The Five Most Common Football Injuries

Football (or 'soccer') is the world's most popular sport. There are over 240 million registered players worldwide, and many more recreational football players. Most football injuries affect the lower limb, involving the thigh, groin, knee or ankle; having more knowledge of common football injuries is a great way to help you to prevent getting injured.

Here are the five most common injuries I see amongst footballers, along with how to treat them:

Hamstring strain

A hamstring strain, also called a 'pulled hamstring', is one of the most common injuries across all sports, as well as the most common in football. The hamstring muscles are a group of three muscles that run down the back of the thigh.

Symptoms of a hamstring strain include a sudden sharp pain at the back of the thigh, usually whilst sprinting, performing a fast stretching movement or when kicking. During such activities, the hamstrings can be forcibly stretched beyond their limits and the muscle tissue can be torn.

A tear in a muscle is referred to as a strain, and, depending on the severity, they're classified as a grade I, II or III strain. Grade I consists of minor tears within the muscle, a grade II strain is a partial tear in the muscle, and grade III is a severe or complete rupture of the muscle. Depending on the severity of the strain, you may experience muscle tightness, pain, muscle weakness, swelling, bruising or difficulty walking or running.

It's very important to begin treating a hamstring strain as soon as possible by following the principles of RICE (Rest, Ice, Compression and Elevation).

  1. Rest from all painful activities.
  2. Apply an ice pack for 15 minutes, every two hours for the first couple of days.
  3. A compression bandage can be worn to minimise bleeding in the muscle and to help control swelling.
  4. Keep the leg elevated where possible.

I also recommend seeing a chartered physiotherapist, as they can advise you on the best ways for you to rehabilitate yourself. A physiotherapist might use massage, taping and ultrasound to speed up recovery, and they will also provide you with a full rehabilitation program, consisting of stretching and strengthening exercises.

Groin strain

A groin strain, or a 'pulled groin', is a tear or strain in one of the groin muscles, resulting in inner thigh pain. Symptoms of an acute groin strain typically include a sudden sharp pain in the groin area, either in the belly of the muscle or higher. A tear in the muscle usually occurs when sprinting, changing direction or when kicking a ball.

Groin strains are graded I, II or III depending on the extent of the injury. As before, grade I consists of minor tears within the muscle, a grade II strain is a partial tear in the muscle, and grade III is a severe or complete rupture of the muscle. Depending on the severity of the strain, you may experience muscle tightness, pain, muscle weakness, swelling, bruising, or difficulty walking and pain when running and changing direction.

It's very important to begin treating a hamstring strain as soon as possible by following the principles of RICE (Rest, Ice, Compression and Elevation), as explained earlier.

If an acute sudden onset groin injury is not treated properly, it could become a recurring injury and cause long-term groin pain. I recommend seeing a chartered physiotherapist, as they can advise on groin strain rehabilitation. A physiotherapist might use massagetaping and ultrasound to speed up recovery, and they will also provide you with a full rehabilitation program, consisting of stretching and strengthening exercises.

Ankle sprain

A sprained ankle is usually caused by soft tissue damage (mainly ligaments) around the ankle, often caused when the ankle twists inwards. Severe swelling, bruising around the ankle, and pressure pain are usually clear signs of a partial or complete tear of the ligament. Putting weight on the foot might be very painful, and in some cases it might be impossible - if this is the case, you should see a doctor for clarification.

As always, treatment should begin immediately, following the principles of RICE (Rest, Ice, Compression and Elevation).

Once the pain has subsided, it's safe to start with some light exercise. Aqua jogging, light jogging on a treadmill and riding a resistance bike are good exercises to begin with. Don’t make the mistake of going back to soccer as soon as you are pain free. A lack of ankle stability can lead to further ankle sprains and chronic foot problems.

Your physiotherapist will be able to give you the right exercises and recommendations throughout all stages of your recovery. This will ensure a smooth recovery from your injury without any setbacks.

Knee meniscus tear

A torn meniscus is a tear to the semi-circular shock absorbing cartilage in the knee joint, which causes knee pain. It's commonly injured through direct impact in contact sports, but it can also occur in older athletes through gradual degeneration.

There are two menisci within your knee joint that are made from tough fibrocartilage. The medial meniscus on the inside is more prone to injury than the lateral meniscus, as it's connected to the medial collateral ligament (MCL) and the joint capsule, making it less mobile.

The most common cause of a meniscus injury is when you twist your knee with your foot planted to the ground, either with or without contact from another player. This may cause the menisci to get jammed between the thigh and shin bones, and if the force is sufficient, a tear of the meniscus will occur. A meniscal injury often occurs in conjunction with injuries to other structures in the knee, such as an anterior cruciate ligament (ACL) injury or a medial collateral ligament sprain.

Pain and knee swelling usually accompany cartilage tears. If it's a small tear, it might settle down with RICE (Rest, Ice, Compression and Elevation) and physiotherapy treatment. However, with larger cartilage tears, the flap of torn cartilage may interfere with joint movement and cause the knee to lock or give way, and it may require some relatively straightforward surgery. A doctor or a chartered physiotherapist should assess cases of knee pain and swelling that are accompanied by locking and giving way.

Knee ligament injuries

Ligament injuries are one of the most common knee injuries in soccer. There are four main ligaments in the knee: the anterior cruciate ligament (ACL), the posterior cruciate ligament (PCL), the medial collateral ligament (MCL) and the lateral collateral ligament (LCL). These ligaments provide strength and stability to the knee joint.

A sprained or torn ligament is usually caused by a blow to the knee or a sudden twist of the knee. Symptoms often include sharp pain, swelling, hearing an audible pop or crack, knee instability and difficulty in walking. The severity and symptoms of a ligament sprain depend upon the degree of stretching or tearing, and this can be graded as either a grade I, a grade II or a grade III.

The ACL is the most common ligament to be injured. A torn ACL usually occurs due to a twisting force being applied to the knee whilst the foot is firmly planted on the ground, typically while trying to change direction or when landing from a jump. The ACL can also be injured through a direct blow to the knee whilst being tackled. If this happens, then there is usually also a tear of the MCL on the inside of the knee, as well as a meniscus injury.

As always, it's important that the injury is treated as quickly as possible following the principles of RICE (Rest, Ice, Compression and Elevation). Seek medical attention from a doctor or a chartered physiotherapist, as they can advise you on your rehabilitation. If required, an MRI scan can confirm the diagnosis of a knee ligament injury, while an x-ray can check for bone injury. Should a ligament or bone injury be discovered, surgery may be necessary if you wish to return to playing at your previous level.

A physiotherapist might use massagetaping and ultrasound to speed up recovery. A full rehabilitation program consisting of stretching and strengthening exercises should also be followed.

Tips for injury prevention

1. Maintain fitness

Be sure you're in good physical condition at the start of soccer season. During the off-season, stick to a balanced fitness program that incorporates aerobic exercise, strength training and flexibility. If you're out of shape at the start of the season, gradually increase your activity level and slowly build back up to a higher fitness level.

2. Warm up and stretch

Always take time to warm up and stretch, especially your groin, hamstring, quadricep and calf muscles. Research studies have shown that cold muscles are more prone to injury. Warm up with very light jogging for five minutes, and then slowly do some dynamic stretching for a further five minutes.

3. Cool down and stretch

Stretching can help to reduce muscle soreness and to keep muscles long and flexible. Be sure to stretch after each training session to reduce your risk of injury. Static stretching for 5-10 minutes has been shown to be beneficial after exercise.

4. Stay hydrated

Even mild levels of dehydration can hamper athletic performance.

Suffered an injury?

Please get in touch with us today and book a physiotherapy session with a member of our team.

This post has been written by physiotherapist Liam Mc Ginley.

The Failings of Flip­‐Flops: Why Singaporeans Are More at Risk from Flat Feet

‘Flat feet’ or pes planus is a condition in which the arch of the foot is lower than usual. However, this can be a misleading term as flat feet can be divided into ‘rigid’ or ‘flexible’. Rigid flat foot is a rare condition in which the bones of the foot are fused together. On the other hand, flexible flat feet are much more common. This is where the joints of the foot move excessively and do not fully support the body’s weight when standing or walking. There are varying degrees of this condition and there are multiple factors which can contribute to it such as age, family history, medical conditions, previous injuries and weight gain (e.g. during pregnancy).

All infants are born with flat feet and it can be difficult to tell whether a child has flat feet because their arches may not fully develop until they're 10 years of age.

Flexible flat feet can occur in approximately 10-20% percent of the population. However, due to the increased ligament flexibility found in Asian populations, estimates suggest that flat feet may occur in as many as 1 in 5 Singaporeans.

Flat feet may put a strain on your muscles, ligaments and joints, which may cause tiredness or aching in your feet, legs, hips and back when you stand or walk for long durations.

Treatment is usually only required if the flat foot is causing pain in the foot or the lower limb. If there isn’t any pain, treatment is not indicated simply as a result of having a flat foot. However, in severe cases, treatment may be advisable in order to prevent any possible future problems.

Contrary to popular belief, having a flat foot does not necessarily increase the incidence of injury and it does not always cause problems. As a physiotherapist, I’ve seen many patients who have ‘flat feet’ but are pain free. But flat feet coupled with the a poor choice of footwear can be a big risk factor for pain, and in particular, a certain type of footwear… flip flops.

Flip Flops

The Problem with Flip Flops

Most Singaporeans own several pairs of flip-flops or slippers. They are hugely popular and are seen by many as the ideal choice of footwear in hot weather due to their comfort and convenience. However, such a choice of footwear might be a real health flop.

Aside from the obvious lack of protection (meaning you're more vulnerable to dropped objects, stubbed toes and infections), being dangerous to drive in, and making you walk slower, your favourite pair of flip-flops could be seriously damaging your feet.

Healthcare professionals will tell you that flip-flops are too flat, too thin and can lead to many foot problems. They should thus be avoided in for prolonged walking because they offer no arch support, heel cushioning or shock absorption. Furthermore, the thong that sits between your toes when wearing flip-flops can also be dangerous as it forces wearers to clench their toe muscles for grip to keep them from flying off. This can lead to repetitive stress on the foot and ankle, leading to overuse injuries or deformities such as hammer toes or claw toes.

This type of shoe can accelerate the problems associated with having a flat foot. The complete lack of arch support in flip-flops means those with flat feet who tend to over pronate already have nothing to limit from further excessive pronation, thus putting more strain on an already stressed arch.

Plantar Fasciitis

Among the most treated flip-flop induced injuries is plantar fasciitis, an inflammation of the tissue along the sole of the foot. It is most often sparked by all-day wear, with flat footed, overweight or sedentary wearers even more susceptible since their arches are already under strain. The feet are the foundation of your whole body and the base of your skeleton. Therefore it’s not surprising that wearing flip flops can have a domino effect, putting stress on your joints, which may result in ankle, knee hip or back aches.

Our bodies are designed to tell us when things aren’t working properly, typically in the form of pain. In the correct shoes you should be easily able to walk for a solid 2-3 hours without feeling discomfort. If your feet or any other part of your lower limbs hurts while walking or standing, there’s a good chance your footwear is playing a part. An easy test to try is to try walking in flip flops for an hour or so and then note how long it takes for any aches, pains or tiredness to set in. Try the same thing again in a sports shoe and take note of how you feel after an hour. Granted everyone will be affected differently, but chances are, walking in a sports shoe will be much more comfortable than flip flops.

We have already written a blog on things to look out for when choosing a shoe, so this can provide with some tips when shoe shopping. If you’re unsure then there’s always expert advice on hand to help pick the perfect shoe for you.

Hopefully I have convinced you how vital it is to wear supportive footwear. For those who ignore such advice and insist on continuing to wear flip-flips, slipping them on for short durations or by the pool should be ok, but moderation is key. Problems arise when flip-flops become your main choice of footwear.

How can PhysioActive help?

It’s important to recognise the problem as early as possible since its severity tends to worsen with time. Treatment would focus on specific aspects or parts of the foot that require modification or healing. This may be achieved in a number of ways.

Thanks for reading!

This post has been written by physiotherapist Liam Mc Ginley.

Quick Q&A with Zara Goodier: Physiotherapist and Manual Therapist at PhysioActive

Today, we want to take the opportunity to welcome physiotherapist Zara Goodier to the PhysioActive team. Originally from the UK, Zara graduated with a B.Sc Management degree before going on to complete a B.Sc Physiotherapy degree from Keele University. Following graduation Zara completed rotations within the NHS as well as working at Manchester City Football Club academy alongside the ladies team.

Prior to joining PhysioActive, Zara worked in Singapore in a private practice, gaining great experience in treating musculoskeletal injuries and post-operative conditions. Zara is registered with the Chartered Society of Physiotherapy (UK) and the Allied Health Professions Council (Singapore). In her spare time Zara enjoys travel and photography as well as keeping fit by joining every exercise class going. Read on to see what Zara had to say...

How did you come to be in Singapore?

I visited a friend who was living in Singapore in 2007. I completely fell in love with the vibrant city. There seemed to be so much to see and do, a diversity of colour and culture and a hop skip and a jump away from some fantastic Asia adventures. It took me a few years to finally make the move, but in 2014 I did!

Where did you work before PhyisioActive?

I have worked for the past two years at another private clinic in Singapore. Prior to this I was working within the UK NHS, specialising in musculoskeletal injuries in inpatient and outpatient settings. I also provided physiotherapy and pitch side support at the Manchester City Ladies Team games.

What is your specialism?

I am particularly interested in the back, pelvis and lower limbs. Whether a condition or injury has developed traumatically or gradually, I particularly enjoy assessing and discovering the key things the client needs to work on. I find it extremely rewarding guiding someone through the rehabilitation process so that they can achieve their goals. It is hugely rewarding seeing someone leave the clinic stronger, more confident and pain-free.

What gets you out of bed in the morning?

Not much! I'm definitely a night owl. However, if anything gets me moving before dawn it's the prospect of far off travel, captivating photographs to snap or just a good old sweaty bootcamp!

What do you do with your holiday time?

I know its a cliche to say this living out in Asia, but travel, travel, travel. I love to see all the different cultures and beautiful landscapes that exist. I take an "always say yes" attitude when on my travels; this has resulted in some interesting experiences, terrifying foods, crazy activities and lifetime memories. It also means that I have climbed Africa's biggest mountain, shook hands with the Dalai Lama and skied, scubaed, biked and hitchhiked my way around Asia and beyond.

Do you have any hobbies?

Photography is probably my biggest hobby at present. I find street photography fascinating when visiting different parts of the region. It is a fantastic way to preserve memories. I also enjoy fitness and wellness classes. I have a fantastic membership which allows me to drop into classes all over the island, keeping it fun and varied. It might be yoga one day, zumba the next or morning bootcamp in one of the parks.


Best of luck to Zara in her new role here at PhysioActive - if you'd look to book an appointment to see Zara or one of our other specialist physiotherapists, be sure to get get in touch.

The Five Most Common Running Injuries (And How to Treat Them!)

According to a report by the Sports Council, jogging is the most popular sport in Singapore. With this in mind, and the fact that the 2015 Standard Chartered Singapore Marathon is fast approaching, we’ve compiled a list of the most common running injuries. So whether you’re a regular runner or a running rookie, this article should boost your chances of staying injury free throughout your training.


5 most common running injuries


1 - Runner’s knee

Patellofemoral pain syndrome (PFPS), also known as “runner’s knee”, is the irritation of the cartilage on the underside of the kneecap. Symptoms include an aching pain in the knee joint, particularly at the front of the knee around and under the kneecap. There is often tenderness along the inside border of the kneecap with swelling sometimes occurring after exercise. Knee pain accounts for 40% of all running injuries.

Runner’s knee typically flares up as running intensity increases, during or after long runs. It may also be worse after extended periods of sitting, or while descending hills and stairs.

Anyone with biomechanical factors that put extra load on the knee is vulnerable to runner’s knee, with risk factors including over pronation of the foot (foot rolls inward excessively) and weak muscles around the hip and knee. This reduced muscle strength can result in incorrect tracking of the kneecap over the femur bone resulting in damage or irritation of the underlying cartilage. External factors such as running surface and improper footwear can also contribute to the problem.

Treatment and rehabilitation is based around reducing pain, identifying the causes and strengthening or re-training muscles which may have contributed to the injury.


2 - Plantar Fasciitis

As we discussed in one of our previous blogs, plantar fasciitis refers to an inflammation in the plantar fascia, which causes pain under your heel and often radiates into the arch of your foot. This painful sensation can range from annoying to excruciating and can account for up to 15% of all running injuries.

It usually has a gradual onset of pain, with tenderness felt under and on the inside of the heel. Pain is usually worse on your first few steps in the morning but eases as the foot warms up. Pain then tends to return later in the day or after exercise.

Runners with very high or very low arches are usually more vulnerable. Other runners at risk would be those with extreme pronation or supination (foot rolls outward excessively), those wearing improper footwear and those who increase their running distance too quickly.

Recovery time can range from three months to a year, but six months is more likely the norm.


3 - Achilles Tendinitis

Achilles tendinitis is an overuse injury causing pain, inflammation and/or degeneration of the achilles tendon - the thick band of tissue that attaches the calf muscles to the heel bone. It makes up about 10% of all running injuries.

Symptoms can be either acute or chronic. An acute case may develop over a few days, is usually more painful and can limit activity. Chronic injuries will come on gradually over a few weeks, not necessarily preventing activity.

The achilles tendon may be painful and stiff at the start of run and first thing in the morning. As the tendon warms up the pain will go away, only for it to return later in the day or towards the end of a long run.

An increase in activity, either running distance, running speed or a sudden change to running up hills can all contribute to this condition. Tight and/or weak calf muscles or over pronation of the foot can be risk factors, as these put increased strain on the achilles tendon.

If you deal with an acute case properly, a few days rest with the correct treatment might be sufficient healing time. If you keep running as usual, you could develop a chronic case that is a difficult condition to treat and may take more than six months to go away.


4 - Iliotibial band syndrome

Your iliotibial band (ITB) is a thick band of fascia that runs from muscles at your hip joint and connects to the outside of your knee. When you run, your knee flexes and extends, which causes the ITB to rub on bony points on the hip and knee. ITB syndrome results in pain usually on the outside of the knee or sometimes the outside of the hip, which is caused by friction of the ITB on these bony points causing inflammation. ITB syndrome can be responsible for up to 12% of all running injuries.

ITB syndrome has a gradual onset. It comes on at a certain time into a run and progressively worsens until often the runner has to stop. After some rest the pain may go, only to return when you begin running again. Running, particularly downhill running, normally aggravates the pain. Pain may also be felt when flexing and extending the knee, which may be made worse by pressing the tender bony point on the outside of the knee.

It may develop in runners who suddenly increase their running distance. A naturally tight ITB may make someone more susceptible to this injury, while weak hip muscles are also thought to be a significant factor. Other risk factors include a leg length difference, runners who over pronate, and poor foot biomechanics.


5 - Shin splints

Shin splints is the common name often given to pain over the inside lower part of the tibia or shin bone. Also known as medial tibial stress syndrome, it is as a result of forces from the muscles of the lower leg pulling on the tissue surrounding the bone resulting in inflammation and pain. This makes up about 15% of running injuries.

There is usually pain at the start of exercise which often eases as the session continues, only to worsen later in the training session or afterwards. Symptoms are often worse the next morning.

Shin splints are common among new runners and those returning after an extended layoff. They're a sign that you've done too much, too quickly.

Biomechanical factors, such high or low arches, over pronation and over supination of the feet can increase the stress on the soft tissues of the lower leg, resulting in pain and inflammation. Other risk factors include running in improper footwear, running on hard surfaces and a lack of lower limb muscle flexibility.

Left untreated, the muscles will continue to pull, causing further stress to the shin bone. This may cause a crack to form in the bone, resulting in what is known as a stress fracture. The pain will progress to the point where it is noticed more during the run, and will result in a longer time away from running. It's possible to prevent a stress fracture by responding to the developing problem: stop running and see a physiotherapist.




Top tips to reduce the risk of injuries


Wear correct/proper footwear

Many runners get excited about starting a training program however they make the mistake of grabbing their favourite pair of old sports shoes and then wonder why they get foot or knee pain two weeks into their program. Its recommended that you replace your running shoes every 500 miles (that’s every 800 kilometers), if not sooner! You should make sure you get a good pair of running shoes BEFORE you start your training program.

Picking the right shoe is key to ensuring comfort, performance, and remaining injury free when you run. So it’s probably worth dropping into a specialty running shoe store, where the staff can help you figure out which shoe is right for you. Things to consider when buying a new pair of running shoes include the type of running, the terrain type, what sort of support your foot needs, the heel to toe drop of the shoe, any current injuries and of course the fit and feel of the shoe. Unfortunately for your bank balance, you usually do get what you pay for when it comes to running shoes.

We have previously written a blog article as a guide to buying a running shoe - to read it, click here.


Warm up and cool down

Always take time to warm up and stretch, as cold muscles are more prone to injury. Warm up with very light jogging for 5 minutes. Research has shown that dynamic stretching is more beneficial before exercise. Then slowly go through some dynamic stretching for 5 minutes. Post exercise stretching can help to reduce muscle soreness and to keep muscles long and flexible. Be sure to stretch after each training practice to reduce your risk of injury. Research has shown that static stretching, holding each stretch for 30 seconds and repeating 2- 3 times, is most beneficial after exercise. Cool down and static stretching should last about 10 minutes.


Increase Slowly

Many people get so excited by training that they go from 3 months on the sofa to attempting a marathon in 4 weeks – this is a recipe for disaster. Make sure you increase your running times by small amounts only - a 5 -10% increase in either distance or time each week is plenty, and it can help you to stay pain free. One of the biggest predictors of injury in runners is rapidly increasing training volume – the more training you do, the greater the risk. Also, you don’t give time for your body to adapt to all the training you do. Don’t be a fool, stick to the 10% rule!


Biomechanical running analysis

Running injuries are often produced or exacerbated due to poor technique, poor biomechanics or the weakness of specific key muscle groups, amongst other things.

At PhysioActive we offer a professional running assessment service where runners of any skill level can come and get their running style analysed. Our running analysis consultation is a biomechanical video assessment of your running, combined with specific musculoskeletal screening tests to assess: running technique, biomechanics and gait pattern when running, shoe wear pattern and key muscle group strength. After evaluating the results we will provide you with the following service: Advice on proper running technique, footwear, an exercise program optimal to you, a DVD recording of you running and a written report. Benefits of this service include: improved running performance, prevention of injuries, optimization of physical condition and optimal training load for your individual goals.


Come get a check-up

One of the biggest predictors for injury is past injury history. A previous injury may have left some scar tissue, reduced range or led to muscle weakness that will greatly increase the risk of injury when you resume training.

At PhysioActive we do more than just treat your sports injury. During the assessment and treatment we do not only focus on the cause of the injury, but also on the sport specific physical demands, skills and movement patterns that are needed for your sport. Our sports physiotherapists incorporate manual therapy, electrotherapy (including ultrasound and shockwave therapy), sports taping and exercise therapy using our cardio, weight machine and free weights in our multi-modal approach to treatment.

To be able to safely and fully return to sports it is essential to regain optimal strength, mobility, stability and coordination. Physiotherapy will help you to achieve these goals and to speed up your recovery.


Suffered an injury?

Please get in touch with us today and book a physiotherapy session with a member of our team.


Thanks for reading!

This post has been written by physiotherapist Liam Mc Ginley.

New year, new resolutions, new aches and pains?

January – the month of renewed dedication to creating that beach body. Or maybe more realistically, the month dedicated to working off the excess of December.

Whether you’ve launched yourself into an active lifestyle for the first time ever or just upped the intensity of your regular training, hopefully you finish your workout feeling justifiably smug at your achievements. That is until you wake up the next morning, barely able to hobble to the bathroom and regretting every one of those squats from the day before.

Enter delayed onset muscle soreness - or DOMS for short - that post workout muscle soreness that makes the average flight of stairs look like your own personal Everest.

But what is DOMS?

The exact mechanism that causes DOMS isn’t well understood; however, it appears to be the result of micro-trauma in the muscle and connective tissue causing inflammation. And while any exercise can induce DOMS, exercise with greater emphasis on the eccentric phase (the lengthening movement – think of lowering the dumbbell during a bicep curl) plays a significant role.

So is DOMS bad for you?

Put simply, no. Painful, limiting and often embarrassing while you waddle like a duck, but not harmful. However, DOMS can reduce muscle efficiency and reduce your range of motion so it is important to remember that your overall effectiveness will be reduced in subsequent workouts/sporting sessions. Due to the increased injury risk this can pose, it's important to allow your body to rest and recover.

Tips for dealing with DOMS:

Final Words:

Don’t be scared by DOMS and don’t use it as a reason to stay away from the gym. However, if you have any concerns – or your pain has lasted longer than 7 days – consult a friendly physiotherapist for advice and reassurance.

Problems with hamstring injuries?

Please get in touch with us today and book a physiotherapy session with Joel and the team.

Thanks for reading!

This post has been written by PhysioActive physiotherapist Lisa Gold.

Thoughts or questions?

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Quick Q&A with Brigitte Lichtenberger: Physiotherapist for the Singapore Wheelchair Basketball Team

With the 8th ASEAN Para Games just around the corner, we wanted to take the chance to sit down with Brigitte Lichtenberger, one of the physiotherapists here at PhysioActive. As well as working tirelessly with our patients, Brigitte is also the physiotherapist for Singapore's national wheelchair basketball, who will be competing in this year's games from 3rd - 9th December.

Brigitte's hard work has already been picked up by the Straits Times, and we're all excited to see how the team gets on! Read on to find out more about Brigitte and the team...

Do you think that competing in Singapore will give you a home turf advantage?

I'm sure that playing in Singapore will motivate the players a lot, and I hope that lots of people will come along to experience the impressiveness of the game.

You're head coach of the team: What exactly does this role entail?

I plan and conduct most of the training, and I'm working closely with the team's manager and with my assistant coach to organise everything before the games so that the athletes can concentrate on their training and their matches.

Are there any skills that you've learned as a physiotherapist that you can apply to your coaching?

The medical background helps me to understand the capabilities of each individual player and to plan where they can improve.

Will you be taking any time off work during the competition? If so, how supportive have Denis and the team been?

I will have to stay in the games village for the entire event, which means that I can’t work in the clinic. Denis and the team were very supportive in giving me time off to represent Singapore.

Singapore Wheelchair Basketball Team
Singapore Wheelchair Basketball Team

Your opponents aren't confirmed yet. Are there any teams that you'd particularly like to either play or to avoid?

The teams we're most likely to play against are very strong, as some of the players in other countries are playing full-time. Our average age is quite high for wheelchair basketball, but my goal is to create awareness of the sport and to motivate other people to join in, as it’s a good opportunity to improve mobility and to get more independent and confident. I look forward to playing against all of the teams, as you can always learn and improve.

How long has the wheelchair basketball team been practicing for the games?

I started to coach them in the middle of August, which isn't much time to prepare them. The team itself has existed for a long time, and they've been training recreationally for several years.

How did you get into coaching the team?

I was coaching them for a while several years back and then stopped, when they just played recreationally. This summer they approached me, when they found out that they'd be participating in the games, and they asked if I'd like to join the team to help them prepare for the event. I started my coaching career about 15 years ago in Switzerland by forming a team in my hometown.

It's half time and your team is losing. You have 30 seconds to give them a pep talk - what do you say?

This is difficult to answer. It depends if we're the attacking team or the defending one. I'd give tactical instructions, but I'd also make sure to motivate them to play until the end, as the game is only over after sure I would motivate to play till the end, as the game is only over after 40 minutes.

Brigitte Lichtenberger B.Sc.
Brigitte Lichtenberger B.Sc.

Best of luck to Brigitte and the Singapore Wheelchair Basketball team - we'll be keeping a keen eye on the results! In the meantime, if you'd like to book an appointment with Brigitte or one of our other specialist physiotherapists, get in touch.

Real Time Ultrasound: What is it and how does it work?

Real time ultrasound has been used for many years in an obstetric setting for foetal monitoring, but in a physiotherapy setting, real time ultrasound is used as a diagnostic tool that allows us to watch our muscles working. Ultrasound is safe and produces pictures of the inside of the body by using sound waves. There is no radiation exposure to the patient at all. Real time ultrasound provides visual biofeedback of the movement of anatomical structures, like a muscle, so movement can be observed as it actually occurs, allowing a better understanding and perception of muscle action and activity levels. This immediate visual feedback improves your ability to learn to control your stabilising muscles, speeding up recovery time and producing a longer lasting outcome.

Depending on what your physiotherapist is looking at, your muscle function can be assessed by the real time ultrasound, and you will be shown any anomalies, if they're present. You will then be shown the best way to use your muscles, with your efforts being relayed by the real time imaging. Most commonly, we look at the deep abdominals (transverse abs or TA), the pelvic floor muscles and the deep muscles of the lower back (multifidus), to assess their activation and function. Real Time Ultrasound can then be used as a training tool to help you to strengthen the muscles.

Medical Ultrasound

In a women’s health setting, real time ultrasound is most useful when helping to facilitate a correct pelvic floor muscle contraction. Having a strong and flexible pelvic floor is essential in the management of incontinence, prolapse, bowel dysfunction, bladder dysfunctions, and certain aspects of sexual dysfunction. Many women incorrectly activate their pelvic floor muscles, which can do more harm than good. Real time ultrasound is a non-invasive tool that provides a dynamic assessment of pelvic floor muscle function in as close to a “real-life” situation as possible. It should not be used as a substitute for a full pelvic floor assessment but it is an excellent adjunct.

Real time ultrasound can also be useful in the management of diastasis rectus abdominis muscles. When the fascia (linea alba) connecting the two rectus muscle bellies stretches, as often happens during pregnancy, the gap that is created along the line of the belly button is called diastasis rectus abdominis. A diastasis can usually be managed well with conventional measurement, appropriate exercises and lifestyle advice, but real time ultrasound allows for a more accurate assessment of the linea alba. It also provides excellent biofeedback as to how reactivating your core muscles prior to certain movements increases the tension of the linea alba, thereby enhancing your core's ability to function correctly.

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5 Vital Pieces of Equipment for Your Home Gym

“Convenience, after all, has a way of inspiring results.” Fancy a gym that's convenient and has free membership? You don't need a ton of equipment to work out. By having a few key pieces of equipment at your disposal, you can have a high quality workout at home.

When choosing the equipment for this article, there were several things to consider. I wanted a mixture of equipment for strength, core stability, flexibility, balance, coordination and cardio fitness. Other considerations included price, simplicity of use and storage space. Let's get started!

Exercise Mat

1 - Exercise mat

A good mat is probably the most essential piece of equipment for any home gym. This inexpensive item is vital if you want to do floor exercises safely and more comfortably. They can be used for strengthening exercises such as ab workouts or flexibility work and/or yoga. They can also provide your feet with grip, and help to prevent slips.

The thickness of the mat depends on what you plan to do with it. Traditional yoga mats are normally thinner and are perfect for standing poses that might be affected by thicker mats, and they don’t affect your balance. However, a slightly thicker exercise mat may provide more cushion and will better protect your knees, elbows, and tailbone during floor work.

If you are using heavy weights and live in a HDB or apartment, your neighbours may complain about the loud noises caused by weights landing on the hard floor. A mat can reduce this impact and can help you to exercise more quietly, without upsetting your neighbours or damaging your floor.

You can even buy some mats that have exercises and stretches printed on them as a guide.

 Prices range from $15-$50

Exercise Ball

2 - Exercise ball

I  consider the exercise ball to be one of the most underrated pieces of gym equipment. These are more than just something that is fun to sit and bounce on. It’s a highly useful and versatile piece of equipment.

An exercise ball is especially useful for core strengthening exercises. Think of an exercise ball as the opposite of solid ground—a soft, unstable surface that challenges your core in multiple directions and helps you to improve your strength, balance and coordination. It can allow you to perform some exercises with a greater range of motion, such as a basic abdominal crunch, thus improving muscle activation.

An exercise ball is also an excellent substitute for a bench, and so it can be used for upper and lower body workouts. Sitting or lying on the ball provides an unstable surface that will challenge your balance, thus meaning you have to activate several muscle groups in order to maintain stability.

It can also be used as an added weight to lift during an exercise - for example, lying on an exercise mat and raising the ball with your feet. You could also use the ball to perform stretching exercises or to sit on to improve your posture.

Exercise balls usually come in a few sizes, depending on your height. To get the most from your workout, be sure to get one that is the correct size. A good rule of thumb for finding the right size is to sit on the ball and to make sure your hips and knees are at right angles with the floor.

 Prices range from $20-50.

 Resistance Bands

 3 - Resistance bands

I have chosen resistance bands over dumbbells as they are highly cost effective and much more versatile. Resistance bands are a great addition to any strength training routine or rehabilitation program and come in a variety of sizes, lengths, and strengths. They can be held by hand, stood on or tied securely to any stable surface to provide resistance.

Unlike normal free-weights such as a dumbbell, resistance bands provide constant tension throughout a lifting movement, increasing the intensity of the exercise and the challenge to your muscles.

They offer great functionality, and can be used for a full body workout to integrate upper and lower body together. They’re also portable, thus enabling you to work out or to continue your rehab when travelling.

Prices range from $10-30.


Skipping Rope4 - Skipping rope

When it comes to fitness, simple is sometimes best. A skipping rope may be the most portable and convenient cardio tool available.

There is a reason that they continue to be a central part of any boxer's training program. You can get an amazing workout with a skipping rope in about 10 minutes. They are excellent for cardiovascular fitness - FACT! Skipping can teach you coordination, and adds a plyometric component to your workout that builds explosive leg power.

They require little space to use and almost no storage space at all, which makes them easily portable.

Before you begin using a rope, measure it to your height. When you stand on the middle of the rope, the handles should extend to your armpits. Adjust the length as necessary. Be sure to wear supportive footwear and make sure you are skipping on an appropriate flat surface.

Prices range from $15-50.

Foam Roller5 - Foam roller

I have previously written a blog on this vital piece of equipment and its many benefits. This foam cylinder is one of the most effective tools available for exercise training, recovery and injury prevention. Very simply, by using a foam roller for 5-10 minutes you can release trigger points in your muscles, break down scar tissue and increase blood flow. Add all of this together and you have a simple way to enhance your mobility and increase your recovery, which in turn will boost your exercise performance.

Prices range from $30-80 depending the brand.

Suffered an injury?

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This post has been written by physiotherapist Liam Mc Ginley.

Dealing with a Labrum Injury and Hip Pain

Hip pain and injury is a complex and fascinating field for us physiotherapists. As medical, anatomical and biomechanical science helps us to understand the entire body better, the hip and its problems are becoming clearer. What we do know is that it's always a multi-faceted issue to assess. Like all parts of the body, the hip is influenced by all around it.

The hip joint and its surrounding structures form a very strong unit that the body relies upon to transfer energy and force from the foundation of our spine to our lower limb extremities. It's a ball and socket joint, which allows movement in every direction. The joint and its surrounding muscle strength allows us to effectively transfer the power of our leg to the stability and control of our spine. This creates efficient movement in the ideal world. When this system is faulty, however, the consequence is an injury to the hip joint itself, or to any of the surrounding structures in the said chain of events.

The labrum is a ring of a cartilage type structure that sits around the socket part of the hip joint. It acts to:

Patients with a labral or cartilage injury will often describe:

Hip Scan

Injury to the labrum can be caused by:

  1. Trauma (including dislocation)
  2. Repetitive and sustained compression to a specific area of labrum
  3. Sports or daily activities
  4. Hip dysplasia (irregular shaping of the joint – genetic)
  5. Hypermobile joint (excessive flexibility)
  6. Impingement (compression caused by femur bone)

The key to understanding where to start with treating a labral injury is understanding the patient themselves - knowing the causes in their day-to-day lifestyle, and carrying out an in depth physical assessment. There are then many tests that help confirm a diagnosis of a labral tear for those with hip pain. Tests that  compress the joint surface and reproduce the patients symptoms are a very good way to pick up indications of labrum and or cartilage injury. 

When we have arrived at the diagnosis of a hip joint labral injury, there are then many factors that need to be corrected. Here, I will discuss these factors and how we go about fixing them:

  1. Joint restriction/stiffness

Having a tight hip joint will place greater stress on the cartilage and labrum. The best way to improve this is to use distraction techniques to gently open and stretch the joint itself. Massage to the surrounding muscles helps blood flow and can increase mobility.


  1. Muscle tightness

Key muscles that pose a problem for the hip joint are the hip flexors, the groin muscles (adductors), the deep hip rotators (piriformis) and the tensor fascia latae (TFL). Trigger point therapy, targeted stretches and self release, active release techniques, sports massage and dry needling are all successful when dealing with muscle tightness.

  1. Pelvis/lumbar spine

Any alteration to normal biomechanics in these areas will affect the hip joint. Both structures have many muscles that cross from one to the other, thus directly contributing to the way that the hip moves. A Pelvis rotation/twist is best fixed with manual mobilisation and manipulation, followed by core and muscle strengthening. Lumbar spine stiffness will also increase the demands on the hip, so stretches can really help.

  1. Weak core

A weak core means poor stability. Imagine running on sand as compared to concrete. When running on sand you have no stability - every muscle has to work harder, and your speed and power drop as there's no solid foundation from which to move from. Studies have shown that weak core muscles are a common factor in patients with hip pain, often related to previous injuries or misfiring muscles. Without these muscles helping to stabilise the area, the hip joint has to cope with considerably more stress. Specific exercises to target the transverse abdominus, the mulitifdus and the pelvic floor are often recommended by physios.

  1. Weak glutes

The glutes are a fascinating group of muscles, comprising of three muscles in the buttock area. They serve to create power when we walk and run. They create stability at the same time, and prevent a drop of the opposite hip when walking and running. Single leg squat and running assessments will pick up any issues with weak glutes. When combined with core strengthening, the hip joint and its labrum/cartilage are only going to be healthier from all of the the hard work.


  1. Flat feet and ankle stiffness

People with fallen arches are more likely to have hip pain. As the foot rolls in, the hip joint twists inwards slightly, compressing the front of the joint. Added up over the thousands of steps we take each day, an abrasive stress is only going to wear away at the labrum.

  1. Posture - Sitting and standing

Sitting compresses the front of the hip labrum and cartilage, and when combined with crossing your legs, a dangerous situation can arise. Fixing any issues ergonomically will help this - for example, if your chair is too low then the hip joint will be more flexed, and this will need to be corrected. Standing with all of your weight shifted to one side will jam your hip joint. This coincides with muscles weakness in your core and glutes, and is something that always needs fixing. Too often, this is a problem with young mums who only hold and carry their child on one hip.

One of the most crucial elements to treating people successfully is understanding the way that the patient moves. If we don’t solve the potentially harmful movement patterns that a patient has, then we won’t ever be truly successful with our treatment. Running assessmentsgolf swing analysis and other sports-specific tests are the best way to understand and correct movement pattern dysfunctions.

Now, it's also important to mention that the injury that does not always heal with conservative treatment. Some tears and degenerative injuries in the hip joint have a limited ability to heal due to limited blood supply. This may indicate the need to consult with an orthopaedic surgeon to understand potential surgery options. Avoiding this need for surgery is the aim of all physiotherapy treatment programs.

Hip joint pain is a debilitating and complex injury, and patients often leave it too long to have it fixed. For treatment to be more successful, it needs to be early on in the process. In the end, I implore patients to listen to their body more. You need to trust what your body is telling you before it's too late and the full injury process has set in.

Problems with Hip Pain?

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This post has been written by PhysioActive physiotherapist Joel Bates.

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Golf and shoulder pain: Know your treatment options

Recently I have had an influx of shoulder based injuries suffered by golfers. Now, not all injuries have been a result of their golf swing. Many patients have actually been recovering from other injuries and even surgery, simply wanting to return to the game that they love. I thought this would be a good opportunity to discuss the main causes of golf related injuries and what you can do to prevent them.

The most common shoulder injuries for golfers:

  1. Rotator cuff tear or inflammation
  2. Impingement (soft tissue swelling)
  3. Bone spurs
  4. Cartilage damage
  5. Arthritis


I feel sorry for the shoulder, especially for golfers' shoulders. It's often not the shoulders' fault that someone is experiencing debilitating pain. After screening these golfers, it’s pretty easy to see that the problem is often coming from somewhere else.

Golfers have a thirst for information, be it the latest technology, the recent PGA results, or simply an analysis of their own game. Most will know what a good golf swing looks like. It’s reproducing that swing ourselves that provides the challenge. We all know that movement should follow this basic sequence:

  1. Hips/pelvis
  2. Torso (thoracic spine)
  3. Shoulders/arms
  4. Clubface

Professional golfers from Rory McIlroy to Jim Furyk maintain this same sequence, despite looking drastically different. When we fall foul of this sequence, problems occur. These problems may include:

Golf Ball

The shoulder is a common site of injury for golfers

It is the main structure that transmits the force and power from the torso to the arms and club. Too often I see people in my clinic who use ‘too much arms’. This refers to an excessive reliance on the arms for power and distance. These people always have one (if not all) of the following results on a physical screen:

  1. Poor hip rotation trail leg
  2. Reduced torso rotation to the right (backswing)
  3. Poor core and glutes strength

This is often matched with:

  1. Poor shoulder and back flexibility
  2. Weak back/shoulder blade muscles

These issues create unnecessary loading and stress on structures in the shoulder joint. If the hips and back are not moving the way they should, then how on earth will the shoulder ever cope?

 Gary Player

How to fix shoulder pain

Screening is the priority. Knowing exactly what your body is unable to do is paramount to finding a fix. I see patterns as I have mentioned above, but everyone presents a slightly different case. By knowing exactly what a golfer needs to work on, I can eliminate the unnecessary exercises and focus on the most important.

Hip and back stretching will be a great start. Here are two excellent stretches to get started on better hip and back mobility:

  1. Thoracic rotation stretch with club
  2. Dynamic hip rotations

The next aim will be to control and transfer energy with a stronger core and glutes. Here are two exercises to begin to improve core and glute strength:

  1. Bridge with leg extension
  2. Bird/dog

Of course the shoulder needs special attention as well. Despite causes potentially coming from other areas of the body, the shoulder isn’t always so innocent. Here are two exercises to help the shoulder become more reliable in the golf swing:

  1. Pec stretch/external rotation stretch
  2. Rotator cuff strength and shoulder blade control (theraband row with ER in abdn)

These exercises are a great start. Of course, once you achieve a more efficient body, good coaching is paramount to improving skill. This is where good coaching can take your game to the next level - not only when it comes to injury management, but also to lower that handicap.

Good golfing!

Working on mastering your swing?

Please get in touch with us today and book a performance golf session with Joel and the team.

Thanks for reading!

This post has been written by PhysioActive physiotherapist Joel Bates.

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Pain during golf - brave or silly?

As a 12 handicapper, I feel I can play some good shots mixed in with some OK shots, all rounded out with some shockers. My body is getting better at controlling my golf swing, so I can be more consistent and less injury prone. However, at this stage I am one of the lucky ones. I don’t feel any pain during or after a game of golf.

As a physio who treats many golfers, I am staggered by how many people simply put up with pain. Maybe it’s male bravado combined with that great Aussie attitude of ‘I’ll be alright’. It simply doesn’t make sense. The easiest time to fix something is now. It only gets harder as we get older.

30% of golfers feel back pain during or after every round of golf. This is crazy. This tells me two things:

1. Golfers are willing to put up with pain to do something they love – very admirable (however silly in my eyes)
2. 30% of all golfers are hitting way too many shots every round (some may see that as value for money golfing)

Golf Ball

There is a strong relationship between pain in the body and poor ball striking. Pain is a fascinating thing. Nerves rightly or wrongly send an extremely strong message to the brain that interprets this information in a split second, causing varying levels of emotional response. What also happens is a subconscious change to the operating system that controls our muscles, joints and our movements. This means that like it or not, we move differently as a response to pain.

If we feel pain during our golf swing, we will compensate accordingly. I have never seen a golf swing that has changed for the better. No one has felt pain and hit the ball further. This is why I find it staggering that people will put up with pain and not do anything about it. It may be as simple as having good warm ups and great stretching, or slightly changing your weekly exercise routines to help reduce these major roadblocks to better golf.

I screen many people and find numerous things that their bodies could do better. This may be the result of sitting in an office for 8 hours a day. It may be a history of serious injury. Whichever it is, it is never too late to change. See a golf specialist physio and you may just surprise yourself. You may start beating your mates.

Good golfing!

Working on mastering your swing?

Please get in touch with us today and book a performance golf session with Joel and the team.

Thanks for reading!

This post has been written by PhysioActive physiotherapist Joel Bates.

Thoughts or questions?

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