Stress Fractures of the Foot: Symptoms, Prevention, and Treatment

Diving wholeheartedly into a fitness regime is admirable, but doing so without adequate preparation can lead to negative health outcomes, like stress fractures in the bones of the feet.

While common, many are still in the dark about the best course of treatment for this type of injury, as well as what can be done to prevent it happening in the first place.

Here are the common causes of stress fractures, the telltale signs that one has occurred, and the treatments that can help sufferers get back on their feet.

What Are Stress Fractures?

Stress fractures are tiny cracks in bones. Unlike acute fractures, which occur after a traumatic one-time injury, they develop gradually from overuse and repetitive force. The feet are especially susceptible because they are frequently under some degree of pressure, force, or weight. 

Bones, including those of the feet, are in a constant state of degradation and regeneration, a process known medically as bone remodelling. This is influenced by a number of factors, including diet, biomechanics, and physical exertion. If such factors cause the breakdown of older bone faster than new bone can be created, the bone weakens, and becomes vulnerable to fracture (1).

What Causes Foot Stress Fractures?

Sudden Increases in Activity

Sudden bouts of rigorous physical activity can result in a number of ailments, including plantar fasciitis, achilles tendon pain, and stress fractures. Those who were previously sedentary, or who rapidly increase the intensity, frequency, or duration of training sessions are at particular risk (2,3).

Change in Training Surfaces

Whether the individual usually exercises on sand, grass, road, or a treadmill, a switch in training surfaces places novel demands on the structure of the foot, potentially forming a stress fracture (4).

Improper Technique

Poor walking form, blisters, or bunions may influence the way a person’s feet strike the ground, placing undue pressure on the bones.

Other Existing Foot Problems

Those with particularly flat feet, high foot arches, or previous stress fractures are more likely to develop the condition.

Inadequate Footwear

Footwear that’s improperly fitted, or fails to provide adequate cushioning, control, or flexibility for the given application increases the risk of a foot stress fracture.

Poor Nutrition

Low levels of vitamin D and calcium decrease bone density and strength over time, making them more prone to injury. Not generally eating enough for the demands of your sport can also lead to problems known as Relative Energy Deficiency in sport (RED-S) which predisposes to stress fracture (5).

What Are The Symptoms of Foot Stress Fractures?

Tenderness, Dull Pain, or Stabbing Pain

Stress fractures can, understandably, be a significant source of discomfort. People with this injury may experience pain or soreness when the affected area is touched or when it bears weight. A consistent ache deep within the foot or toes may also be present, though the pain tends to subside when at rest.


Performance during sport or day-to-day activities is likely to diminish when the structure of the foot is compromised by a fracture.


Swelling may appear over the fracture site. This is particularly noticeable on the top of the foot.

Changes in Biomechanics

Sufferers may change their cadence, stride, gait, or stance in order to put less pressure on the foot. This can lead to developing inefficient and harmful movement patterns.


Though infrequent, blue, red, or purple bruising of the skin can be observed in untreated stress fractures.

How Can You Prevent Foot Stress Fractures?

Ramp Up Your Training Slowly

The old adage “slow and steady wins the race” remains a classic for good reason. Easing into your fitness regime helps mitigate the chance of not only developing a stress fracture, but also a raft of other lower limb injuries

To avoid overexerting the structures of the foot and ankle, it’s recommended that you only increase the amount you train by 10% a week (6). This measured approach, often referred to as ‘gradual loading’, helps your body build up the strength needed to tackle longer intervals, and adjust to new surfaces or movements (7).

It’s also important to warm up appropriately before exercising, and seek medical attention should lasting or acute pain occur.

Choose Appropriate Footwear

The right shoes can encourage the wearer to strike the ground with their midfoot or forefoot rather than their heel. This distributes shock more evenly throughout the feet and body, minimising the chances of sustaining a stress fracture (8).

Depending on the needs of the individual, increased arch and ankle support may be called for (9).

Undertake Low-Impact Activities

As well as being a great way to maintain overall fitness, cross-training with low-impact activities helps you avoid repeatedly stressing the same part of the body. 

Swimming and weight lifting, including seated resistance training, should be used as a complement to higher-risk activities like running, dancing, and basketball.  

Maintain Proper Nutrition

The benefits of maintaining proper nutrition are vast. Ensure your calcium and vitamin D levels are adequate to minimise the risk of bone fracture or breakage.

What Treatments are Available for Foot Stress Fractures?


Physiotherapists employ a range of techniques to help patients manage the pain of foot stress fractures and prevent their recurrence (10).

To stem the associated pain and inflammation, ice, acupuncture, deload taping, and massage may be administered. Such interventions are non-invasive or minimally-invasive, and have been shown to provide significant relief from swelling and discomfort.

If the individual can walk without excessive pain, further treatment is often centred around rest, stretching and strengthening of the surrounding muscles, and avoiding activities likely to worsen the injury. In more severe cases, the specialist may recommend temporary immobilisation of the foot and ankle through the use of a weight-bearing boot. 

In either case, focused shockwave therapy may be performed as an adjunct to other modes of physiotherapy. The procedure involves directing acoustic waves into damaged tissue via handheld device – an act that encourages both rapid healing and enhanced pain management. A 2015 International Journal of Surgery article stated that when used to treat stress fractures, focused shockwave therapy was associated with a “… high rate of recovery, return to competition and pain control” (11). 

In order to prevent re-injury, continued rehabilitation and progressive strengthening are of utmost importance. The physiotherapist will be able to develop a tailored program to enable the patient to resume day-to-day activities, exercise, and sport safely.


Using pins, screws, or metal plates, surgeons are able to repair high-risk or highly severe stress fractures. This option is a last resort, and should only be considered when all other treatments have been exhausted (12). 

What Should You Do If You Experience a Foot Stress Fracture?

If you experience recurring pain in the feet, it’s important to consult with a qualified health professional. An accurate diagnosis is vital to get you on the correct management plan. Reliable and experienced physiotherapists, like those at E3 Physio, will be able to pinpoint the source of your discomfort, as well as administer proven and effective therapies.

At E3, we help patients manage foot stress fractures through a combination of pain relief and active treatments such as stretching and strengthening exercises. Additionally in some cases we find focused shockwave therapy can be a helpful addition to our care. This multifaceted approach has allowed countless clients to overcome foot pain and  safely return to doing the things they love.

You can reach out to our friendly team via phone, or book an appointment online.

Achilles Tendon Pain? Here Are The Causes (And Leading Treatments)

The achilles tendon is a cause of concern for many. It’s vital to everything from cycling to running to walking, and when injured, can significantly affect a person’s quality of life.

Thankfully, non-invasive measures like strengthening, choosing appropriate footwear, focused shockwave therapy, and undertaking targeted physiotherapy are all that’s needed in most cases to manage injury to the achilles tendon, as well as restore movement and function.

What are the Symptoms of Achilles Tendinopathy?

Persistent achilles tendon pain, or ‘achilles tendinopathy’, often begins as an ache in the back of the ankle after playing sports like basketball, soccer, tennis, or after running. It’s also been known to present following gentler activities, such as climbing stairs and walking. The key cause is a change, usually an increase, in activity or loading.

While this pain may subside temporarily with rest, those who experience it commonly report tenderness and stiffness in the heel upon waking – a discomfort that improves as the area ‘warms up’ throughout the day.

When the condition progresses, it may cause parts of the tendon to become thicker and harder, further reducing mobility and escalating pain. They can become very stubborn if not managed early.

What are the Achilles Tendinopathy Risk Factors?

Achilles tendon pain can have a multitude of causes, and while physical activity is the primary trigger, the following are pertinent risk factors:


Because the water content of tendons decreases with age, these tissues gradually become stiffer and less able to tolerate a change or increase in load, leaving them more prone to injury (1).

Foot Mechanics

People that have over-pronated or flat feet are more likely to experience achilles tendon pain. The lack of foot arching in these cases places additional tension on the calf muscles, and in turn, the achilles. Over time, this may cause pain and swelling of the tendon (2).


Being overweight or obese means the achilles tendon bears a greater load and more stress during movement.

Training Choices

This includes using incorrect running shoes, increasing your running training too quickly, or running on flat or hilly terrain. Inadequate preparation for many forms of physical activity can heighten your risk for developing an achilles injury. If you are playing sport, pre-season training including stretching and strengthening of the leg muscles will reduce the risk of achilles issues (3).

How is Achilles Tendon Pain Treated?

Recovery from achilles tendon pain is highly dependent on the severity of the condition, the physical activity of the person in question, and how consistently they follow the recommended course of treatment. 

Some of the more commonly prescribed therapies include:


Early and accurate diagnosis by a physiotherapist specialising in foot and ankle pain is vital for a quick recovery. 

Current evidence suggests isometric and eccentric exercises are important for the recovery and health of the achilles. These accentuate the ‘lengthening phase’ of movements, and while the exact mechanism by which they alleviate achilles tendinopathy isn’t fully understood, they have proven effective in both managing pain and restoring function (4).

In addition to manual manipulation and strengthening, a physiotherapist may recommend orthotic devices. These shoe inserts elevate your heel to ease tension on the achilles tendon and cushion it from excess force.

During recovery, physiotherapists can guide you with low-impact rehabilitation so that you can safely maintain your overall activity and health. It’s then vital that you have a graded and sensible re-loading and return to sports or activity rehab plan so you can get back to doing what you love.

Focused Shock Wave Therapy

Used as an adjunct to more traditional physiotherapy practices, focused shockwave therapy has shown great promise in the management of hard to treat conditions like achilles tendinopathy. 

It involves directing targeted acoustic energy into the affected tissue via a handheld device. The procedure is non-invasive, and has shown “statistically significant improvement for outcomes of pain and function” (5). 


While corticosteroid injections used to be recommended, they are now rarely  administered due to the potential to weaken the tendon. In one as frequently used as the achilles, this could lead to further disability and even rupture (6).


If less radical treatment options fail, or the tendon has torn completely, surgery may be required to repair the achilles tendon. In such a case, it’s necessary to engage in appropriate post-surgery physiotherapy to regain function and strength.

What should you do if you experience Achilles Tendon Pain?

If you experience achilles tendon pain, it’s important to consult with a qualified health professional. An accurate diagnosis is vital to get you on the correct management plan. Reliable and experienced physiotherapists, like those at E3 Physio, will be able to pinpoint the source of your discomfort, as well as administer proven and effective therapies.

At E3, we help patients manage achilles pain through a combination of manual and active treatment including joint mobilisation, stretching, and strengthening exercises. Additionally in some cases we find focused shockwave therapy can be a helpful addition to our care. This multifaceted approach has allowed countless clients to overcome pain and return to doing the things they love.

You can reach out to our friendly team via phone, or book an appointment online.

Clicking Knee: Cause For Concern?

Most people are used to their joints ‘clicking’ or ‘popping’ every now and then. Though often innocuous, like when you crack your knuckles, these sounds can sometimes be indicative of an underlying tendon, cartilage, muscle, or movement concern1 2.

One region that is particularly prone to these is the knee. There are a variety of issues that can afflict this joint, and many result in a painful ‘pop’ when climbing stairs, squatting, or even just walking.

Thankfully, there are a number of effective, non-invasive treatments that can help manage knee discomfort and painful clicking, as well as restore lost movement and function.

clicking knee

What Is Knee Clicking? 


Throughout the medical field, the popping, clicking, cracking, or grating sensation people experience in their joints is referred to as crepitus. It derives its name from the Latin word for ‘rattling’ or ‘creaking’, and can occur in people of all ages and fitness levels. When experienced without pain, this clicking is not usually cause for concern. 

Benign cases are often attributed to cavitation – a process in which joints gradually build up nitrogen bubbles. When these bubbles gather in the spaces between bones, it can cause the affected area to feel stiff or tight. ‘Cracking’ the joint releases the pent up nitrogen, which restores movement and prevents further popping until the next accumulation cycle3

What Causes Painful Knee Clicking? 

Painful clicking or popping in the knees can be due to a number of ailments. It’s not possible to determine which without an appropriate medical examination, though some of the more common culprits are:
Torn Meniscus – A partially or completely torn meniscus can result from any activity in which you forcefully rotate or twist your knee, for example during sport. It involves an injury to the C-shaped piece of cartilage that cushions the thigh bone and the shin bone4
Osteoarthritis – More common in the elderly (though certainly capable of affecting younger demographics) knee osteoarthritis is a deterioration of the knee cartilage over time. It’s generally thought of as a ‘wear and tear’ issue that slowly increases in intensity, as opposed to one that appears after a single trauma.
Iliotibial Band Syndrome – This occurs when the iliotibial band on the outside of the knee ‘catches’ as the joint bends. It manifests as a snapping feeling on the outside of the knee, and is capable of causing significant inflammation and pain when the individual runs, cycles, or performs other repetitive leg movements5.
Anterior Cruciate Ligament (ACL) and Medial Collateral Ligament (MCL) Injuries – While capable of producing a loud popping sound, these types of injuries usually only do so once, and with trauma to the knee. That’s because the noise is created by a one-off tear to the ligament itself, rather than any repetitive mechanism. Both ACL and MCL injuries result in disabling pain and swelling, as well as buckling of the knee upon use6.
Patellofemoral Pain Syndrome – An umbrella term for pain originating from the patellofemoral joint itself (i.e. the kneecap), patellofemoral pain syndrome may arise from a combination of overload or overuse, anatomical or mechanical anomalies, or muscular dysfunction. Individuals with the condition often report snapping, popping, or grinding in the knee7.


It’s important to seek appropriate medical treatment when a clicking knee produces pain, or has an impact on movement or quality of life. Depending on the severity of the condition, the following therapies may be employed:
Physiotherapy – Using orthopaedic testing and diagnosis, a qualified physiotherapist can recognise the source of the clicking or popping, and help you manage it accordingly. 
They can gently stretch and strengthen the muscles surrounding the knee, increasing mobility and reducing pain. They also offer advice to patients on the activities that are likely to cause further harm, and can provide low-impact alternatives to help sufferers maintain their fitness during recovery.
Focussed Shockwave Therapy – Focused shockwave therapy is a non-invasive procedure whereby acoustic energy is directed into damaged tissue via a small, handheld device.
Despite being a little unconventional, it’s shown promising results in helping reduce some causes of knee clicking. Studies have found that focused shockwave therapy can have “beneficial effects on cartilage, subchondral bone and surrounding tissues”, and is particularly helpful in the treatment of knee osteoarthritis pain8.

Surgery – Recognised as a last resort, keyhole surgery is necessary in some cases to repair any physical damage to the ligaments and cartilage9

In such an instance, undertaking a suitable post-operative physiotherapy plan is vital to regaining strength, mobility, and functionality in the knee joint and legs10.

What should you do if you experience painful clicking knees?


If you experience recurring and painful clicking or popping knees, it’s important to consult with a qualified health professional. Knee issues can have many causes, so an accurate diagnosis is needed to get you on the correct management plan.

Once diagnosed, reliable and experienced practitioners, like those at E3 Physio, will be able to treat your condition with proven and effective therapies.

At E3, we help patients manage knee pain through a combination of manual treatments including joint mobilisation, stretching, strengthening exercises, and focused shockwave therapy. This multifaceted approach has allowed countless of our clients to overcome knee pain, and return to doing the things they love.

You can reach out to our friendly team via phone, or book an appointment online.




Knee Osteoarthritis Treatment

With age or an increased training schedule comes risk of developing injury or pain. While some of these movement mishaps occur without warning, others develop slowly, often starting from a minor niggle.

One such condition is knee osteoarthritis. Thankfully there are a number of options available to help manage knee osteoarthritis (KOA) to prevent worsening function, and get the pain settled and under control.

What is Knee Osteoarthritis?


Acquiring its name from the Greek terms for “bone”, “joint” and “inflammation”, osteoarthritis refers to deterioration of the flexible tissue, known as cartilage, between bones1. Knee osteoarthritis can be thought of as ‘wear and tear’ that develops gradually over time.

Those with KOA report pain in the knee, particular when walking and on stairs. They may feel stiffness, loss of flexibility, swelling, a grating sensation in the joint, and popping or cracking sounds. In some people the pain from osteoarthritis can impair mobility, and in the worst cases cause sleep disturbances and bouts of depression2.

OA commonly occurs in the knees because of the daily work our knees do, and it’s becoming more prevalent due to a range of societal and public health factors. In 1996 2.0% of the population was estimated to be suffering from the condition, a figure which had risen to 3.6% by 20153.

What Causes Knee Osteoarthritis?

Despite a popular belief that osteoarthritis affects only certain demographics, people from all walks of life can be susceptible to the disease. Factors that contribute to its development include:
Age – Old age increases the likelihood of developing all kinds of osteoarthritis, including that of the knee.
Sex – Due to reasons that are poorly understood, women are more likely than men to develop the condition.
Stress on the Joint – A person’s job, sport, or weight can place excessive and consistent stress on the knee.
Genetics – A tendency to develop knee osteoarthritis can be inherited.
Joint Defects – Malformed or defective joints and cartilage may be present from birth, leading to osteoarthritis later in life.
Metabolic Disease – Hemochromatosis (excessive iron in the blood) and diabetes have been linked to a higher risk of the condition.

What Happens if Knee Osteoarthritis is Left Untreated?

For a lot of people knee OA is a minor inconvenience and can be settled quickly with the right care. Without appropriate treatment, however, knee osteoarthritis can have negative effects on movement and subsequently quality of life, including:
Further Injury – A loss of dexterity, strength, and flexibility in the lower limbs means sufferers of knee osteoarthritis are up to 2.5 times more likely to experience a fall.
Weight Gain – An increase in weight can occur when osteoarthritis impedes regular exercise. As the joints are forced to bear a greater load, this unfortunately only compounds the condition.
Disability – If the associated pain becomes overwhelming, everyday activities such as cleaning, working, and even getting dressed can feel like impossible tasks4.
Fortunately there are a range of treatment options available to help manage the condition.

What Knee Osteoarthritis Treatments Are Available?

As with most bodily issues, early intervention is key to ensuring the best possible outcome for those with knee osteoarthritis. Depending on the severity of the pain, the following treatments may be employed:
Physiotherapy – Physiotherapy is often the first port of call for those diagnosed with knee osteoarthritis, and with good reason.

A specialist practitioner can help stretch and strengthen the muscles surrounding the knee, thereby increasing mobility and reducing pain. Following appropriate patient education, such exercises can then be self-performed for lasting relief.

If weight loss is necessary, physiotherapists will also be able to guide the patient through additional low-impact aerobic activities5.

Focussed Shockwave TherapyFocused shockwave therapy is a non-invasive procedure whereby acoustic energy is directed into damaged tissue via a small, handheld device.

It may sound a little odd to the uninitiated, but it’s shown great results in the treatment of knee osteoarthritis. A study published in 2019 concluded that focused shockwave therapy significantly reduced pain and improved knee function among sufferers of the condition6. This finding was corroborated by a similar study a year later, which observed that it has “beneficial effects on cartilage, subchondral bone and surrounding tissues and can provide relief from chronic OA pain”7.

Medication and Injections – A number of medications and injections may be administered to help relieve the pain from knee osteoarthritis. These range from corticosteroids delivered directly into the joint, to orally-administered nonsteroidal anti-inflammatory drugs.

Surgery – Surgery can range from a keyhole ‘washout’, to a replacement of the joint altogether with a Total Knee Replacement.

Artificial knee joints provide pain relief and improved function, however rehabilitation is vital8. To best regain mobility and strength, rehabilitation with a physiotherapist is recommended after such a procedure.


What should you do if you experience symptoms of Knee Osteoarthritis?


If you experience symptoms of knee pain, it’s important to consult with a qualified health professional. Knee pain can have many causes, so an accurate diagnosis is needed to get you on the correct management plan.

Once diagnosed, reliable and experienced knee physiotherapists, like those at E3 Physio, will be able to treat your condition with proven and effective therapies.

At E3, we help patients manage knee osteoarthritis through a combination of manual treatments including joint mobilisation, stretching, strengthening exercises, and focused shockwave therapy. This multifaceted approach has allowed countless of our clients to overcome knee pain, and return to doing the things they love.

You can reach out to our friendly team via phone, or book an appointment online.





Plantar Fasciitis Treatment Explained

Nothing hinders your health and fitness goals quite like nagging foot pain. While some passing discomfort in the feet is innocuous, when it becomes an everyday obstacle your performance, motivation, and self esteem can suffer.

One of the most common sources of such pain is plantar fasciitis. It can be debilitating if neglected, but thankfully, there are a number of effective treatments available to those diagnosed with the condition.

plantar fasciitis treatment

What is Plantar Fasciitis?


Plantar fasciitis refers to inflammation or degeneration of the thick, fibrous band of tissue that connects the heel bone to the toes1. It derives its name from the Latin words for ‘foot sole’ and ‘band’, but has been known by a variety of informal terms over the years, such as “jogger’s heel” and “heel spurs” (the latter being a misnomer)2

Plantar fasciitis manifests itself as a stabbing or dull pain in the feet, typically towards the heel. Symptoms are often worse during the first few steps after waking, though extended periods of sitting or standing can also trigger discomfort3.

It’s estimated that around 10% of the general population will experience some form of the condition in their lifetime. Being so prevalent, it accounts for 11-15% of all foot symptoms requiring professional care4

What Causes Plantar Fasciitis?

Despite promising advances in the treatment of plantar fasciitis, its causes remain poorly understood. There are factors, however, that have been linked to the condition, including:
Overload – Any activity that causes repeated and sustained stress on the fascia can result in small tears, and thereby, inflammation. This can include things like long-distance running, dancing, or even standing for too long on hard surfaces. 
Obesity – Due to the extra strain placed upon the feet, the risk of developing the condition is compounded if the individual is overweight or obese.
Age – Older demographics typically experience reduced elasticity in the structures of the foot, making them more prone to plantar fasciitis5.
Foot Mechanics – An unconventional walking pattern, flat feet, or high arch can result in greater stress on the fascia.
Other Medical Conditions – Sometimes other medical issues such as lupus or rheumatoid arthritis may cause plantar fasciitis6.

What Happens if Plantar Fasciitis is Left Untreated?

It’s possible for mild cases of plantar fasciitis to resolve on their own, but when more advanced forms of the condition are neglected, serious complications are likely to occur7. These include:
Improper Movement Patterns – Sufferers often attempt to avoid heel pain by changing how they walk. This can result in foot, knee, hip, or back problems8.
Heel Spurs – Over time, calcium deposits can appear in the pad of the heel, causing even more pain with each step.
Plantar Rupture – This occurs when plantar fasciitis is not addressed, and the sufferer continues to place a great deal of stress on their feet. A ‘moon boot’ or crutches are needed to promote healing after such an event.
Disability – Sustained heel pain may make walking and exercising unbearable, in turn leading to negative health outcomes.
Though plantar fasciitis can certainly be debilitating if left unmanaged, there are a number of medical treatments that allow patients to make a full recovery from the condition. 

What Plantar Fasciitis Treatments Are Available?

As with most bodily issues, early intervention is key to ensuring a speedy and comprehensive recovery from plantar fasciitis. Depending on the severity of the pain, the following treatments may be employed:
Physiotherapy – Strengthening and stretching of the foot muscles and achilles tendon are some of the most effective treatments for plantar fasciitis. A qualified and experienced physiotherapist can show you how to perform these exercises, as well as provide therapies like manual treatment and soft tissue release.
It only takes a few months to resolve most cases of plantar fasciitis with an appropriate physiotherapy plan.
Focussed Shockwave Therapy – An excellent adjunct to physiotherapy, focused shockwave therapy (FST) delivers targeted acoustic waves that reduce inflammation and accelerate healing of damaged tissue. It’s administered via a small hand held device, and is non-invasive.
focused shockwave therapy
A practitioner administering focused shockwave therapy
A 2017 meta-analysis found that when used to treat plantar fasciitis, FST was associated with “higher success rates and greater pain reduction” than a placebo9. A 2020 study in the journal Nature corroborated its effect on pain reduction amongst sufferers of the condition10.
Steroid Injections – If symptoms fail to respond to the above treatments, doctors may recommend steroid injections to quell the inflammation. This can ease the associated foot pain for about a month11.
Surgery – Surgery is rare, and recommended only when alternative therapies fail to relieve heel pain. It involves manually detaching the fascia from the heel bone in order to relieve tension and swelling. While healing, lengthening of the fascia itself is encouraged through growth of new connective tissue12. Three quarters of patients who undergo surgical intervention for plantar fasciitis report less pain than before the surgery13.

What should you do if you experience symptoms of Plantar Fasciitis?

If you experience symptoms of heel pain, it’s important to consult with a qualified health professional. Foot pain can have many causes so an accurate diagnosis is vital to get you on the correct management plan.
Reliable and experienced foot and ankle physiotherapists, like those at E3 Physio, will be able to provide you with a diagnosis, as well as treat your condition with proven and effective therapies.
At E3, we help patients manage plantar fasciitis through a combination of manual treatment including joint mobilisation and fascial release, stretching, strengthening exercises, and focused shockwave therapy. This multifaceted approach has allowed countless of our clients to overcome foot pain, and return to doing the things they love.
You can reach out to our friendly team via phone, or book an appointment online.



Gold Coast Sports Physio Reveals 7 Running Dos and Don’ts

Gold Coast sports physio

Many see running as an act that requires little to no thought. After all, it’s something we’ve done since we were children, and it’s what our bodies are built for, right?

The reality is that this aerobic activity, like so many other forms of exercise, is fraught with pitfalls when performed with poor form, inadequate equipment, or a lack of preparation. To help you avoid injury and start pounding the pavement with confidence, here are some dos and don’ts when getting back into running.

  1. Do Ramp Up Your Training Slowly

There’s no expectation that you’ll break the four minute mile or nail a marathon with no training. Ease into your running regime to ensure you don’t push yourself too far, too fast.

A walk, a saunter, or a shuffle is a fine place to start, especially if you’re coming off little to no regular physical activity. If your fitness means you’re better challenged by a jog or a slow run, then go for it. A good rule of thumb is that if you’re able to talk, but not sing, you’re probably at an ideal level of exertion. 

Be sure to start small when it comes to distance, too. Covering countless kilometres on your first session might feel like a big achievement, but all too often it leads to injury or motivation-sapping muscle soreness. Allow your body to adjust to these new demands by mastering a lap of your neighbourhood before tackling longer distances.

  1. Don’t Heavily Strike the Ground With Your Heel

With the amount of cushioning provided in the heel of many common running shoes, you’d be forgiven for thinking that it’s the perfect place to spring off the pavement into your next stride. Mounting scientific research, however, has revealed that this is not the case.

An inefficient way to disperse shock throughout your body, ‘heel striking’ can cause issues with your knee and hip joints. Instead, you should aim to hit the ground with your midfoot, before rolling through to the ball and propelling forward. This technique may take some getting used to, but it can be vital to keeping your joints healthy in the long run … so to speak.

  1. Do Perform Complementary Exercises

Running isn’t all about cardio. To perform at your peak and remain injury free, it’s necessary to strengthen the muscles of your legs, core, and even your upper body.

Record-breaking deadlifts and leg presses aren’t called for here, instead simple bodyweight exercises are all that’s needed to see real results. Try standing on one leg while brushing your teeth, for example, to strengthen the stabilising muscles in your ankles and improve your balance. 

Pilates is great for those seeking a full-body strengthening solution, particularly when done with the help of a qualified instructor. E3 offers group clinical pilates classes that allow you to safely increase your mobility, stability, and strength. Click here for more information.

  1. Don’t Run Barefoot … All The Time, At Least

With promises of improved coordination, increased movement economy, and reduced impact on your knees, it’s easy to see why the barefoot running craze has swept through the fitness world. Much like chocolate ice cream, though, barefoot running is a good thing that can easily be overdone.

Catherine Ketsimur and Duncan Sanders from E3 Physio discuss barefoot running, along with many other exercise-related topics, on episode #131 of the Proactive Podcast.


Habitually ditching the joggers in favour of this more ‘natural’ approach can place stress on the connective tissues of the foot, lower leg, and ankle, and damage to any of these can be debilitating.

“Being barefoot for some part of each day is actually very good for you,” explains E3 Co-Founder Catherine Ketsimur.

“Where we see issues is when people jump into barefoot training without enough preparation.”

As with reincorporating any type of running into your fitness plan, a gradual uptake of the barefoot variety is needed to reap the benefits while mitigating the risks. If you’re interested in adopting it, increase the amount of time you spend sans-shoe at home, and begin with brief intervals on a soft, grassy surface. 

  1. Do Choose Your Running Surface Carefully

Speaking of running surfaces, it’s important that your go-to running track matches your goals and capabilities.

Unfortunately there’s no one ideal surface that can challenge all runners without risking injury. Soft sand can be gentle on the knees, but a nightmare for those with poor balance and stability. A flat concrete pathway can be great for improving endurance, but it’ll do little to prepare your legs, feet and ankles for the rigours of a tough hike. 

Whether you’re ramping up to a fun run, looking to tackle a steep mountain trail, or just want to be able to keep up with your kids on a trip to the beach, it’s important that you pick a training surface that caters to your needs. At the risk of sounding like a broken record, start slow, and if you feel something is wrong, don’t ‘push through the pain’.

  1. Don’t Ignore Your Body

Sure, sometimes it’s necessary to disregard the burning in your lungs, calves, and quads if you want to conquer more demanding distances. What shouldn’t be ignored, however, is lingering pain in your joints, the base of your foot, or in your ankles.

If it’s been a few days since your last run and you still find yourself hobbling around the house or enduring wince-inducing discomfort, it’s wise to see what the experts have to say. Maybe your form is off, maybe your footwear is inadequate, maybe you’re training too intensely. Without consulting an experienced and qualified physiotherapist, it’s difficult to pinpoint exactly what the problem could be.

  1. Do Contact E3 Physio If You Have Any Concerns 

If your return to running has been marred by injury, or you just can’t seem to shake a nagging knee, ankle, or foot related issue, reach out to the experts at E3 Physio. The leading Gold Coast sports physio, our certified practitioners are passionate about helping patients overcome a wide variety of movement concerns. 

From athletes looking to maximise their performance, to weekend warriors chasing that all important PB, our diverse range of services can help people from all walks (or ‘runs’) of life get back to their best, sooner. We offer foot and ankle therapy, knee therapy and rehabilitation, pilates and clinical exercise, pain management, acupuncture, and focused shock wave therapy, among many other personalised treatments. 

Book a time online with our experienced physiotherapists, or reach out to us here to find out more. Happy running.

What is Physiotherapy?


From improved movement, to enhanced sports performance, to greater mental wellbeing, the benefits that can accompany an appropriate physiotherapy plan are significant. While many are familiar with this type of treatment, an equal number remain in the dark about what the methodology actually involves, and the conditions it’s able to help. Allow us to shed some light on the matter.

So, what is physiotherapy?

Broadly speaking, physiotherapy is a way to maintain or restore a person’s mobility, well-being, and function. This is done through, you guessed it, physical means. Think exercise, massage, manual mobilisation, stretching, as well as the application of emerging technologies like focused shockwave therapy.

Is physio effective?

In a number of studies, physiotherapy has been shown to have a positive effect on patient pain, quality of life, physical function, and mental wellbeing, particularly amongst those recovering from surgery¹²³.

The freedom that comes with restoring movement, increasing movement efficiency, or alleviating debilitating pain can be life-changing, and this is what drives us at E3. When delivering our range of services, we adopt a modern, evidence-based approach to ensure our patients enjoy the best possible real-world outcomes.

What conditions can physiotherapy help manage?

what is physiotherapy?

Physiotherapy can be beneficial for a plethora of movement concerns. 

Sports injuries, arthritis, aches, sprains, neurological conditions, and occupational health may all be improved with the help of physiotherapy4.

E3’s specific focus is on the treatment of complex foot, knee, and ankle problems, as well as ongoing pain management. Along with the techniques listed above, we employ adjunctive therapies such as acupuncture and pilates (or ‘clinical exercise’) to help address these issues.

Who administers these treatments?

Physiotherapists are experts at the structures that comprise the human body, and in movement.

To earn the title of “Physiotherapist” in Australia, all practitioners must hold either a bachelor degree in physiotherapy, or have completed a science based degree, followed by a two-year Master of Physiotherapy degree.

In addition, all physiotherapists in Australia must be registered with the Physiotherapy Board of Australia, and complete 20 hours of Continued Professional Development (CPD) annually. This can include, but is not limited to, attending lectures or conferences, presenting education sessions, and reviewing journals.

At E3, we relish this opportunity to educate both ourselves and others on developments within the physiotherapy field. After all, ‘Educate’ makes up one of our eponymous ‘E’s, the other two being Enhance and Empower.

You can learn more about our team here.

Who should seek this treatment?

The scope of those who can benefit from physiotherapy is vast. 

Our patients have spanned a diverse cross-section of the Gold Coast community, including sportspeople, NDIS participants, seniors, post-operative patients, runners, and more. 

Anyone who experiences persistent muscular or joint discomfort, particularly during exercise, would do well to discuss physiotherapy with a qualified medical professional.

Do I need a doctor’s referral to see a physiotherapist?

No, you don’t. Though many of our patients come via doctor’s referral, we’re happy to assess your condition independently and provide information on appropriate physiotherapy solutions.

How do I find a physio near me?

Gold Coast residents can visit our Burleigh Heads-based clinic, contact us online, or get in touch by phoning 0403 780 836. Our practice is wheelchair accessible, and our friendly and passionate staff have years of experience treating a wide range of movement conditions.







Focused Shock Wave Therapy (fSWT)

Shock wave therapy, especially focused shock wave therapy, has been found to be a safe, effective and useful tool for management of hard to treat conditions. These include plantar fasciitis (1) and calcific tendinopathy (2) which are both very debilitating and frustrating problems that are tough to get better.

A shockwave machine produces powerful acoustic shockwaves that are transmitted into the problem area. There are two main types, the Radial Shockwave which produces the most effect at the surface of the skin and just below (<3cm), with the waves becoming dispersed as they go deeper. The second type is the Focused Shock Wave Therapy (fSWT) machine, which is called this as it has the ability to focus on a structure and transmit the waves right to the target. This means that the focused machine is being found to have better effects, as backed up by research (ref?). One of the benefits of focused shockwave is that it effectively penetrates tissue up to 12.5cm deep. This depth covers all tissues, including, tendons, ligaments, muscles and bones. The ability to reach deeper means a focused SW machine is better for insertional tendinopathy (i.e. where the tendon attaches to the bone), bone healing stimulation, as well as in larger individuals; to get right to the source of your pain and tissue injury.

Here at E3 physio we have chosen to go with the ‘gold standard’ focused SWT machine. This gives us the ability to get to deeper tissue, it is more comfortable on the outer tissue and it stimulates a higher level of cellular regeneration (healing), and in recent studies it has demonstrated better results for tendinopathy pain and healing than the radial SWT (3). Basically meaning you are getting a stronger physiological effect and will need less treatment sessions generally. We would recommend Focussed Shockwave Therapy, so if you are considering treatment with shockwave, it’s worth checking what type of Shockwave the clinic you are going to go to is using beforehand.

If you have the old dreaded plantar fasciitis or chronic tendon problems, especially if treatment so far has failed to improve it, then come and see us for focused SWT today.

Conditions that fSWT can help:

  • Plantar fasciitis
  • Calcific tendinopathy in the shoulder, knee, ankle/heel
  • Chronic tendinopathy including gluteal, patella and achilles
  • Insertional tendinopathy including hamstring, quads, patella
  • Tennis elbow (Lateral epicondylitis)
  • Shin splints (medial tibial stress syndrome)

1. Sun et al 2017, Medicine, Extracorporeal shock wave therapy is effective in treating chronic plantar fasciitis: A Meta-analysis of RCTs

2. Bannuru RR, Flavin NE, Vaysbrot E, Harvey W, McAlindon T. 2014, High-energy extracorporeal shock-wave therapy for treating chronic calcific tendinitis of the shoulder: a systematic review. Ann Intern Med. Apr 15;160(8):542–549.

3. Chengxin Li, Zhizhuo Li, Lijun Shi, Peixu Wang, Fuqiang Gao, and Wei Sun, 2021
Effectiveness of Focused Shockwave Therapy versus Radial Shockwave Therapy for Noncalcific Rotator Cuff Tendinopathies: A Randomized Clinical Trial, Biomed Research International

Pilates / Clinical Exercise

If you asked people why they do pilates, the main response they give is to ‘strengthen their core’. This might be for improving sports performance, for managing pain, or to simply look and feel better. So a good question is – what is the core?

The main muscles generally known to be the core are the abdominals; especially the deep abdominals (transversus abdominis) and obliques. There is more to the core than this though! From a physio point of view we see all of the trunk muscles as vital in giving you a strong core and a strong base for your arms and legs to work from.

The other muscles involved in trunk strength are the back muscles (multifidus and erector spinae), the lats (latissimus dorsi) and gluteals, as well as hip flexors. Internally the pelvic floor muscles contribute and need to be strengthened as well; so if you are having problems with incontinence a trip to a good pelvic floor physio is a must.

The diaphragm makes up the top of the core, so breathing well and being able to control the diaphragm is essential. Being able to continue breathing is important so that we don’t overload the pelvic floor (the base of our core) and to provide oxygen to our muscles so they work efficiently.
As physiotherapists’ we use the theory of Pilates along with current evidence about anatomy, injuries, and treatment principles to develop a program that addresses your specific problems. This is why it is important to use adapted and individualised versions of the traditional exercises and so we now call it ‘Clinical Exercise’ rather than Pilates.

Clinical exercise is well known to help with low back pain. There has been quite a bit of research into low back pain (LBP) and the value of pilates based exercises in helping. The research has found that it does provide benefits with reduced pain and improve function if you have chronic low back pain (1).

It’s not all about the trunk and back pain though. A strong and effective core also gives a solid base for your arms and legs to work from which helps to transfer force and create drive which helps running, cycling, tennis and, well, basically any sports. This is important for rehab from injuries or surgery that affect your limbs and for helping improve your sports performance.

The ‘core’ is only the beginning as far as clinical exercise is concerned. The initial focus is to learn where these trunk muscles are, and how to activate them. Then we concentrate on building strength and control in the core muscles as we move and then as we do the activities we love – whether sports or day-to-day activities.

The exact exercises your program includes depends on why you are doing clinical exercise. There will need to be a different emphasis on the program for every injury or pain condition, for example an ankle post fracture, versus kneecap (patellofemoral) problems. In each case the exercises have to be planned and performed in a way that gives you the best result.

It is important that you initially do 1-2 individual sessions to learn how to activate these muscles well, while breathing and moving as well. In fact in the acute phase it is best to do individual sessions and then aim to join a class once your pain and control reach a certain level.

It is important to take your time, concentrate and both ‘listen’ and ‘talk’ to your body; focusing on effective movement patterns and flowing controlled movement. This takes a bit of getting used to as we normally move without thinking about or analysing it. The aim is to gradually make these ‘better’ movement patterns automatic so we can use them without thinking, enabling you to move well and enhance your wellbeing.

Sound interesting - get assessed by our in-house expert!

1. Effects of pilates on patients with chronic non-specific low back pain: a systematic review, 2016, Hui-Ting Lin, PT, PhD,1 Wei-Ching Hung, OT, PhD,2 Jia-Ling Hung, PT,3 Pei-Shan Wu, PT,1 Li-Jin Liaw, PT, PhD,3 and Jia-Hao Chang, PhD4, J Phys Ther Sci

Post-operative Knee Rehabilitation

Not being able to keep up with the family on walks; not being able to go at all; pain at night keeping you awake, and losing the ability to do all the things you love can be frustrating and disheartening. That is why many people make the decision to have a knee replacement and the outcomes can be life changing when surgery goes well and you do a good job on your rehabilitation.

There are important things you can do post-operatively that will set you up for great rehab and results.

  1. Manage your pain. The first thing is to use the pain relief you are given. There is no medal for enduring pain and in fact one of the predictors of ongoing pain after joint replacement is poor pain control early on. So take what you are offered and be comfortable. You may still have pain but it should be manageable and you can then move more and get going.
  2. Manage your swelling. The less swelling you have the easier it is to move and the less pain as swelling contains inflammatory chemicals that can irritate your local nerves. This means pacing your activities and exercises through the day, doing a little often, and getting your leg up at regular intervals. It needs to be higher than your heart so sitting is not best, the ideal is to lie down with your leg on a pile of pillows, then moving your ankle and activating your knee muscles often to pump the swelling away. Ice can also help to reduce swelling so while you have it up you can place a bag of crushed ice over a towel on your knee.
  3. Walk. Little and often, and build up gradually. I believe walking is the best exercise: it is free, you can do it anywhere and it is beneficial for your heart, circulation, strength, movement and your feeling of wellbeing. The other form of exercise that is really helpful is pedalling – you can use an exercise bike or a set of pedals. Both these give a gentle steady movement that encourages muscle work, knee flexibility and circulation boost.
  4. Hands-on treatment helps. If you are struggling to get moving, your knee feels stiff, then a few sessions of hands-on physio can really help to shift swelling, release tight muscles and get the knee moving.
  5. Do your exercises!! It is surprising that anyone expects to get better if they don’t do their exercises but this does happen. Usually this is because the exercises are boring, not specific for you and not explained well. At E3 physio we make a point of making sure your exercises are specific for you and tailored to what you want to get back to. We explain the how and why – what it will help and exactly how best to do them.