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Performance Physiotherapy News

Knee arthritis (OA) – An Adelaide physiotherapist’s take on the latest research.

Recently the Australian Federal Government has launched a review into the Medicare Benefits Schedule, to help align the MBS items with contemporary clinical and research based evidence. One of the items under review will be the use of arthroscopic surgery for knee osteoarthritis (OA), which has been shown be no better than placebo (1,2). It is now widely accepted that the most effective management of knee OA is through a combination of physiotherapy and anti-inflammatory medication (3).


One of the confusing aspects of knee OA is that the pain a person feels in the knee is not closely related to the progression of arthritis shown on an X-Ray (4). The chondral cartilage that wears away in OA has no nerve supply, so is therefore unlikely to be the source of pain. If other structures in the knee are involved, this may explain the poor correlation between chondral cartilage loss and pain.


A recent pilot study by Physiotherapist Jenny McConnell, has implicated a structure in the knee called the ‘infrapatella fat-pad’ as a potential source of pain in knee OA (5). Using a specific strapping technique to reduce pressure on the fat-pad, along with a program of strengthening exercises, participants recorded significant improvements in the following areas: Pain, symptoms, activities of daily living, participation in sport and quality of life. This improvement was achieved after only 6 sessions of physiotherapy over 4 months. Amazingly, there were visible improvements shown in the structure of the fat-pad on MRI after the treatment also.


The physiotherapists at our Adelaide CBD clinic can assess if you may benefit from this type of treatment plan.



1. Kirkley A, Birmingham TB, Litchfield RB, et al. A randomized trial of arthroscopic surgery for osteoarthritis of the knee. N Engl J Med. 2008;359:1097-1107.

2. Moseley JB, O’Malley K, Petersen NJ, et al. A controlled trial of arthroscopic surgery for osteoarthritis of the knee. N Engl J Med. 2002;347:81-88.

3. Zhang W, Nuki G, Moskowitz RW, Abramson S, Altman RD, Arden NK, et al. OARSI recommendations for the management of hip and knee osteoarthritis: Part III: Changes in evidence following systematic cumulative update of research published through January 2009. Osteoarthritis Cartilage 2010;18:476-99.

4. Bedson J, Croft PR (2008) The discordance between clinical and radiographic knee osteoarthritis: a systematic search and summary of the literature. BMC Musculoskelet Disord 9: 116.

5. McConnell J & Reed JW (2014) magnetic resonance imaging pre and 4 Months post 6 physiotherapy treatments for OA knee pain – a pilot study. Rheumatology: Current Research 18:8.

Understanding Greater Trochanteric Pain Syndrome

Greater Trochanteric Pain Syndrome (GTPS) may be a mouthful but it’s not as scary as it sounds. GTPS is a condition that is characterised by outer hip and thigh pain. Whilst there are a number of causes, proper management and therapy will leave your side feeling fine in no time.


GTPS is quite a common condition, affecting around 10 – 25% of the general public. It is more prevalent in women and predominantly people aged between 40 – 60. There are numerous factors that cause the condition and therefore a range of treatment options available.


Here we will aim to outline the various causes of GTPS and provide a number of treatments, many of which our Performance Physiotherapists can assist with.


GTPS – What is it?

Greater Trochanteric Pain Syndrome (GTPS) is characterised by pain over the outside of the upper thigh and hip, most noticeable when weight is transferred to the affected area. Pain can also be felt when the patient lies on the affected side. Like all injuries we treat at Performance Physiotherapy, we assess each patient individually to determine the primary factors involved.


Causes of GTPS may be:

* An injury such as a fall on to the side of the hip area.

* Repetitive movements involving the hip area, such as excessive running or walking.

* Prolonged or excessive pressure to the hip area (for example, sitting in bucket car seats may aggravate the problem).

* Weakness and/or tightness of hip muscles

* Poor running technique / biomechanics

* Patients with coexisting back pain, osteoarthritis or iliotibial band tenderness


GTPS is also sometimes referred to as Trochanteric Bursitis, however more recent studies have shown that the two are not one and the same. While Trochanteric Bursitis is cased by inflammation in the Bursa, GTPS is, as previously mentioned, often a result of friction and tearing however patients may show symptoms of both.


Treatment Options

Physical Therapy can aid in strengthening and stretching the muscles with various therapeutic exercises designed to increase range of movement and making changes to stance where needed to once again avoid placing unnecessary pressure on the area. This may be coupled with manual therapy (deep tissue massage, myofacial release techniques and soft tissue mobilisation) and dry needling to release the tension on the area.


If you experience symptoms such as the above and would like to come in for a consultation with one of our Performance Physiotherapy Physiotherapists or if you would simply like some more information on GTPS, call 8215 0047.


Reference list




Tennis elbow

How to smash tennis elbow

Don’t let the name ‘tennis elbow’ fool you. You don’t need to be Roger Federer or Serena Williams to experience sharp pain when you lift or extend your arm.

Our therapists have seen many cases of tennis elbow and patients range in age, mobility and in the intensity of the pain they feel. Key to successful treatment is understanding the history of the injury and contributing factors, a thorough assessment an treatment plan to restore normal movement and a rehabilitation plan to ensure you will be back to your best sooner.

In this blog post, we outline the common symptoms of tennis elbow and the treatment methods our Performance Physiotherapists can offer to speed up recovery.

What tennis elbow is and why it happens.

Lateral epicondylalgia, more commonly known as tennis elbow, is characterised by pain and tenderness around the outside elbow when the tendons are overworked by repeated activity. This includes wrist and arm motions that put stress on tissue. Repeated activity can cause small tears in the tendons that attach the forearm muscles to the outside of the elbow.

Symptoms of tennis elbow include:
* Pain that spreads from the outside of the elbow into the forearm and wrist.
* Pain when the wrist and forearm are extended.
* Wrist and forearm weakness and pain when gripping objects.
* Increasing pain over time.

Left untreated, tennis elbow aches and pains can increase in intensity. And the correct diagnosis is critical to differentiate it from other sources of elbow pain, such as nerve entrapment, which will require a different treatment plan.

Treatment options

Our physiotherapists will assess the site of pain and will develop a treatment plan that may consist of the following therapies:
* Braces and strapping can support your tendons and muscles and reduced stress on the affected area.

* Exercises to strengthen your muscles and tendon over time. The intensity of the exercises will increase over time, with focus on the forearm and wrist. These exercises should be practiced at home daily and may be adjusted over time by the therapist.

* Dry needling, a form of western acupuncture to reduce muscle tension and decrease sensitivity of the area.

* Massage to improve muscle stiffness and promote healing of the affected tendon.

* Mobilisation of any joint stiffness found to be a contributing factor.

For more information on elbow pain or to book an appointment with a Performance Physiotherapist, call 8215 0047.

Reference Sites



The low-down on Runner’s Knee – August 2015

As passionate runners, we know how frustrating running injuries can be.

One of the most common running injuries we treat is Patellofemoral Pain Syndrome (PFPS), more commonly known as Runner’s Knee. As the name suggests, it is characterised by pain in and around the knee joint and accounts for up to 20% of running ailments.

The main symptom of runner’s knee is a mild pain that is felt intermittently, and experienced only when running. After time, the pain becomes stronger and felt more often.

Runner’s Knee can throw training off track. Performance Physiotherapy specialises in assisting those with running injuries, and in this blog post, we explain the common symptoms of Runner’s Knee, possible causes and treatment options.

What is Runner’s Knee? The technical information

Runner’s Knee is localised pain around the patella (kneecap). Pain is often felt when the patella rubs against the socket/groove in the femur (leg bone) when you extend your leg, thus flexing your knee.

Aggravating motions include squatting, running downhill, descending stairs and prolonged sitting. Resting legs (i.e legs extended) or pushing against the kneecap can also cause tenderness.

Science has not been able to identify a single cause or action that causes Runner’s Knee. Common theories are:
*Increasing training distance before the body is ready to sustain it. Overuse of muscles and ligaments can lead to aggravation
*Quadriceps (thigh muscles) that hold the patella in place are weak
*Incorrect footwear that does not provide support when running
*Poor running style or undiagnosed flat feet without the use of orthotics, which can put pressure on the knee joint

Runner’s Knee can also cause referred pain in the hip when the weak knee causes it to ‘collapse’ towards the centre of the body. Therefore, when experiencing any pain from running, it is critical to speak to a professional and identify the root cause of the pain.


Our physiotherapists will review the site of pain and run a series of tests to identify the cause of Runner’s Knee. As this can demand multiple sessions, therapies such as tight strapping, manipulation, foaming and stretching can provide immediate relief. Other techniques may include:
*Studying the biometrics of runners
*Hip strengthening exercises
*Pain relief for the knee

Remember never to ‘run through the pain’. To assist with the healing process,  elevate and ice the knee. For best results, make an appointment with a physiotherapist to diagnose the injury and provide you with effective treatment solutions.

The good news is that PFPS is a mild injury and can easily be treated. The sooner your therapy begins, the sooner you will be back on your feet and running – pain-free.

Reference Sites


Winter Newsletter – June 2015

Check out our winter newsletter featuring:

*Treating your neck related headaches with physiotherapy

*Three steps to fix your runners knee and ITB

*How podiatry can assist with heel pain


Introducing the new Anti-Gravity AlterG Treadmill – March 2014

Are you losing fitness due to an injury?
Trying to return to walking or running following surgery or injury?
Struggling to get over chronic tendonitis?

Working with our partners, Podiatry First Sports, the new Anti-Gravity AlterG treadmill is now available to assist with your recovery.

The AlterG is the perfect solution to help you return to pain free running or walking. Using NASA patented technology, the Anti-Gravity treadmill helps a broad spectrum of people – elite athletes, orthopaedic patients, seniors and those looking to lose weight – to achieve their personal health or performance goals.

*30 minute and 60 minute sessions available under the care of Physiotherapists and Podiatrists.
*Health fund rebates available.
*Get back to your best faster with the anti-gravity treadmill and make a booking today 8215 0047.