Tennis elbow – or lateral epicondylalgia – is inflammation of the tendon which connects the forearms muscles to the elbow. Although it is called ‘Tennis Elbow’ you don’t have to have played the sport to get it. It is usually associated with highly repetitive activities that require a lot of gripping, or wrist and hand movements.
Pain is the most common symptom that people experience, however you may experience a loss of grip strength, reduced ability to lift heavier objects, tingling or pins and needles in the forearm and hand in more extreme cases, and loss of fine motor control movements.
The above symptoms mean that tennis elbow can really start to affect your ability to perform activities of daily living and work-related tasks.
Although it is usually self-limiting – that means that it will eventually go away – it can occasionally last for weeks and even months before settling unless an intervention is made.
Some of the things that your therapist may suggest to help your symptoms include:

1. Activity modification – reducing how much of an activity you do or the way in which you do it
2. Soft tissue therapy – by massaging some of the muscles which are affected, it can reduce the severity of symptoms and allow you to perform a task for longer before pain limits you.
3. Provision of a brace – Using a brace can help to unload the affected muscles and allow you to perform daily tasks with reduced discomfort
4. Provide an exercise program – Exercise is one of the best ways to help reduce the severity of your symptoms and expedite the healing process while also helping to prevent reoccurrences of your symptoms in the future.

Below are some of the best exercises we have found to help improve tennis elbow symptoms and speed up recovery:
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1. Forearm Stretch

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​Forearm stretches help to reduce some of the tension in the muscles which develops as we use them for everyday activity. Increased tension in the muscles puts added stress where the muscles connects to the bone, thus causing your symptoms.

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Give these exercises a try and see how they can improve your elbow pain! ​

by Matthew Calabrese
Activ Therapy Clemton Park

One of the most difficult shoulder problems to improve is a frozen shoulder.  So what is it?  

Also called adhesive capsulitis it is characterised by a stiff shoulder, pain and a loss of range of movement.  It involves the capsule of the shoulder thickening and becoming inflammed, often associated with other shoulder injuries like rotator cuff tears and bursitis as well as surgery or when immobilised for long periods.

The true reason for this developing isnt fully known.

Frozen shoulder will proceed in 3 stages 
1.  Freezing (painful) stage.  This is at the beginning and is characterised by the shoulder getting more and more stiffer as well as high levels of pain in the shoulder joint.
2.  Frozen stage.  Where the shoulder is stiff and limited in movement but usually no longer painful unless stretched.
3.  Resolution (or thawing) stage.  In this stage the shoulder is able to gradually regain its movement.

The timeframe for frozen shoulder can be difficult to predict.  It can often last for 1-2 years and in many cases resolving on it's own.

Treatment for frozen shoulder in each phase is focusing on managing pain and inflammation as well as improving or maintaining range of movement.

Physiotherapy techniques, like capsule releases, dry needling and stretches may improve movement and pain and in some cases a cortisone injection may help.

In the early phase of a shoulder injury if there isn't improvement in movement then it may br progressing to a frozen shoulder in which case progression to movement maintenance is important as a fast recovery may not be realistic.

​Below some of our senior physiotherapists show us exercises to improve movement in the early phase of frozen shoulder.  The first is from our physio Paul at our Clemton Park clinic demonstrating the pulley range of movement exercise.

Paul's second exercise is the wall crawl.  Again a good exercise to use in the early phase when the shoulder is stiff and sore.

The third exercise from Paul is our laying down shoulder flexion exercise.

and our third is from Steve, our head physio at Sans Souci demonstrating the external rotation movement exercise for the shoulder.

These exercises are all useful to do in each phase of frozen shoulder even the early phases.  It is likely to be more painful and difficult early on so it is important to check with your therapist how many repetitions is appropriate and how far you should take the movements.

One you reach the resolution or thawing phase of frozen shoulder it is important to include strengthening and stability exercises to rebuild the shoulder strength and function as the movement returns.

In most cases there are minimal lasting effects once the recovery from frozen shoulder is complete but it can be a challenging condition to live and work with while you have it.

To reduce the risk of getting frozen shoulder make sure that you manage any shoulder injury promptly and correctly and ensure that recovery after surgery is done as the specialist recommends (even if it is a relatively mild one), 

If you feel like you are getting a sore shoulder and movement is very limited see a physiotherapist or a doctor and get it diagnosed in a lot of cases it may not be frozen shoulder and a quick recovery with treatment is very much possible.

Leave a comment if this has been helpful and thanks for reading!

By now everyone is probably aware that we all sit more than we should and it is having a huge impact on our health.  We sit at a desk for work, sit at home, look down at our phones more often and sit longer on our way to and from work.

Not only is this having an impact on our obesity levels, cardiovascular fitness and core strength but it is also a big reason behind persisting neck and shoulder pain.

This is tied in most cases to 2 things:
Sitting for too long at a time, and
Sitting with worse posture.

We will chat about what good posture is in another blog but today I wanted to focus on what is causing that pain and few easy exercises you can do to help reduce these pains.

What most of us feel is a sense of stiffness in the back and tight shoulders and neck.  This comes from that rounded upper back position we all haev when we are hunched at a laptop, looking at our phone or have been sitting at a computer for too long.  We all know we should sit up straight but lets face it, that isnt easy to keep up..

The muscles in your neck and shoulder that get tight are usually one of two.  The first being the upper trapezius muscle which runs from the top of your shoulder up to your neck.  When you get that big knot on top of your shoulder, that's the upper trap.  below our senior physio Michael shows how you stretch out the uppper trapezius muscle.

The other big muscle in the neck and shoulder is the levator scapulae.  This also runs from the top of the shoulder and up to the base of the skull.  Michael is back below to show us the best stretch for the levator scapulae (it is also a really good exercise for headaches that are caused by the neck).

Now all of that neck and shoulder tightness happens because of that stiff upper back and that hunched position we all spend too much time in.  It's a big complex area so we have got 3 different ways to relieve stiffness, improve movement and reduce pain in that area.

First one is Michael again showing us a mckenzie extension exercise you can do against the wall.

The next 2 exercises are with the foam roller.  Below we have our chiropractor Michael (I know it gets confusing and they both work at the same Moorebank clinic as well!) showing us a rotation exercise for the thoracic spine.

And chiro Michael is back to show us a thoracic extension exercise for the upper back with the foam roller.

These exercises are great to reduce the effects of sitting in the short term and also potentially reverse the effects of years of sitting.  So give them a try.

With that being said there is one thing is very important to note.  Exercises and treatment can help manage the effects of poor posture and reverse some effects but it will always be an uphill battle unless you look at your sitting posture first.  Sit for less time and sit in better positions.  These 2 simple things will make all the difference.

Foot drop can happen with a range of conditions, most typically when there is irrtation or damage to the common fibula nerve including the sciatic nerve.

In itself it is a symptom so it's important you see a physio to get to the cause of it.  While addressing the underlying cause it is important to address the footdrop itself.  Below are a few simple exercises that might help.

Foot drop can be a difficult condition to live with because it makes it hard to walk.  It is also an issue that can lead to trips as the toes can get caught on small cracks or edges on the walking surface.  The last thing you need is a fall!

One of the consequences of a foot drop is tightening of the muscle groups at the back of the calf. 

The first two exercises focus on stretching the gastrocnemius and soleus muscles.  Below Matt (head physio at Clemton Park) demonstrates these).

Once you have started work on flexibility of what is tight you then need to strengthen the muscles that raise the foot back up.

​The first exercise to try is a simple foot lift.  Below, our Senior physio at Activ Therapy Casula Lawrence shows how to do this exercise.

The next exercise is resisted peroneal strengthening.  Lawrence again shows how to perform this exercise.

The last in this series is the tibialise posterior exercise.  Along with the peroneals they function to lift up the foot.  Lawrence shows how to perform this in the video below.

Give the exercises a try.  If you have any issues get in touch with one of our physios with your questions.

Do you sit for work?  Even if you don't chances are you sit for a good part of your day.  Recent research has suggested that on average we sit for 9 hours each day!!!

All this sitting position does a lot of things to our bodies.  Weight gain, reduced leg strength, muscle density and neck and lower back issues.  One thing that we find increasingly that often is forgotten is gluteal weakness.  The sitting position puts the the hips into a bent position leading to tightness of the hip flexors (at the front) and weakness of the gluteal hip extensors (at the back).

Weakess of the glutes then can lead to a spiral of further tightness of the hips and gradually increasing load and reliance on the lower back.

There are a LOT of exercises that can improve gluteal strength but a staple is the glute bridge and its progressions.  The glute bridge is a favourite because it is relatively simple to perform, safe and it can be beneficial for everyone from elderlies that have trouble getting around through to athletes.

So let's start with the simple hip bridge, the most basic version.  Paul Truong,  Senior physio at our Casula clinic shows how its done.

If the hip bridge gets easy you can add holds or place a weight like a bar or dumbell on your hips to make the exercise more difficult.

You could also progress to a one leg version for a real challenge.

Another of our favourite progressions is the elevated bridge.  This helps to increase the range through which the hip works.  To add some stability challenge to this you can perform the exercise on an exercise ball.  check out Paul's video below.

If you can do this version then the final version in our sequence is the walking bridge.  We love this exercise because it also challenges your trunk stabilisers (core muscles) while also using your glute muscles.

Paul demonstrates it in the video below:

Give these a rtry and build your hip strength and save yourself from tight and weak hips!

​A lot of individuals will experience lower back pain at some point in their life, as it is fairly common. In the old days' bed rest was recommended if your back was “playing-up,” while in the present day it is suggested to continue working out. Of course, the workouts that you perform have to be fitting, we are not proposing to go for a run or lift heavy weights, as that would not be the smartest thing to do. Still, there are quite a few excellent workouts you can perform which should aid in relieving your lower back pain. These exercises are tremendously mild, but of course, pay attention to your body and discontinue if you start having any pain.
The workouts act by elongating out muscles that are generally taut when you have lower back pain and firming up muscles which have a tendency to be weak. Of course, there are a lot of causes for having lower back pain, so it is probably wise to get it checked out by a physical therapist or a doctor.
Make certain you warm-up your muscles in advance to stretching them (you could even perform a few breathing exercises to get you in the mood). You should under no circumstances spring up in the course of stretching, and all stretches should be gentle and measured. Do not overstretch, stretch your muscles until you feel a minor stretch only, and maintain every stretch for 20-30 seconds.

                                             Image source: https://www.self.com

It is also nice to stretch out your hip as your hip flexor muscles are every so often taut when you have lower back pain. When the hip flexors are taut it can change your stance resulting in what is designated as ‘Donald duck posture’ where your butt sticks out too far. This stiffens up your lower back and can result in lower back pain. To stretch the hip flexors, go down on your knees with one knee on the ground and the other foot in front with the knee bent. Thrust the hips onward and retain your back in an upright position. Hold the stretch for 20-30 seconds. Recap two times on each side.

The days are getting warmer, the beaches are getting busier and the holidays are just around the corner, summer is officially here!
 
Though most of us may be looking forward to spending our days sunbathing at the beach, for some this time of year means finally getting our bodies back on track starting with early morning workouts, after work bootcamps or perhaps getting back out onto the paddock for some early preseason training.
 
Whatever you’re doing, getting your body fit and ready for the summer and the coming months can be tough, especially with so many distractions present this time of year.
 
So, making sure that you’ve gotten yourself into a good stretching routine for your workouts can be a great place to start!
 
When looking to improve sports or training performance, stretching regularly, knowing when to stretch and which type of stretch to apply can be a simple but effective method for keeping yourself on the pitch and off the treatment tables.

​Now most of us have probably been told at some point in time by our coaches, parents or physiotherapists, to sit down reach forward and hold for an indeterminate amount of time, usually 30 to 60 seconds, to stretch out a muscle group and then transition to a different position then rinse and repeat.
 
Though not necessarily wrong, dependent upon the activities that you may be engaging in, the timing of your stretches and the type of stretching you perform may influence your overall performance and your risk of injury.
 
Multiple stretching techniques exist and a few of the common techniques that we come across are static (passive) stretching, dynamic (active) stretching, ballistic stretching and proprioceptive neuromuscular facilitation or PNF stretching for short.

​Probably the most familiar technique to us all, static stretching involves passively lengthening the muscles by taking the tissue as far as comfortable, to the end of its range and maintaining that position for a length of time. 
 
This form of stretching is often a great tool for relaxing tense musculature and for improving tissue flexibility and joint mobility.
 
However, when performed immediately prior to strenuous activity requiring maximal muscle effort, this form of stretching has been shown in some studies to impair performance with strength and coordination based tasks.
 
As such this form of stretching is best served as a cooldown stretch following physical activity or as a flexibility exercise outside of vigorous activity, as it may help reduce the muscle contracture associated with physical exertion.

​Also known as active stretching this technique involves actively stretching the muscles and joints through the performance of a series of controlled movements designed to take the tissues through their full range of motion.
 
These types stretches are great when used as part of a warm up routine as they have been shown to improve muscle flexibility and joint range of motion whilst maintaining muscle contraction velocity and strength.
 
It has also been shown to be particularly useful with the performance with agility, balance and coordination based tasks.
 
For a great example of a quick dynamic stretching warm up check out the link below.
https://www.youtube.com/watch?v=Dy3yB_I9FBA

​Another variation of a dynamic stretch, this technique utilises quick, active movements or ‘bouncing’ movements to forcibly move a joint and its surrounding tissue to end-range positions and oscillates between sub-maximal and end-range position.
 
This form of stretching has been shown to assist with improving tendon elasticity and flexibility.
 
However, it is not highly recommended due to risk of injury associated with improper application due to the high levels force that can be applied to local structures associated with the stretch.

​PNF stretching for short, refers to a series of stretching techniques that combine passive stretching with isometric (contraction of the muscle without movement) or isotonic (contraction of the muscle with movement) contractions of the stretched muscle.
 
Traditionally used as a rehabilitative exercise for patients with neuromuscular conditions such as those found in stroke, for the everyday person, PNF stretching has been shown to be one of the most effective forms of stretching for improving joint range of motion and muscle flexibility.
 
There are three different variations of PNF stretches which are the hold-relax, contract-relax and hold-relax-contract stretches.
 
Hold-relax stretches involve placing the muscle into a stretch position and holding for a few seconds, then isometrically contracting the muscle against stretch for 5-10 seconds and then relaxing the stretch and repeating at a deeper range.
 
Contract-relax stretches are similar to hold-relax stretches, except instead of isometrically contracting the muscle, the muscle is contracted whilst moving through range. For example, in a hamstring stretch, contracting the hamstring against light resistance as the leg returns to the floor.
 
Hold-relax-contract stretches again are similar to hold-relax stretches, except instead of relaxing into a passive stretch, the stretch is brought on by actively pushing further into the stretch. For example, in a hamstring stretch, activating the quads and hip flexors to pull the hip further into flexion to increase the stretch on the hamstring group.
 
Similar to static stretching, PNF stretches have also been shown to reduce strength and power when done prior to high intensity exercises such as sprinting, though conversely have been shown to improve function with sub-maximal exercise such as jogging.
 
For any other questions regarding stretching or formulating a proper stretching routine, pop by and chat to your local physio to see how we could help you with improving your exercise regime.

Most of us have had some experience with lower back pain, whether it be severely debilitating where sitting or standing is already causing you excruciating pain, to just a niggle in the lower back that’s constantly there throughout your day. We can all agree that, YES, the pain is annoying and very frustrating, but it’s worse when it prevents us from doing what we love – for some it’s running or lifting weights, for myself it’s Brazilian Jiu-Jitsu (BJJ).
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BJJ is a grappling martial art and combative sport, which involves controlling and submitting your opponent with pressure, chokes and joint locks, often this is happening on the ground with you crunching up and on your back. This position can lead to the front of your hips, abs, chest and neck muscles to become very tight, while back becomes stretched out and weak. This combined with the fact that a lot of us spend most of our day sitting, can lead to muscular imbalances in our bodies, which not only has a direct impact on our performance but can lead to issues like low back pain. 

To get relief and correct those muscular imbalances you want to stretch out the tight muscles at the front of your body and strengthen the muscles at the back.
Here are my THREE GO-TO stretches and exercises that I do in all my warm-ups.

• Half Kneeling Hip Stretch
  • Chest up
  • Tail bone tucked under
  • Slightly push your hips forwards

It’s also important to off-set all that sitting we do at work, so every hour get up and spend 30-seconds on one of the follow stretches or exercises:

• Half Kneeling Hip Stretch
• Standing Ab Stretch

• Squats
  • Focus on keeping your trunk upright and chest up.
  • Keep your heels on the ground
  • Aim to get your hip crease below your knee level

​A good variation is to use a bar or weight on your chest which can help you maintain your centre of gravity forward and also give you feedback to keep your chest up.

All of these stretches and exercises should be pain free. In addition to the above, if you have access to weights, try to front squat 3x a week to strengthen all those back muscles. Personally I prefer using the barbell as it encourages you to extend through the mid back which can get extremely stiff after prolonged sitting, which in turn had a significant effect on my ability to invert as I transitioned into different positions.
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Give these exercises a try and watch your body and game thrive. Oss!

Paul is a senior physiotherapist at Activ Therapy Casula
He trains at Absolute Fighting Arts and holds the rank of blue belt.
Paul's special interests are in recovery and perfomance for combat sports.