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Services

 

Assessment of your Knee Injury

A through assessment, including a detailed subjective history, assessment of imaging, objective examination (both functionally and non-weight bearing). A differential diagnosis and appropriately stage rehabilitation, time frames and expectations. Plus if required priority onward referral to Melbourne's leading sports physcians or surgeons whom we work closely alongside.  


Return to Sport Testing

After Anterior Cruciate Ligament reconstruction, it is important to assess the appropriate timing of your return to sport while keeping re-injury risk minimal. Certain factors increase your re-injury risk eg. female gender, age less than 20 years, family history of ACL injury (e.g. parent/sibling), non contact injury (landing or side stepping), and return to a change of direction sport (e.g. AFL, netball or Ultimate Frisbee). 

Your local Physio can refer for this testing procedure (see attached referral pack). After your test you will be provided a 2 page report and recommendations.

Testing includes  

1) Clinical assessment of your knee 

2) Functional testing - hopping power, endurance and control 

3) Isokinetic testing of quads and hamstring power 

4) Questionnaires regarding symptoms and confidence


Screening & Prevention Program

 We are passionate about keeping people active and injury-free. Our state of the art facilities at Prahran Market include a functional testing pod, along with strength and power testing equipment normally found only in research labs. Our specialist and sports physiotherapists have formulated evidence based testing protocols using these physical tests combined with clinical questioning to determine an individuals injury risk for a particular sport. From these screening findings, we tailor a prevention program consisting of targeted strength and neuromuscular control training, and advice. Our specialized gym facilities are also available to clients to use to complete their programs.


Strength Testing

Muscle strength is the force a muscle can generate. We use strength testing to measure the symmetry of leg muscle groups (difference between left and right limbs) as it is a reliable indication of physical function and rehabilitation progress.

Depending on your knee condition, strength testing is either completed at one, four or eight repetition maximum. These test results can then be used to set individualised training programs to achieve specific goals at each phase of rehabilitation e.g. hypertrophy (muscle growth).

We complete this on our state of the art pneumatic Keiser equipment and send your referrer a report. This is really important to gauge progress and set appropriate goals for conditions that often take a number of months to return to activity. 


GLA:D

Good Living with Arthritis: Denmark (GLA:D) is an education and exercise program developed by researchers in Denmark for people with hip or knee osteoarthrtitis (OA).

Research has shown great results in pain reduction and improved function in people completing the GLA:D program, without causing flare ups. This is consistent with current national and international clinical guidelines recommending patient education, exercise and weight loss as first line treatment for OA.

What's involved? An initial appointment assessing your suitability for GLA:D, explaining the program and conducting a few basic physical tests. Two education sessions teaching you about OA. Group exercise sessions twice a week for 6 weeks focusing on strength and limb control. This helps improve movement patterns at the knee and hip which leads to reduction in symptoms and improved quality of life. 

Is the evidence based testing procedure for before surgary (unaffected limb) and at end stage rehabilitation post Knee reconstruction (to compared the strength of Quadriceps and Hamstrings).  

We work closely with Flexwell to provide this service.

 For all booking please click below link to website 

Isokinetic Testing 

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Patient Information 

Ligament Injuries

What is a knee ligament injury?

A ligament is made of collagen fibres organised into a thick band of tissue, like a rope. Ligaments connect one bone to another and are important stabilisers of joints.

The knee joint has four main ligaments:  two are located inside the knee joint (the anterior and posterior cruciate ligaments); the others are located outside the joint (the medial and lateral collateral ligaments).

What causes a knee ligament injury?

The most common and serious knee ligament injuries include those to the anterior cruciate ligament (ACL) and the medial collateral ligament (MCL).

An ACL injury usually occurs during cutting or twisting movements, sudden stopping, or incorrect landing from a jump (all called ‘non-contact’ ACL injuries). These movements most commonly occur in sports such as netball, football, basketball, soccer and gymnastics. Less frequently, the ACL can be injured during a tackle or collision with another player (contact ACL injury) or an awkward fall while skiing. ACL injuries usually happen when the athlete’s foot is in contact with the ground and their knee is suddenly forced backwards, or when the knee is slightly bent and collapses inwards.

Young females and people with a family history of ACL injures are statistically at a higher risk of an ACL injury. Australia has the highest incidence in the world of ACL injuries, thought to be due to the sports we play and our climate and grass types.

The MCL is damaged when the lower leg (tibia) is stretched outwards, causing the knee ligaments on the inner aspect of the knee to tear. MCL injuries commonly occur during an awkward landing, a tackle or fall over another player, during skiing or when a foot or ski gets caught, causing the knee to collapse inwards.

Posterior cruciate ligament (PCL) injuries are less common than either ACL or MCL injuries. The PCL may be injured during a fall onto a very bent knee, or via the knee hyperextending if a player lands against the front of the knee, forcing the shin backwards relative to the thigh bone. PCL injuries are commonly associated with cartilage injuries.

Further common questions and answers are linked below


Patella Femoral Pain / Knee Cap Maltracking 

What is patellofemoral pain (PFP)?

The patellofemoral joint is part of the knee joint. It is where the kneecap (patella) sits within its groove (trochlea) on the front of the thigh bone (femur). A smooth layer of joint cartilage covers the trochlea and the back of the patella to help the joint surfaces glide without friction. There are ligaments which help hold the patella centred on the trochlea, and also several muscles attaching to the patella which move it along the trochlea groove. The patellofemoral joint functions as a pulley system to help the quadriceps muscles straighten the knee most efficiently.

PFP is a condition where pain is felt on the front of the knee, either around or behind the patella. It is commonly felt with activities such as squatting, running, jumping and going up or down stairs; often limits a person’s ability to participate in their chosen activity or work; forms 25–40 per cent of all knee presentations to a sports injury clinic, and can affect people of any age, though studies have shown up to one-third of adolescents report PFP.

What causes patellofemoral pain?

Patellofemoral pain occurs due to a variety of reasons. In some cases, there is no particular trigger or injury, though in others, pain may arise after a change in knee loading (eg, suddenly increasing sporting activity, running more on hills or after a growth spurt). In other people, their PFP arises after a separate injury or surgery (eg, following an ACL reconstruction).

Though each person with PFP may have different contributing factors to their condition, there is strong evidence for the most-common reasons. These include:

Weakness of the front of thigh (quadriceps) muscles: This can cause the patella to not glide centrally within its groove, leading to areas of increased pressure or friction in the patellofemoral joint.

Weakness in the hip/buttock (gluteal) muscles: This can contribute to poor alignment of the leg and knee, or excessive tightness of other thigh muscles- both of which place extra stress on the patellofemoral joint.

Variations in bony anatomy: For example, this could be a kneecap which sits high or wide (laterally) in its groove; a trochlea groove which is relatively shallow; or variations of the shape of the hip and thigh bone which cause the knee to turn inwards with walking. In some people, additional factors may include foot posture (eg, flat feet), weak calf muscles, a stiff ankle, hip or knee joint, or tightness of the muscles and other tissue on the outside of the thigh.

Though not classically PFP, there are two other conditions affecting the patellofemoral joint which can cause pain in the same area and lead to similar functional limitations:

Patellofemoral osteoarthritis: OA can affect the patellofemoral joint, and is as common as tibiofemoral (the bigger part of the knee joint) OA, though they often occur together. The symptoms are similar in nature to PFP.

Patellar instability: Some people have had dislocations of their patella, leading to pain and ongoing instability. There are some similarities between the management of people with patellar instability and those with PFP, though, depending on the degree of instability, the opinion of an orthopaedic surgeon may need to be sought.

Patella Femoral Pain (Knee cap) - Patient information sheet 


Cartilage or Meniscal Injuries

What is a knee cartilage injury?

There are two types of cartilage inside the knee. Both can be injured in different ways.

1) The lateral and medial menisci are ‘C’-shaped and made of tough, rubbery fibrocartilage. They are located within the knee joint and function like washers, helping with shock absorption and aiding joint stability. Meniscal injuries are generally classed as sudden onset (acute) or wear and tear (degenerative).

2) Joint (articular) cartilage is the solid layer of cartilage which covers the bony surfaces inside the knee joint (between the tibia and femur, and between the kneecap and its groove on the femur). This specialised type of cartilage provides a shiny, smooth, friction-free surface for the joint to glide, and also protects the underlying bone. It can be injured through traumatic injury, wear and tear, or by other conditions. Injuries around growth areas (eg, the epiphyseal plate and apophysis) can occur in children and adolescents.

What causes a knee cartilage injury?

Injuries to the menisci generally fall into two categories:

Acute injuries: These mainly occur with sudden movements involving rotation, generally while the foot is in contact with the ground, as can happen in sport. This force can cause an acute meniscal tear. Sometimes this happens in conjunction with a knee ligament injury. Meniscal injuries vary in severity depending on the size and location of the tear within the meniscus.

Degenerative injuries: As we age, the meniscal cartilage gradually thins and becomes a little less robust. Degenerative meniscal tears therefore sometimes happen without a memorable incident or can become apparent with a relatively minor twisting movement.

Injuries to the articular cartilage also occur in several ways:

Trauma or acute injury: If a person’s knee sustains a high force injury (eg, a fall from height or a heavy awkward landing in sport), this can result in chipping of the articular cartilage or a cartilage compression injury. 

Via a patellar dislocation: Sometimes when a person sustains a patellar (kneecap) dislocation, a piece of articular cartilage on the surface of the patella can be chipped or fractured.

Conditions such as osteochondritis dissecans (OCD): This is a condition mainly found in adolescents and young adults in which a small patch of bone beneath a portion of articular cartilage develops a lesion. This is considered a stress injury to the developing articular cartilage, and can cause the cartilage and bone piece to weaken and occasionally separate from the bone beneath it. With unloading, the OCD lesion can heal without any further consequence, but with repeated and sustained loading, the lesion doesn’t heal and can became separated and displaced and lead to ‘locking’ and clicking’ of the knee.

Wear and tear (OA): Joint surfaces can accumulate injury via the process of ageing. Wear and tear of the articular cartilage can occur earlier in people who have had previous traumatic knee injuries, highly physical jobs, or who have movement patterns (biomechanics) which put extra stress on areas of joint cartilage.

Apophysitis: Related to growth and load, this is where the cartilage is transitioning to bone at the tendon insertion, with injury also in the adjacent tendon and bone. Most common around the knee is the attachment of the patella tendon at the tibial tub (Osgood-Schlatters disease) or the bottom of the kneecap.


Knee Osteo Arthritis (OA) 

What is knee OA?

Knee OA is one of the most common chronic musculoskeletal conditions seen by physiotherapists, and affects a large number of Australians. It is generally considered a degenerative condition (ie, occurs via wear and tear).

Hyaline articular cartilage is a special type of tissue that coats the ends of the bones located inside joints. In the knee, articular cartilage covers the ends of the femur and tibia, and the back of the patella along with its groove. It is made of cartilage cells (chondrocytes), collagen, water and various proteins. Its role is to provide a smooth, friction-free surface to allow the joint to glide, while helping transmit load to and protect the underlying bone (subchondral bone).

OA is a condition in which the hyaline articular cartilage thins, develops cracks and can eventually wear away. This can result in a rough joint surface and reduce the cartilage’s ability to protect the subchondral bone. OA doesn’t, however, just affect the joint cartilage. As OA progresses, bone spurs can form in the joint, the subchondral bone can form cysts and the menisci (washer-type cartilages within the knee joint) often develop degenerative tears. The layer of tissue which surrounds the inside of the knee joint (synovium) can also become inflamed and increase production of joint fluid, leading to swelling. All of these changes are thought to contribute to the pain and various other symptoms of knee OA.

What causes knee OA?

The articular cartilage of the knee is kept healthy by movement and load. OA develops when the articular cartilage is either exposed to higher loads than it can withstand, often over a long period of time, or when the cartilage itself isn’t able to withstand relatively normal loads. Knee OA is therefore caused by a variety of factors including:

·Age. Though knee OA can affect younger people, it is significantly more common with each decade above the age of 45.

Weight. Being overweight increases the risk of knee OA, and increases the likelihood of it progressing. This is because the knee is a load bearing joint and as such, loads on the articular cartilage of the knee are relative to body weight.

Gender. Before the age of 50, men have slightly higher rates of knee OA, but after the age of 50, the rates are higher in women.

·Past history of trauma or surgery to the knee (eg, ligament reconstruction). This may lead a person to develop knee OA at an earlier age than average due to specific damage to the cartilage at the time of injury, or the strength and stability able to be regained in the knee post-injury.

·Family history of knee OA. Some people may have inherited a form of articular cartilage which is less robust than average, reducing its ability to withstand load over time.

Heavily physical occupations. These can place a lot of load on the knees over many years.

·Natural leg posture. For example, in a person with ‘bow legs’ the inner aspect (medial compartment) of the knee will bear more load than the outer aspect (lateral compartment). This load accumulates over the years and can cause early wear and tear of the cartilage in the medial compartment of the joint.

·Biomechanics. For example, in a person with long-term patella (kneecap) maltracking, the repeated rubbing of the patella against its groove can cause early wear and tear to the articular surfaces of the patellofemoral joint.

·Muscle weakness. Especially in the quadriceps (front of thigh) muscles can contribute to increased loads being placed on the joint surfaces.


Patella Tendinopathy

Information to come.

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Courses

The Acute Sporting Knee 

Presented by Specialist Sports Physiotherapist Jane Rooney, the course will cover contemporary evidence based assessment and management of commonly presenting acute knee conditions. This 2 day course has a large practical component and interactive clinical problem solving. The cases presented include assessment and management of

  • ACL injuries 
  • Patellofemoral joint injuries and pain
  • Meniscal and chondral injuries 
  • Patella tendinopathy 
  • Live patient assessment and treatment 

Dry Needling 

The level 1 dry needling course is an introductory APA accredited, highly practical 12 hour course conducted by Jane Rooney, FACP ( as awarded by the Australian College of Physiotherapists) Specialist Sports Physiotherapist and Dr Peter Selvaratnam, FACP ( as awarded by the Australian College of Physiotherapists) Specialist Musculoskeletal  Physiotherapist . The course is instructional in the theory and safe application of dry needling for a variety of spinal and peripheral conditions and includes a comprehensive manual and needle starter pack.