Tag Archives: overuse injury

Yoga or Pilates? What’s the difference? Which one is best for me?

Many of my clients, looking for a way to stretch and keep their muscles pain free ask me whether yoga or Pilates is a good option for them and which is best. The reality is that both are great ways to keep moving but are good for our bodies in different ways.

Pilates was developed in the early 20th Century by Joseph Pilates, a German physical trainer. He developed his concept of an integrated, comprehensive system of physical exercise, which he himself called “Contrology” through the study of yoga and the movements of animals combined with his knowledge as a gymnast, bodybuilder and boxer.

Reformer Pilates

Pilates is great for movement of joints and focused strengthening of the muscles. It can help strengthen areas that may be weakened by a sedentary lifestyle, injury or misuse of the area. It can help correct posture and motor skills through use of body weight exercises performed on the floor or with equipment such as the reformer or therabands, foam rollers and exercise balls.

Pilates equipment

Originating in India, yoga has been practised for centuries as a physical, mental and spiritual discipline. Various styles of yoga are popular today for developing greater strength, flexibility, relaxation and meditation. Popular styles throughout the world include hatha, iyengar and ashtunga yoga. Yoga can be used for improving the flexibility of the muscles and it will also increase the flexibility of the joints. Specific poses are said to massage organs, lengthen and strengthen muscles and tendons and promote inner wellbeing.


While it’s impossible to tell how many people regularly practise both disciplines, it’s often said that yoga, with its countless offshoots and different styles is the most widely practised exercise system in the world. While Pilates estimate more than 25 million people worldwide as devotees, largely in western countries such as Australia, Canada and the UK.

Some experts say practising Pilates can help build strength to improve yoga performance. While stretching of yoga, will help relieve muscles sore from Pilates strengthening. As yoga and Pilates have different aims, it’s unlikely that combining the two would cause overuse. However, if muscles and joints are sore, give them time to rest and recover.

So which is best to incorporate into your routine?


There is little scientific evidence to say which is best for what. Although I would say that if you are currently injured or not exercising that some stretching and prescribed or clinical Pilates instruction from a qualified physiotherapist or remedial massage therapist might be best. Starting yoga with an existing injury or little fitness could lead to further injury.

That said, gentle styles of yoga such as hatha and iyengar with a good instructor can be beneficial to all, especially for those looking for relaxation and guided meditation techniques.

Devotees to both disciplines will say that theirs is the better option. However, the thing to remember is that all movement is good movement, and the best exercise is always the one that you prefer – as this helps motivation and consistency, with improved and long-term results.

The best strategy? Try them for yourself and see what you like best.

Runners Knee, it’s not just for runners

itb-syndrome-mWhat is ‘runners knee’?

Runners knee, or iliotibial band friction syndrome (ITBS) is when iliotibial band irritates the lateral (outside) of the knee to cause knee pain.
The band is thought to be a type of tissue with little or no elasticity, similar to a tendon, that runs from the hip joints along the femur (thigh bone) and works with the quadriceps (thigh muscles) to provide stability to the outside of the knee joint during movement.
What are the signs and symptoms?
Pain on the outside of the knee, particularly during activity such as running. Pain is likely to get worse until the activity is stopped, only to start again once activity resumes. Running downhill or on banked surface is likely to cause more irritation.
Who gets iliotibial band friction syndrome?
Most common in runners particularly women but can occur in anyone.
Poor posture and/or poor biomechanics such as over-pronation of the foot may increase risk of irritation. Also weak hip flexors and gluteals can increase risk of developing the injury. Overuse, increase of training too fast, returning from injury too soon can all lead to ITBS.
How is iliotibial band friction syndrome treated?
• Rest
Take a break from running. Try an alternative such as swimming that does not put pressure on the same structures.
• Ice & heat therapy
In the initial stages of inflammation use ice or cold packs for 10-15 minutes every hour until the pain has eased. Then repeat 2-3 times per day or after exercise until the pain does not return. Once the initial inflammation has eased, the muscles around the ITB may require heat to ease tension. Apply a heat pack for 10 minutes a day to keep the joint from stiffening at times of rest.
• Stretching and foam rolling
Stretches to the quadriceps, hip flexors, hamstrings, TFL and gluteals will all help take the pressure off the ITB (see below). Using a foam roller to self massage is always a great way to treat any injury at home.

TIP: rolling directly over the ITB can be quite painful. Try rolling the quadriceps and hamstrings, and then then the hip flexors, just below the front hip bone instead.

ilotibial-band-foamroller • Physical therapy including massage, acupuncture and electrotherapy can be very effective for ITBS
• Strengthening exercises
Strengthening the gluteal muscles and the hip abductors, on the outside of the hips will help take the pressure of the ITB
For example
Heel drops, clam exercise and hip abductions


Clam Shell exercise


Hip Abductions


Heel Drops


• Modification to training, footwear and biomechanics

How can massage help?
Massage will help release the tight muscles around the ITB to, in turn, help release the ITB. This may include the muscles that feel weak like the gluteals.
Are there any complications?
Typically there are no long-term complications of iliotibial band syndrome but without taking proper steps to reduce the pain and correct any biomechanical problems, the pain may persist.
How can I avoid getting iliotibial band syndrome?
Running on a flat or soft surface. Wearing arch support and having adequate footwear for training. Adequate warm up and stretching each time you exercise and modifying your training routine will help.


Stretches for ITB


Standing ITB stretch


Pigeon Pose






Stretches for runners from “Stretching” by Bob and Jean Anderson

Stretches 3, 4, 5, 7 are recommended for ITBS

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Overuse Syndrome – What is it? How do I avoid it? How can I help it?

What is Overuse Syndrome?
Overuse syndrome is a disorder where a certain part of the body is damaged by repeatedly overusing it or subjecting it to too much stress.

For example, if you rely on your hands for your work, you are more prone to overuse injury of the arms.

Typists are prone to overuse injury of the wrists

What are the signs and symptoms?
Initially the area affected may feel fatigued, ache or tension; swelling, heat or redness in the area can also occur. If this fatigue is not resolved prior to your return to the activity, micro-trauma may occur, building up over time more serious syndromes can develop.

Weakness, numbness and or tingling in the extremities can occur as well as general aching or shooting pain.

Some common examples of overuse syndromes are:
Carpal Tunnel Syndrome
Patellofemoral Pain
IT Band Syndrome
Plantar Fasciitis

ITB irritation is a type of overuse injury

Who gets over use syndrome?
Those who are prone to overuse syndrome are usually those involved in occupations that rely heavily on the use of hands or arms. Trades such as builders and electricians; check out or line production workers; typists. Some athletes may be prone to overuse syndrome in other areas of the body, and those with hobbies that require lots of ‘hand heavy’ work, such as knitting or crocheting,

How is it treated?
Most start with conservative treatments such as massage, physiotherapy and some stretching and strengthening exercises such as yoga or prescribed pilates.
At home treatments such as heat and cold therapies, rest, and the use of compression bandages can also help.
If conservative treatments are unsuccessful cortisone injections or surgery may be suggested.
Ideally, the best way to treat an overuse injury is to rest the affected area, and to discontinue the activity that is causing the injury. For some this may be impossible due to their work. The employment of an occupation therapist can be useful to help you change the way you operate and keep you working without pain or further injury.

Are there any complications?
It is always best to seek treatment as early as possible for an overuse injury. The longer an injury of this type goes on, the harder and longer it will take to heal. On-going injury can lead to tendon damage, calcification and spur build up, or cartilage damage, for example, all of which will require surgery to rectify.

How can I avoid getting over use syndrome?
Warming up and stretching before use. Before exercise and even before work, take some gentle exercise and stretching of the area.
Negotiating with your employer to change your routine work throughout the day. The less you repeat the same action, the less you are likely to cause injury.
Resting at the end of the day, to ensure any micro injuries heal before you next return to the activity.
Ensuring you are doing your activity with the best ergonomics possible. For example, ensuring your desk is set up for you.

Correct posture can help to avoid overuse injury

How can remedial massage help?
Remedial massage will use various soft tissue manipulation techniques to relieve any muscle tension build up that could cause further complications from overuse.
Deep tissue massage improves circulation around micro-trauma in the muscle to speed up recovery. It also breaks down calcification build up that leads to spur development.
Cupping stretches the connective tissue surrounding the muscles, allowing for release of compartment tension and greater movement of muscles.
Dry needling alleviates trigger points in the muscles and referred pain that may have built up with overuse.

Stretches for arm overuse syndrome from “Stretching” by Bob and Jean Anderson

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Shin splints or Compartment Syndrome

Shin Splints

Shin splints, a common term used amongst the athletic community, describes chronic shin pain resulting from overuse.

It occurs in two regions of the leg.

imageWhen it occurs in the front outside region of the leg, it’s called anterior shin splints. Shin splints is also regularly seen in the lower inner region of the leg, where it’s called posterior shin splints or medial tibial stress syndrome (MTSS).  Anterior shin splints is routinely confused with another overuse condition of the lower leg called chronic extertional compartment syndrome.image

Anterior shin splints usually result from overuse of the muscles the flex the foot down, for example, the muscles used when running downhill.  The condition usually occurs after continual repetitive use or sudden onset or increase of use. Most complain of the pain occurring at the beginning of exercise and then easing with use, only to return after stopping, even hours after.

What causes shin splints?

Anterior shin splints is usually an imbalance of the muscles of the calves and muscles of the front of the leg, usually afflicts beginners or runners who do not stretch enough. It is more likely to afflict the foot of the dominant side. For example, right handed people are more likely to suffer shin splints in their right leg.

Frequent cause of MTSS is over pronation, inadequate stretching, worn shoes or excessive stress placed on one leg from running in one direction, such as on a track.

It is suggested that during overuse the muscle separates itself from the shin bone, which results in inflammation and pain.

How to treat shin splints?


Firstly you need to rest. Stop what is causing the pain, ice your shin to reduce the pain and inflammation. Start some rehabilitation such as stretching and strethening exercises after you have rested. Over-training or not addressing the issue as it arrises, may lead to serious injury.



Ankle flexes, with bent knee and straight knee
Seated on the floor, use a thermoband wrapped around the foot to flex the ankle forward. Do this first with a bent knee, and then with a straight knee

Toe flexes
Seated on the floor with a straight leg, wrap the thermoband around the toes and flex forward

Ankle rotations
Seated on the floor with a straight leg, wrap the thermoband around the sole of the foot and rotate the foot. Do this in both directions.

Heel & toe walk
First walk on your heels on a soft surface (carpet) for 25metres. Then walk back on your toes.

Standing calf raises
Standing on a step, raise up onto your toes and hold for 10 seconds. When you come down, go past the level of the step so your heel dips down. Do ten of these.

Standing toe raises
Leaning against a wall, raise your toes up, so you’re on your heels. Hold for a few seconds.
Or you can perform a simple toe tap, this can be done anywhere, anytime.

Glute, core and pelvic strengthening
Any glute, core or pelvic strengthening will help take added pressure of the legs.

Stretches and massage

Stretching can increase range of movement and help reduce any tension that may be causing your pain. It’s not always the cause but is an important part of recovery process.

Front of shin stretch
Kneel on the ground and sit back on your heels. Stretch the front of your shins. Hold for 15 seconds. If this is too strong, stand, with the top surface of your toes on the floor, stretching the front of your shin

Calf stretch
Keep your knee straight and place your toes to the edge of a platform. Feel the stretch in the calf and the bottom of the foot. Hold for 15 seconds.

Achilles stretch
Follow the same steps and bend your knee to target the stretch to achilles and lower calf. Hold for 15 seconds.

Hip flexor stretch
Start by standing straight, bend your knee forward and step straight back to the ball of your foot. Keep your hips even and hold the stretch for 20 seconds.

Knee to chest
Laying flat on your back, bring the right knee toward the chest as far in as possible. Hold for 15 seconds. Repeat with the other leg.

calf-foam-rollFoam roller techniques for calf and shins (go easy on the foam roller, as this can be quite painful)

When treating shin splints I will use a combination of myofascial release, with both cupping and dry needling, and some deep tissue massage. Releasing through the longitudinal fascial lines from the lower back, the hamstrings, calves and bottom of the foot. Warming the tissue of the calf with some massage and then muscle stripping of the individual muscles of the calf and shin. Then treating any remaining trigger points through the major calf muscles with deep ischemic pressure. I would then have the client turn face up and treat any remaining trigger points in the front of the shin, either with deep ischemic pressure or dry needling.

Wear the correct footwear

Being fitted for the correct footwear for you can make all the difference.

Avoid hard running surfaces

Hard surfaces have greater impact on your body and can cause trauma to the shins. Dirt, grass or unpaved surfaces are better than the footpath or road.

Also add variety to your training, as repetitive motion, such as running on a track in the same direction can add stress to your body.

Strengthen core and glute muscles

This will take further pressure off the muscles of the lower leg by being able to balance and control your legs more effectively .

There are various other supportive methods for shin splints such as, tapping, compression sleeves, ice and heat treatments. It’s best to see your physical therapist to help you with these treatments, to learn the best techniques on how to use them.

Compartment Syndrome

Fascia surrounds all our muscles and groups of muscles in compartments. Compartment Syndrome is increased pressure of fluid within the body’s compartments that contain muscles and nerves. Most commonly occurs in the lower leg and can often be misdiagnosed as shin splints. Chronic Exertional Compartment Syndrome is what most runners experience. It is induced by overuse and exercise where the pressure in the muscles increase to extreme levels. This creates a decrease in blood-flow and deprivation of oxygen to the muscle.

Symptoms include sensation of extreme tension in the muscle and burning increasing through exercise.  The pressure usually decreases after exercise has stopped and the pain will be relieved.

Chronic or chronic exertional compartment syndrome are not emergency situations but can cause permanent damage to the muscle and nerve function of the limb.


Calf-massage-300x200Conservative treatment to reduce the pressure include rest, anti-inflammatory medications and manual decompression such as myofascial release. Do not elevate the limb or apply pressure to the area. Instead lie with the limb at the level of the heart. Massage can help once the inflammation has gone down.

Invasive treatment such as surgery can be an effective for sufferers of compartment syndrome.