How to prevent netball injuries – the KNEE program!

The game of netball is such that injuries can and do happen, as much as we may not want them to. However, is there a way of preventing them? Well, the short answer is YES! The single best means of preventing netball-specific injuries, is through the use of the NETBALL KNEE PROGRAM.

Netballers will well know that, netball injuries tend to occur most commonly in the ankles and knees. One of the most concerning injuries, which is common to netballers, is the anterior cruciate ligament (ACL) rupture in the knee – this can account for up to 25% of serious netball injuries and often results in surgery, extensive rehabilitation and a lengthy period of time out of netball. As the name of the program would suggest, the NETBALL KNEE PROGRAM does specifically target knee injuries.

Regular completion of the NETBALL KNEE PROGRAM has been show to reduce all lower limb injuries and in particular ACL injuries in the order of 40-70%!!! You can check out the Netball Australia Flyer regarding the NETBALL KNEE PROGRAM here.

The NETBALL KNEE PROGRAM is designed as a series of exercises to be used as a warm-up prior to training and games. There is no need for any additional warm-up to take place. The program is designed to be used by netballers aged 10+ and there are 3 different levels of the program – junior, recreational & elite. Completion of the program should take between 10 & 12 minutes each time.

Netball Australia has produced a wealth of resources for the NETBALL KNEE PROGRAM including videos of each of the exercises. To access these resources, visit /

As physiotherapists with a strong interest in sport, we would love to see all netball players (aged 10+) completing an appropriate injury prevention program as a warm-up. We cannot see any reason why this shouldn’t be standard practice for coaches, clubs & associations to implement. The evidence is there to indicate that this is the single best injury-prevention measure available and as such there simply shouldn’t be any excuse not to use it.

If your coach, club or association is not using the NETBALL KNEE PROGRAM, you may wish to point this out to them. We are always more than happy to speak to coaches, clubs or associations and discuss the program with them and any concerns they may have along with directing them to all the appropriate resources. Get them to get in touch with us.

Our principal physiotherapist, Brendan Limbrey is a Nationally Endorsed Provider of Netball Australia’s KNEE Program. If you would like any further information regarding the NETBALL KNEE PROGRAM, you can contact Brendan Limbrey (APA Sports & Exercise Physiotherapist) directly by email and he will be more than happy to help you out.

What is the best way to reduce football (soccer) injuries?

Football (or soccer) injuries can and do occur, whether we like it or not. The most common injuries being that of the lower limbs including ankles, knees, groin, hamstrings and calves. One injury of note, which is particularly troublesome and has a high incidence in football, are anterior cruciate ligament (ACL) ruptures in the knee, which can result in the need for surgery, significant rehabilitation and a lengthy period of time on the sideline (typically in the order of 12 months).

How do you prevent football (soccer) injuries?

The single best way to reduce football-specific injuries, including ACL ruptures, is through the regular completion of the FIFA 11+ warm-up program. It is a series of exercises, which has been proven to reduce injury rates in footballers of all levels, ages (14+) and genders. There is also a FIFA 11+ kids version for those 7 – 13 years – see below for specific details. The FIFA 11+ is designed to be used as a warm-up prior to all training sessions and there is an abbreviated version to be used prior to games. The FIFA 11+ program is your warm-up – there is no need for coaches or players to implement any additional warm-up!

There are ample resources available for FIFA 11+ program, including exercise posters, instruction manuals and more – read on for details on how to have these sent out to you.

As physiotherapists with a strong interest in sports, we would love to see all soccer players (14 years and older) completing the FIFA 11+ program as a warm-up. We cannot see any reason why this shouldn’t be standard practice for coaches to implement. The evidence is there to indicate that this is the single best injury-prevention measure available and as such there simply shouldn’t be any excuse not to use it.

If your coach is not using the FIFA 11+, you may wish to point this out to them. We are always more than happy to speak to coaches and provide them with resources (for free!) – so get them to get in touch with us.

If you would like copies of any of the FIFA 11+ resources to implement yourself or with a team that you coach, we would be more than happy to provide these. Simply contact Brendan Limbrey (APA Sports & Exercise Physiotherapist) by email and he will send them out to you.

Is there a football injury prevention program for kids?

Yes, there is a separate football-specific injury prevention program for children aged 7-13 called the FIFA 11+ Kids. As younger children are not as skeletally mature as older children or adults, they are subject to a completely different type of injuries. As such, a separate set of warm-up exercises have been devised to help prevent injuries in soccer players of this age.

The FIFA 11+ Kids works in a similar manner as that of the FIFA 11+, in that it should be performed prior to training and games.

There are ample resources available for FIFA 11+ Kids program, including exercise posters, instruction manuals and more – read on for details on how to contact us to have these sent out to you.

As physiotherapists with a strong interest in sports, we would love to see all soccer players (including kids) completing an appropriate injury prevention program as a warm-up. We cannot see any reason why this shouldn’t be standard practice for coaches and clubs to implement. The evidence is there to indicate that this is the single best injury-prevention measure available and as such there simply shouldn’t be any excuse not to use it.

If your coach or club is not using the FIFA 11+ Kids, you may wish to point this out to them. We are always more than happy to speak to coaches or clubs and provide them with resources (for free!) – so get them to get in touch with us.

If you would like copies of any of the FIFA 11+ Kids resources to implement yourself or with a team that you coach, we would be more than happy to provide these. Simply contact Brendan Limbrey (APA Sports & Exercise Physiotherapist) by email and we will send them out to you.

GLA:D Program Coming Soon

Arrow Physiotherapy is soon to be launching the GLA:D (TM) program. The GLA:D (TM) program is considered to be the best first treatment for hip & knee arthritis. It is an education & exercise program developed by researchers in Denmark for people with hip or knee osteoarthritis symptoms.

What does GLA:D (TM) involve?

The education and exercise program reflects the latest evidence in osteoarthritis (OA) research. It also includes feedback from people with OA and trainers on what works in the real worls to help patients manage OA symptoms.

GLA:D (TM) Australia training consists of:

  • A first appointment explaining the program and collecting data on your current functional ability,
  • Two education sessions which teach you about OA, how the GLA:D (TM) Australia exercises improve joint stability, and how to retain this improved joint stability outside of the program.
  • Group neuromuscular training sessions twice a week for six weeks to improve muscle control of the joint which leads to reduction in symptoms and improved quality of life.


For further information about the GLA:D (TM) program, visit


We will be looking to commence GLA:D (TM) programs at Arrow Physiotherapy from the beginning of April 2019.

The program will run for 6 weeks (2 x 1 hour exercise sessions each week) + 2 x 1 hour education sessions towards the beginning of the program. The program will be run by Chris Musgrave (physiotherapist). Full details to be confirmed.

To express interest in the program or if you have any questions, please contact the clinic on 8850 7770 or email the clinic at

Core Values

The team at Arrow Physiotherapy recently worked to refine the core values of the organisation.

Arrow Physiotherapy’s core values are:

  • Our patients are at the centre of everything we do,
  • We are results & outcomes oriented,
  • We are committed to delivering the best possible care,
  • We are driven to excel & exceed expectations,
  • We are actively involved in The Hills community.

How Stressed are your Bones

Being stressed is something that you can probably relate to. However, have you ever put any thought to how stressed your bones might be?

Normal day-to-day activity places a certain level of stress on your bones – this is generally healthy and helps keep your bones strong.

Failure to stress your bones much (i.e. lack of physical activity and minimal incidental activity with day-to-day activity) can contribute to loss of bone density and in time osteoporosis.

Physical activity (especially of the weight-bearing kind) places additional stress on your bones. In most circumstances, your body will respond to this activity load and stress to become stronger and more resilient to higher levels of activity (bone stress) in the future.

Repeated bouts of physical activity or weight-bearing activity, especially if for prolonged periods of time or repeated regularly without adequate periods of rest in between, can lead to over-stressing your bones. Initially this will result in a bone stress reaction, which is where there is oedema (or swelling within the bone) and can be painful. If the bone is continued to be stressed, this can result in a stress fracture!

We see lots of people in the clinic with varying degrees of bone stress reactions & stress fractures. Identifying a bone stress reaction or fracture ASAP is incredibly important, as continuing to place stress on the bone can worsen the injury. Most of these injuries require rest from activity for a certain period of time as part of the required treatment. The worse the bone stress reaction or if a stress fracture has occurred the longer the required period of rest and this may require you to be non-weight bearing which can have considerable impact on work, physical activity and day-to-day activities.

As you can see, bone stress to some extent in normal and actually healthy. It is a continuum and you ideally want to be stressing your bones enough to keep them healthy and strong to be able to tolerate the level of activity that you do whether that be with day-to-day activities or sporting/recreational pursuits.

How would I know if I had a bone stress reaction or stress fracture?

It can often be difficult to differentiate a bone stress reaction or fracture from other injuries – many people will often think that they have a muscle strain or some general post-exercise soreness. There are some key defining features of most stress reactions/fractures:

  • Completion of regular weight-bearing activity or exercise in the lead up to onset of symptoms. This is usually at a higher intensity, duration or frequency than previous levels of activity.
  • Pain tends to be present during activity that places stress through the bone and gets worse as activity is continued.
  • Pain eases after activity, although may linger as the condition worsens (lingering pain especially at rest typically is associated with more significant stress reactions or stress fractures).
  • Pain tends to be quite focal initially and if left to worsen often becomes more disperse.

There are a number of other factors which can influence the likelihood of sustaining a bone stress reaction or stress fracture. These include:

  • Reduced bone densityhormonal factors & low body mass are all associated with an increased risk of bone stress reactions/fractures.
  • Various anatomical differences can increase the risk of certain bone stress reactions/fractures e.g. reduced foot arch height and shin stress injuries.
  • Certain sports are associated with particular types of bone stress injuries:
    • Running sports/walkers – feet & shins
    • Rowing – rib
    • Cricket fast bowlers & gymnasts – lumbar spine
    • Dancers – feet
    • Retail workers (or people standing on their feet for considerable period of time) – feet & shins
  • Other factors can include activity technique, footwear, surface on which activity is performed.

What should you do if you think you may have a bone stress reaction/fracture?

It is incredibly important to get an accurate diagnosis, such that you know whether you do have a bone stress injury and how bad it is. It is also important to know exactly which bone is involved, as different bones require different treatment and differing time-frames to heal. Different bones also have different risk factors which also need to be looked at to ensure that once the injury has healed, that you don’t sustain it again in time.

So, it is incredibly important to see a health professional who has lots of experience in assessing and managing bone stress injuries (we can help with this! Click here to make an appointment for us to assess your bones). If it is suspected that you do have a bone stress injury, you will likely be sent for some form of imaging to help confirm the injury. In most cases this will require an MRI or bone scan. Xrays are not good for looking at bone stress injuries – they only show stress fractures when they are really bad (we often find that people are sent for these to rule out bone stress injuries – they don’t!!).

What treatment is needed for a bone stress reaction/stress fracture?

The treatment required is dependent of the extent of bone stress injury, which bone is involved and whether there are any underlying contributing factors to address. In general, all bone stress reactions will require a period of reduced activity (so as not to continue to stress the bone) – the extent of injury will dictate the length of time for this and how extensively activity needs to be reduced. Once the symptoms have settled and there is evidence of healing, activities that stress the injured bone are gradually re-applied. Whilst the above management of the injury is being conducted, it is important to address any contributing factors to ensure (or reduce the likelihood) that the injury doesn’t reappear – this can be checking bone density, working with coaches to better manage activity load, addressing strength/biomechanical/technique issues or fixing footwear.

From everyone at Arrow Physiotherapy, we hope that you are stressing your bones adequately to keep them strong and healthy, but hopefully staying short of over-stressing them!

Introducing our Nordboard

Introducing our NordBoard. Our physio, Chris Musgrave, has put his handyman skills to good use recently in constructing this fantastic piece of equipment. To see a video of it in action visit this link.

Chris has written the following information about NordBoards and the benefits they have for those with a history of HAMSTRING strains.

What is the NordBoard?

The NordBoard is a device that allows the use of a Nordic Hamstring curl without the assistance of a partner. With the addition of load cells, the device can be used to measure eccentric hamstring strength (the ability of a muscle to withstand force whilst lengthening).

What are Nordics?

Nordics are a hamstring exercise that has received quite a lot of attention in the sports medicine community in the past few years. As shown in the video – they basically involve lowering yourself as slowly as possible, using your hamstrings to stop yourself falling forwards. Despite some claims that it is a “core” exercise, its is predominantly a hamstring conditioning exercise.

Why do Nordics?

The Nordic exercise in itself has been researched extensively and has been shown to significantly reduce the incidence of hamstring strains. In particular – it appears to be particularly effective in reducing the recurrence of hamstring tears. In a study by Petersen et. al. (2011) recurrent hamstring injuries were reduced by 85% and new injuries by 60%.

How do Nordics work?

Nordics have a few characteristics that make them an efficacious exercise. The primary changes relate to increased fascicle length and increased eccentric strength. In basic terms, fascicle length pertains to the length of individual muscle fibres and eccentric strength is the ability of a muscle to withstand force whilst lengthening. Nordic curls appear to have a large effect on these two features – with short fascicle lengths and low eccentric strength being modifiable risk factors for injury.

However, to gain these benefits it appears that the exercise needs to be performed in a supramaximal fashion and it requires maintenance dosage to retain the benefits. What this means is that the exercise needs to be hard enough that you are unable to lift yourself back to the starting position using just your hamstrings (it is rare to be this strong!).

Who are Nordics useful for?

As suggested above, Nordics are particularly useful for those who have a prior history of hamstring strains. Low eccentric strength and short fascicle lengths occur post hamstring injury, thus reversing these changes is pivotal in reducing future injury risk.

Furthermore, they can be used quite successfully at a group level as well. If you are a involved in any sports with a lot of high speed running, this simple exercise can ensure you keep your athletes fit and firing throughout the season. Sports that are at particular risk of hamstring injuries include soccer, AFL, sprinting, hurdling, rugby.

Standing desks may not be the answer after all

A recent study (Baker et al. 2018) examining a small group of people doing 2 hours of computer work at a standing desk, resulted in:

general body discomfort
lower limb swelling
cognitive function
mental state

However on the plus side, it resulted in:

creative problem-solving ability

As you can see, standing desks should be approached with caution. If you have been a patient of ours and had discussions with us around sitting or standing at work, you will probably have heard us talking about the need to avoid prolonged sedentary postures, whether sitting or standing. The best thing to be doing is to try to move often and if possible vary your work position.

Perhaps as an alternative, we all need a treadmill desk!! If you have been in the clinic at times, you may have seen our physio Chris turning our treadmill into a desk (see photo).


Had an ACL reconstruction you might want to know this

In the last few weeks, one of the only studies looking at the long-term effects following ACL rupture has been published – van Yperen et al. 2018.

Cutting to the chase, after 20 years following ACL rupture there was found to be equal rates of knee osteoarthritis irrespective of whether one was to have an ACL reconstruction or not.

The study looked at 50 athletes who ruptured their ACL 20 years ago. 25 of the subjects did not undergo any reconstructive surgery. The other 25 subjects did have reconstructive ligament surgery using a patella tendon graft – although this was after 3 months on conservative management initially.

After 20 year, the study examined the presence of knee osteoarthritis using xray, looked at any symptoms the subjects may have been experiencing in relation to pain or dysfunction and also a functional activity scale.

Osteoarthritis on xray was found to be present in 80% of those who had an ACL reconstruction and in 68% of those who did not have surgery (despite the difference, this was not a statistically significant difference).

It was also found that there was no difference between the groups of subjects in relation to any symptoms that they may have had or functional ability.

The significance of this study, is that there are very few studies looking at the long-term outcomes following ACL injury or reconstructive surgery. It also helps our understanding in relation to expectation of rate of arthritis following ACL injury, irrespective of having reconstruction or not.

Like all studies, there are limitations, which include:

  • Many people undergoing ACL reconstruction do so relatively swiftly following injury, rather than waiting in excess of 3 months like in the study. This may have an effect on long-term outcomes.
  • Surgical techniques and equipment continue to develop over time and the techniques used these days do differ from what was done 20 years ago. As such, the study may not be comparing apples with apples.
  • All of the surgeries in the study were done using a patella tendon graft. In Australia, patella tendon grafts are not common. Hamstring grafts and even synthetic grafts are more commonly used. As such, this again does not mean that we are comparing apples with apples.


Doms Doms Doms

Muscle soreness following exercise, known as DOMS, is very common for people to experience this time of year as lots of people start or resume exercise – for more read on below.

If you have increased your exercise in recent weeks as part of a new year resolution or got back into exercise after a holiday or perhaps you have started football preseason, you may have experienced some muscle soreness! Muscle soreness after getting back into exercise or on starting a new exercise regime is common – it is typically referred to as DOMS! DOMS stands for Delayed-Onset Muscle Soreness.

If you have had trouble standing up or sitting down or even negotiating stairs for a few days after some leg exercises, it was probably DOMS. For your upper body, if you have had trouble lifting things or even putting on shirts after some upper body weights, it was probably DOMS.

DOMS usually kicks in 24-48 hours after exercise and lasts for a couple of days. It is basically a response to you overstressing your muscles – you will have created quite a bit of microtrauma within your muscles. Your body will adapt to this and future exercise efforts of similar intensity, should not evoke the same response.

DOMS is much more prevalent to exercises like running downhill, activities involving lots of landing or exercises involving a particular type of muscle contraction, known as an eccentric contraction – where your muscles are working hard whilst lengthening at the same time!

So, how do I know if I have or had DOMS?

Basically, if you have exercised heavily (especially with exercises that are either new to you or you haven’t done for some time) and have developed a muscular ache type pain in the proceeding 24-48 hours, then it is likely DOMS!

If your symptoms start immediately during or following exercise or last longer than 48 hours, then it may not be DOMS! Similarly, if the pain is located near your joints rather than your muscles, then it may not be DOMS! In these cases, you should consider seeing your physiotherapist to see if you have actually injured something more significantly.

If I have DOMS, what can I do to help it?

If you have DOMS, the best thing to do is to gently keep moving (e.g. gentle walking or even slow stationary cycling with limited resistance). This is better that resting in static positions. Icing the affected area can also assist. Gentle massage and the wearing of compression garments (e.g. skins) has been shown to shorten the duration and lessen the extent of symptoms.

You should avoid vigorous/strenuous exercise whilst the symptoms are present. Deep tissue massage should also be avoided for the first 24-48 hours. Once symptoms have resolved, you can gradually resume exercise. If you need further guidance, you should consult your physiotherapist.

In summary, DOMS is very common following starting an exercise program or when completing strenuous exercise. The typical symptoms are a dull muscular ache in the affected regions for 24-48 hours. The best thing you can do is to gently keep moving. Compression garments, icing the affected region and gentle massage can also assist with the recovery. If the symptoms persist beyond 48 hours, are not limited to muscle areas, start during or immediately after exercise or return regularly after exercising, then you may not actually have DOMS – in these cases you should consult your physiotherapist for assessment and to be diagnosed accordingly such that appropriate management can commence.

5 tips to keep you healthy injury free this Christmas

With Christmas just over a week away, we wanted to share 5 of our best tips with you to keep you & your family healthy & injury free this festive season.

Every year, we see a spike in certain injuries just after Christmas. There are a number of things for you to be aware of, to make sure these don’t happen to you.

So, here are our top tips to consider this holiday period.


If you have a regular routine of exercises, stretches, icing, etc to manage a particular condition, make sure you continue with this over the holiday period. Every January we see an increase in people presenting to physiotherapy with injury “flare-ups” due to taking a holiday from their injury management routine.


Every year we hear some impressive (& sometimes disastrous) injury stories of adults mucking around with kids toys. So, if you are going to be tempted to play with your child’s new Christmas present, make sure that it can tolerate your weight & perhaps think about the last time you did something like that (e.g. riding a skateboard for the first time in 20+ years often results in broken arms!).


The Christmas period can be a wonderful time of fun, family, food, drink & relaxation. See if you can find some time to get some exercise in. You may even have more time than normal to go for a walk, a bike ride or a swim down at the beach. Exercise is a great way to keep the body moving well.


Alcohol can be a major factor of many injuries over holiday periods. With alcohol consumption comes impaired judgement, reduced steadiness, in-coordination & reduced inhibitions. This combination is perfect for all manor of injuries. So without trying to sound like the Christmas Grinch, perhaps think about what activities you do and take care if you choose to drink this Christmas.


If you have been battling with injuries or illness, make a resolution to better manage or continue to manage these as best you can in 2018. If you don’t have any particular health issues requiring attention, may we suggest the following physical health resolution for 2018 – to commit to meeting the Australian Physical Activity Guidelines at a minimum. For adults these are:

  • Accumulate 2.5 to 5 hours of moderate intensity physical activity or 1.25 to 2.5 hours of vigorous intensity physical activity, or an equivalent combination of both moderate and vigorous activities, each week; and
  • Do muscle strengthening activities on at least 2 days each week.


Have a safe festive period & wishing you a healthy 2018!