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Maintaining the best results requires knowledge and expertise. Our athletes train and so do we, through our professional development program. Meaning that when a practitioner the treats you, they have the most advanced injury care knowledge. Read about what our practitioners are thinking in the injury blogs below.

Is Rest Really Best?

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Ankle sprains are one of the most common lower limb injuries we see as physiotherapists. As children, we were taught the principles of R.I.C.E rest, ice, compression and elevation. Most people believe the best way to heal an ankle sprain is by resting it and keeping off it. However, recent evidence suggests otherwise!

The ankle joint helps to hold our body weight over our feet. It has a prime role in balance and coordination. There are three main ligaments that run along the outside of your ankle into your foot to help stabilize the joint.

There are many causes and contributing factors to ankle sprains. If you are an athlete involved in high impact sports with change of direction you are at risk of injuring these ligaments. Furthermore, if you are in poor footwear, have poor balance or exposed to uneven surfaces you are more likely to sprain your ankle.

So, you've rolled your ankle, its bruised and swollen and all you want to do is lie in bed with an ice pack. But, is rest really best?

An important study on ankle rehabilitation found ‘an accelerated exercise protocol during the first week after ankle sprain improved ankle function’ (Bleakely et al, 2010). The study compared two rehabilitation programs which both included ice and compression. One rehabilitation group performed therapeutic exercises in the first week post injury whilst the other simply rested. It was found that the group with early intervention had better overall outcomes and earlier return to activity - such as work and school.

This article challenges popular advice for rest and protection of minor to moderate ankle sprains. It highlights the importance of early management and implementation of therapeutic exercises in the successful rehabilitation of ankle sprains.

Rest is not really best! If you or a family member experiences an ankle injury please seek early medical advice. At CSSM, we specialize in the assessment and management of all sporting injuries.

The abstract of the article is outlined below, however if you're interested in reading the full study please click here.

Bleakley et al (2010) Effect of accelerated rehabilitation on function after ankle sprain; randomized controlled trial


Objective To compare an accelerated intervention incorporating early therapeutic exercise after acute ankle sprains with a standard protection, rest, ice, compression, and elevation intervention.

Design Randomised controlled trial with blinded outcome assessor. Setting Accident and emergency department and university based sports injury clinic. Participants101patientswithanacutegrade1or2ankle sprain.

Interventions Participants were randomised to an accelerated intervention with early therapeutic exercise (exercise group) or a standard protection, rest, ice, compression, and elevation intervention (standard group).

Main outcome measures The primary outcome was subjective ankle function (lower extremity functional scale). Secondary outcomes were pain at rest and on activity, swelling, and physical activity at baseline and at one, two, three, and four weeks after injury. Ankle function and rate of reinjury were assessed at 16 weeks. Results An overall treatment effect was in favour of the exercise group (P=0.0077); this was significant at both week 1 (baseline adjusted difference in treatment 5.28, 98.75% confidence interval 0.31 to 10.26; P=0.008) and week 2 (4.92, 0.27 to 9.57; P=0.0083). Activity level was significantly higher in the exercise group as measured by time spent walking (1.2 hours, 95% confidence interval 0.9 to 1.4 v 1.6, 1.3 to 1.9), step count (5621 steps, 95% confidence interval 4399 to 6843 v 7886, 6357 to 9416), and time spent in light intensity activity(53minutes,95% confidence interval 44 to 60 v 76, 58 to 95). The groups did not differ at any other time point for pain at rest, pain on activity, or swelling. The reinjury rate was 4% (two in each group).

Conclusion An accelerated exercise protocol during the first week after ankle sprain improved ankle function; the group receiving this intervention was more active during that week than the group receiving standard care.

Knee’d Some Help With Your Running?

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The popularity of recreational running is sky rocketing with the number of runners coming through the CSSM doors higher than ever.

Iliotibial band syndrome is the most common injury to the outside of the knee in runners with an incidence rate between 5% and 14% (Van der Worp et al, 2014). The ITB is a long fibrous structure that extends from the hip to the knee. Iliotibial band syndrome is caused by friction between the ITB and the underlying bony process of the femur. The highest friction point is at 30 degrees of knee flexion during foot strike and the early stance phase of running. The cause of ITBS is multifactorial involving both intrinsic and extrinsic factors.

Risk factors

  • Downhill running
  • Poor footwear
  • Poor gluteal strength
  • Poor pelvic control
  • Uneven surfaces
  • Running biomechanics
  • Leg length discrepancy


  • An ache and/or tenderness over the outside of the knee
  • Pain onset at about the same time/distance on each run
  • Pain aggravated by running downhill
  • Pain descending stairs

Recent evidence

A recent systematic review has investigated the aetiology, diagnosis and treatment of ITBS in runners.

Iliotibial Band Syndrome in Runners A Systematic Review

Maarten P. van der Worp,1 Nick van der Horst,1 Anton de Wijer,1,2 Frank J.G. Backx3 and Maria W.G. Nijhuis-van der Sanden4

The main results of the study showed:

The studies of the aetiology of ITBS in runners provide limited or conflicting evidence and it is not clear whether hip abductor weakness has a major role in ITBS. The kinetics and kinematics of the hip, knee and/or ankle/foot appear to be considerably different in runners with ITBS to those without. While articles were inconsistent regarding the treatment of ITBS, hip/knee coordination and running style appear to be key factors in the treatment of ITBS. Runners might also benefit from mobilisation, exercises to strengthen the hip, and advice about running shoes and running surface.


Here at CSSM we can help!

Clearly the biomechanics of different running styles can contribute to ITBS. With our latest technology we are able to assess your running technique to help treat the cause of your pain. An appropriate rehabilitation program should be prescribed to strengthen and stretch the relevant pre-disposing structures. A podiatry appointment may be necessary to assess foot posture to ensure you are wearing the correct footwear.

If you are experiencing an ache in the outside of the knee, first line treatment is relative rest and ice. However, prevention is always the best cure. If you have any queries, contact any of the friendly practitioners at CSSM for an opinion or advice.

Health By Chocolate - Is Chocolate The New Super Food?

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Easter is the time of year for friends, family and slight over indulging. Chocolate is a major weakness of mine and Easter eggs are of no exception. But, is chocolate really that bad for you? Read on and rid yourself of the Easter guilt.

Recent studies have found that chocolate may improve your brain power and mental health. The New England Journal of Medicine in 2012, established a loose relationship between that of countries with high Nobel Prize winners and country’s with high chocolate intake. Whilst I’d like to believe chocolate is increasing my intelligence, unfortunately there was no strong cause-effect relationship established. Ever wondered why chocolate makes you feel so good? It stimulates the release of endorphins, which is a natural hormone produced by the brain that generates a sense of well-being. Furthermore, chocolate contains tryptophan, an essential amino acid needed by the brain to produce serotonin. Serotonin is a mood modulating neurotransmitter that gives us the feeling of happiness. (Benton et al, 1999)

Chocolate has also been known to provide great benefits to the cardiovascular system. Dark chocolate contains flavanols which have an anti-oxidant effect, improve endothelial function, improve platelet function and reduce blood clots as well as decreasing hypertension and reducing the risk of heart disease. (3 - 5) Perhaps, a square of dark chocolate a day could keep the cardiologist away. Unfortunately, chocolate high in sugar and fat can contribute to cardiovascular disease, so choose wisely whilst in the supermarket aisle. Dark chocolate with greater than 80% cocoa and low in sugar, is the best for you.

Recent evidence has suggested that chocolate milk is an excellent recovery drink following endurance events. It has been proven to be an affordable recovery drink for many athletes, replacing our common commercialised sports drinks. Low in fat chocolate milk has the same ratios of carbohydrates to protein (4:1) as popular recovery beverages. It also offers fluids and sodium to optimise the athletes’ post-workout recovery. It is recommended to consume the milk immediately after exercise and again 2 hours later to ensure peak recovery and potentially a reduction in muscle damage (Pritchett & Pritchett, 2013). Sound crazy? Follow this link for the full article: …

Pritchett K, Pritchett R. 2013. Chocolate milk: a post-exercise recovery beverage for endurance sports. Med Sport Sci. (59): 127 – 34.


As I eluded too earlier, the type and amount of chocolate you consume is essential. The benefits of chocolate are found in cocoa and very few chocolates on the market are rich in pure cocoa. Cocoa has been mixed with other ingredients to make it more attractive to our taste buds. Chocolate high in sugar and fat provides the body with significant calories, if not burned, these calories can be the cause of obesity. Similarly, highly processed chocolate reduces the concentration of flavanols in turn reducing its cardiovascular benefits.

This Easter, I recommend you enjoy your chocolate, for some types have great health benefits, but always eat in moderation and balance with a healthy, active lifestyle.

Resources: 2. Messerli FH. 2012. Chocolate consumption, cognitive function, and Nobel laureates. N Engl JMed. Oct 18:367(16): 1562 – 4. 3. Benton D, Donohoe RT. 1999. The effects of nutrients on mood. Public Health Nutr. Sep;2(3A):403-9. 4. Hollenberg NK, Schmitz H, Macdonald I, Poulter N. 2004. Cocoa, Flavanols and Cardiovascular Risk. Br J Cardiol 11 (5):379-386. 5. Keen CL, Holt RR, Oteiza PI, Fraga CG, Schmitz HH. 2005. Cocoa antioxidants and cardiovascular health. Am J Clin Nutr. Jan;81(1 Suppl):298S-303S. 6. Lee KW, Lee YJ, Lee HJ, Lee CY. 2003. Cocoa Has More Phenolic Phytochemicals and a Higher Antioxidant Capacity than Teas and Red Wine. J. of Agric. Food Chem. 51 (25): 7292-7295. 7. Fisher ND, Hughes M, Gerhard-Herman M, Hollenberg NK. 2003. Flavanol-rich cocoa induces nitric-oxide-dependent vasodilation in healthy humans. J Hypertens. Dec;21(12):2281-6. 8. Pritchett K, Pritchett R. 2013. Chocolate milk: a post-exercise recovery beverage for endurance sports. Med Sport Sci. (59): 127 – 34.

Tips For An Injury-free Ski Season

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Ten Tips for the Ski Season

The snowflakes are falling and soon Melbourne will be migrating to the mountains for weekends of skiing and tobogganing!

Here are my top ten tips to ensure you make the most of your ski trip and be as prepared as possible.

  1. Equipment

  • Check your equipment well before you depart for your trip. Consider buying new equipment as newer light weight equipment will have more bounce in it and make your skiing much more enjoyable. Try on your boots and make sure they fit correctly, wear them around before your holiday to make sure they are comfortable.


  2. Fitness

  • Increase your base fitness level and you will be able to make the most of your costly lift pass. Cardio respiratory fitness is essential for skiing so try something like cycling as a great work out that won’t over load your knees. Furthermore, do a ski fitness program to target specific muscle groups you require for skiing (see tip #10).


  3. Stretch

  • Rest is the most underrated performance enhancer. Whilst it is essential to strengthen in preparation for skiing it is just as important to provide the body with rest and stretching. Focus on stretching quadriceps, glutes and hip flexors to maximise your flexibility and muscle function.


  4. Chill (Pardon the pun)

  • Take it easy! Start slowly and build the intensity and difficulty of your runs. Train yourself on the groomers to get use to your skis and boots and slowly progress. It’s easy to arrive at the mountain all amped up but try to save yourself from burning out on day one.


  5. Learn

  • Take a lesson. Yes, they are expensive but at the same time a half day of expert tips doesn’t go astray whether you’re a novice or experienced. An instructor will help you make the most of your new equipment, give you specific skills to work on and provide advice on the best runs for you.


  6. Drills

  • Just like a netballer practices throwing drills and a swimmer practices high elbows – a skier should perform drills to improve technique. It is recommended that you find a gentle run and practice long radius and short radius turning as well as identifying your centre of balance by leaning too far forwards and too far backwards. Once you’ve nailed this try progressing to some steeper runs.


  7. Plan

  • It pays to plan out your goals and what you’d like to achieve by the end of the week. Perhaps, this is something you could discuss with your instructor.


  8. Drink

  • Swap the wine for water; it easy to overdo it on the first night when you’re 10,000 feet higher than normal. Alcohol can exacerbate symptoms of high altitude sickness, including headaches and nausea. Never the less, a celebration at the end of a week well skied is always warranted.


  9. Rest

  • When you’re fatigued and running out of gas, back off. It’s always the skiers who keep hurtling down the black runs that end up calling the rescue toboggan. As a physio, I see tonnes of skiing injuries, from broken wrists to ruptures ACLs. When required, rest and rejuvenate, take a day sitting by the fire and return to skiing when your body is back at its best.


  10. Strengthen

  • Skiing is a fantastic workout for your body as it requires the use of all muscles. Here are some specific muscles to target and strengthen in the lead up to your trip:

    • Quadriceps: the most vital muscles required for skiing are your quads. These muscles hold you in position and help you steer and stop. Fabulous exercises for your quads are squats and lunges.

    • Hamstrings and Glutes: As you are skiing downhill you typically will hold your trunk in a flexed position, this requires strong eccentric (contraction on length) strength from your hamstrings and glutes. Good exercises for this are; bridges, single legged dead lifts and step ups.

    • Inner and Outer thighs: Your outer thighs help keep your body stable and enable you to steer whilst your inner thighs work like crazy to keep your skis together. Work these muscles with side lunges, side leg lifts, inner thigh squeezes and side leg squats.

    • Calves: Because your knees are bent as you ski, your calves (in particular your soleus) help you stay up right so you don’t fall over. Strengthen your calves by performing calf raises off the edge of a step.

    • Abs and Back: To maintain a forward flexed position through your trunk whilst skiing your abs and back must have great endurance. It is essential to strengthen these muscles in order to protect your spine. Work these muscles with exercises like toe taps, planks, back extensions and dumbbell rows.

    • Arms: Arms help push off with your skis and balance you. Make sure you work your biceps and triceps along with the rest of your body.

The Shoulder: To Operate Or Rehabilitate?

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The shoulder joint is a complex ball and socket joint that allows 180 degrees of movement. Shoulder impingement occurs when the rotator cuff tendons or bursa (a fluid filled sack) are repetitively compressed in the subacromial space (see image below).

This compression can cause localised inflammation and results in painful movements of the shoulder. It is one of the most common conditions we see in the clinic, especially coming into tennis and cricket season.


The impingement can be “primary” resulting from a structural narrowing of the space or “secondary” due to poor biomechanics and movement patterns of the shoulder. Some of us are born with smaller subacromial spaces or develop bony spurs over time. Secondary impingement can be a result of impaired scapula control, poor posture, or increased mobility in the shoulder joint (Holmgren et al, 2012). 

Patients with subacromial impingement may experience pain when sleeping on the effected side, weakness when reaching and lifting and/or an ache referring from the shoulder down the outside of the arm.

Shoulder impingement is classified as a symptom, with many causative factors, rather than a diagnosis (Kibler et al, 2013). It is essential that your physiotherapist acknowledges the concepts of mechanical, movement-related impingement which may in hand prevent the potential for inappropriate surgical interventions (Braman et al, 2014).

The scapula is controlled by a pulley system comprised of muscles attaching to the spine, thorax and arm. Optimal shoulder posture, movement, stability and muscular control are heavily dependent on scapula performance (Kibler et al, 2013). Each muscle has a specific role in helping to tilt and rotate the shoulder blade to allow movements of the arm. The 2013 scapula summit defined altered scapula movement and position as “scapula dyskinesis”. If taping or gentle manual assistance to correct your scapula dyskinesis relieves your shoulder pain this is a fabulous indicator that you are an ideal candidate for rehabilitation and can avoid going under the knife.

As discussed, impingement is caused by a myriad of factors.  Traditional treatment involved corticosteroid injections and surgical subacromial decompressions.

Recent evidence has found that exercise management for subacromial impingement is as effective as surgery at 1, 2, 4 and 5 year follow ups (Haahr et al. 2005, Haahr & Andersen (2006), Ketola et al. 2009 and Ketola et al. 2013). This is an exciting revelation in shoulder treatment, showing that a specific exercise program focusing on scapula muscle control, is effective in reducing shoulder pain and improving shoulder function (Holmgren et al, 2012). Exercise management has reduced the need for sub-acromial impingement surgery by up to 80% (Holmgren et al, 2012). 

If you are experiencing shoulder pain we recommend you seek a thorough assessment to determine whether your injury will respond to a specific, personalised exercise program to avoid the need for surgical intervention.



Braman, J.P., Zhau, K.D., Lawrence, R.L., Harrison, A. K., & Ludewig, P. M. (2014). Shoulder impingement revisited: evidence of diagnostic understanding in orthopaedic surgery and physical therapy. Medical & biological engineering & computing, 52(3), 211 – 219.

Haahr, J.P., Ostergaard, S., Dalsgaard, J., Norup, K., Frost, P., Lausen, S., Holm, E.A., & Anderson, J.H. (2005). Exercises versus arthroscopic decompression in patients with subacromial impingement: a randomised, controlled study in 90 cases with a one year follow up. Ann Rheum Dis, 64(5), 760 – 764.

Haahr, J.P., Andersen, J.H. (2006). Exercise may be as efficient as subacromial decompression in patients with subacromial stage II impingement: 4 –8- years’ follow-up in a prospective, randomized study. Scand J Rheumato, 35(3), 224-8.

Holmgren, T., Hallgren, H.B., Oberg, B., Adolfsson, L. (2012). Effect of specific exercise strategy on need for surgery in patients with subacromial impingement syndrome: randomised controlled study. British Journal of sports medicine, bjsports-2012.

Ketola, S., Lehtinen, J., Arnala, I., Nissinan, M., Westenius, H., … & Rousi, T. (2009). Does arthroscopic acromioplasty provide any additional value in the treatment of shoulder impingement syndrome?: a two-year randomised controlled trial. J Bone Joint Surg Br, 91(10), 1326-34.

Ketola, S., Lehtinen, J., Rousi, T., Nissinen, M., Huhtala, H., Konttinen, Y. T., & Arnala, I. (2013). No evidence of long-term benefits of arthroscopic acromioplasty in the treatment of shoulder impingement syndrome. Bone and Joint Research, 2(7),132-139. 

Kibler, W. B., Sciascia, A.D., Bak, K., Ebaugh, D., Ludewig, P., Kuhn, J., … & Cote, M. (2013). Clinical implications of scapula dyskinesis in shoulder injury: the 2013 consensus statement from the ‘scapular summit’ report of 2013. British Journal of sports medicine, bjsports-2013.