Your feet are full of bits and pieces that can cause plenty of pain. 26 bones, 33 joints and over 100 ligaments, nerves, muscles and tendons that are all capable of causing varying degrees of feeling from ooh that tickles to CALL THE AMBULANCE!!! Each foot is intricately designed to absorb the forces of walking, running and jumping, morphing to the shape of the ground and transmitting these forces through the ankle to the legs. When everything is going smoothly, this process is seamless and unnoticeable, when it’s not, it can affect your day to day life. According to the 2017 Healthy Feet Survey around half of Australians experience heel/arch pain and 6% of people surveyed wake up every morning with foot pain. The same study also showed that despite having expert knowledge, musculoskeletal physiotherapists are only consulted by 5% of people suffering foot pain, with 80% heading to the GP for advice. GP’s commonly refer clients to musculoskeletal physios for foot and ankle pain, physios are really just doctors to manage and prevent pain.
So, what are the most common types of foot pain, and what do they mean?
Ball of the foot pain or Metatarsalgia
Pain and inflammation in the ball of the foot is referred to by physiotherapists as Metatarsalgia . Good news for people who are more active, you’re more likely to experience ball of foot pain due to your activities that involve a lot of running and jumping. It is also common for people to suffer Metatarsalgia due to the over-usage of improper fitting shoes.
Musculoskeletal physiotherapists recommend a number of conservative treatment methods for ball of the foot pain such as rest and ice therapy. It is also important to take an in depth look at your shoes. Ideally you participate in sports with shock absorbing arch supports or insoles to minimise future complications or recurrences of metatarsalgia. Signs and symptoms of ball of foot pain include:
- Burning or aching pain in the ball of the foot
- Pain around the big toe only
- Worsening pain with weight bearing activities such as standing, running or walking
- Numbness or tingling in the toes of the foot
- The pain improves with rest
Plantar Fasciosis aka Plantar Fasciitis
“Plantar fasciitis” (a common misnomer as there is rarely any inflammation!) is one of the most common causes of heel pain characterised by pain in the plantar fascia, a thick fibrous band of connective tissue running from the bottom surface of the heel bone extending along the sole of the foot towards the toes. Have you ever jumped out of bed in the morning only to feel a stabbing pain in your heel with each step? That’s probably plantar fasciitis. Plantar fasciitis is most commonly found in impact and running sports but can sometimes feel like it just popped out randomly out of nowhere. People with poor foot biomechanics and those with flat feet or weak foot arch control muscles are more likely to suffer heel pain.
One of the most important aspects of treating and preventing a recurrence of plantar fasciitis is assessing and correcting any issues in your foot and leg biomechanics, sporting technique and your shoes. Not all Dee why physio clinics are experts in foot control assessment and its dynamic biomechanical correction. After an initial in depth physiological assessment, your physiotherapist will likely prescribe manual therapy techniques such as joint mobilisations, soft tissue massage or release, muscle stretches for flexibility, foot taping and lower limb strengthening exercises.
Characterised by pain in the Achilles tendon or its covering, Achilles Tendonitis is an overuse injury that is most common in joggers, jumpers and other activities that require repetitive actions. Tendons are tough fibres that connect your muscle to bone but they are susceptible to overuse and injuries are usually caused by a number of micro tears occurring over a period of time. Common causes of Achilles tendonitis include:
- Tight hamstrings and calf muscles
- Walking on your toes (or excessive high heel wearing)
- Overtraining and failing to warm up or down
- Poorly supportive footwear
Foot pain is a common issue for Australians to put off until recovery includes being totally laid off your feet. It can be easy to write off foot pain as simple pain but it can also be caused by fractures, nerve compressions, loss of blood supply to the bone and even problems stemming from the lower back. The best way to pinpoint and treat foot pain is to undergo a full body analysis with your local physio. The good news if you are suffering foot pain is that research has shown that physiotherapy is effective management and will get you back to playing the sports and doing the activities you enjoy, free from pain.
We’re an active bunch on the Northern Beaches and you’ll find that injury prevention and recovery are 2 major aspects of sports physio clinics in Dee Why. Chances are at some point you’ve experienced an injury, whether you tore an ACL, strained a hammy or twinged your neck and if you’re one of the unfortunate many you’ve probably reinjured it at least a couple of times. Recurrent injuries aren’t confined to AFL players and other professional athletes. Computer programmers are more susceptible to a recurrence of tennis elbow than tennis players, remember? Unfortunately prevention can’t always prevent a hammy strain, but once an injury has occurred you have the power to start the prevention cycle all over again.
There are a number of factors that influence the statistical probability of suffering an injury recurrence; if you watch a sport regularly you can probably name 1 or 2 athletes that seem to suffer the same injury over and over again. NRL player Tautau Moga for instance is only 25 years old and has torn his left ACL 4 times, having a full reconstruction and rehabilitation after each occasion. Researchers are getting better at injury prevention and management every day and sports and musculoskeletal physiotherapists are experts in getting to the things that increase injury recurrence:
Insufficient rehabilitation from previous injury
Call it youthful exuberance in wanting to get back into it too quickly, call it being lazy and not completing your full rehabilitation but one of the most common reasons for suffering a recurrence of an injury is failing to rehab properly. Overloading is a great short term principle and is part of effective programming to allow for super-compensation and increase fitness and strength, but IT DOES NOT APPLY DURING INJURY RECOVERY. Any professional level athlete in any sport will tell you their recovery is just as important as their training when it comes to performance. Failing to follow your physiotherapist’s full rehabilitation program for your sore hammy is only going to end one way. Your guessed it – a pain in the butt!
Neglecting symptoms of pain
Speaking of pain, one of the next most popular reasons people reinjure themselves is failing to heed your body’s best warning signal; pain. “I’ll just run it off” doesn’t cut it as an effective treatment strategy for managing most musculoskeletal injuries but it’s still one of the most common things that people like to do for some reason. Most chronic back, neck, knee, hip, groin, ankle and hamstring injuries will usually give you some warning sign before they completely give up. Don’t treat that shooting pain in your leg like the check engine light in an old car and just put some tape on it either. Strapping and taping is good in some instances, but it can’t keep a hamstring in place for long.
Poor conditioning or fitness
Coming back from long term injury can be tough and it’s common to let fitness levels slip while injured which can often lead to poor performance or additional musculoskeletal injury upon returning to physical activity. Every bit of physical activity outside of your physically repetitive job is going to lower your chances of suffering a repetitive strain injury as well. While you are recovering from an injury, try and do all you can to keep moderately active, whether it be short walks, dumbbell curls or simple sit-ups.
Poor technique and movement control
Poor technique and movement control are probably the 2 most important factors that cause injuries in the first place and they continue to play a part in injury recurrences. I don’t know how many times I’ve seen someone load up weights to the max at the gym, lifting far too much and trading technique for weight. This principle can be applied to most physical activities. Most injuries occur when you go too hard, are fatigued and are using movements that you are not at the unconscious competence stage of performing yet.
Poor or no warm-up/warm-down
Be honest, do you spend 10 minutes warming up and down every time before and after sport and physical activity? A well performed warm-up before a workout is going to dilate your blood vessels, ensuring your muscles are supplied with enough oxygen while also raising your muscles’ temperature aiding in achieving optimal flexibility and efficiency. Cooling down after physical activity is every bit as important as warming up. Stretching while you’re cooling down is the way to go because your muscles, limbs and joints are still warm. Stretching is going to reduce the build-up of lactic acid, which is the leading cause of muscle cramp and stiffness.
If you have suffered an injury, don’t shirk your recovery. Speaking with an expert in sports and musculoskeletal physiotherapy and undertaking a custom made rehabilitation program is going to shorten the length of your recovery, minimise your risk of a recurrence of your injury and also help provide you with the knowledge you need to continue to prevent injury independently.
Hamstring strains (a.k.a. “doing a hammy!”) are one of the most common injuries seen by Northern Beaches physiotherapists. Hammy strains are most prevalent in sports that use a combination of dynamic movements like sprinting, Australian Rules football (AFL), soccer, dancing, surfing, rugby league and other activities where quick eccentric contractions, when the leg is being straightened and the hamstring is working hard, occur frequently such as slowing the leg down after kicking a ball. In AFL hamstring strains are the most common injury with a rate of 6 injuries per club per season combined with the highest rate of re-injury at over 30%. Musculoskeletal physiotherapists know that it is perfectly normal for two people to tear exactly the same muscle but recover at different speeds. Recovery time is dependent on the grade of the injury with a grade 1 injury possibly healing in only a few days, while a grade 3 injury could take months and, in extreme cases, even require surgery.
“My hamstring is ok but derogatory and sexist comments aren’t”
Most hamstrings will have torn well before this point so all can admire the incredible strength and flexibility of Tayla Harris during the AFLW 2019 season.
What are the hamstrings and what do they do?
The hamstrings are a group of muscles and their tendons at the back of your upper leg. They are made up of three different muscles: the biceps femoris, the semitendinosus and the semimembranosus. You use your hamstrings for all kinds of things: walking, running, dancing and jumping. They enable you to flex your knee and extend the hip at the beginning of each step you take. Your hamstrings play a large role in many movements of the legs and hips which is why physiotherapists have spent so long studying them and how to reduce the occurrence and length of injuries.
How do hamstring injuries occur?
Like most injuries, hamstring strains or injuries can be classified as being caused by either primary or secondary factors.
- Primary factors include:
- Poor timing coordination in the hamstring (the swing phase of the leg in sprinting)
- Lack of strength and stiffness in the hamstring
- Muscle imbalances
- Increased neural tension through the sciatic nerve
- Common secondary factors include:
- Overstriding or poor pelvic control when running
- Improper warm-up to prepare hamstring muscles
- Lower back problems
- Prior hamstring injuries
What are the symptoms of a hamstring strain?
The nature of hamstring strains means that symptoms can vary greatly between injuries. Mild hamstring strains could present as tightness or a mild ache in your hamstring. While a severe strain can be extremely painful, with some people describing it like being shot in the back of the leg even making it impossible to walk or even stand. If you have any of the following symptoms get in to see your Dee Why physio ASAP:
- Hamstring tenderness
- Pain or difficulty running, walking or standing
- Pain in the back of the thigh or lower buttock
- Bruising or swelling
- Sudden severe pain while exercising, with a popping sound or snapping feeling
How physiotherapy helps treat hamstring strains
If you have had a hamstring injury your best course of action is to consult with a physiotherapist that has an expert knowledge of sporting and musculoskeletal injuries. Due to the high rate of reinjuring your hamstring, there is no substitute for high quality initial care and rehabilitation. Physiotherapy helps patients with a hamstring injury to speed up the healing process and ensure the best outcome. They will be able to assess and treat your strain and help you to minimise their recurrence in the future.
- Acute or initial phase of a hamstring injury
Your physio will likely recommend the trusty RICE (Rest, Ice, Compression, Elevation) method for the first few days. This will help to reduce swelling and minimise pain. I like the saying ‘the early bird gets the worm’ and when it comes to intervention for hamstring injuries the early bird getting treatment always recovers quicker and more effectively. An expert sports physio will also get you loading your hamstrings in a variety of different ways, even in the early stages!
- Your physio will then comprehensively assess:
- Your range of motion
- The strength and mobility of your lower back
- Your gait
- Your flexibility
- If possible, your running, jumping and sporting techniques
How to prevent another Hamstring Strain
If you’ve ever had a hamstring strain I can pretty much guarantee you won’t want another one, they certainly don’t tickle. Dealing with a hamstring injury once it’s already happened is much harder than preventing it. Here are some tips:
- Stretch before and after physical activity
- Increase the intensity of your physical activity gradually
- If you feel pain, stop exercising (it’s not all ‘no pain, no gain’)
- Stretch and strengthen hamstrings as a preventative measure
Whether you have recently suffered a hamstring injury and are in need of immediate physical therapy or you have suffered a hamstring injury in the past, a physiotherapist is able to assess and recommend the best activities and stretches to help speed along your recovery and reduce the likelihood of experiencing further strains.
 Sutton G. Hamstrung by hamstring strains: a review of the literature*.J Orthop Sports Phys Ther. 1984; 5(4):184-95.
 Orchard J, Seward H. Epidemiology of injuries in the Australian Football League, season 1997–2000. Br J Sports Med2002;36:39–44.
 Schunke M., Schulte E., Schumacher. Anatomische atlas Prometheus: Algemene anatomie en bewegingsapparaat. Nederland: Bohn Stafleu Van Loghum, 2005.