To osteopathy Paediatrics is a specialised area of osteopathy that supports babies and children during a particularly sensitive phase of development. More than seeking to “correct” something specific, its aim is to understand how the baby's body is adapting to the different stimuli and challenges of the first few months of life, helping it to find balance and comfort through gentle techniques adapted to its physiology.

The fundamental principles of osteopathy are based on the idea that the body has a natural capacity for adaptation and self-regulation. The osteopath seeks to identify restrictions in mobility or tensions that may interfere with this capacity, influencing comfort, movement, or certain bodily functions.

Contrary to the idea often associated with manipulation, paediatric osteopathy is not based on abrupt or “spectacular” techniques. The intervention is carried out through gentle and precise contact, respecting the baby's tissues and developmental stage. The aim is not to force the body, but to facilitate its adaptation and functional reorganisation.

Childbirth and the Baby's Adaptation to the Outside World

Birth represents one of the greatest transitions in human life. During pregnancy, the baby develops within a protected and relatively constant environment. At the moment of birth, it needs to adapt rapidly to a completely new set of stimuli: gravity, light, sound, temperature, breathing, feeding, and physical contact.

During this process, the baby's body can be subjected to significant pressures and strains. Passage through the pelvic canal, prolonged labour, breech presentations, C-sections, inductions, the use of forceps or ventouse, or even the presence of a nuchal cord can influence how the baby adapts in the early days of life.

In most situations, the body adapts naturally. However, some babies may develop tensions or imbalances that manifest through seemingly common infancy signs.

Frequent Signs in the First Months of Life

Not all discomfort necessarily means there's a problem. However, in some cases, certain signs may warrant further assessment by a paediatric osteopath.

Among the most frequently observed situations are:

• difficulty finding comfortable positions;
• irritability or frequent crying;
• I am agitated or have frequent awakenings;
• preference for one side during breastfeeding;
• positional asymmetries;
• Congenital torticollis;
• positional skull deformities, such as plagiocephaly;
• frequent cramps, gas or constipation;
• regurgitation or reflux in babies;
• Difficulty relaxing or calming down.

Many of these signs can be part of normal development. However, when they persist or cause significant discomfort to the baby and family, osteopathy for babies can work as an interesting complement to Medical follow-up and Physiotherapist.

Paediatric Osteopathy Does Not Replace Medical Care

It is important to stress that paediatric osteopathy does not replace medical or paediatric follow-up. It works as a complementary, integrated approach focused on the child's overall well-being.

At OsteoSalvador, we value teamwork and cooperation between different healthcare professionals, always striving to ensure that the baby's care is provided safely, coherently, and adapted to their needs.

How Does a Paediatric Osteopathy Consultation Work?

The consultation usually begins with a detailed conversation with the parents. The aim is to understand how the pregnancy, birth, and early days of life went, and what the main current difficulties or concerns are.

The observation of the baby allows for the assessment of:

• Posture and positioning;
• Global mobility;
• body symmetry;
• comfort in different positions;
• response to touch and movement.

Through gentle and specific manual techniques, the osteopath assesses the baby's tissues, joints, and different body structures, looking for areas with reduced mobility or increased tension.

Many babies progressively relax during the session, and some even fall asleep.

Movement, Development and Regulation

In the first few months of life, movement plays an essential role in the child's neurological and motor development. The way a baby moves, explores space, and reacts to stimuli progressively influences their postural and functional development.

By facilitating comfort, mobility, and adaptation, paediatric osteopathy can contribute to:

• a more harmonious motor development;
• better tolerance to external stimuli;
• greater capacity for self-regulation;
• better quality of sleep and overall comfort;
• A more relaxed relationship with food and positioning.

More than “correcting” the baby, the aim is to help them find better conditions to grow and develop in a balanced way.

A Preventative and Individualised Approach

Paediatric osteopathy can also have a preventative component, identifying tensions or functional changes early on before they become more limiting.

Every baby is unique. Some adapt quickly after birth; others may need more support during this transition. The approach should always be individualised, respecting the rhythm, sensitivity and specific needs of each child.

When to Seek an Evaluation?

Many parents seek paediatric osteopathy for specific symptoms. Others do so simply because they feel “something isn't quite right”, even if they can't pinpoint exactly what.

Clinical experience often shows that parents recognise small changes in a baby's behaviour or comfort before they can rationally explain them. Listening to this perception, without alarmism but also without ignoring it, can be important.

An assessment by a paediatric-trained osteopath can help to clarify doubts, reassure parents, and identify if there are any functional factors that would benefit from follow-up.

In summary

Paediatric osteopathy is a gentle and integrated approach that supports babies and children through the initial challenges of adapting to the outside world.

Rather than seeking to treat isolated symptoms, it aims to understand the baby as a whole – respecting their development, facilitating comfort, and promoting better conditions for movement, regulation, and overall well-being.

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“What is physiotherapy?” It's a more common question in clinics than you might expect. So let's try to summarise this profession, which is as current as it is complex. Using the definition World Physiotherapy International as a base:

Physiotherapy is often associated with recovery from injury, surgery or an acute episode of pain. However, contemporary physiotherapy goes far beyond this limited vision. Rather than treating an injured structure, it focuses on understanding the mechanism of injury, analysing movement and the body's ability to adapt to the physical and contextual demands of everyday life.

In clinical practice, this implies:

• understanding the mechanism of injury and movement behaviour;

• interpret the severity, the period of evolution and estimate recovery based on the available scientific evidence;

• modulate pain and restore function through technology, manual therapy and clinical exercise;

• consider the emotional needs and individual context of each person.

It's not just about recovering what has been lost, but restoring function and increasing the resilience of the system as a whole.

What is physiotherapy anyway?

In clinical practice, physiotherapy begins with a detailed assessment that seeks to understand not only where it hurts, but how the person moves, how they react to the load, what compensation strategies they have developed and what beliefs they hold about their pain.

The educational role is fundamental. Explaining what is happening, clarifying the meaning of complementary tests and contextualising pain within an adaptive process are essential steps to reduce fear and increase confidence. Understanding directly influences the way the nervous system interprets stimuli and, consequently, the experience of pain.

Physiotherapy in Acute Injury: Intervene Critically

In the context of acute injury - such as sprains, fractures or ligament ruptures - physiotherapy works to manage pain, protect the structure involved and maintain mobility within safe limits.

However, even at this early stage, the goal is not just tissue healing, but the preservation of overall function. Excessive immobilisation or prolonged rest can compromise recovery, leading to stiffness, loss of strength and changes in motor pattern.

Appropriate load progression, even in the early stages, stimulates regeneration and keeps the system active. This progression is always organised on the basis of available scientific evidence and clinical experience, respecting biological timescales and individual response.

Sports Rehabilitation: From Return to Optimisation

In the context of sport, physiotherapy plays a central role. A return to sport doesn't just depend on the absence of pain or the structural consolidation of the injury. It requires sufficient strength, adequate neuromuscular control, the ability to absorb impact, sport-specific endurance and, above all, the athlete's confidence.

The transition between rehabilitation and optimisation is a continuum, with no rigid dividing line. A hasty return increases the risk of relapse and perpetuates cycles of injury.

Physiotherapy accompanies this process progressively, monitoring the response to the load and working in conjunction with coaches and other professionals involved.

And Outside of Sport? Movement for Daily Life

Limiting physiotherapy to sport would be reductive. Most people seek counselling in order to resume simple activities: walking without pain, working without limitations or exercising safely.

In these cases, physiotherapy acts as a movement facilitator, helping to rebuild efficient motor patterns and increase progressive tolerance to activity. Manual therapy, rehabilitation technology and therapeutic exercise are central tools in this process.

The selection of exercises, dose, frequency and progression depend on the stage of recovery, the level of sensitisation of the nervous system and the person's current ability.

Physiotherapy in Chronic Pain: Regulating and Reorganising

Intervention in persistent pain deserves special mention. In chronic pain, It is common to have a long history of therapeutic attempts, inconclusive tests or alarmist interpretations of structural alterations that are common in the general population.

Physiotherapy plays a strategic role in reorganising movement and reinterpreting it. pain as a multifactorial phenomenon. The gradual progression of the load, combined with education and controlled exposure to movement, reduces hypervigilance and restores confidence.

The process requires consistency, but is often decisive in breaking cycles of functional limitation.

Physiotherapy and Osteopathy: A Complementary Approach

In cases of persistent pain, the professional's first objective should be to reassure and help the person to reinterpret their pain.

In this context, osteopathy can act as a strategic crossroads, facilitating mobility, reducing tension and influencing the perception of pain through its global approach to physical systems and the modulation of the nervous and musculoskeletal systems.

At OsteoSalvador, based in Lisbon, physiotherapy does not work in isolation. The articulation with osteopathy, the careful use of manual therapy and the integration of structured exercise allow for a more comprehensive approach.

While manual intervention can facilitate mobility in the early stages, the year consolidates gains and promotes adaptation in the medium and long term. This complementarity is strategic: each tool has its moment within the recovery plan.

When to seek physiotherapy?

Physiotherapy can be indicated in many situations: recurring lumbar or cervical pain, sports injuries, post-surgical recovery, sprains, fractures or headaches associated with muscle tension.

More than the specific condition, what justifies intervention is the presence of functional limitations, persistent pain or difficulty in resuming normal activities. Early assessment makes it possible to structure recovery and prevent initial changes from evolving into more complex conditions.

An Active and Participatory Process

Physiotherapy should be understood as an active process. Recovery doesn't just happen in the session, but above all in the way the person moves, progressively exposes themselves to the load and interprets their body's signals.

The physiotherapist's role is to guide, adjust and create the conditions for this adaptation to take place safely and sustainably. It's not just about treating an injury, but promoting adaptability, autonomy and confidence in movement.

Article written by Ricardo Salvador
Osteopath and Physiotherapist | Specialist in Chronic Pain and Sports Rehabilitation

Ricardo Salvador is dedicated to an integrated approach to musculoskeletal pain, combining physiotherapy, osteopathy and therapeutic exercise to promote functional recovery and progressive adaptation to movement.
At OsteoSalvador, he works as part of a team, ensuring clinical coherence between assessment, manual intervention and structured rehabilitation.

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Low back pain is very common in adults but it's not always the same. Although it's common to hear someone just say “I have back pain”, from a clinical point of view there is a fundamental difference between acute low back pain vs chronic low back pain. This distinction is not just a matter of time - it directly influences the way pain is understood, approached and treated.

Realising this difference helps to reduce fear, unrealistic expectations and frustration, especially when the pain doesn't go away as quickly as expected.

What is acute low back pain?

To acute low back pain usually appears suddenly and is often associated with an identifiable episode: a less usual movement, an unexpected effort, a period of increased physical load or even a moment of stress.

It is characterised by:

• recent onset (days or a few weeks),

• more localised pain,

• greater relationship with certain movements or positions,

• tendency towards progressive improvement.

Although it can be intense, the acute low back pain doesn't mean gravity. In most cases, it is part of the body's adaptation process and develops favourably when there is proper guidance.

What is chronic low back pain?

We talk about chronic low back pain when the pain persists for more than three months. Here, the scenario changes. Pain is no longer just a local response to a physical stimulus, but involves the nervous system more significantly.

In chronic pain:

• the intensity of the pain doesn't always correspond to the condition of the tissues,

• tests may not justify the symptoms,

• fear of movement and insecurity become frequent,

• factors such as stress, sleep, previous experiences and expectations have a greater weight.

This doesn't mean that “the pain is in the head”. It means that the body and nervous system are more sensitive, The pain is maintained by multiple factors.

The difference isn't just time

A common mistake is to think that the only difference between acute and chronic pain is the number of weeks or months. In reality, what changes is a how the body processes pain.

In acute low back pain, the focus is often on tissue protection and recovery. In chronic low back pain, the challenge becomes helping the nervous system to recover confidence in the movement and reduce hypersensitivity.

Therefore, applying exactly the same approach in both cases rarely works.

What about the exams? Do they help to distinguish?

Imaging can be useful in specific contexts, but do not define whether the pain is acute or chronic, nor do they in themselves explain the intensity of the symptoms.

It's common to observe:

• structural changes in people without pain,

• persistent pain with no relevant changes in the tests,

• old findings that no longer explain the current complaint.

Clinical assessment remains the key to understanding the type of pain and guiding the approach. Imaging tests are an important variable, but alone they rarely explain the pain.

Clinical approach Acute low back pain vs chronic low back pain: what changes in practice?

In acute low back pain, the main aim is to..:

• control the pain,

• keep the movement going as long as possible,

• avoid excessively restrictive strategies,

• promote a natural and progressive recovery.

In chronic low back pain, the approach is necessarily more comprehensive. In addition to pain control, it is essential to:

• understand the factors that maintain it,

• reduce the fear of movement,

• gradually reintroduce the load,

• work on trust, autonomy and predictability.

In both cases, the clinical follow-up adequate makes a difference, but the strategies are not the same.

Why is this distinction so important?

When chronic low back pain is treated as if it were always acute, frustration and a sense of failure often arise: “I've done everything and it won't go away”. On the other hand, treating acute pain as if it were chronic can lead to unnecessary worry.

Realising what stage you're in allows you to:

• adjust expectations,

• choose the right approach,

• avoid unnecessary interventions,

• promote a more consistent recovery.

How we view low back pain in clinical practice

At OsteoSalvador, the distinction between acute and chronic low back pain is an essential starting point. The clinical assessment endeavours to understand not only where it hurts, but also how pain behaves, the impact on everyday life and the factors that influence it.

The aim is not just to relieve symptoms, but to help each person understand their condition, regain movement safely and trust their body again.

To summarise

• Acute low back pain and chronic low back pain are not the same thing

• The difference goes beyond the length of time

• Tests help, but they don't explain everything

• The clinical approach should be adjusted to the stage of pain

• Understanding pain is a fundamental part of recovery

A clear and contextualised reading of low back pain allows for more informed decisions and more effective recovery paths, as well as deciding physiotherapy's most assertive approach.

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Receiving a diagnosis of lumbar or cervical disc herniation is, for many people, a cause for immediate concern. The word scares, the tests impress and doubts quickly arise about limitations, treatments or even surgery.
However, in clinical practice, the reality is often quieter than it seems at first glance.

Having a herniated disc doesn't automatically mean having pain, nor does it require invasive intervention. To better understand this condition, it's essential to understand what a herniated disc is, how it manifests itself and what the real role of examinations is.

What is a herniated disc?

The vertebral column is made up of vertebrae separated by intervertebral discs, The discs are structures that act as shock absorbers and allow mobility between the segments of the spine. Each disc has a tougher outer ring and a softer, gelatinous inner core.

We talk about disc herniation when part of this inner nucleus goes beyond the outer ring and can come into contact with neighbouring structures such as nerve roots or, in rarer situations, the spinal cord.

It's important to emphasise one essential point straight away:
the presence of a herniated disc on examination does not in itself equate to an active clinical problem.

Lumbar disc herniation and cervical disc herniation: what changes?

The main difference between a lumbar hernia and a cervical hernia is the affected area of the spine and, consequently, the type of symptoms that can appear.

When the hernia is located in the lumbar region, it is common for the pain to appear in the lower back and, in some cases, radiate to the buttocks or leg. There may also be tingling, numbness or a feeling of weakness in the lower limb. In cervical hernias, the symptoms tend to be in the neck and can extend to the shoulder, arm or hand, whether or not accompanied by changes in sensitivity.

Despite these patterns, the body's response is highly individual. Two people with similar tests can have completely different experiences.

Protrusion, hernia and degenerative changes: why they're not all the same

When reading exams, terms such as disc protrusion, hernia or wear. Although related, they don't mean exactly the same thing.

In simple terms, protrusion is a change in the shape of the disc without rupturing its outer ring. A herniation implies that the inner nucleus has come out. Degenerative changes, on the other hand, are part of the natural ageing process of the spine.

In clinical practice, these alterations are extremely common in people without any pain, which emphasises the importance of not interpreting a test in isolation. The pain alone often cannot be explained by the diagnosis herniated disc.

The role of tests: they help, but they don't tell the whole story

Magnetic resonance imaging is a valuable tool, but it has clear limits. The scans show anatomical images, They do not show pain, nor do they explain the functional impact of each alteration. There isn't always a direct correlation between tests and symptomss and is often observed:

• visible hernias in examinations of people without relevant symptoms;

• severe pain without significant changes in the image;

• old changes that no longer correspond to the current complaint.

Therefore, in the clinical assessment, the tests should be seen as complementary and never as a definitive judgement.

Why a herniated disc can cause pain... or not

Low back pain in adults is common and may or may not be associated with a herniated disc. It doesn't just depend on the size or location of the lesion and is often related to a number of factors including local inflammation, sensitivity of the nervous system, movement patterns, accumulated physical load and even the person's emotional context.

In many cases, the the body has the capacity to adapt and recover, This reduces inflammation over time. When there is adequate monitoring, clear information and safe progression of movement, the evolution tends to be favourable.

Treatment: is surgery always necessary?

No. In most situations, a conservative approach is sufficient and effective. Treatment involves, above all, understanding the problem, reducing the fear associated with the diagnosis and gradually recovering function as a result. in some cases, pain can persist even after the initial injury has resolved.

Surgery is only considered in specific situations, such as progressive neurological deficits, significant loss of strength or persistent pain that doesn't respond to adequate clinical follow-up.

How we view disc herniation in clinical practice

At OsteoSalvador, herniated discs are seen as part of a global context, and not as an isolated label. A detailed clinical assessment makes it possible to understand the origin of the symptoms, the relationship with movement and the impact on the person's daily life.

Rather than “treating a hernia”, the aim is to help the person regain confidence, function and quality of life, using the exams as a support and not as a starting point.

When to seek help?

It is advisable to seek clinical assessment when pain persists, worsens or interferes with daily activities, when there are radiating symptoms accompanied by tingling or loss of strength, or when fear of movement begins to limit daily life.

Proper monitoring helps not only to reduce the pain, but also to prevent the problem from continuing unnecessarily.

To summarise

A herniated disc is a common condition and in most cases.., manageable without invasive measures. Tests are important, but they don't explain everything. The clinical assessment, the individual context and the way the body responds to movement are determinants of progress.

Clear information, appropriate follow-up and a progressive approach make all the difference in the recovery journey.

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O integrative physical exercise goes beyond the idea of training as an isolated tool for gaining strength or improving physical condition. It frames movement as a central element in the regulation of metabolic, immune, neurological and musculoskeletal health.

In clinical practice, movement is one of the most consistent tools to help the body adapt better to the demands of everyday life and deal with pain more effectively.

Movement as a regulator, not just a stimulus

The human body was made to move. Movement directly influences metabolism, immune system function, nervous system regulation, pain perception, sleep quality and recovery.

However, not all movement has the same effect. The absence of movement, as well as excess or inadequate exposure to the load, can contribute to imbalances and physical symptoms.

Integrative physical exercise seeks to find the right balance between stimulation and recovery, respecting each person's ability to adapt.

Exercise, the nervous system and pain

Pain is not just a sign of injury. The nervous system plays a central role in how the body interprets stimuli and reacts to movement, especially in the context of persistent pain.

Exercise, when well orientated, can help to reduce over-sensitivity of the nervous system, restore confidence in movement, break cycles of protection and avoidance and improve load tolerance progressively.

For this reason, integrative exercise is not based on universal formulas, but on gradual adaptations, adjusted to the recovery phase and the context of each person.

Movement and metabolic and immune health

Physical exercise has a profound impact on metabolic health, influencing energy management, insulin sensitivity and inflammatory processes. It also plays an important role in modulating the immune system, contributing to more balanced responses in the body.

These effects help explain why regular, well-dosed movement is associated with a lower risk of illness, better recovery and greater physical and mental resilience.

Integrative exercise is not “more exercise”

A common mistake is to assume that, when faced with pain or discomfort, the solution is to do more exercise or quickly increase the load. In many cases, this can aggravate symptoms or reinforce compensation patterns, especially in situations of persistent pain.

Integrative exercise emphasises the quality of movement, appropriate progression, variability and respect for the body's signals. Moving better is often more important than moving more.

Integrating exercise into the clinical approach

At OsteoSalvador, exercise is seen as an integral part of the clinical approach and not as an isolated element. Movement complements assessment and treatment, helping to consolidate gains, reduce relapses and promote autonomy.

When integrated into a global clinical approach and properly, exercise becomes a powerful tool for improving function, reducing pain and increasing confidence in the body.

🔍 For those who want to delve deeper: exercise as a systemic regulator

In addition to its effects on movement and strength, integrative physical exercise acts as a true systemic regulator. Muscle contraction, respiratory activation and increased circulation facilitate metabolic drainage processes, promoting waste elimination and integration between the lymphatic, cardiovascular, respiratory and renal systems.

Regular movement also stimulates the function of the vascular endothelium, improving vasodilation and tissue perfusion, including the central nervous system. These mechanisms help explain the benefits of exercise in regulating blood pressure, cardiovascular health and emotional balance.

From a metabolic point of view, exercise promotes cellular adaptations that increase metabolic flexibility, i.e. the body's ability to switch between different energy sources efficiently. These adaptations are the basis for better glycaemic management, chronic low-grade inflammation and resilience in disease contexts.

Today we also know that muscle functions as an endocrine organ, releasing substances that communicate with other tissues, including bone and the immune system. These processes help us understand why well-dosed movement has such a significant impact on overall health and the body's ability to adapt over time.

(This section may link to specific in-depth content in the future).

To summarise

• Physical exercise is a regulator of health and pain, especially in cases of chronic pain

• Movement influences the nervous system, metabolism and immunity

• The dose and context are decisive

• Integrative exercise doesn't follow universal formulas

• The approach must be progressive and individualised

Understanding the role of movement helps us look at exercise not as an obligation, but as an ally in recovering and maintaining health.

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A practical, science-based analysis for surfers of all levels

Surfing is more than a sport - it's a passion, a lifestyle. However, like any intense physical activity in contact with nature, it also carries risks. This article is a complete guide to the most common surfing injuries, their risk factors and, above all, how physiotherapy can help with prevention, recovery and a safe return to the sea.

1. Profile of Surfers: Who Is Most Susceptible to Injury?

Let's start by distinguishing between three types of surfer. The frequency and severity of surfing injuries vary according to the level of the surfer:

👨‍🦱 Recreational Surfer

• Surf at weekends or occasionally
• Shorter exposure time
• Basic technique and less control of the board
• Reduced risk, but still subject to (usually minor) injuries

👨‍🦱 Amateur Surfer

• Practise several times a week
• Participates in local competitions
• He's developing technically and physically
• Greater exposure and therefore greater risk

🏄‍♂️ Professional Surfer

• He trains daily and competes at a high level
• Takes on big waves and extreme conditions
• Executes high-impact manoeuvres
• Subject to more serious and recurrent injuries

2. Surf injuries

Below are the most common types of injuries among surfers, with their causes, locations and recommended care.

🔪 2.1 Lacerations and cuts

Lacerations represent the most common traumatic injury in surfing and occur mainly through contact with parts of the board itself - such as the fins, nose and edges - or with the seabed. Wipe-outs, collisions with other surfers or impacts in shallow water significantly increase the risk.

Deep cuts are especially common on beaches with coral or rocky bottoms. Although many of these injuries are not serious from a functional point of view, they require immediate care, such as proper cleaning, haemorrhage control and, in some cases, suturing. Prevention involves the use of flexible fins, boards with rounded edges and respect for the practitioner's technical level in relation to the sea conditions.

🤕 2.2 Bruises

Contusions are injuries caused by direct impact and are very common in surfing, especially in rough seas. They occur when the body collides with the board, another surfer or the seabed. Although they are most often classed as minor, their frequency is high, accounting for between 14% and 29% of injuries in some surfer populations.

The lower limbs are the most affected, especially the legs and knees, as they are in direct contact with the board during falls. However, the arms, back and even the chest can also suffer bruising - especially when losing control of the board or wipe-outs in heavy waves. Although many of these injuries improve with rest and ice, deep bruising, persistent pain and loss of mobility can occur, requiring professional assessment.

2.3 Ankle sprains

Ankle sprains are among the most frequent injuries in surfing - especially in disciplines that involve aerial manoeuvres or unstable landings. When the surfer returns to the board after a jump, the poorly distributed impact can generate a forced rotation of the foot, often in excessive dorsiflexion (elevated toe), resulting in high syndesmosis sprains - a more serious type of injury and slower to recover.

This type of sprain is often overlooked in the early stages, which can lead to chronic instability. The stiffness of the board and poor impact absorption technique contribute to the risk. In more severe cases, the ankle may show persistent swelling and functional limitation, requiring specialised physiotherapy.

We talk more about sprains in Ankle Sprain: Symptoms, Treatment (What to do in the first 24 hours) and How to Prevent Recurrences

2.4 Knee sprains

Knee injuries are common in surfing due to the biomechanics involved in manoeuvres, changes of direction and falls. A typical scenario is when one leg slips off the board while the other remains fixed - causing an intense twisting force on the joint. This rotational movement places excessive stress on the medial collateral ligament (MCL)often the most affected.

The knee, designed for flexion and extension, also undergoes lateral displacements under extreme loads. This is evident when the surfer uses the back leg to manoeuvre, applying angular force to the knee. The injury known as "surfer's knee" can evolve from mild pain to a more serious condition if not treated in good time.

2.5 Shoulder dislocations

Shoulder dislocations are one of the most feared injuries among surfers - especially young, male surfers. This injury occurs when the glenohumeral joint moves, usually forwards (anterior dislocation), out of its anatomical position.

In surfing, the most common causes include violent falls with the arm in an extreme positionThe risk of a wipe-out, such as wipe-outs on big waves, or when the surfer is thrown by the water while holding the board. Impact with the board or the bottom aggravates the risk.

To repetitive rowing also contributes to shoulder instability, especially with muscle imbalances between the internal and external rotators. The recurrence rate exceeds 90% if there is no adequate treatment.

Recovery involves intensive physiotherapy and, in more serious cases, surgery. The rehabilitation plan includes strengthening exercises, stability training, biomechanical correction and functional assessment before returning to sea.

🩻 2.6 Fractures

Fractures are less common, but potentially serious. They occur in high-energy collisions with the board, other surfers or the seabed. The most affected areas are the face, head and upper limbs. Despite the low hospitalisation rate (less than 4%), they require urgent medical attention and may require surgery, immobilisation and prolonged physiotherapy.

We've also talked more about fractures on our blog: Ankle Fracture: Learn to Identify, Treat and Prevent This Frequent and Painful Injury!

2.7 Muscle injuries

Muscle injuries in surfing are mainly caused by repetitive strain or explosive movements. They account for around 12.5% of injuries, mainly affecting the lower back, shoulders and neck. Prolonged paddling and muscle imbalances are significant risk factors.

Lumbar sprains are common in surfers who keep their torso elevated without a strengthened core. Excessive paddling can cause injuries to the rotator cuff muscles. Prevention involves functional training, muscle balance and proper technique.

🧬 2.8 Gradual Onset Lesions (Chronic)

Chronic injuries develop over time due to repetitive overload and lack of rest. They are common among regular surfers, affecting the back, shoulders and neck.

For example "surfer's shoulder" can start with mild pain and develop into severe tendinopathy. Recurrent low back pain affects performance and posture. Physiotherapy is essential for postural correction, strengthening and movement re-education.

2.9 Surfer's Shoulder (Rotator Cuff Injury)

This injury results from overloading the rotator cuff - a group of muscles that stabilise the shoulder. Repeating the rowing movement without compensating with strength and stretching exercises leads to micro-injuries, pain and eventually tendon rupture.

More than 68% of shoulder injuries among surfers are chronic, associated with paddling without compensatory training.

🧠 2.10 Low back pain

The paddling position - with the lumbar spine in constant extension - is the main cause of lower back pain when surfing. Shortened hip flexors, abdominal weakness and poor posture aggravate the situation.

If left untreated, they can develop into herniated discs or chronic low back pain. Physiotherapy corrects postural imbalances and prevents worsening. Find out more here : Low back pain affects 80% of the population

2.11 Neck pain

The need to keep the head elevated while rowing causes overload in the cervical muscles and facet joints. This can cause pain at the base of the skull, stiffness and radiating pain.

The treatment involves muscle release, strengthening and correcting the paddling technique. Osteopathy is very helpful in these cases: Neck Pain and Cervicalgia: When the Neck Calls for Help and Osteopathy Responds

🧭 3. Prevention Strategies: Smart Surfer, Resilient Body

Prevention is essential to keep your body healthy in the water. It's not just about stretching before surfing - it includes physical preparation, body awareness, technique and the right equipment.

Before entering the seaA good warm-up (15 to 20 minutes) is essential, as it activates the muscles and improves mobility. Out of the water, training should include strengthening the core, shoulders, knees and ankles, as well as balance and proprioception exercises.

In techniqueKnowing how to land correctly, avoiding forced landings and improving positioning on the board reduces joint impact. Surfers must respect their own limits and be aware of the sea conditions.

EquipmentThe use of protected fins, a suitable leash and well-maintained boards reduces the risk of cuts and collisions.

🩺 4. Physiotherapy in Surfing: Beyond Recovery

Physiotherapy in surfing isn't limited to treating injuries - it's a tool for performance, prevention and rehabilitationThis allows surfers to stay healthy, technical and competitive.

✔️ In Prevention:

• Biomechanical assessments identify asymmetries and imbalances that increase the risk of injury
• Personalised preventive exercises strengthen key muscle groups

Treatment:

• Acute injuries are treated with techniques such as mobilisation, manual therapy and proprioceptive re-education.
• Chronic injuries require an integrated approach: postural correction, stabilisation and functional training

🏄‍♂️ On the Return to Surfing:

• Physiotherapy guarantees safe and progressive return to sport
• Surgical cases require specific rehabilitation plansfocused on preventing relapses

Bibliographical references

Surfing injuries
Injuries to professional surfers
Analysing the prevalence of injuries in surfers on the coast of Paraná
SHOULDER INJURY IN SURFING: A SYSTEMATIC REVIEW WITH META-ANALYSIS
Chronic and Gradual-Onset Injuries and Conditions in the Sport of Surfing: A Systematic Review 
Surf injuries
Prevalence of sport surfing-related injuries - A cross-sectional study of the Portuguese surfing teachers
The Surfer's Shoulder: A Systematic Review of Current Literature and Potential Pathophysiological Explanations of Chronic Shoulder Complaints in Wave Surfers
Competitive Surfing Injuries: A Prospective Study of Surfing-Related Injuries Among Contest Surfers
An investigation of surf injury prevalence in Australian surfers: A self-reported retrospective analysis.
Chronic and Gradual-Onset Injuries and Conditions in the Sport of Surfing: A Systematic Review
Injury Prevention in The Sport of Surfing: An Update 

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O Blood Flow Restriction (BFR), also known as training with restricted blood flow or BFR trainingis an innovative technique that combines low-intensity exercises with the controlled application of a partial restriction of blood flow, usually in the upper or lower limbs. This approach has been gaining ground both in rehabilitation in physiotherapy as in sports trainingdue to its proven effects on muscle hypertrophy and increased strength - even with significantly reduced loads.

How does Blood Flow Restriction work?

The principle of training with restricted blood flow is based on physiological mechanisms such as metabolic stress. The partial restriction of venous flow during exercise promotes the accumulation of metabolites such as lactate, which stimulates muscle growth through the activation of anabolic pathways and the release of hormones such as growth hormone (GH). This environment also favours the recruitment of fast twitch muscle fibres (Type II), which are essential for developing strength and muscle mass.

Another important factor in BFR training is the activation of satellite cells, which play a decisive role in the repair and growth of muscle tissue, something fundamental in recovery and rehabilitation processes.

Strength and pain reduction benefits

Several studies have shown that Blood Flow Restriction allows significant gains in muscle strength, even with loads between 20% and 40% of maximum repetition (1RM). This makes training with restricted blood flow especially beneficial for people undergoing rehabilitation who are unable to train with heavy weights due to injuries or joint limitations.

What's more, the BFR training also has a proven analgesic effect, useful for patients with chronic musculoskeletal pain, osteoarthritis and tendinopathies. The combination of restricted blood flowThe increase in endorphins and regulation of Central Sensitisation helps to reduce the perception of pain and improve function.

Equipment and application

O training with Blood Flow Restriction uses elasticated or inflatable bands, called CuffsThese are applied to the proximal part of the limbs. The pressure is adjusted in such a way as to restrict venous return, without blocking arterial flow - a task that should always be done with adequate monitoring, for example with Doppler or specific modern BFR training.

Prescribing training with restricted blood flow

• Intensity: 20% to 40% of 1RM.

• Volume: Common protocol of 4 sets (30-15-15-15 repetitions) per exercise.

• Rest: Short breaks, between 30 and 60 seconds.

• Frequency: 2 to 3 times a week.

This model allows for muscle hypertrophy and strength gains similar to those obtained with high loads, significantly reducing the impact on the joints - an essential advantage in contexts of rehabilitation with BFR. 

Populations benefiting from the BFR

The application of Blood Flow Restriction is recommended in various clinical and sporting situations:

• Rehabilitation with BFR in the post-operative period, making it possible to preserve and recover muscle mass without overloading;

• Patients with musculoskeletal injuries;

• People with chronic illnesses, such as osteoarthritis, who cannot tolerate intense training;

• Athletes who are recovering or maintaining muscle mass.

Contraindications

Although BFR training is safe, it is not suitable for everyone. It should be avoided in cases of

• Deep vein thrombosis;

• Decompensated hypertension;

• Cardiovascular diseases;

• Advanced varicose veins;

• Lymphoedema;

• Pregnancy.

Final considerations

O training with restricted blood flow offers an effective solution for those looking for muscle hypertrophy and increased strength, with less joint impact and less risk of overload. To be safe and effective, it is essential to use qualified professionals and suitable devices.

Whether you're undergoing rehabilitation or just trying to boost your training, the Blood Flow Restriction can be a powerful tool for accelerating results.

Bibliographic Reference : Blood Flow Restriction Therapy and Its Use for Rehabilitation and Return to Sport: Physiology, Application, and Guidelines for Implementation

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Ankle Fracture: Symptoms, Treatment and Prevention

To ankle fracture is one of the most common orthopaedic injuries and can seriously affect mobility and quality of life if not properly treated. The ankle, which supports the entire weight of the human body, is made up of three main bones: the tibia, fibula (or fibula) and astragalus - a structure that, despite being robust, is vulnerable to trauma.

In addition to sports accidents, falls and sprains, factors such as osteoporosis, obesity, sedentary lifestyles and even wearing unsuitable footwear can increase the risk of suffering a sprained ankle. ankle fracture. Recognising the signs and acting quickly is essential to ensure a full recovery.

How Does an Ankle Fracture Happen?

To ankle fracture usually results from a twist, fall or direct impact, but even routine movements can cause the injury, especially if there is bone fragility. As the ankle is a fundamental joint for walking, running and balance, any fracture can significantly compromise these functions and require rigorous treatment.

Ankle Fracture Symptoms

The signs of a ankle fracture are generally clear and include:

• Intense and immediate pain after trauma;

• Swelling and bruising in the area;

• Inability to bear weight on the affected foot;

• Visible deformity, in more severe cases;

• Limited movement due to pain and oedema.

In open fractures, the bone can pierce the skin, which requires urgent medical intervention.

Treatment: Conservative or Surgical?

Conservative treatment

Conservative treatment is indicated in stable fractures without bone displacement and with ligament integrity. The ankle is immobilised with a plaster cast or orthopaedic boot for around six weeks. During this period, it is essential to control swelling, keep the limb elevated and apply ice to relieve pain, as well as gradually resuming weight-bearing under medical supervision.

Surgical Treatment

When ankle fracture has significant misalignment, instability or ligament damage, surgery is generally recommended. The most common technique is open reduction with internal fixation (ORIF), where the fractured bones are aligned and fixed with plates and screws, ensuring the stability needed for healing.

Rehabilitation in Physiotherapy

Rehabilitation is an essential stage in the process of recovering from an illness. ankle fractureafter conservative or surgical treatment. The aim is to restore the mobility, strength, balance and functionality of the ankle through:

• Joint Mobilisation: exercises to prevent stiffness;

• Manual therapy: mobilisation and massage techniques to improve circulation;

• Muscle strengthening: strengthening the leg and foot muscles;

• Proprioceptive training: activities to improve balance and coordination;

• Functional Training: exercises adapted to daily activities and sports.

The duration of the process depends on the severity of the fracture and the body's response to treatment, and personalised follow-up by qualified professionals is essential.

Possible complications

A ankle fracture poor treatment can lead to various complications, such as

• Post-traumatic arthritis, due to joint misalignment;

• Compartment syndrome, which compromises circulation and neuromuscular function;

• Infections, especially in open fractures or after surgery;

• Deep vein thrombosis, if there is prolonged immobilisation.

Rapid identification and appropriate treatment significantly reduce the risk of complications.

How to Prevent Ankle Fractures?

Preventing a ankle fracture is possible through simple measures:

• Walk barefoot whenever possibleThe foot strengthens the foot muscles and improves balance;

• Muscle strengtheningexercises to strengthen the leg and ankle muscles;

• Proprioception trainingImproves body control and reduces the risk of falls;

• Wear suitable footwearComfortable, stable and suitable for the type of soil and activity;

• Maintaining bone healtha diet rich in calcium and vitamin D, regular exercise and control of diseases such as osteoporosis.

Conclusion

To ankle fracture is an injury that requires attention and care because, as well as limiting mobility, it can lead to serious complications if not treated properly. Early diagnosis, individualised treatment and physiotherapy are essential for an effective and safe recovery.

If you suspect a ankle fractureDon't hesitate: go to a qualified health professional and follow all medical and rehabilitation recommendations. The right care at the right time makes all the difference in getting your life back to normal!

The mechanism of injury in an ankle sprain can be confused with a potential fracture. To find out more about sprains, read here: Ankle Sprain: Symptoms, Treatment and How to Prevent Recurrences.

If you're curious to learn more about this topic, here's an aclinical report article of a diaphyseal fracture of the tibia.

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To ankle sprainalso known as tibio-tarsal sprainis one of the most common musculoskeletal injuries, affecting people of all ages and levels of physical activity.

Epidemiology

Ankle sprains are among the most common injuries in sports. Prospective studies indicate a cumulative incidence rate of 11.5 per 1000 exposures and a prevalence of 11.8%. The most common form is sprain with inversion and internal rotation of the foot, often with associated plantar flexion. The anterior peroneal-astragalus ligament (APAL) is the most frequently injured in these cases.

In the most serious cases of ankle sprainOther ligaments, such as the peroneus calcaneus or deltoid, may also be compromised.

The average time to return to sport after an ankle sprain varies between 16 and 24 days. However, many athletes experience recurrences or chronic problems. Recurrence rates are high, especially in sports such as basketball, volleyball and American football.

An ankle sprain can develop into chronic instability, with a feeling of joint failure, persistent pain and functional limitation. Around 40% of people with repeated sprains develop this condition, with a negative impact on quality of life and physical activity.

Risk Factors

The main factors that increase the risk of ankle sprain include:

• Previous history of sprains;

• Muscular weakness of the ankle stabilisers;

• Changes in balance and proprioception;

• Congenital ligament instability;

• Slippery or uneven surfaces;

• Muscle fatigue, especially in athletes.

Differential Diagnosis in Physiotherapy and Osteopathy

It is important to differentiate tibio-tarsal sprain of other injuries that involve pain in the area, such as fractures or osteochondral lesions. Tests such as the anterior drawer and talar tilt help to identify specific ligament injuries.

Injury Mechanism

Most ankle sprains occur due to a forced inversion and plantar flexion movement. In less common situations, eversion movements (foot outwards) can injure the deltoid ligament.

Classification by Grade

Ankle sprains are classified into three degrees:

• Grade I (light): Mild ligament strain, moderate pain, no instability;

• Grade II (moderate): Partial rupture, oedema, intense pain and some instability;

• Grade III (severe): Total rupture, marked instability and functional limitation.

Week One: PEACE & LOVE Therapeutic Approach

In the acute phase (first 5-7 days) with special attention to the first 24 hours, the approach PEACE & LOVE is recommended:

PEACE

• Protection: avoid aggravating movements;

• Elevation: reduce oedema;

• Avoid anti-inflammatory drugs: so as not to interfere with healing;

• Compression: control swelling;

• Education: inform the patient about the recovery process from the ankle sprain.

LOVE

• Charge: gradual introduction of pain-free movement;

• Optimism: encourage a positive mindset;

• Vascularisation: maintain circulation with light activities;

• Exercise: mobility and progressive muscle strengthening.

Physiotherapy and Osteopathy Interventions

Physiotherapy and osteopathy should start early after the ankle sprainosteopathy, with techniques such as gentle mobilisation, lymphatic drainage and myofascial release. Osteopathy is effective in correcting altered biomechanical patterns and improving circulation.

Post-sprain rehabilitation

• Subacute phase (2-4 weeks): mobilisations, initial proprioception and muscle strengthening;

• Functional phase (4-8 weeks): advanced proprioceptive training, muscle strengthening and reintegration into sport with specific exercises.

Osteopathy can complement rehabilitation with joint and neuromuscular techniques applied to the ankle, knee, hip and spine.

Return to Sport

Returning to sport after a ankle sprain should be gradual, respecting the body's signals. The use of kinesiotape can help prevent relapses and improve stability.

Chronic Tibio-Tarsal Instability

When there is residual ligament laxity and proprioceptive deficits, chronic ankle instability can set in, resulting in recurrent sprains. The approach involves strengthening the stabilising muscles, improving balance and motor control.

Causes and Evaluation

• Mechanical instability: ligament laxity;

• Functional instability: neuromuscular deficit.

Clinical assessment is essential, using physical tests and tools such as the CAIT and FAAM to identify the functional impact of instability.

Treatment and Prevention

• Functional rehabilitation: strength, balance and neuromuscular control exercises;

• Surgical intervention: reserved for severe cases or those not responding to conservative treatment;

• Prevention: specific training programmes and the use of external supports during risky activities.

Prognosis

With a proper rehabilitation plan and ongoing monitoring, most people are able to fully recover from a ankle sprainThis significantly reduces the risk of new injuries and improves the overall function of the foot and ankle.

Physiotherapy has a major impact on recovery from sports injuries, the recoveries from cruciate ligament ruptures are a very common example, along with foot sprains.

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Pain is a complex experience. Although it's common to look for a single, localised cause - “it's a muscle”, “it's a nerve”, “it's a disc” - the clinical reality shows us that pain rarely depends on a single factor.

In practice, the musculoskeletal pain results from the interaction between different elements of the body, the nervous system and the context in which the person lives. Understanding these factors helps explain why two people with the same diagnosis can have completely different experiences of pain.

1. The state of the tissues

Muscles, joints, ligaments and other structures can contribute to pain, especially in situations of overload, trauma or insufficient adaptation to the load.

However, alterations in the tissues don't always explain the intensity of the pain. It is possible to find structural changes without pain and, conversely, significant pain without relevant changes in the tests, A good example of this is lower back pain. So the condition of the tissues is only part of the equation.

2. The nervous system

The nervous system plays a central role in how pain is perceived. In situations of persistent pain, This can make them more sensitive, overreacting to stimuli that were previously well tolerated.

This phenomenon helps to explain why pain can persist even after tissue recovery and why fear of movement or anticipation of pain can aggravate symptoms.

3. Movement and load

The way we move - or stop moving - directly influences pain. Both lack of movement and excessive load without adequate adaptation can contribute to the onset or maintenance of symptoms.

In clinical practice, it is often observed that repeated movement patterns, prolonged stiffness or too rapid a return to activity after an injury influence the evolution of pain.

4. The emotional context and stress

Stress, emotional tension and mental overload have a direct impact on the perception of pain. By influencing muscle tone, sleep and the nervous system, these factors can amplify physical symptoms, even without an obvious injury.

This is particularly relevant in areas such as the neck, shoulders and the lower back, where tension tends to accumulate.

5. Background and previous experiences

Past experiences of pain, previous injuries, expectations and beliefs about the body influence how pain is experienced in the present. Current pain can be interpreted in a more threatening way if there is a history of similar episodes or previous negative experiences.

This factor helps to understand why some pains become recurrent or persistent over time.

Because these factors influence pain and do not act in isolation

These factors rarely act independently. In most cases, pain arises from a combination of several of them, which influence each other.

For example, physical overload can lead to initial pain, which generates fear of movement, alters activity patterns, affects sleep and increases the sensitivity of the nervous system. Over time, the problem is no longer just local.

The importance of an integrated clinical approach

At OsteoSalvador, pain is seen as a multifactorial phenomenon. The clinical assessment endeavours to understand not only where it hurts, but also because it hurts that person, at that time and in that context.

This integrated reading allows us to define more adjusted approaches, respecting the individuality of each body and avoiding unnecessary or overly simplistic interventions. A Sports Physiotherapy and Osteopathy are the foundations of these approaches in our clinic.

To summarise

• Pain rarely has a single cause

• Tissues, nervous system, movement and context interact

• Tests help, but they don't explain everything

• Understanding the factors that influence pain improves the approach

• Clinical assessment is essential

Realising that pain is a multifactorial phenomenon is a fundamental step towards dealing with it better and reducing its impact on everyday life.

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