Running Injuries

Defying Gravity with the Alter-G

Alter G Anti Gravity Treadmill Sydney CBD

Alter G Anti Gravity Treadmill Sydney CBD

The AlterG Anti-Gravity Treadmill has finally arrived in Sydney CBD.

Here at Sydney Physiotherapy Solutions we understand how important it is for runners and other athletes to recover quickly so that they can continue participating in the sport that makes they love.

We are dedicated to continuously educating ourselves in order to provide the the most current and effective treatment possible. This is why we have decided to introduce the Alter-G anti-gravity treadmill to our brand new clinic at 155  Castlereagh Street in Sydney CBD.

Sydney Physio Solutions is proud to be one of the only clinics in Sydney to have an Alter-G anti-gravity treadmill.

Working with runners and athletes is a speciality here at the clinic. Many of our therapists are runners themselves which gives us an advantage when treating running injuries as we understand the sport and have the necessary experience in treating the associated injuries. More importantly, we understand that most of our athletes would prefer to keep running while injured and so we have introduced the Alter-G to ensure that we can keep our athletes running.

Advantages of the Alter-G Treadmill

  • Helps minimize time lost from training, especially those training for an event such as a marathon
  • Maintains cardiovascular fitness during rehab
  • Reduces stress on joints
  • Improves bone density measures
  • Suitable for runners who may be overweight
  • Allows gradual loading as our injury heals during rehabilitation

Specific injuries that the Alter-G is suitable for

  • Knee osteoarthritis
  • Complex regional pain syndrome
  • Fibula stress fracture
  • Lumbar disc herniation
  • Metatarsal stress fracture
  • Plantarfasciatis
  • Ankle sprains
  • Tibial stress fractures
  • Navicular stress fractures
  • All types of muscle strains

To find out how the Alter-G AntiGravity Treadmill works read more here.

Alter G Anti Gravity Treadmill Sydney

Alter G Anti Gravity Treadmill Sydney

The Alter G treadmill uses an inflatable bubble to enable users to walk and run in a reduced gravity environment. The effects of training in this environment is lowered impact on your lower body meaning a reduced risk of long term injury in addition to reducing the time to return to running post injury.

The Alter G in the Hi Performance Centre (HPC) is available to everyone whether you’re an athlete, returning to exercise from an injury or to aid weight loss.

Contact our Castlereagh Street clinic to make a booking on the AlterG Anti-gravity Treadmill machine.

Recurrent Hamstring Strains

HamstringRecurrence of a hamstring strain is incredibly frustrating, not only for the injured person, but also to see as a physiotherapist!  A hamstring strain may reoccur if a person suffers a worsening of their original strain, or otherwise another area of muscle along the muscle/group becomes injured. Commonly this occurs when the person is just getting back into training or attempting to return to their previous sport. It is disappointing to see as a physiotherapist, since often re-injury is preventable with good management. Different outcomes will depend on factors such as the degree of the initial injury, its location (i.e. muscle versus tendon) as well as personal and external variables, however general guidance can be provided for optimal rehabilitation.

Best tips for best rehabilitation and avoiding re-injury:

  1. Progress your hamstring through a series of exercises aiming to achieve full concentric/eccentric strength, dynamic muscle length, power and plyometric ability (strength with speed), and endurance, before considering returning to sport and sport specific drills. See Dynamic Stretches
  2. Ensure your hamstring has been rehabilitated through sport-specific tasks, when it is appropriate to do so. Exercises need to consider the location of the injury in the hamstring, stage of injury, and the multiple functions of the hamstring muscle. Your hamstrings will work hard when you are speeding up and slowing down from a run, stopping quickly, kicking a ball, bending forward from the hips (e.g. picking something up), and control twists and turns of the leg when you are moving at quick speeds. As such – the muscle group needs to be trained well to be able to cope with these activities for a successful return to sport. Even if your main sport is running, your hamstring should still be progressed to be able to tackle less frequent tasks with confidence for best function.
  3. Perform a graded, specific running programme which is best advised by a suitable physiotherapist. This should incorporate graduated progressions of running distance for endurance, sprint exercises, forwards/backwards/sideways and cutting movements, and stop-start work. Hamstring strains most commonly occur during quick acceleration or deceleration – and therefore this needs to be trained back for the tissue to be able to cope with this, under high repetition/load.
  4. Return to sport gradually! Make sure you progress back carefully towards a previous level of activity/intensity. The tests we can do for a hamstring in a physiotherapy clinic and even outdoors assessment are only one level of assessment. Fatigue has big implications for muscle. Only when you can manage full training sessions at 100% intensity over the week, then consider playing or running at a competition level. And even then, only playing only part of the first game back rather than the full game is best, since you will likely be working a lot harder in this situation! De-conditioning occurs from not playing sport in a while, and this may be when you are more prone to injury.
  5. Listen to the muscle. The helpful thing about a hamstring strain is that it often gives you big clues as to how it is going, and when it might be about to restrain! If the muscle or group feels tired, or like it is “tightening”, or “about to go”, then stop! It is at a high risk of reinjury at this point. “Pushing it” has a high chance for reinjuring the torn tissue or injuring healthy hamstring tissue from overload.
  6. Address any contributing factors. Common culprits which contribute to hamstring strains include biomechanics and imbalances about the spine, pelvis, hips and legs. For example, players of kicking sports may have imbalances from constant rotational forces in one direction, influencing pelvic/hip stability. Optimising core stability and glute/hip timing/power and balance with specific exercises is important to prevent overwork through hamstrings. Neural tension through the injured tissue or from tight associated hip/back structures can also increase likelihood of restrain and there are treatments/exercises available to help this. Read more
  7. Maintain good hydration and nutrition throughout your rehabilitation, and  use good recovery practices, for optimal muscle tissue healing and recovery.

If recurrent hamstring strains are a problem for you, seek advice from a good physiotherapist to help answer any questions and assess for any contributing reasons that may be leading to re-injury, as above.


A Physio’s Top 4 Stretches for After a Run


There is a lot of information out there regarding stretching for runners so we have tried to summarise a few key fact to help you with your running-stretch-strategies!

Firstly research has shown that static stretching prior to exercise can reduce power output and thus is no longer being promoted for use prior to our runs. However, static stretches are still recommended for after our runs to aid recovery and reduce DOMS (delayed-onset-of-muscle-soreness).

It is still important to warm up our joints and cardiovascular system before our runs, so a brisk walk/light-slow jog, some dynamic stretches and joint mobility exercises are a great start as part of your warm up. Please see our blog for more details on this if interested.

As for after your runs – please find four of our favourite stretches below to target the key running muscles groups. Hold each of them for a count of 40 (minimum of 30sec but we recommend 40 as we usually count too fast!) and repeat twice on each leg.

1. Quadriceps Stretch Quad-Stretch

Take your right foot in your right hand behind you. Keep your knees together and tail tucked under. Feel the stretch in the front of your thigh.






2. Hamstring Stretch Hamstring-Stretch

Place your right foot up onto a step and slightly bend your right knee. Tip your tail bone out and bend forwards, maintaining a straight back posture. Feel the stretch in the back of your thigh only.






3. Calf Stretch Calf-Stretch

Lean against a wall with your right leg bent in front of you and your left extending back behind you. Ensure your feet are facing forwards, your left knee is straight and that your left heel is down. Feel the stretch in your left calf.





 4. Gluteal (Buttock) Stretch  GluteStretch

Lying on your back take your right knee into your chest and across your body towards your left shoulder. Add a little rotation by drawing the left ankle in towards you. Feel in the buttock only. Cease if you feel this in your groin/front of hip and seek guidance from your physio for an alternative stretch.


With your static stretches hold a light stretch and gradually increase the intensity within comfortable limits. If you are over zealous with your stretches your body can tighten up in response to protect itself – so ‘slow and steady wins the race’ in this case folks!

Running With Injury – Is It Time For A Rest?

Running With Injury – Is It Time For A Rest?

If you’re a runner, chances are you’ve asked yourself this question. Up to 80% of runners will sustain a running-related injury at some point. If we include running with a cold or flu, then the number jumps to 100%. The question is, do you rest, modify your training or continue on as if nothing’s wrong!



Whilst we’re all different and each of our circumstances unique, here’s what I suggest you think about as you contemplate whether to strap the shoes on or stay in bed:

  1. Is it acute? If you suffered an injury significant enough to cut a training session short, you should take 48-72 hours off, give it a chance to settle and throw some ice on it. If it’s still troubling you after this rest period, get it seen to.
  2. Is the injury bad enough to affect your running style? If you can’t run with your normal gait, continuing to train will lead to a worsening of the injury or a secondary injury somewhere else. We see this all the time. Take some time off, cross-train, and/or see a professional.
  3. Is this a recurrence of an old injury? Keep an eye on these ones. It may just be that your brain (and your genes) have some ‘memory’ of the old injury, but always better to get on to managing these injuries quickly. If you do, you can usually stop them from progressing.
  4. Is the injury getting worse? In most cases, if you record a worsening of an injury over the previous week of training, it’s not going in the direction you want! Take some time off and consider getting someone in the know to have a look at it.
  5. Is your ‘cold’ more than just a ‘cold’? If your symptoms are typical for an upper respiratory tract infection (sore throat, sniffles and other things above the neck) then you’re probably ok. Research suggests that training in this situation wont make you worse or slow your recovery. However, if you have symptoms of a fever or cough (i.e. anything below the neck) then you need to rest, or there’s a good chance you’ll regret it!

I hope these tips help, but regardless of your answers, as you start to feel better and make your way back into training, back off a little and build your training up slowly. Taking some time off and then jumping straight back in is one (if not the most-likely) reason for problems to occur.

Most injuries are simple to manage with a common-sense approach. Be wary of reading too much on the net, as there’s an awful lot out there and a lot of it is…not prudent advice! If you’re unsure whether you need to see someone, set up a Skype appointment with one of the expert Sydney Physio Solutions Physiotherapists. They’ll ask you a series of questions and help you wade through the plethora of information available to advise you how best to tackle it.

Shin Splints



What are shin splints?

Shin splints is a general term used to describe pain in the shin (usually the front or inside) and is a common problem in runners. Physiotherapists refer to shin splints as medial tibial stress syndrome (MTSS) as the pain most commonly occurs along the inside border of the shin bone (tibia) and is the result of overuse which causes inflammation of the bone and/or muscle in that region.

Diagnosis of shin splints

The severity of MTSS is quite variable. A low grade injury usually means that the main problem is muscle tightness or inflammation and this should settle relatively quickly with the appropriate treatment.

  1. Key signs and symptoms of a low grade injury are:
  • A history of impact loading (e.g. running) and usually a rapid increase
  • Tenderness along a large portion the shin bone or muscle
  • Pain improves after warming up (e.g. a few minutes into a run)
  • Pain generally does not return after cooling down
  1. A high grade injury refers to the presence of a stress fracture (a small crack or severe bruising in the bone) and in this case, rest from high impact exercise is essential (usually for several months). Whilst uncommon, if MTSS continues to be abused, it is possible for the stress fracture to turn into a complete fracture! It is therefore crucial to consult a qualified physiotherapist early to get an accurate diagnosis as this will dictate what the appropriate treatment is and stop your injury from progressing to a stress fracture.
  1. Key signs and symptoms of a higher grade injury are:
  • Tenderness over smaller, specific point/s of the shin and possibly a lump
  • Night pain e.g. throbbing or aching of the shin when in bed
  • Pain at rest or with simple weight bearing and poor tolerance to light impact activity


The cause of MTSS can be many things, but the most common factor is overload of the muscles/shin through training errors. For example, training for a marathon and increasing running distance and frequency too quickly which does not allow enough time for recovery and adaptation of the bone and muscle to the training stimulus. Training speed, frequency, duration, surface (e.g. grass vs concrete), and footwear, all contribute to the amount of load experienced by the bone and muscles around your shin. It’s a sensible idea to talk to an experienced physiotherapist or running coach about how to plan out and manage your training loads so as to avoid overloading your legs, particularly if you are new to running. Another good idea is to have your running screened. This involves a series of tests of your strength, endurance, balance and flexibility, as well as filming your running technique. Based on the findings of the screening, corrective exercises can be prescribed to minimise the risk of you developing problems from running.

Are radiological investigations necessary?

Patients often ask about whether an X-ray or scan is appropriate to investigate the severity of their MTSS. I generally do not recommend getting scans in the early stage as it normally settles with appropriate physiotherapy management and the results of scans do not change the treatment approach if you have been assessed by an experienced physiotherapist. The best way to manage MTSS is based on signs and symptoms anyway. However, in cases where the diagnosis is unclear or in patients who are very anxious or time constrained (e.g. building up to a Marathon), I often recommend an MRI as this does not expose the patient to any radiation and is quite sensitive for picking up the problem.

I think I have MTSS, what should I do!?

Treatment of MTSS depends on the underlying causes identified by your physiotherapist. For example, it may be determined that muscles around the hip are weak and causing the calf to overload. Therefore, strengthening and stability exercises would be the most important rehabilitation strategy. Another person may have excessive calf muscle tightness (from increasing their running distance too quickly) and this is causing compression and inflammation of the bone and tendons in the shin. In this case, loosening the muscles around the calf will relieve the tension and therefore the patient’s pain. This could be achieved through massage but I find dry needling to be far more effective.



So in summary, MTSS refers to pain in the front or inside of the shin and is the result of overloading of the bone or muscles in that region. Catching it early is important to prevent it progressing to a more serious grading of injury which requires complete rest from high impact activity such as running. A graduated running program and screening for biomechanical deficiencies (e.g. weakness, joint or muscle tightness) are good ways to reduce the risk of developing this common problem.

However, if you do suffer from MTSS, there are treatment options available to settle your condition and keep or return you back to running as soon as possible. For more advice or information, contact an experienced physiotherapist.

No pain, no gain

No Pain No Gain??

One of the most common things we get asked is how much pain is acceptable?

We watch images of pro athletes pushing it to the limit and we hear stories of people smashing themselves day in day out…but the question always remains…how do we know when to push and when to hold back?

The question is an interesting one and the answer (of course) is not a simple one.  There are many contributing factors….I’ll try to explain the most common ones.

  1. How used to this kind training are you?

If you have gone from a relative couch potato to captain motivation overnight you are HIGHLY likely to get injured.

Sudden changes in exposure of our bodies to unfamiliar movements means that we are often poorly prepared to cope.


Engage in a progressive demands system

Start light and easy and progress your exercise demands slowly

If you are completely new to exercise it may even be worthwhile in the long run to be assessed by a physio/exercise physiologist for identification of biomechanical ‘risk factors’ (e.g. tight calfs, flat feet, poor lumbopelvic stability) and integrate some preventative training into your actual training.

  1. The pain disappears when you are actually running, only to stiffen up again after you’ve rested


Unfortunately pains that settle with more activity can often mean the tendons are struggling with the change in load.


You may have to reduce your training load if this is happening, identify what tendon is causing the trouble and treat it locally with ice and targeted exercises.

In extreme cases you can use GTN patches to reduce the tendon pain but you will have to talk to your physio/GP/sports physician to make sure that this approach is right for you.


  1. The pain comes on with training and then just gets worse and worse until I physically have to stop.



This is not ok pain.  If the pain is in your legs it can be a compartment syndrome (where the muscles swell and are compressed within the fascial outer casing of the muscle) or it could even be a stress reaction in the bone.  Either way you need to get this looked at by someone who knows their stuff.


  1. My muscles are sore for up to 3 days following activity, but then they feel fine.


Well Done

You are experiencing delayed onset muscle soreness…this is the no pain no gain they talk about.

You have exercised just enough to cause damage to the muscles, but it will be repaired and new, improved sarcomeres (the building blocks of muscles) will be laid down.

It is however a good time to rest for a day or two while you are sore, or cross train by doing something different (go for a swim or hit a few tennis balls gently).

Overall some discomfort is a acceptable with training, but if it is impacting your ability to perform regularly you must get it checked out.

Stuart Doorbar-Baptist | Senior Clinician and Research

How to Avoid Overuse Running Injuries

With all the marketing hype around, you might be forgiven for thinking that footwear is the key to preventing running injuries. Especially now, with most runners at least aware of the “barefoot” craze, it’s becoming harder to know what is the right shoe. The “old” advice around finding the right shoe for a particular foot-type is slowly being tested, and the trend is towards a more lightweight, minimalistic running shoe.

This phenomenon is primarily due to Chris McDougall’s book, that I’m sure everyone has read or at least knows the context, and to a study published in the British Journal of Sports Medicine. There will likely many more studies popping up in the next couple of years to corroborate these findings, as this is a big shift in thinking around footwear and running.

The study, by Ryan et al., showed that matching the “correct” shoe to a foot type had no effect on injury rates in a group of 81 female runners. In fact, those that received the “correct” shoe were slightly more likely to get injured. I think it’s important not to take this conclusion too far, as this was a relatively small study and had some major limitations. It does, however, give some credence to the view that we need to reassess the way we professionals in sports medicine approach running footwear.

While a bit un-scientific, selecting a shoe based on comfort is probably our best bet at present. For example, a study on 206 military personnel, who were allowed to select a foot insert based on their feelings of comfort, showed a significant reduction in injury rates, even though the inserts often had no association with their “foot type” or what would normally have been considered the appropriate insert for their foot. If you have a specific injury, or history of injury, affecting your foot then a consultation with a good physiotherapist or sports podiatrist is probably appropriate.

Anyway, regardless of all this hype and innuendo, a far more important issue than footwear is how you manipulate your training variables. Some studies have suggested that up to 80% of overuse running injuries are attributable to training errors. How you build your training up—including mileage, terrain, speed, and frequency—is the most important single consideration in avoiding a running injury. Regardless of what shoes you wear, how you run, how tight your hamstrings are or how poor your core control, the body needs to adapt to new loads. If you haven’t run much before, or you’re ramping up in preparation for an event, how you choose to do this will be the major factor in determining success or injury.

The 3 keys to avoiding running injuries:

1) Plan your event preparation, including the training variables of mileage, terrain, speed, frequency and, of course, the rate of increase in these variables. Discuss your plan with a sports medicine professional as well as a coach.

2) If you’re unsure on the footwear issue, discuss it with a professional. At present, research evidence suggests that you select a shoe that is comfortable for you, rather than one that has been “prescribed”. The way I address this is to give you a few options and suggest you go for a run around the store and select the one that feels the most comfortable.

3) Have a good biomechanical assessment – it’s a small investment in the overall scheme of things and will allow you to deal with pre-existing issues and risks, and help to prevent further problems.

…and it really is preventing an injury that is the key. Once an overuse running injury has occurred, it’s much harder to fix the problem and get you back on track.

What should be covered at the 3-month check up? This is probably the most critical point in preparing for an event. Identifying problems at this stage gives us the time and opportunity to fix the issue before it takes you out of training or results in a serious injury.

The key elements are:

• Discuss previous history of injury and any current niggles
• Assess weaknesses and areas of potential overuse injury
• Discuss your training plan and current fitness level
• Discuss your footwear
• Assess running mechanics using video analysis
• Establish a plan to avoid any potential injuries


If you suffer from running injury why not contact the team at Sydney Physiotherapy Solutions to make an appointment at either of our Sydney CBD physiotherapy clinics or at our recently opened Chatswood Physiotherapy clinic.

Running and Knees

Runners knee pain 

The most common type of knee pain is pain around the knee cap (patella) and can come on as load, like increased running distance and time, is increased. A common time when this occurs is when a runner is training for a running race like a half marathon or marathon.

Why? Because if there is any problem with the biomechanics of the pelvis, hip and foot the most common site for pain to present is at the anterior knee as it attempts to transfer load from the core to the ground


If you start to feel any type of knee irritation during your running  training come to Sydney Physiotherapy Solutions so the biomechanics of your running can be addressed before pain stops you running for long periods of time. Better yet, before you increase load on the knee come in and get a full running assessment to get the tick for good biomechanics or a program to address any biomechanical problems.

We are the experts at running assessments and have the latest technology, including Dorsa Vi, to assess your running style.

If your underlying problem revolves around your pelvis and hip we have dedicated Physiotherapist who are Pilates Instructors to teach you superior core control specific to runners needs.

If the underlying problem is your feet we have a strong relationship with the best professional running shoe facility in Sydney.

The movement of running is beauty in motion when done correctly. The trick is knowing what is ugly and how to make it beautiful.

Arthritis in my knee – should I run, will I wear out my knee joints?

We live in a world with gravity.  This means as we move, our load bearing joints are compressed and frictional forces applied to the joint surface, and just like a car’s brake discs when we continue to use them in this fashion they will eventually undergo erosion. (a.k.a. arthritis)

Unlike brake discs though articular cartilage is a live tissue, requiring food and nutrients to stay optimally healthy.  As the blood supply within cartilage is not great, joint surface nutrition occurs by gentle compression and release of the cartilage layer (movement).

And that is the dichotomy….we need movement to create an optimally healthy environment for the cartilage….too much though and we risk erosion.  So how are we supposed to know what to do? Run? not run?


In my opinion the best option is to look at things from a number of avenues…Firstly make sure you are a healthy weight.  Knee joint loading is exactly proportional to how heavy you are…if you stay in control of your body weight and strive to keep a healthy BMI you will minimise the excessive force through the knee.  Eating well also maintains optimal internal health to help recover from the microtrauma stress and strain of running.

Secondly… learn your craft.  Running is not a simple activity, it requires a great deal of muscular coordination and effort.  Poor technique will increase the loading at the knee and can accelerate degeneration.  Get your running assessed and perform corrective exercise to get the most out of your body.

and lastly…be sensible…thrashing yourself doesn’t allow time for tissue recovery.  If you are looking at increasing your fitness…do this in a number of ways rather than just relying on one discipline.  If you are training for a specific event ramp up slowly and listen to your body.  Look at your family tree…if arthritis has been an issue in the family be cautious about embarking on an intensive running program.

We need to move to maintain joint health, run smart and enjoy longevity…be a candle not a firework!

The sling systems of the body and functional movements

The human body is truly an amazing machine! We are all aware that our bodies have muscles, nerves, fascia, bones etc….. These allow us to move, lift, produce force and get about our daily activities. But when we look a little more closely, we see that the body is a complex system consisting of many different chains. When we injure our self – we can often create a dysfunction or a weakness in a particular chain. This can then go on to create problems with the way we move or perform tasks.

These chains that I am talking about are often referred to as slings. Physiotherapist Diane Lee identifies 4 main sling systems within the human body.


The top picture is the posterior sling, the middle is the anterior sling and the bottom picture is the lateral sling. The posterior sling is an important one, as we use this sling to drive movement in walking and running. As you can see from the picture below, the glute max muscle works with the opposite lat dorsi muscle during the push off phase of walking or running. This combined contraction counters rotation and produces tension in the fascia joining the two muscles. This allows the system to work like a spring as it stores energy and also stabilises the sacroliliac joint (the back on the pelvis). It’s very clever!

running posterior sling

Sometimes people who have sustained injury to the hip, back or shoulder will need to retrain these muscles as a system in order to return to full function – particularly if they are keen to get back into running. This is just one of many examples of how the body works in this way. Pilates is a great way to retrain dysfunction within all sling systems to allow efficient movement and peak performance.