Racquet sports - Tennis/Squash/Badminton - Sports Injury

$fibula stress fracture$

Do I have a Fibula stress fracture?

by Pete Colagiuri - Sports Physiotherapist

Fibula stress fractures are less common that Tibial stress fractures and much harder to detect!

That’s because the Fibula isn’t like other leg bones – it’s not a weight-bearing bone!

Most leg stress fractures happen due to forces associated with ground impact.

But Fibula stress fractures are unique – the injury occurs due to muscles pulling on the bone.

What are the symptoms of a Fibula Stress Fracture?

The first warning sign is a vague pain on the side of the calf.

It feels similar to an overworked or sore muscle.

That can get confusing because the most likely cause of lateral calf pain IS an overworked muscle.

Initially it only feels sore after exercise.

The more intense the exercise, the greater the post session soreness.

Next phase of the injury, the soreness begins to last longer.

What used to resolve in a few hours now takes longer that 24 hours to disappear.

In the last phase before a stress fracture, we often see the symptoms become more constant.

The intensity may vary but it’s still aching day and night, regardless of exercise.

How is a Fibula Stress Fracture diagnosed?

The first step for most people is a clinical diagnosis – that is, getting assessed by a doctor or physio.

The is usually enough to suspect a Fibula Stress Fracture but not enough to CONFIRM a stress fracture.

From here, imaging is needed to get a confirmed diagnosis.

MRI is the best option, but also the most expensive. It can see bone reactions as well as cracks in the bone. It gives the whole picture.

X-ray is not sufficient as it’ll only see a bone that has already cracked. Even then, it’ll only spot it if the crack is at a particular angle (relative to the image).

Bone scan is helpful as it shows the bony reaction around the stress fracture. It can’t see the fracture itself but it’s good enough to confirm a significant bone reaction.

CT scan shows a much more detailed picture of the bone but, like an X-ray, will only see a bone that’s already cracked. It can’t spot the reaction that’s the immediate precursor to a fracture.

What’s the rehab plan for a Fibula Stress Fracture?

Fibula stress fractures tend to occur because of the actions of FHL (big toe muscle) or Peroneals (lateral ankle and medial foot stabilisers).

The first step in the rehab is to back off the causative activity.

That doesn’t mean rest!

You can still keep active, provided it doesn’t cause pain or load on the stressed bone.

Then you’ll need to add in a strength program to maintain muscle function while you’re not as active.

Lastly, you need to rebuild the causative activity.

For example, if faster running has caused the problem, it might be linked to FHL loading.

You can return to running after 4-6 weeks but you’ll need to back off the pace.

Over the next few weeks or months, you can gradually return to fast paced running as the bone adapts and strengthens.

It’s important that you listen to your body and give yourself enough recovery time between training sessions.

Remember that you’re recovering from reduced activity, so you can’t flick a switch and be back to normal in a week.

What’s causing my deep hip pain?

by Pete Colagiuri - Sports Physiotherapist

If you’re experiencing deep hip pain, you know just how frustrating it can be!

Trying to find a diagnosis feels like finding a needle in a haystack.

So is there any way to figure out what’s causing the pain deep in your hip?

More importantly, is there a quick way to reduce the pain or get rid of it?

Finding a diagnosis for deep hip pain

The difficulty with getting a diagnosis is that one pathology will often generate other issues.

So while your first problem might have related to the hip joint, it very quickly becomes a joint + muscle + tendon issue.

That means any treatment targeting a symptomatic area might not be effective as they’re missing the underlying cause.

Top tips to identify the main cause of your hip pain

So here are the best questions to consider to diagnose your deep hip pain:

1. Is it worse first thing in the morning or after a prolonged period of inactivity?

This indicates an inflammatory component to the underlying issue.

These diagnoses include hip arthritis and hip muscle tendinitis/tendinopathy.

2. Does it flare up during high intensity exercise (eg. running) or hip strength exercises?

Pain during exercise tends to indicate a component of overload.

These diagnoses include muscle fatigue and bone stress injuries.

3. Is there a prolonged effect from taking anti-inflammatory medication?

This means that the pain stays reduced for days/weeks after you’ve stopped taking the meds, not just while you’re on them. This confirms an inflammatory condition rather than just a pain-relieving or masking effect from the meds.

These diagnoses include hip arthritis and hip muscle tendinitis/tendinopathy.

4. Have you lost range of motion in your hip?

You might notice that it’s more difficult to reach your shoelaces or that you can’t bring your knee to your chest on the painful side. A loss of range is usually an indication that the hip joint is involved.

This includes diagnoses such as hip osteoarthritis and femoroacetabular impingement (FAI).

5. Does the pain extends further down into the leg or up into the lower back?

If the pain radiates from the buttock down into your leg or hamstrings, that can indicate nerve involvement, referred pain or hamstrings muscle pathology.

Diagnoses in these categories include sciatica, referred lower back pain, nerve root compromise at the lower back and hamstrings tendinopathy.

6. Do you have pins & needles or numbness into the leg?

Tingling or numbness in the leg, anywhere from the back of the thigh right down to the foot, is almost always an indication of a nerve problem.

These symptoms are usually the results of a compromised or pinched nerve in the lower back.

Treatment for deep hip pain

Once you’ve identified the possible underlying cause from the questions above, you need to carefully plan your management strategy.

If there is a possible involvement of nerve, with tingling, numbness or referred pain down the leg, the best plan is to seek proper assessment with a health professional. This type of injury is difficult to self manage and can become a more significant problem if not addressed.

When the joint is part of the underlying cause of your hip pain, a combination of exercises and medication give the best results.

Over-the-counter medication is limited to short periods of use due to the likelihood of side effects. Seeing your doctor for prescription medication is a better option as it can be used more consistently for longer periods.

The exercise approach needs to focus on building hip strength without irritating the symptoms. Because the “no pain, no gain” approach often causes more trouble than it fixes and worsens inflammatory reactions.

Muscles and tendons respond well to loading – more specifically, to strength exercises.

The trick is striking a careful balance between doing enough to stimulate improvement without doing too much and irritating symptoms.

Start with a simple collection of exercises that seem like they’re challenging but comfortable. It might be a little boring to start with but it’s a necessary building block.

Every two weeks, make the exercises slightly more challenging and monitor your symptoms. If you experience of flare up when you first change exercises, stick with it for another two sessions.

If the pain is getting gradually worse or the soreness after exercise is not improving, drop back to the previous program. Then you can try a different set of exercises after a week or so.

If you experience repeated flare-ups, or if you don’t seem to making progress, speak to a health professional to diagnose your injury and design and appropriate program.

Sharp pain at the inner thigh?

by Pete Colagiuri - Sports Physiotherapist

The typical scenario for a sharp pain in the inner thigh or groin area goes like this:

didn’t warm up properly, or cooled down after a break in play…
sudden sprint, agility or cutting movement, or a cross-body kick…
and BANG, feels like you got stabbed!

This type of injury is called an acute injury, which means it occurs suddenly and due to a single incident that overloads the soft tissue.

It causes a sharp pain at the inner thigh where the overload has occurred. It could a muscle injury, a tendon injury or even a bone injury (such as an avulsion fracture).

We’ll cover muscle injuries in this post but the same principles apply for acute tendon injuries.

The most likely culprit is one of the adductor muscles, a group of six muscles that move the leg inwards (as well as assisting with other movements).

They are:

Obturator Externus (also known as External Obturator)
Pectineus
Adductor Brevis
Adductor Longus
Adductor Magnus
Gracilis

Each of these muscles contribute to the adduction, or inwards movement, of the leg and can be injured during rapid or forceful muscle contractions or if the leg is suddenly resisted (eg. kicking the ground).

Working out the muscle injury grade

Muscle injuries are graded based on their severity. It’s a simple scale of 1-3, with a grade 1 being minor and a grade 3 being a major injury.

These grades help forecast the duration of recovery at the time of injury. But they shouldn’t be used to guide rehab progression (“a grade 2 injury should be doing xyz exercise at 3 weeks”). Progression is highly individual and should be guided by symptoms and function.

Tips for working out the injury grade

The day after you feel that sharp pain at your inner thigh, check for a bruise. If the injury causes a bruise, you’re looking at a grade 2 or 3 injury. That’s around 6-12 weeks before you’ll be back to high intensity running and agility/cutting.

Note that if there’s no bruising, that doesn’t mean it’s a grade 1. It could still be a grade 2 injury but deep within the muscle.

If it feels better the day after the injury, it’s probably a grade 1 injury or a low grade 2 injury. You could be back in 2-4 weeks.

If the injury feels worse the day after the incident, it’s probably a grade 2 or 3 injury.

What to do when the injury first happens

Don’t

Don’t panic. It’ll hurt to walk because the bleeding inside the muscle (with grade 2-3 injuries) takes up space and walking stretches the muscle, squeezing the injured area.

Don’t take anti inflammatories (Nurofen, Voltaren, Advil, etc). They increase bleeding and will extend your recovery time by weeks.

Don’t elevate it. You can’t ready elevate that part of the leg, the bleeding had nowhere to drain to and you’ll look like a goose.

Don’t stretch it. Stretching can damage the early tissue healing and increase pressure on the injury.

Don’t massage it. Massage will shift the bleeding around the injury and allow more bleeding to refill the area.

Do

Limp if you want to. If it’s more comfortable to limp, go for it. You’re best to compromise “normal” walking mechanics for an alternate method that doesn’t load the injury and hurt. It’s only for a few days.

Do compress it. An elastic bandage is great but compression tights (Skins, 2XU, etc) work well to.

Do ice it. Apply 10min of ice two or three times on the day of the injury to reduce pain. It’s not needed after that.

How to plan your rehab

Rehab for a groin/adductor muscle injury needs to follow two simple principles:

It shouldn’t hurt, and
It needs to progress in small increments

That’s it. Simple, but getting some guidance can definitely help with point #2.

Point #1 doesn’t mean that any sensation or awareness in that area is bad.

It’s still recovering so expect it to be noticeable, uncomfortable at times and mildly sore with loading. And that’s not a concern, that’s almost a necessary ingredient to ensure we’re loading the area sufficiently for recovery.

Point #2 sounds simple enough but a knowledge of biomechanics and function certainly helps. That’s why professional rehab is designed specific to your injury, sporting history and your requirements.

“It wasn’t hurting to walk so I tried a run”…

Never base a return to sport on the fact is doesn’t hurt any more! The brain will naturally adjust your movements to avoid bothering the injury. You’ll step shorter or reach your shoe in a different way.

It’s a huge step up to go from pain-free daily tasks to sports. It’s the most common reason for re-injury and extended recovery periods.

Typical progressions go from very small adductor activations, to low loads in neutral positions, then low loads away from the body and higher loads in neutral positions.

Once that’s done, you can add faster movements, higher loads away from the body and some running at easy paces.

The final step is to put it all together in fast, strong muscle activity – sprinting. On top of that you can add pre-planned agility/ cutting manoeuvres and finally, unplanned/unexpected movements.

Groin pain treatment

by Pete Colagiuri - Sports Physiotherapist

Groin pain treatment can be a slow and tedious process. It needs to focus on the underlying cause of the groin pain. But the cause of groin pain can be hard to identify. It’s a vicious cycle.

Groin pain is one of the most common injuries in agility sports, such as football or ice hockey. It’s in the top 3 for both most common and most debilitating injuries.

Groin pain in daily life

After flaring it up during sport, people can experience groin pain when walking or they might have lower back pain and groin pain together. It can be a pretty miserable time.

Groin pain can be caused by so many injuries. Lower back injuries can refer to the groin. Hip joint injuries can cause groin pain. Adductor muscles can send pain up to the groin. Then there’s inguinal hernia, pelvic conditions and bone stress injuries, just to add to the mix.

If that wasn’t confusing enough, research tells us that after a few months, it’s likely that you have at least two different pathologies affecting the area. So doing rehab that worked originally may not be as effective any longer.

Groin pain rehab programs

So your rehab approach needs to fix the most likely causes while not bothering other potential causes.

Simple, right?

Actually, simple is the key. Often programs start on the right track but then flare up the injury when they try to progress or add complexity.

Here are a few examples of the progression of exercises and restrictions across each phase of groin pain treatment rehab.

Groin pain rehab – phase one

Activity modifications

Avoid lunges and single leg exercises
Don’t do deep squats
Avoid stretches
Reduce activities that irritate symptoms (eg. Run slower or less distance)

Exercises

Half depth box squats
Crab walk
Hip bridges

Groin pain rehab – phase two

Activity modifications

Avoid stretches
Avoid full depth squats
Increase exercise loading as tolerated (eg. Each week, try running a little further, or faster, but not both)

Exercises

Half depth lunges
Single leg kettlebell squat to one third depth
Side plank

Groin pain rehab – phase three

Activity modifications

Increase exercise loading as symptoms allow
Begin higher load exercises gradually eg. Sprints, agility running

Exercises

Power (high speed) step ups
Hopping exercises
Jump lunges

Do I have a Fibula stress fracture?

What are the symptoms of a Fibula Stress Fracture?

How is a Fibula Stress Fracture diagnosed?

What’s the rehab plan for a Fibula Stress Fracture?

What’s causing my deep hip pain?

Finding a diagnosis for deep hip pain

Top tips to identify the main cause of your hip pain

1. Is it worse first thing in the morning or after a prolonged period of inactivity?

2. Does it flare up during high intensity exercise (eg. running) or hip strength exercises?

3. Is there a prolonged effect from taking anti-inflammatory medication?

4. Have you lost range of motion in your hip?

5. Does the pain extends further down into the leg or up into the lower back?

6. Do you have pins & needles or numbness into the leg?

Treatment for deep hip pain

Treatment for nerve-related hip pain

Treatment for joint-related hip pain

Treatment for muscle- or tendon-related hip pain

Sharp pain at the inner thigh?

Working out the muscle injury grade

Tips for working out the injury grade

What to do when the injury first happens

Don’t

Do

How to plan your rehab

Groin pain treatment

Groin pain in daily life

Groin pain rehab programs

Groin pain rehab – phase one

Activity modifications

Exercises

Groin pain rehab – phase two

Activity modifications

Exercises

Groin pain rehab – phase three

Activity modifications

Exercises