints and describes the pain that is often felt by runners and athletes at the front of your tibia (shin bone) with exercise. There are two distinct aetiologies in MTSS that result in this pain:

• The overuse or excessive pulling on the connective tissue that covers the tibia called the periosteum by the surrounding musculature and tissues
• Injury to the tibia bone itself through increased stress, repetitive loading and excessive bending (in activities such as running) that result in micro-fractures that can progress to fractures

Pain typically presents after and during exercise. MTSS can be effectively managed but needs to be differentiated from other conditions with similar symptoms such as compartment syndrome, a tibial stress fracture and tendon pathology.

Achilles tendinitis/Tendonopathy
refers to the damage to and irritation of your achilles tendon - the cord-like tendon that extends from your calf muscles into the back of your heel. It plays an important role in helping you take your foot off the ground when you walk and generally any action or activity that involves pointing your toes, especially sporting activities that have quick transitions between standing still and running or moving suddenly. Unlike plantar fasciitis pain that is felt beneath the heel, achilles pain will be felt at the back of the heel and may radiate up the back of your lower leg. Causes include increases in activities that strain the tendon like those requiring standing on the toes, tightness in the tendon and calf musculature, faulty foot biomechanics that increases the load on the tendon, improper footwear and more. This condition is not uncommon and as such can be effectively managed and resolved.

Rear Foot Pain? What Could It Be?

Plantar Heel Pain is the most common cause of heel pain and describes the irritation or degeneration of a tissue that attaches from the bottom of your heel and spans out like a fan to your toes, called your plantar fascia. Because this tissue plays a crucial role in supporting your arch and helping you walk, pain is felt beneath the heel at varying intensities throughout the day on stepping, with a tendency to be worse in the mornings and on standing after rest. There are various causes including repetitive stress on the fascia pushing your tissue out of its envelope of function, changing to unsupportive, un-pitched (flat) footwear, an increase in activity levels with faulty foot biomechanics, and one-off injuries such as jumping down from a significant height. Because of the location of this injury, it makes resting and alleviating pressure altogether extremely difficult as most of us need to continue to walk and carry out our daily activities. This mean it can be a long-standing condition with patients initially waiting months to years before seeking treatment in the hopes that it will resolve itself. At Physio Connect, we treat this condition on a daily basis and as such have adopted solid, evidence based treatment strategies that we are confident will help you too, both in clinic and at home.

Cuboid Syndrome is characterised by the subluxation (partial dislocation) of the cuboid, a bone located on the outside border of the mid-foot. Subluxation occurs when, during gait, stress and traction forces are exerted on the cuboid and the connective tissues that exceed the load that the tissues that function to stabilise the cuboid and attach it to surrounding bones can withstand. This stress is caused by contraction of muscles in the leg and foot (commonly the Peroneus Longus), as well as improper biomechanical loading, lateral ankle instability and inversion ankle sprains. The resulting malalignment results in pain in the region of the cuboid that worsens with weight-bearing and twisting motions. This pain can radiate through the foot and can cause an altered gait where the outside border of the foot is attempted to be avoided to reduce pain on walking, and often occurs in conjunction with Peroneal Tendonitis (see above).

Forefoot Conditions

As forefoot pain and abnormalities have a diverse range of causes with very differing treatment requirements, it is important to have a thorough assessment and accurate diagnosis. Our podiatry team are highly skilled to help you effectively manage and resolve the following conditions and more:

Plantar plate injuries are the most common cause of pain beneath the 2nd metatarsophalangeal joint (your second toe joint at the ball of your foot), though also occur in any of the metatarsophalangeal joints. The plantar plate consists of ligaments attached into the base of your toes at the ball of your foot and function to stabilise the toes and hold them in place, preventing them from hyperextending, spreading out abnormally or overloading so your toes can easily bend up and down with every step. Injuries usually occur when a plantar plate undergoes repetitive stress and abnormal pressures that causes a tear in the plate. Increased activity loads combined with situation-based faulty biomechanics and unsupportive footwear are usually contributing factors, though injuries can also occur from trauma where a toe is pulled too far back. Symptoms can include pain, swelling and redness at a metatarsophalangeal joint, the feeling that you’re walking directly on a bone, and occasionally there may be a separation of the toes leading to a ‘V’ shape between two toes where a toe could begin to point upwards.

A Morton’s Neuroma is a swollen or thickened nerve in an interdigital space (space between the toes) at the ball of the foot, commonly occurring in between the 3rd and 4th toes. It is typically caused by repetitive compression of the nerve, which can be attributed to by foot biomechanics, tight footwear and high heels, or may arise from trauma. Symptoms include a sharp, burning pain in the ball of the foot, especially on compression of the nerve such as when walking or wearing tight footwear (and subsequent relief after removing footwear), feeling a ‘click’ on walking, numbness or tingling in the toes, and the feeling that you are standing on a pebble.

Metatarsalgia is a broad term used to describe pain and inflammation at the forefoot. The inflammation may be present at a joint capsule (capsulitis), within the capsule (synovitis) or surrounding tissues (bursitis) at the end of the long bones of your feet (metatarsals). The pain may be experienced as a sharp radiating pain, numbness/tingling, aching, throbbing, burning, or a bruising feeling at joints that tends to worsen when active on your feet, especially on a hard surface. Irritation and damage to this area is often caused by high-impact, repetitive activities such as running and jumping, through faulty foot biomechanics and improper footwear are also common contributors.

Plantar Fat Pad Atrophy describes the breakdown of the ‘fat pads’ on our feet - little cushion-like compartmental structures composed of fatty tissue and surrounded by elastin that serve to protect the bones and soft tissues our feet. They do so by absorbing impact forces and pressures during our daily activities, such as vibration and shock forces during walking. Over time, with age and many long days on our feet, these fat pads diminish, so we lose protection and become more susceptible to pain and injury. This can feel like walking on a bruise or a deep ache depending on the location of the damaged or diminished fat pad - this may be at the heel or the forefoot. Moreover, more shock is then forced onto the bones, ligaments and tendons, increasing the risk of injury to these structures. The skin can also be affected, with increased shear forces leading to wounds, lesions and ultimately ulceration. Alongside fat pad atrophy, trauma and repetitive high-impact activity may result in painful inflammation of the fat pad, and it may also displace or thin leaving the areas beneath with less protection. Additional contributor factors include an increased weight, poor footwear, diabetes and spending long periods of time on hard man-made surfaces.

Stress Fractures are small cracks in a bone that are often caused over time by repetitive high-impact forces and general overuse. As such, they are most commonly experienced by active individuals and those involved in running sports where the lower limb bones are currently absorbing shock and impact forces. Stress fractures may also occur where there is a decrease in bone mineral density such as in osteoporosis, a sudden increase in physical activity, improper footwear and situational faulty biomechanics. Stress fractures can occur in any bone but more commonly present in the second, third and fourth metatarsals (long bones of the foot), the calcaneus (heel bone), the talus (the bone in your ankle joint next to the heel bone), and the navicular (a bone on the inside edge at the mid-foot). Symptoms typically include pain that worsens throughout weight-bearing activities with periodic aching post activity and ceases during longer resting, inflammation and tenderness on palpation at the fracture site and occasionally bruising.