Hip tendinopathy problems and solutions

Aggravating movement Why does it aggravate Solution
Lying on painful side


Direct compression from the mattress Add a soft mattress cover eg use a spare duvet
Lying on the non-painful side Upper leg adducts, causing compression Place pillows between your knees and ankles to reduce hip adduction
‘Hip hanging” standing position Increases tension of the ITB, increases compression and may lead to abductor weakness Don’t hip hang
Sitting with legs crossed Compression from the ITB with adduction Don’t cross your legs
Sitting in low chairs Hip rests in flexed position which increases tension on your TFL muscle and your ITB increasing compression. Can cause pain on rising from sitting. Sit on a tall chair so hips are above the level of your knees
Standing on painful leg Pelvis drops on non-weightbearing side leadign to hip adduction Use some support for single leg activities – eg dressing or do in sitting
Walking (especially climbing hills or over striding) If pelvic control is poor the hip can adduct during gait causing compression and pain Stay active but stick to what you can comfortably do, avoid large hills and over- striding
Climbing stairs Pelvis drops on non-weightbearing side leading to hip adduction Hold onto hand rail for support. If servere do 1 step at a time leading with the good leg.

Exercise for a happy brain

Mental health has become a lot more recognised in the 21st century and the importance of managing mental health has increased. In the 2011/2012 New Zealand Health survey, 14.3% of adults living in New Zealand had been diagnosed with depression at some time in their lives. Ups and downs in mood and anxious feelings are normal to respond to everyday stressors but depression is defined as “an illness that can affect how you feel and behave for weeks or months at a time. When you are depressed, your low mood lasts, affecting your sleep, relationships, job and appetite”.

The most common treatment for depression is pharmacological medication such as sertraline, fluoxetine and citalopram. Another common treatment is psychotherapy undertaken by a psychologist. But there is good news for those that don’t like taking lots of medication or don’t like the side effects that come along with it.

Exercise has been proven to be as effective in treating depression as pharmacotherapy and psychotherapy with a lower degree and relapse rate of depression. There is also very strong positive evidence of exercise being a successful treatment to alleviate symptoms of depression when compared to no treatment. Exercise has a direct effect on the pathology, improve symptoms of the disease, and increase general physical fitness and strength and therefore quality of life in individuals.

The benefits of exercise on mental health include:


• Assertiveness

• Emotional stability

• Self-control

• Work efficiency

• Mood


• Alcohol abuse

• Anxiety

• Depression

• Work errors

• Headaches

The evidence shows stronger results for individuals who participate in group exercise classes. So come talk to one of our physiotherapists about what exercise would be right got you or come along to one of the Bureta Physiotherapys pilates or circuit classes and fight mental illness!

For more information regarding help with mental illness look up www.mentalhealth.org.nz or free call 0800 111 757.

Are you breathing right?

Do any of these sound like you?

  • Do you struggle with persistent neck or back pain?
  • Struggle with breathlessness during sport, exercise or activities of daily living when you are otherwise healthy?
  • Do you regularly have pins and needles in your hands or feet?
  • Do you have cold or sweaty clammy hands or feet regularly?
  • Do you yawn excessively?
  • Do you suffer from Asthma, allerties, rhinitis, hay fever, sinusitis
  • Do you suffer from facial or jaw pain, Tinnitus
  • Do you suffer from reflux?
  • Have you struggled with your breathing since hospital admissions/surgeries
  • Do you suffer from Panic attacks or chronic anxiety
  • Are you an athlete who isn’t performing at a level that is appropriate to your underlying fitness level?

Research shows that Breathing pattern disorders affect up to 10 – 30% of the general population and atleast 30% of those with asthma.

Faulty breathing patterns can be caused by a variety of reasons from bereavement to tight clothes, from a history of abuse to chronic sinusitis to sitting poorly. Whatever the cause the first step is in addressing and correcting this faulty pattern as the cycle it sets us on otherwise continues to strengthen the effects it has.

Faulty breathing patterns affect different people in different ways. Some patients are more inclined to mental distress, fear, anxiety and co-existing loss of self-confidence. Others may exhibit musculoskeletal and more physical symptoms such as neck and shoulder problems, chronic pain and fatigue. Many are a combination of both mental, emotional and physical factors.

All babies are nose breathers and unfortunately during our lives many of us for a  variety of reasons become habitual mouth breathers. This has a signifcant effect on physcial, physiological and chemical processes in our bodies. The number one aim of the Bradcliffe breathing programme is to restore your ability to nose breath and as a result of this correct a large number of variables that can occur.

In the Western World we seem to have become addicted to “doing”. We are highly prone to stress and anxiety and we struggle to relax. We are stimulation addicts and there are now even things developing such as “Email apnoea” where we hold our breathe when we are emailing. Our increasingly sedentary lifestyles contribute to postures that make correct breathing more difficult but even our elite athletes are affected with breathing pattern disorders which can have significant effects on their performance.

For more information email jacinta@buretaphysio.co.nz or blair@buretaphysio.co.nz ring 075761860 to book an hour appointment with Jacinta or Blair in order to have your breathing programme started today!

9 Top Strapping Tips – Bureta Physio

At Bureta Physio in Tauranga and as Sports Physio’s with local and International sports teams we spend a large amount of time strapping all sorts of injuries. To strap well follow the basic steps below and get practicing! Taping is both an art and a skill – if you want to learn from us visit our youtube channel to learn how to tape the ankle, knee, foot and other various joints


1.Anchors- Tape sticks better to tape than it does to skin so ideally always put on an “anchor” which is simply a piece of tape that is placed on loosely around i.e. the thigh that the other pieces will stick to at the top and bottom.Surface – Ideally shave the area to be taped

2.Ideally ensure there is no moisturiser or cream such as linemen on the area to be taped.
3.Reinforce – Overlap each piece of tape by 30 – 50% so each piece is reinforced.
4.Safety- Ensure the person has no skin allergies or allergies to tape – if so use an anti-allergic tape underneath.
5.Comfort – Your aim is to not get any creases in the tape in areas you put weight on – such as under the foot as these will potentially cause blisters.
6.Your tape can get wet but pat it dry afterwards and ensure that it doesn’t stay on for longer than 48 hours (unless it is kinesio taping which can stay on for up to a week).

7.Every piece of skin does not need to be covered in order to have a well strapped joint – it simply requires applying the tape with tension at the right time then rub the tape well afterwards to heat it up and therefore ensure it is well stuck.

8. It is easiest to take tape off when wet.

9. Taping Rash – If you have been using tape everyday for a period of time and your skin is being irritated you can use a liquid such as Mylanta (anti-acid) and pat it over the area which helps settle rash or irritated area.


Groin injury’s return to sport faster with…….

At Bureta Physiotherapy we see a lot of people presenting with hip and groin pain. Individuals who play sports involving kicking, sprinting and change of direction are putting huge strains through their groin. Acute injuries are often see in these sports but a number of people also have long-standing groin pain.

The groin area has very complex anatomy with multiple structures in close relation to each other. People experiencing pain in their groin or hip should have a full physiotherapy assessment to explore a correct diagnosis and address any underlying factors in order to start on a road to recovery.

The source of groin or hip pain could be the
– bone : fracture,  dislocation and stress fracture of the hip, pelvis or spine
– joint : osteoarthritis, impingement, cartilage tear
– muscle : quadriceps, hamstring,  adductor, abductor, pelvic floor, hip flexor or abdominal
– other soft tissue : hernia, bursitis, ligaments
– referral from: lumbar spine, sacro-iliac joint, thoracic joint or abdominal organs
– other : developmental, tumour, infectious disease,  vascular or nerve entrapment

The way our body is made up and how we have always been moving it can predispose us to different injuries. The hip joint can be loaded with 8 times our body weight whilst running so imbalances in muscles can lead to injury. People with long-standing hip impingement are more pre-disposed to requiring a total hip replacement in the future.

The Holmich protocol is an example of rehabilitation used as a basis for a management plan or appropriately diagnosed groin strains. This includes a progression of exercises which will be shown and personalised to your level of activity and grade of injury. Holmich conducted a study looking at two groups of patients with correctly diagnosed groin strains. The first group used the Holmich exercise protocol, the second group had a multi-modal approach to rehabilitation including manual therapy techniques performed by a physiotherapist, a stretching program and the Holmich protocol exercise program. Both groups had ‘successful’ outcomes at the 16 week mark. The group participating in the multi-modal rehabilitation plan returned to sports 4.5 weeks earlier than those only doing the exercises.

Rehabilitation from groin injuries is hugely important because it has been found that individuals with a previous groin injury have double the chance or re-injury to their groin, and individuals playing in high grades have triple the risk of injuring their groin.
The treatment plan changes for each individual to address their injury, activity level and goals. The exercises are important to strengthen structures around the hip, groin and core to ensure these muscles are in balance and transferring load to help prevent further ground injury. Treatment can also include education of how to safely return to sprinting, kicking, change of direction and sport to ensure best performance and low chance of re-injury. If conservative management is not successful, a specialist appointment can be arranged

Do you have Sciatica?

At Bureta Physiotherapy we see a number of people being referred with or complaining of “sciatic pain”. A percentage of these presentations do have true sciatic pain but large number actually have pain in a similar distribution but arising from other structures.


What is true sciatic pain?

The typical presentation of sciatic pain is that of pain radiating from the lower back into the buttock and down the back of the leg (usually one) at times all the way to the ankle. The quality and intensity of pain can vary greatly from a mild ache to an excruciating sharp or burning pain. Other symptoms that can accompany pain are areas of numbness or weakness in the leg or foot and in severe cases loss of bowel and/or bladder control.


What causes sciatic pain?

Sciatica most commonly occurs when a herniated disk, bone spur in the spine or narrowing of the spine compresses part of the sciatic nerve. This causes inflammation and causes symptoms along the nerve pathway down the leg.


So what else can cause similar pain?

There are a number of structures that can cause pain that is often misdiagnosed as sciatica…

  • Muscular trigger points – several muscles in the lower back and buttock commonly refer pain into the buttock and leg and can be surprisingly painful. These tend to give a deep achy type pain and can be secondary to a lower back injury.
  • Joints of the lumbar spine – Between every level of your spine there is a small joint on each side called a facet joint. When inflamed, facet joints will also cause pain to radiate into the buttock and at times, upper thigh. This is different to sciatic pain however as the sciatic nerve itself may not be affected at all.
  • Upper hamstring tendon – The upper hamstring attachment into the sitting bone of the pelvis is another cause of pain easily confused with sciatica. When this tendon becomes overloaded it can cause buttock and thigh pain and become very uncomfortable especially in sitting.


What should I do if I think I have sciatic pain?

The vast majority of sciatic pain as well as similar pain arising from other structures can be managed conservatively by your physiotherapist at Bureta Physiotherapy. They can perform specific tests to correctly diagnose the source of your pain and form an appropriate management plan with you to reduce your symptoms, achieve your goals and prevent similar episodes from occurring in the future. Your Physiotherapist can also arrange an x-ray or referral for review by a Specialist if necessary.

Bureta Physio Bike Fitting

As not all bikes are created equal and each of us have different levels of strength and flexibility having a bike that fits you regardless of whether you are a beginner or an experienced cyclist is important for comfort, enjoyment and performance.

Here are 5 reasons for getting a bike fit.

  1. Reduce the risk of injuries

When cycling either on the  road or off-road there are 3 places that your body is attached to the bike – your feet, sit bones and hands. It is this combination of  body placement on the bike, the bike dimensions – whether it is too small/large, seat is too high/low and your flexibility that will influence the amount of force put through your soft tissues. As cycling is repetitive in nature and you are pedalling at 80-90 pedal revolutions per minute over a 2 hour ride this adds up to 9600 to 10800 revolutions. If your set up is less than ideal more load/stress will be placed on musculoskeletal structures and this can lead to an overuse injury. The most common sites being your knees and Achilles tendon.

  1. Increased comfort

Many riders whether novice or experienced  think that being comfortable on your bike and  performance is mutually exclusive – you can have one or the other but not both. It doesn’t have to be like this, as the goal of having a bike set up is to find the centre position of your bodies range of motion and then adjust the bike so as to put you in the most neutral position. This central positioning will lessen the forces being put though your body and lead to a more comfortable set up.

  1. Increased physical performance

Comfort and performance should go hand in hand. With a bike set up optimised to the individual you will be able to produce more power, be more comfortable and less wear and tear will be transmitted to your body.

  1. Faster recovery

With an individualised bike set up there will be less abnormal force/stress placed through soft tissue structures leading to less damage of these tissues resulting in a quicker recovery. It is only when we recover from exercise that we become stronger/fitter/faster.

  1. It is difficult, if not impossible, to fit yourself on a bike

We only feel something such as pain, when something is going wrong. However, the absence of pain isn’t enough to tell you that you are actually in the middle of your range of motion. Since pain often doesn’t show up until you’ve been riding for a while, perfecting your bike fit by yourself is a very difficult thing to do.  If you experience pain, discomfort, tightness, numbness in any part of your body neck, back, feet and/or hands while or after riding or have any questions about bike set up, strength and flexibility training for cycling

For more information on our services please see our website in the bike fit section or please feel free to contact me at matt@buretaphysio.co.nz