Orthotics in Physiotherapy

Orthotics are shoe inserts used for correcting the biomechanics of your feet where it is that your foot mechanics are causative or a part of the reason for your presenting complaint. This commonly includes heel (spurs, plantar fascia, Achilles tendon), knee, hip or lower back complaints.

I have an arch, I don’t need orthotics do I?

Orthotics can be for people with all foot types. We think of them as a device to control your foot’s motion to within normal limits. They are not designed to stop normal motion but reduce or control excessive motion causing potential harm.

The biomechanics of the foot are very important for the optimal functioning of the rest of the body when you stand and walk. If your feet aren’t well positioned or moving optimally the effects can be felt not only in the feet but up your body. The foot should be in what is known as a neutral position where the foot bones sit nicely on one another. This position lies between a pronated (flat foot) and supinated (very high arch) position. Pronated feet are very common in today’s world where we are always walking on hard, flat surfaces that offer no support to the arches of our feet. Increased body weight also puts more pressure through the feet from above and often leads to a flattening effect. Do you have an arch lying down that then disappears when you stand on your feet or a very large arch that perhaps moves too much in walking?

The arch in the foot is an important structure that allows mobility and shock absorption on impact with the ground but also locks into a solid position that creates a spring effect in walking and running. When the arch flattens it leads to other parts of the body to compensate and become overloaded, leading to injuries. A common issue we see with pronated (flattened arch) feet is calf pain as your calf must work harder in the pushing off phase of walking because the arch doesn’t have the normal spring effect. Another common problem is knee pain. This results from the bones in the feet rolling inwards and out of alignment resulting in the knee joint to also point towards your midline. This position can lead to uneven pressure on the knee joint and patellar (kneecap) tracking problems.

Can’t I get them from the Chemist or shoe shop?

The orthotics we prescribe may appear similar to some orthotics within these retail stores but, generally these retail orthotics lack the degree of rear-foot control of our medical grade devices. Many of the ‘orthotics’ available off the shelf within these stores are not for foot control but shock absorption and therefore have little effect on fixing the problem. Simply pick them up and try to bend the inside of the orthotic where the heel cup moves into the arch of the foot. This is the crucial area for many true orthotics and should therefore be difficult to move, resisting excessive motion of your foot.

In short, off the shelf orthotics are generally very soft, don’t last long and are a one shape fits all rather than custom made to your foot and your biomechanics. This therefore requires anatomical knowledge and a good understanding of biomechanics to ensure prescription and fitting doesn’t result in a secondary problem. Often we see people with problems stemming from poorly fitted orthotics within retail stores, many who have invested a fair bit of money chasing different shoes and inserts to find the answer. We are all different and require individual prescription. Some will need extra adjustment (wedging, doming, firmer/softer, full length, 2/3 length) and hence our physio’s are best to give you advice re your footwear, orthotics and individually prescribe and shape your orthotic. The orthotics we use are heat moulded to your feet to position them (and the lower limb) into a neutral alignment.

What about the Podiatrist?

Orthotics from a podiatrist on the other hand are quite rigid and are custom made from scratch to the shape of your foot and are made very precisely. These are often quite expensive and can be uncomfortable for athletic pursuits. It is also extremely important that should you see a Podiatrist they have a greater knowledge of the body’s biomechanics and will take into account more than just our foot. If your feet require more than what we provide, we can refer you to an excellent team of Podiatrists who we trust to provide you with an orthotic that takes into account more than just your foot.

What are your Orthotics like?

The orthotics our physiotherapists fit lie somewhere in between retail stores and Podiatry orthotics in more way than one. They are inexpensive, rigid and are moulded to the shape of your foot.

If you have flat feet, or think you might need orthotics, come in and see us to get fitted and put you on the right track. There’s more to addressing your mechanics than orthotics alone. Evidence shows orthotics and a combination of other interventions (stretching, strengthening, education around movement habits) have a greater outcome than orthotics alone. Book your appointment now.

Written by: Scott Ward

Repetitive Strain Injuries – Part 2

Workplace Strains & Repetitive Strain Injuries

Do you experience soreness that becomes more noticeable by the end of the day or the end of your working week? This is how Repetitive Strain Injuries (RSI) behave in the early days of the injury. Then, with a weekend or few days off work, the symptoms calm down… only to return when work resumes.

RSI is an overload injury, caused by repeated movements that cause strain on the soft tissue which exceeds the body’s ability to recover. This causes inflammation which stimulates the sensation of discomfort. Over time, as the daily work demands continue, the pain increases to the point of creating pain and weakness. This weakness is often due to pain inhibition, which is not a true weakness but rather the body’s way of protecting itself from further harm.

The typical areas affected by RSI, in the office worker, include the forearm and elbow (e.g. tennis and golfer’s elbow), the wrist (e.g. carpal tunnel syndrome), the shoulder (e.g. impingement syndrome). Other areas include the neck, upper and lower back and the shoulder blade area – typically these are muscular pains that can feel great when applying heat or massage to the area.

If you are currently experiencing aches and pains that may be as a result of your work it is best to make a physiotherapy appointment sooner rather than later. Dealing with an injury that has been around for months is harder to settle than one that has only been there a short period of time.

Your physiotherapist can help with treating the symptoms and providing you with clear advice on how to alter the workplace to avoid irritating the condition – hence providing the injury with best environment to settle. Little changes to the workplace may include altering how you sit, the type of mouse/keyboard you use, advising on exercises and taking micro-breaks from your work. To assist with severe cases of RSI a more intensive approach may be required, including adjusting what you do outside of the workplace, addressing your sleep pattern, and introducing certain types of cardiovascular exercise into your week. Discussions with your GP may be required should scans or medication be required

Written by: Austin Wiehahn

Put it on Ice?


What am I talking about? Find out here. Maybe you have a suggestion to add to the list.

The RICE principle has transitioned from RICE to PRICE to POLICE to now PEACE & LOVE.

Rather than trying to describe it all in words, I’ve attached the source, a really short editorial piece explaining each of the letters of the acronym, PEACE and LOVE. Click here to read the article.

The greater question you may be wondering is:

So don’t I use rest, ice, compression and elevation the area after I hurt myself?

The answer is likely no, well to some degree! It appears that once we have ruled out anything requiring referral for emergency medicine (fracture, dislocation, etc), that we need to get rid of or decongest the area of injury by using the lymphatic system. The lymphatic system relies on the pumping of muscles and breathing to rid our system of the “rubbish” produced after injury. Therefore often early mobilisation of the area is helpful.

Ice itself though, was proposed for anti-inflammatory benefits. However, we need some inflammation for healing to occur. Ice can be useful for making the area feel better (see paper attached). Unfortunately the penetration of topical ice is unlikely to change the muscle temperature to accepted levels required to have a metabolic effect, hence it’s application remains mainly for pain relief. This can be provided in some ways more effectively though than by others (click here to read which ice application technique may be best).

Compression of the area may reduce swelling, but in many regions the compression created by adjacent muscle contraction can produce greater pressure differences than external compression. This is evidence to support the avoidance of absolute rest.

Elevation is good to do, but has relatively low evidence. It is normally recommended because it has low risk and some benefit. Often the combination of elevation with muscle contraction is the most effective means of reducing swelling.

Therefore a combination of two new acronyms has been proposed to optimize recovery.

Immediately after a soft tissue injury, do no harm and let PEACE guide your approach

After the first days have passed, soft tissues need LOVE

Someone also recently chimmed in with another acronym for treatment of these soft-tissue injuries. Here, is how it goes;

“Is it now UNLESS?

Well RICE was nice
and PEACE & LOVE suffice
but UNLESS you do your rehab well
you’re gunna pay the price…

Unload – first do no more harm
Nurture – let it heal with sensible time frames
Load – gradually load the area with suitable tasks
Exercise – maintain general exercise for fitness and stamina
Strengthen – ensure you regain adequate strength and endurance
Skill – proprioceptive and sports specific high level function”

What are your thoughts? Perhaps you could throw some suggestions our way for how it should go. What is for certain is the acronym of do no HARM after an injury. That means no Heat, Activity, Alcohol or Massage for the first 48-72 hours (keep in mind though, not complete rest J).

Compiled by: Scott Ward


  1. Blaise Dubois et al. (2020). Soft tissue Injuries simply need PEACE & LOVE British Journal of Sports Medicine, 2020. 
  2. Herrera et al (2010). Motor and sensory nerve conduction are affected differently by ice pack, ice massage, and cold water immersion. Hysical Therapy 90 (4): April 2010: 581-591.
  3. Caswell, D. The Prehab Guys. The truth about icing injuries. Cited 20th November 2020, https://theprehabguys.com/the-truth-about-icing-injuries/


Repetitive Strain Injuries

Repetitive Strain Injuries (RSI), are common injuries that can affect both the upper and lower limbs and even the back and neck regions. Yes, even the spine, how many times have we felt back pain after a heavy bout of gardening or home DIY? This is a repetitive strain injury as a result of overdoing an activity and can affect the muscles, tendons or nerves in the affected region.

Most people have heard of RSI and would immediately think of injuries such as tennis elbow or golfer’s elbow. These are probably the most researched injuries and the literature abounds with information about these 2 injuries. It might surprise you that tennis elbow is often unrelated to playing tennis and non-golfers can be afflicted with golfer’s elbow. Interestingly injuries to the lower limb such as achilles tendonitis, plantar fasciitis and shin splints are also types of RSI – we will discuss these another time. This blog will focus on the upper limb.

What is a repetitive strain injury? Well, it is an overload injury to the soft-tissues (e.g. tendons, muscles and/or nerves). An overload injury means that a stress has been applied to the soft-tissues repeatedly or constantly and this accumulation of stress outweighs the tolerance of the soft-tissue. So, for example, typing is an activity that places some stress (albeit a very low-level stress) on soft tissues in the forearm, wrist and elbow. Whilst the soft tissue can handle a certain amount of stress, asking it to tolerate increased stress repeatedly may start to overload the tissue cells and cause microtrauma. This results in a ‘low grade’ inflammation that manifests as a slight soreness that is not too much of a bother. It is only when the stress is continued that the inflammation causes more soreness to the point when the person decides they have a real problem and seeks help.

Let’s go through the biomechanics of typing: muscles create the finger movement or wrist posture and the muscles attach to bones via tendons. By raising a digit to press on a key the muscle pulls on the tendons to lift the finger and the tendon relays that stress to the bone. All along the muscle, tendon or the tendon attachment-point into the bone, stresses are being exerted. Now pretty much all of us can type for long periods of time without issues. Let’s say that an individual has a poor technique at the keyboard and places more stress through their forearm than someone else – they have a greater chance of getting an RSI. Let’s add in another variable, workload, what if there was a surge in workload? Again, the risk is increased. Let’s keep adding stresses: the task of data entry – repeated use of only a few keys (hence reduced task variability)… Work stress, a short turnaround time for the work to be completed – all of a sudden the soft-tissues have to tolerate a higher volume of stress. What if the person has poor sleep patterns (e.g. parent to a newborn child) – less time to recover…how about a co-morbidity (e.g. diabetes or heart disease) – so the ability for that person to recover is less efficient versus a fit and healthy individual. There are hundreds of variables that might cause one person to get RSI versus another person…and vitally why some people recover faster than others. The information and answers people search for on Google are too generic for most people – the information may be ‘sort of’ correct…but does not take into account the person and the numerous variables that might be impacting on the recovery.

How does a physiotherapist at Nelson Bay Physio manage someone with a suspected RSI? This starts with making an accurate diagnosis through careful history taking, observation and testing. Occasionally a scan or investigation may be required but often this is not required. The background history to the injury is paramount in how we manage the injury. Applying therapy to the injury site is helpful in dealing with the symptoms, addressing the contributing factors to the injury is paramount in settling the condition and preventing the likelihood of relapses.

So how can you expect your physiotherapist to manage your injury? This may involve several of the following:

  • Providing local treatment to the injured area.
  • Splinting the joint in certain circumstances and normally only in the inflammatory phase of the injury
  • Providing you with copious amounts of advice regarding how you can alter your working posture and tasks (i.e. ergonomics)
  • Addressing any postural issues
  • Advising on and providing ergonomic equipment
  • Reviewing your workplace and workplace habits if necessary
  • Analysing your daily tasks – basically everything that you do that may impact on your injury

Remember, one size does not fit all.

So when should I seek help if I am getting twinges?

Having the problem assessed early makes it easier to treat. If the episodes of discomfort are becoming more frequent and more uncomfortable…and less able to settle naturally on your non-work days or rest days…seek help. Leaving it beyond this point simply means it will take longer to recover and may mean more drastic measures need to be taken.

Written By: Austin Wiehahn

Cycling Injuries & BikeFit Assessments

Cycling is a great form of exercise, especially for those who may not be able to walk or jog due to weight bearing problems such as osteoarthritis. However, cyclists are still commonly afflicted with repetitive strain injuries to the knee and hip in particular. Other injuries often seen and effectively managed with a bike fit can be neck pain and associated trapped nerves, wrist pain and numbness, and back pain.

When considering that cycling involves approx. 80 revolutions per minute it becomes evident that cyclists are prone to repetitive strain injuries. Having the bike setup correctly is vitally important to help lower the risk of injury.

A bike setup at Nelson Bay Physiotherapy & Sports Injury Centre involves ensuring that one’s bike is fitted to the individual in order to reduce the risk of injury. Bike adjustments may need to be made to help settle the injury, this may result in a less aerodynamic position on the bike. Once the injury settles, then, and only then can we consider increasing the aerodynamics.

So what does a bike set up involve? We will take a careful history of the injury delving into your training mileage and lifestyle before assessing the injury itself and other variables such as leg strength, flexibility and posture. Following on from this we will get you set up on the turbo-trainer and take photographs and video clips of you on your bike. From these images we can take static and dynamic measurements of key angles that are known to contribute to common injuries. These can highlight issues with the height of the saddle, the handle bar height or frame size. Interestingly it often reveals odd glitches with the pedalling action which, over a one hours cycle ride equates to approx. 5400 revolutions…this is a lot of low level force that cumulatively may cause a cyclist knee pain.

It should be noted that the bike fit is tailored around you as a person and your injury, and not against a template which may be more suited to somebody wanting a more aerodynamic and power-generating position on the bike. An example of the complexity of this service is a person presenting with knee pain. Now the knee joint actually comprises 2 separate joints which behave almost in opposite ways, so if the person has pain coming from the hinge joint the seat height will be modified differently to the person who has an injury in the knee cap joint.

If you are a cyclist with a niggle of pain that just does not seem to be going away please get in touch to arrange a BikeFit assessment.

Written by: Austin Wiehahn

Breaking News: Health Fund Rebates announced for online Physiotherapy consultations

Private health funds are fast tracking access for members to tele-physiotherapy consultations while Australians’ movements are restricted by the COVID 19 pandemic.

Several private health funds have agreed to provide benefits for individual (one on one) physiotherapy tele-consultations/video consultations where:

  • The customer is undergoing an existing course of treatment and the customer has seen the physiotherapist over the past six months, or
  • For new patients, the tele-physiotherapy service has been recommended by their general practitioner or relevant medical specialist, and
  • The primary condition being treated is one of:
    • Post orthopaedic surgery rehabilitation (e.g. Total hip or knee replacement)
    • Chronic musculoskeletal condition (e.g. osteoarthritis)
    • Cardiac rehabilitation
    • Pulmonary rehabilitation, or
    • pelvic floor muscle training,
  • The service is delivered before 30 September 2020, and
  • The service is undertaken in accordance with Australian Physiotherapy Association guidelines.

Health funds will provide coverage for tele-consultations provided by physiotherapists from Tuesday 14 April 2020 subject to the conditions listed above.

We encourage patients who are health fund members to check with their health fund to see if they will cover tele-physiotherapy consultations. Some funds may impose additional conditions.

Initially benefit payments will be on production of a receipt from the provider.  Patients will have to pay the provider for the consultation and then claim the benefit through their health fund.

Claiming systems and health funds’ processes are not set up to deliver benefits for tele-health services automatically as is possible with face to face services. Claiming systems, PHA, professional associations and individual funds are working address the system issues as quickly as possible.

The government, WorkCover and now our Private Health Insurers are all supporting the provision of this online video consultation or Telehealth service to you. Again we remind you that our service continues within our clinic as normal and also via our new online digital video consultations. Click here to see how easy it is to connect to us via an online video consultation.

So our advice would be to continue your treatment currently either in clinic or via our online video consultations. We are continuing in clinic as normal. Our video consultations are markedly reduced in charge to enable you to continue your care from home if you wish. There is so much we can help you with from the comfort of your home so please contact our reception staff to organise this. I will share on our website a video displaying how easy this is later today so please don’t feel you cant do it if you are technologically challenged. I am that way myself and this was easy so be reassured. The appointments are open to booking now.

So to summarise, if you have no Health Insurance you can come and see us at anytime in-clinic or via video consultation.

For those with Private Health Insurance: In order for you to claim through your health fund what we think is the case is:

  • that unless you see us as a new patient before the 14th April, you will not be able to see us via video consultation as a new patient without seeing the Dr. and only for the conditions listed above.
  • If you have seen us in the 6 months prior to the 14th April, you will be able to continue to be treated without seeing the Dr. and for whatever injury you have as opposed to the listed criteria I will now post.

We will seek clarification on this matter.

So move well stay well everyone. We are here to help you. Give us a call and arrange if we can. In the meantime keep up to date by following us here or via Facebook.

Night Cramps

Often people come to us reporting night cramps in their legs. Did you know there exists evidence to suggest that stretching before bed can help this?

Joannes M Hallegraeff et al (2012) found that stretching the calf and the hamstrings for as little as 10 seconds each for 3 repetitions immediately before going to bed, reduced both the frequency and intensity of hamstring and calf cramps in a population of 80 elderly adults when performed over a six-week intervention period. Click here to see the pictures of how participants did this and read more about this easily applied principle to help you live your life better.

Additionally, click this link to read more about night cramps, their causes, risk factors and other treatment options available.

Chronic Pain Mythbusters

2019 World Physiotherapy Day – Sunday 8th September

People who have chronic pain often tell us that it can be difficult to get or stay active. But physiotherapists can suggest activities or an exercise program that are right for the individual experiencing chronic pain. They can help understand how pain works, reduce fear around pain, educate about your condition, encourage safe participation in physical activity, build confidence, help return to remain at work or participate in activities that allow you to live life to the fullest.

This year we were promoting our role in chronic pain during World Physiotherapy Day via our facebook account. The campaign was focused around the following key messages about the benefits of using exercise to manage chronic pain and:

  • maintain flexibility and movement
  • improve cardiovascular health
  • build and keep muscle tone
  • improve mood and general wellbeing
  • help control pain
  • increase confidence to take part in activities
  • take back control of your life and reduce your fear

Hip Bursitis or is it?

Greater Trochanteric Pain Syndrome or Hip ‘Bursitis’?

Greater Trochanteric Pain Syndrome (GTPS) is a term used to describe the condition previously often inaccurately diagnosed as trochanteric bursitis.

Bursae are fluid filled sacs that provide cushioning between bony prominences and overlying tissues. Trochanteric bursitis was previously used to indicate inflammation of the bursa of the lateral hip that are located between the greater trochanter (bone on the outer hip) and the overlying gluteus tendons (buttock muscles), iliotibial band (ITB) and tensor fascia lata (TFL).

A clinical diagnosis included both an aching lateral hip pain and distinct tenderness around the greater trochanter, pain on moving the leg to the side, pain when lying on that side, pain with prolonged standing, and pain increased by walking and running.

Epidemiology studies suggest that these symptoms are a common complaint amongst active and sedentary individuals, have a higher prevalence in women (4:1), are most commonly found in those 50-70 years of age and have no racial predilection.

Trochanteric bursitis may be classified as either an acute injury or a repetitive irritation. Acute injuries may occur due to impact from falls, sports or other high impact trauma. Repetitive traumas are usually due to irritation from the friction of the iliotibial band (ITB) rubbing over the trochanter during continuous flexion and extension of the hip. This type of irritation is most often seen in runners, however is not exclusive of less active individuals.

The term ‘trochanteric bursitis’ has been substituted for GTPS as current research using ultrasound and medical resonance imaging highlights a paucity of evidence supporting the inflammatory process of the condition. This evidence also identifies that in the majority of patients with pain and tenderness over the greater trochanter, the bursae are not involved, emphasizing instead tendinosis or tears of the gluteal muscles as the primary cause of the pain. These signs and symptoms are often secondary to other pathologic conditions that have been caused by biomechanical deficiencies that can be treated with physiotherapy.

Conditions that may be causative of GTPS include;

  • Chronic mechanical low back pain
  • Degenerative arthritis or disc disease of lower lumbar spine
  • Degenerative joint disease of knees
  • Patellofemoral pain
  • Fibromyalgia
  • Iliotibial band syndrome
  • Inflammatory arthritis of the hip
  • Ipsilateral or contralateral hip arthritis
  • Anterior hip impingement
  • Leg length discrepancy
  • Obesity
  • Pes planus or excessive pronation
  • Tendonitis of external hip rotators
  • Total hip arthroplasty
  • Hip abductor weakness

All of these factors can be treated and improved with physiotherapy. Whilst cortisone injections into the hip can reduce your pain, they do not fix the underlying biomechanical deficiency and therefore without correction many people develop chronic hip or other secondary problems. Cortisone can be used to decrease pain and therefore allow physiotherapy to correct underlying deficits. Present to your physiotherapist today for a full assessment and correction. We will direct you appropriately should we feel that a local injection will make your rehabilitation easier. Ultimately avoid an injection until you try conservative management.

Written by Scott Ward

What’s best for your ankle sprain?

When should you see a Physiotherapist for your ankle sprain?

Ankle sprains (rolled ankles) are one of the most common musculoskeletal injury. Most people think that a sprained ankle is a minor injury that will resolve on its own. However, research has shown that symptoms such as pain, swelling, reduction in range of motion and instability, persist in up to 30% of cases. This can lead to a reduction in exercise, sport and daily activities and can become a major burden in one’s life. Management is generally conservative which can involve immobilization, strapping, strengthening, balance training, joint mobilization, massage and jumping and landing practice.

It is beneficial to see a physiotherapist early after your injury for many reasons:

  • The first reason is to ensure there is nothing fractured or anything sinister going on in your ankle such as a syndesmosis or joint surface injury. A physiotherapist is the best judge of what your specific injury requires, whether that be further investigation with scans, immobilization or early mobilization.
  • There is also a high rate of re-injury with ankle sprains. If you have rolled your ankle, you are at a higher risk of doing it again and the more you do it, the more unstable it becomes. An ankle sprain will require exercises to improve stability and increase control of your ankle in everyday and athletic tasks. Therefore, if you see a physiotherapist, even for a minor injury, we can set you on the right path for prevention of further injury or re-injury in the future.
    Seeing a physiotherapist for early treatment on an ankle sprain has been shown in multiple studies to have a positive effect on pain, function and swelling when compared to a delayed treatment. Early assessment and treatment result in a quicker return to function and fast-tracked rehabilitation process. This will lead on to strengthening, balance and return to work/sport specific exercises so you perform at your best.

If you sprain your ankle come in and see us so we can make sure you get the best treatment for your specific injury. We will ensure you are assessed properly and get the right treatment to get you back to what you love doing as soon as possible. Read the evidence below to know what’s best for your ankle and why seeing a physiotherapist is evidence-based.

Current Evidence for Ankle Sprain Treatment

Here is the highest level of evidence available regarding the treatment of ankle sprains. The points below confirm that if you injure your ankle don’t sit around at home, come and see us and get back on your feet earlier with less chance of future injury. Remember you don’t need a Dr.’s referral. Until then R.I.C.E.!

  • There are no indications that the use of ice on its own is effective(4)
  • Intermittent application of ice will reduce pain more than with standard application of ice(4)
  • Ice combined with exercise therapy decreases swelling in comparison with heat(4)
  • Those receiving physiotherapy intervention made significant improvements compared with those just receiving R.I.C.E. at both 6 weeks and 3 months post injury(3)
  • Functional treatment (elastic bandaging, soft casting, taping or orthoses with associated coordination training) for 4 to 6 weeks is preferable to immobilisation in a cast for outcomes(1,4)
  • Lace-up supports (braces) are more effective than elastic bandaging(1,4)
  • Using a brace or tape reduces the risk of recurrent inversion injuries in those who are active in sports(4)
  • It is unclear whether a brace is more effective than a tape. Therefore it comes down to individual preference. It is recommended to use a brace or tape to prevent a relapse(4)
  • Exercise therapy, training coordination and balance, prevents recurrence in the long term (up to 12 months) and should include proprioception, strength, coordination and function maintenance(4)
  • Exercise therapy should be included as much as possible into regular activities to prevent recurrences(4)
  • No recommendations can be made concerning the type of shoes to prevent recurrence of ankle ligament injury(4)
  • There is a role for surgical intervention in severe acute and chronic ankle injuries, but evidence is limited. Functional treatment is preferred over surgical therapy(4)

Written by: Scott Ward & Lachlan Oberg, Nelson Bay Physiotherapy & Sports Injury Centre


Bleakley, C.M., O’Connor, S.R., Tully, M.A., Rocke, L.G., MacAuley, D.C., Bradbury, I., Keegan, S. and McDonough, S.M., 2010. Effect of accelerated rehabilitation on function after ankle sprain: randomised controlled trial. Bmj, 340, p.c1964.

Hubbard T &.Hicks-Little C.A. Ankle Ligament Healing After an Acute Ankle Sprain: An Evidence-Based Approach. Journal of Athletic Training 2008;43(5):523–529.

Hultman K, Falstrom A & Oberg U. The effect of early physiotherapy after an acute ankle sprain Advances in Physiotherapy, 2010; 12: 65–73.

Kerkhoffs G.M., Van den Bekerom M. & Elders, L.A.M. Diagnosis, treatment and prevention of ankle sprains: an evidence-based clinical guideline. British Journal of Sports Medicine 2012 46: 854-860.

Lin, C.W.C., Hiller, C.E. and de Bie, R.A., 2010. Evidence-based treatment for ankle injuries: a clinical perspective. Journal of manual & manipulative therapy, 18(1), pp.22-28.
Hultman, K., Fältström, A. and Öberg, U., 2010. The effect of early physiotherapy after an acute ankle sprain. Advances in Physiotherapy, 12(2), pp.65-73.

Seah R. & Mani-Babu S. Managing ankle sprains in primary care: what is best practice? A systematic review of the last 10 years of evidence. British Medical Bulletin 2011; 97: 105–135

Concussion in Children’s Sport

It’s Winter and often with it comes an increase in the number of children participating in contact sports. Did you know that concussion is a from of traumatic brain injury and it can occur even without contact to the head? Please prepare yourself for the care of your child by clicking and reading this link to an article by Gemma Nisbet in The West Australian. Gemma discusses the matter with paediatric physiotherapist, Nicole Pates. Your physiotherapist may then have a role to play in the assessment of any suspected concussion using an administration tool specifically designed to do so, named the SCAT5 or Child SCAT5. More can be found at the Sports Medicine Australia website and it is important to note that different sports have different policies regarding concussion.


Do you have Knee Osteoarthritis?

A new decision support tool for patients suffering with osteoarthritis (OA) of the knee has recently been developed. The tool will provide evidence-based information to assist you in making more informed decisions by identifying treatment options, including the risks, benefits and cost. Find out more about this comprehensive tool by clicking here. Remember to also read our previous documents regarding how to future proof your knees and learn why arthroscopic knee surgery for degenerative knees is not recommended. Come and see the physiotherapist for the best advice and outcome for prevention, prehabilitation and rehabilitation around joint replacement. The evidence supports a better outcome.

Heat or Cold – What’s best to use when?

As physiotherapists we often get asked whether the application of heat packs or ice packs is more useful for all sorts of injuries. The answer isn’t black and white. It depends on your injury, what stage of healing you’re up to and what your preferences are. Typically, an acute (fresh or new) injury will respond better to icing and a chronic (older or persistent) injury will like heat. However, there are exceptions and the effectiveness of both is up for debate.

What does heat do?

Physiological effects of heat therapy include pain relief, increases in blood flow, metabolism and elasticity of connective tissue. Increasing blood flow and metabolism is thought to promote healing by increasing the supply of nutrients and oxygen to the site of injury. Increased elasticity can lead to improvements in range of motion.

When should I use heat and how do I do it?

Heat therapy is good for muscle spasm, joint pain and chronic pains. Heat should be avoided when inflammation is present as it can make it significantly worse. It is good for back pain, osteoarthritis and general muscle soreness. Heat can be applied via a heat pack, hot water bottle or via hot water such as a bath or shower. Heat should not be applied to an infection, acute injuries or flare ups of arthritic joints. It is best applied as a comfortable even warmth for some 20-30 minutes and can be applied whenever you are able.

What does cold do?

Cold therapy decreases blood flow which is thought to reduce swelling and slow the delivery of inflammatory mediators, reducing inflammation of the affected area. Interestingly, this is most effective when combined with elevation and compression. Most importantly, it induces a local anaesthetic effect by decreasing the activation of nociceptors and the conduction velocity of nerve signals conveying pain.

When should I use cold and how?

Cold therapy is best used for acute injuries. Back pain generally prefers heat rather than cold and is an exception to this rule. It is best applied with an ice pack, frozen peas or massaging with an ice cube. If using an ice pack or frozen vegetables it is best to wrap in a moist towel and apply for 20 minutes at a time every 2 hours. If massaging directly with ice, rub your skin for a few minutes or until the area becomes numb. Cold therapy should not be used in patients with cold hypersensitivity, cold intolerance, or Raynaud’s disease, or over areas of vascular compromise.

Heat and cold therapy will not have a huge effect on your recovery from an injury, though they do have a recognized effect for decreasing pain. A reduction in pain can, however, allow you to start moving earlier which is important for all injuries. If you are torn between using cold or heat, try them both and see which you prefer. Use whatever feels the best to you.

Should you need a hot or cold pack please pop in. We have varying options readily available for your immediate relief.

Written by: Lachlan Oberg


Moody, J. Heat Vs Cold Therapy- Which One Should I Use? https://www.physioinq.com.au/blog/cold-vs-heat. 2016

Ingraham, P. The Great Ice Vs Heat Confusion Debacle. https://www.painscience.com/articles/ice-heat-confusion.php. 2017

Ingraham, P. Heat for Pain. https://www.painscience.com/articles/heating.php. 2016

Ingraham, P. Icing For Injuries, Tendonitis, and Inflammation- Become a Cryotherapy Master. https://www.painscience.com/articles/icing.php. 2017

Gerard A. Malanga, Ning Yan & Jill Stark (2015) Mechanisms and efficacy of heat and cold therapies for musculoskeletal injury, Postgraduate Medicine, 127:1, 57-65, DOI: 10.1080/00325481.2015.992719

Manual Therapy PAIVM

What are we as physiotherapists doing when we push on your back?

We are performing a technique known to us as a PAIVM or passive accessory intervertebral movement. A PAIVM involves a small movement of one vertebrae in relation to the vertebrae above and/or below. We use this technique as an assessment and as treatment.

In assessment we push on segments of your back and are feeling for the amount of movement and the feel of this movement i.e. is it stiff or loose.

In treatment we are trying to stretch the fibrous tissue surrounding each particular joint and desensitize the area. Research has shown that PAIVMs can have a significant effect on pain and range of motion. It is useful for those with pain, stiffness, temporary jabs of pain and some specific disorders of the back.

So if you have any stiffness or pain in your back, come in and see us so we can relieve you’re pain/niggle and get you moving better.

Better still, lets find out the reason for it and see if we can stop it happening again.

Written By: Lachlan Oberg


Manual Therapy Techniques For The Lumbar Spine. (2018, June 8). Physiopedia. Retrieved March 8, 2019 from https://www.physio-pedia.com/index.php?title=Manual_Therapy_Techniques_For_The_Lumbar_Spine&oldid=189931.

Abbott, J. H., Flynn, T. W., Fritz, J. M., Hing, W. A., Reid, D., & Whitman, J. M. (2009). Manual physical assessment of spinal segmental motion: intent and validity. Manual therapy, 14(1), 36-44.

Fundamentals Of Maitland Mobilizations. Hall, S. J. Retrieved March 8, 2019 from http://morphopedics.wikidot.com/fundamentals-of-maitland-mobilizations.

Frozen Shoulder

Frozen Shoulder also known as Adhesive Capsulitis is a musculoskeletal condition affecting range of movement and resulting in pain in the shoulder joint for long periods of time (generally 9 months to 2 years in duration).

This condition can occur as a result of immobilisation, trauma or spontaneously for no apparent reason and it is for this reason that its prevention is most difficult. What we do now is that there are several conditions that have a higher prevalence for frozen shoulder, including diabetes and female between 40-65 young.

It presents firstly as an insidious onset of pain that progressively worsens and a gradual decrease in movement in all directions.  People have sharp pain with end range movement and pain at night. Often people have trouble with overhead activities, dressing and reaching behind the back. Frozen shoulder may however mimic other conditions of the shoulder in its early stage, such as rotator cuff dysfunctions, subacromial impingement/bursitis and osteoarthritis.

Frozen shoulder presents as 3 phases:

  1. Freezing/painful: gradual onset of pain at rest and sharp pain at end range movements and night pain
  2. Frozen/ stiffening: pain remains and shoulder loses range of movement before pain starts to subside
  3. Thawing/ resolution: range of movement starts to improve

This is a self-limiting disease meaning it will get better by itself. There are a few strategies often employed to break these adhesions (hydrodilatation, manipulation under anaesthetic and operative capsular release) but despite their application, many people return to a “frozen” state some months later. Recovery times range between 6 months to several years.

Physiotherapy treatment is beneficial for patients with frozen shoulder. The treatment depends on the phase the patient is in and their particular symptoms and functional ability. A physiotherapist can diagnose and explain the condition, provide pain relief and maintain and/or improve range of movement depending on stage.

Article By: Lachlan Oberg


  1. Manske RC, Prohaska D. Diagnosis and management of adhesive capsulitis. Curr Rev Musculoskelet Med. 2008;1(3-4):180-9.
  2. Adhesive Capsulitis. (2019, February 4). Physiopedia, Retrieved March 6, 2019 from https://www.physio-pedia.com/index.php?title=Adhesive_Capsulitis&oldid=204318.

Sponsors Nelson Bay Football Club

We are pleased to announce that we are continuing our association and sponsorship of Nelson Bay Football Club this year. We are excited to be a part of helping the club to stay fit, run fast, and score lots of goals on and off the pitch in 2019! It all started with the FIFA 11+ Education workshop, a good night well attended by coaches and players keen to do their best to prevent injuries in 2019 by establishing a solid evidence-based injury prevention program as their warm-up and warm-down routine for training and match day.

Pelvic Form Physiotherapy

A wonderful professional development session today was enjoyed with Pelvic Form Physiotherapy’s Amy Hansen discussing all things pelvic floor.

Did you know that:

  • 75% of women experience prolapse at some point in their life
  • 40% of men in their 40’s have erectile dysfunction (and this statistic increases by 10% for every decade).
  • It is estimated that 65% of women and 30% of men who visit the GP are affected by incontinence, yet more than two thirds don’t discuss it!
  • Pelvic pain, pain during intercourse and incontinence are not normal so see a physiotherapist for help.
  • Surgery is a last option and should only be considered after conservative management and physiotherapy.

There is a lot of evidence for physiotherapy management of incontinence, retention, defacation disorders, pelvic girdle pain, antenatal and postnatal care, cancer rehabilitation, pre and post prostatectomy and erectile dysfunction. The concern is people don’t come forward and seek help and often get referred to a surgeon before anything else.

You don’t need a referral to see a physiotherapist privately.

This topic needn’t be covered by a fig leaf ? as there is so much that can be done! Why not make the life changing changes conservatively! This topic needs a change in direction so don’t turn it away. Please go to Amy’s website and give her a call or send her an e-mail and help yourself or someone you know. www.pelvicformphysiotherapy.com.au

Can Physiotherapy help my Osteoarthritis?

Yes! High-quality evidence proves that exercise reduces pain and improves physical function in patients with osteoarthritis.

Osteoarthritis (OA) has a significant impact on one’s physical function and quality of life. The knee, hip and hand joints are predominantly involved, resulting in physical symptoms of pain, swelling and reduced function. Furthermore psychosocial symptoms of anxiety and depression can occur as a result of this condition.

Exercise has been shown to reduce pain and also demonstrate positive effects on physical function immediately after treatment, and sustained 3-6 months after treatment. Research has also shown that Physiotherapy manual mobilisation alongside exercise prescription has shown greater improvement in pain.

In summary your Physiotherapist can help your osteoarthritis through use of manual mobilisation to optimise pain relief, alongside a prescribed evidence based exercise program to target the affected joint(s).

Written by: Nicole Pereira


Walsh, N. E., Pearson, J., & Healey, E. L. (2017). Physiotherapy management of lower limb osteoarthritis. British Medical Bulletin, 122(1), 151-161. doi:10.1093/bmb/ldx012

Bennell, K. (2013). Physiotherapy management of hip osteoarthritis. Journal of Physiotherapy, 59(3), 145-157. doi:10.1016/s1836-9553(13)70179-6

Jansen, M. J., Viechtbauer, W., Lenssen, A. F., Hendriks, E. J., & De Bie, R. A. (2011). Strength training alone, exercise therapy alone, and exercise therapy with passive manual mobilisation each reduce pain and disability in people with knee osteoarthritis: a systematic review. Journal of Physiotherapy, 57(1), 11-20. doi:10.1016/s1836-9553(11)70002-9

Beckwée, D., Vaes, P., Cnudde, M., Swinnen, E., & Bautmans, I. (2013). Osteoarthritis of the knee: Why does exercise work? A qualitative study of the literature. Ageing Research Reviews, 12(1), 226-236. doi:10.1016/j.arr.2012.09.005

Lumbar Disc Herniation: Should I have Surgery?

Lumbar disc herniation is a common low back disorder that produces low back pain and/or leg pain in adults. A herniated disc is a displacement of disc material beyond the intervertebral disc space, these usually remain asymptomatic however can cause discomfort if the disc compresses an adjacent nerve or the spinal cord. Disc herniation often occurs as a result of age-related degeneration of the outer fibrous portion of the disc (annulus fibrosis), however trauma, straining, torsion and lifting injury are also involved.

Often we get asked – I have a herniated disc, do I need surgery to fix it?

Not Necessarily! Physiotherapy often plays a major role in disc recovery. Infact, research shows no statistically significant differences between conservative management and surgical management of disc herniation after 1 and 2 years. Physiotherapy does not only offer pain relief and decrease disability, but it also contributes to protecting the body to prevent further injury.

Research shows that large disc herniations decrease in size proportionally more than smaller protrusions and therefore that the greater the herniation the greater the resorption.

In some instances however, surgical intervention may be required. Your Physiotherapist will determine your prognosis on examination, and take appropriate action.

Written by: Nicole Pereira


Chui, CC, Chuang, T., Chang, K.H., Wu, C.H., Lin, P.W, & Hsu, W.Y. (2015). The probability of spontaneous regression of lumbar herniated disc: a systematic review. Clinical Rehabilitation 29 (2): 184-195.

Gugliotta, M., Da Costa, B. R., Dabis, E., Theiler, R., Jüni, P., Reichenbach, S., … Hasler, P. (2016). Surgical versus conservative treatment for lumbar disc herniation: a prospective cohort study. BMJ Open, 6(12), e012938. doi:10.1136/bmjopen-2016-012938

Jacobs, W. C., Van Tulder, M., Arts, M., Rubinstein, S. M., Van Middelkoop, M., Ostelo, R., … Peul, W. C. (2010). Surgery versus conservative management of sciatica due to a lumbar herniated disc: a systematic review. European Spine Journal, 20(4), 513-522. doi:10.1007/s00586-010-1603-7

Weinstein JN, Tosteson TD, Lurie JD, et al. Surgical vs Nonoperative Treatment for Lumbar Disk HerniationThe Spine Patient Outcomes Research Trial (SPORT): A Randomized Trial. JAMA. 2006;296(20):2441–2450. doi:10.1001/jama.296.20.2441

Inadequate Sleep and Resistance Training

A recent systematic review has evaluated the effect of sleep deprivation (i.e. no sleep) and sleep restriction (i.e. a reduced sleep duration) on resistance exercise performance. Resistance exercise is an effective means to maintain and improve physical capacity and metabolic health, however, the outcomes for populations who may perform resistance exercise during periods of inadequate sleep are unknown. Inadequate sleep (e.g., an insufficient duration of sleep per night) can reduce physical performance and has been linked to adverse metabolic health outcomes.

The outcomes show that inadequate sleep impairs maximal muscle strength in compound movements when performed without specific interventions designed to increase motivation. Strategies to assist groups facing inadequate sleep to effectively perform resistance training may include supplementing their motivation by training in groups or ingesting caffeine; or training prior to prolonged periods of wakefulness.

Read the full paper here:

Inadequate sleep and muscle strength- Implications for resistance training


Anterior Cruciate Ligament Injuries

Anterior cruciate ligament (ACL) injury is one of the most commonly seen injuries in sport and has a devastating influence on patients activity levels and quality of life.

Complete ACL rupture can induce other pathological knee conditions including knee instability, damage to menisci and the chondral surface. This can lead to early onset of osteoarthritis.

Athletes who participate in high demand sports like soccer, football, and basketball are more likely to injure their anterior cruciate ligaments. Female athletes had a higher incidence of ACL injuries compared with their male counterparts. Studies have shown that the incidence in female athletes is two to eight times higher than in males in soccer, basketball and volleyball.


Three bones meet to form your knee joint: your thighbone (femur), shinbone (tibia), and kneecap (patella). Your kneecap sits in front of the joint to provide some protection.

Bones are connected to other bones by ligaments. There are four primary ligaments in your knee. They act like strong ropes to hold the bones together and keep your knee stable.

Collateral Ligaments

These are found on the sides of your knee. The medial collateral ligament is on the inside and the lateral collateral ligament is on the outside. They control the sideways motion of your knee and brace it against unusual movement.

Cruciate Ligaments

These are found inside your knee joint. They cross each other to form an “X” with the anterior cruciate ligament in front and the posterior cruciate ligament in back. The cruciate ligaments control the back and forth motion of your knee.

The anterior cruciate ligament runs diagonally in the middle of the knee. It provides approximately 85% of total restraining force to prevent the shin bone from sliding out in front of the thigh bone, as well as provides rotational stability to the knee. To a lesser degree, the ACL checks extension and hyperextension ACL

Mechanism of Injury

ACL tears typically occur during activities placing excessive strain on the ACL. This generally occurs suddenly due to a specific incident, however, occasionally may occur due to repetitive strain. Movements that place stress on the ACL include:

  • twisting of the knee
  • hyperextension of the knee
  • sudden deceleration when running
  • poor landing from a jump
  • collision forcing the knee to bend in the wrong direction

More than three quarters of ACL injuries have been reported to occur in noncontact situations (no direct contact to the knee when knee is injured), mostly while performing sports. A person typically reports feeling a popping sensation in the knee, as well as a rapid onset of considerable swelling (within the first few hours following injury).

Written By: Nicole Pereira


Dordevic, M., & Hirschmann, M. T. (2014). Injury Mechanisms of ACL Tear. Anterior Cruciate Ligament Reconstruction, 49-53. doi:10.1007/978-3-642-45349-6_7

Yu, B., & Garrett, W. E. (2007). Mechanisms of non-contact ACL injuries. British Journal of Sports Medicine, 41(Supplement 1), i47-i51. doi:10.1136/bjsm.2007.037192

Paterno, M. V., Rauh, M. J., Schmitt, L. C., Ford, K. R., & Hewett, T. E. (2014). Incidence of Second ACL Injuries 2 Years After Primary ACL Reconstruction and Return to Sport. The American Journal of Sports Medicine, 42(7), 1567-1573. doi:10.1177/0363546514530088

Hewett, T. E., Myer, G. D., Ford, K. R., Paterno, M. V., & Quatman, C. E. (2016). Mechanisms, prediction, and prevention of ACL injuries: Cut risk with three sharpened and validated tools. Journal of Orthopaedic Research, 34(11), 1843-1855. doi:10.1002/jor.23414

Carrying backpacks doesn’t cause back pain in children and teenagers

Children and adolescents who carry backpacks aren’t at higher risk of developing back pain, according to a study published today in the British Journal of Sports Medicine (BJSM). Researchers found no evidence to suggest a link between carrying a heavy backpack and back pain in these age groups.

This calls into question popular opinion, as well as guidelines published by numerous organisations recommending limits on backpack weights for children. Globally, there’s been little agreement on what a limit should be. Guidelines vary, with the limit being anywhere between 5% and 20% of body weight.

Children and adolescents commonly report back pain. Research shows the prevalence of complaints by the end of adolescence reaches levels comparable with adults. There is also evidence having back pain during adolescence predicts having back pain as an adult.

Currently, the causes of back pain in children and adolescents are unclear. This is because there are no strong longitudinal studies (that follow people over a long time) that have investigated all of the possible risk factors.

Past studies in posture

Some studies have looked at links between posture or body position and carrying a backpack. These are based on the belief that poor posture would be related to discomfort, which might lead to pain. Studies have found that, for example, carrying a backpack results in changes in head posture and in the distribution of weight across the foot.

Read more: Health Check: can bad posture give you a hunchback?

Some researchers have looked at whether it can lead to a change in the curvature of the spine. One study found no significant difference in spinal curvature when carrying a bag on one shoulder compared to two shoulders. But it reported trends that might suggest spinal curvature changes with bag carrying in ways that might be detrimental to the spine.

But accurately measuring spinal curvature is a tricky business. This is because highly accurate measurements such as x-rays are unethical to use in large population-based studies.

Other studies have shown the type of backpack appears to have an effect on a child’s respiratory function too. A “mono-strap” backpack caused a reduction in forced vital capacity (a measure of a person’s breathing performance or the function of the lungs).

However, none of these studies investigated relationships between backpack carrying and pain.

A study found no significant difference in spinal curvature with a one-strap bag compared to two. from shutterstock.com

What about the current study?

The latest BJSM study was a systematic review, where researchers compiled evidence from a number of different studies. These included five prospective studies (which followed a total of 1,799 children and adolescents over time) and 63 cross-sectional studies.

Most of the evidence for an association between back pain and backpacks came from the cross-sectional studies. These compile measurements taken at a single point in time and use them to compare characteristics between specific groups of people. They are considered weaker evidence than prospective studies, which follow individuals over time.

Read more: Teenage pain often dismissed as ‘growing pains’, but it can impact their lives

Among the 63 cross-sectional studies, four found that a heavier backpack was associated with reports of back pain, three showed the method of carrying was related to pain, and three found carrying a bag for longer periods was related to having pain. One study found that 75% of students who had back pain reported that carrying their bag aggravated their pain.

It’s likely that current beliefs and guidelines for carrying school bags have been based on the data from these or similar cross-sectional studies.

With the five prospective studies, only two actually measured backpack weight and both found it wasn’t associated with reporting back pain. Two studies found that the perceived weight or reporting difficulty carrying the bag was associated with back pain for kids aged nine to 14.

The fifth study didn’t report any variables about backpacks. But in a question posed to kids (mean age of 15) with back pain asking what aggravated their pain, carrying their backpack was not mentioned.

Backpacks may aggravate existing pain. from shutterstock.com

The take-home message

The review tells us that the characteristics of a backpack don’t cause back pain. For someone who has back pain, it may seem it worsens when carrying a heavy bag or carrying it on one shoulder, but it’s unlikely the backpack was the cause of the initial pain.

The Australian Physiotherapy Association provides a message consistent with this review, recommending that moderately loaded backpacks are not detrimental to back health.

The study authors indicate the findings from the included prospective studies are limited. This is because identifying risk factors for back pain wasn’t the primary aim of these studies, so the measurements used and the timing of data collection may not have been optimal for establishing causal relationships.

Read more: Explainer: what is pain and what is happening when we feel it?

Studies investigating causal links between backpack wearing and back pain don’t exist, as study designs requiring children to carry backpacks of specific weights could not be reliably or ethically performed.

Future studies investigating the causes of back pain in children and adolescents need to consider a wide range of possible risk and lifestyle factors that might contribute to pain. For instance, reduced physical activity is known to be associated with poorer health.

Parents shouldn’t be overly concerned about backpack weight causing future problems for their children. But if carrying a heavy backpack means a child avoids walking or cycling to school, or other forms of incidental physical activity, this might be a reason to reduce backpack weight.

If you or your child already has back pain that is aggravated by carrying your bag, it makes sense to reduce its weight or carry it for less time.

Source: The Conversation, May 3rd 2018

Author: Suzanne Snodgrass, Associate Professor Physiotherapy, The University of Newcastle

Sleep On It

Did you know people spend about one-third of their lives sleeping? Therefore, which type of pillow is best? It’s a question we are asked often.

Research previously into this topic was not of high quality and hence pillow prescription has largely been provided on the anecdotal suggestions of expert colleagues and professional associations. The range of advice provided by expert colleagues and pillow manufacturers was confusing for both physiotherapists and their patients. However, recent research has been done by Dr. and Associate Professor Susan Gordon, Associate Professor Patricia Trott and Professor Karen Grimmer-Somers. Associate Professor Dr. Gordon is head of the Physiotherapy Department at James Cook University. Here is what they found;

The first investigation was a random, population-based telephone survey conducted to identify the behaviour of cervico-thoracic symptoms in the community. 46% of 812 participants reported waking with arm pain (27%), headache (19%), cervical pain (18%) and cervical stiffness (17%). Of particular interest are two contrasting groups: those who did not retire with neck symptoms but woke with them, and those who did retire with neck symptoms but woke without them. This indicates that something was happening overnight that assisted to abolish or produce symptoms.

The survey also showed that most people reported sleeping on their side (72%) for most of the night so the research studied symptom behaviour associated with pillow use in side sleepers.

Participants were randomly allocated to pillows (polyester, foam regular shape, foam contour shape, latex rubber and feather). Participants kept a diary, slept on all 5 pillows for a week, with a one-week wash-out period between pillow trials.

42.5% of patients reported no symptoms when sleeping on their own pillow. However, 50% of patients reported regular waking symptoms, failure to relieve retiring symptoms, uncomfortable pillows, and/or poor-quality sleep.

Participants own pillow performed similarly to the polyester and foam pillows in terms of production of waking symptoms and maintenance of retiring pain.

The shape of the foam pillow appeared to make no difference to waking pain or the abolition of night pain. The contour pillow was less comfortable and provided poorer quality sleep and hence was less efficacious for these reasons. Contour pillows were initially developed to support the cervical lordosis when sleeping on your back however, 43% of people using contour pillows in the phone survey were side-sleepers.

The feather pillow was a consistent poor performer in all measures and therefore cannot be recommended to patients requesting a pillow better than their own.

The rubber pillow performed consistently well and was a better performer than participants own pillow in all measures and should be recommended as an alternative should people seek a better performing pillow than their own. Furthermore the rubber pillow can be recommended in the management of waking cervical pain and headache and to improve sleep quality and comfort.

Thanks to the APA for their permission in allowing us to reproduce snippets of this article for your reading MPA In-Touch Magazine Issue 3 2012. ‘Sleep On It’ pg. 16-18.

The Placebo Effect

The basis of the word placebo comes from, in Latin, ‘it will please’. Therefore placebo is generally conceptualized as something which is done to someone rather than giving them ‘real’ treatment, per se. The response seen in the patient has nothing to do with what is in the treatment per se but it is the simulation of therapy that drives changes in the person’s brain and body. Therefore when we study the placebo effect we are studying the effect of the psychosocial context around the person and how this context affects their mind, brain and body.

There is also more than one placebo effect. From a biological viewpoint we know that certain placebo’s are mediated by our internal opioid system, or endogenous opiates, and others by chemicals (such as dopamine) and systems (motor, cardiovascular, respiratory and endocrine systems). From the psychological viewpoint, there are many instances where the expectation of benefit increases placebo effects. But there are also instances when conditioning or learning mechanisms are at play – background experience, social observation, differences in culture, etc.

Learn more from our previous blogs on this topic by clicking the links below. Some interesting reading and watching indeed!




Stability – Part 2 – The Pelvis

Stability Part 2 – Pelvic stability

PelvicStab1In the first blog on stability (click here) we spoke about the core and all the components that make up the core. We spoke about how the core acts as the stabiliser of the spine and trunk, and its importance as a point of transition of forces from the lower limbs to the upper limbs, and vice versa. This is an integral to ensure correct kinetic chain mechanics, and prevention of increased loading and injury to the spine….


Over the last 20 years the profession of sports rehabilitation has undergone a trend away from traditional, isolated assessment and strengthening. We have moved toward an integrated, functional, movement‐based approach. Being functional is of utmost importance to excellent and comprehensive rehabilitation.

Therefore focusing on the core alone is not the answer, instead we need to look at the pelvis and lumbar spine as a whole in functional movement patterns to ensure optimal positioning and loading.

What is Pelvic stability?

Pelvic Stabilisation is geared toward improving the function and strength of the pelvis and hip regions. Inefficient pelvic and hip stabilisation can lead to faulty movement patterns as listed below (seen in the pictures alongside):

  • Trendelenburg (drop hip)
  • Rotation and side flexion of the spine
  • Internal rotation of the lower limb
  • Knocked knees
  • Foot pronation
  • Excessive forward or backward pelvic tilt

These changes in body alignment can lead to problems in the lower back, hip, knee and ankle.


How does the Pelvis become inefficient in the first place?

There are many reasons as to why we see weakness in the pelvis:

  • Sedentary lifestyle resulting in increased sitting, and less activity
  • Sitting and standing in poor postures places the glutes in less optimal positions for activation
  • Pain in the lower back, hip and knee region can lead to muscle inhibition in the pelvis area
  • Pregnancy/ post-child birth

PelvicStab3When your body forgets how to properly activate the gluteal muscles, you lose the ability to move your hips through their full range of motion and compensatory recruitment of other muscles. Ultimately this means that other back and hip muscles tend to tighten up to try and stabilise your wobbly hip. This leads to overactivity of the wrong muscles which alters movement patterns and results in pain and injury.


The body works as whole and when certain body regions are inefficient, the body will find a way to make the movement happen using another muscle or joint in a way that was not intended. If your not feeling 100% it is likely that your body is already ‘cheating’ and not moving the way it should. A full assessment by your Physiotherapist will identify and optimise your movement and performance, as well as prevent injury and pain.

Written By: Nicole Pereira (Physiotherapist & Pilates Instructor, Nelson Bay Physiotherapy & Sports Injury Centre)


Phrompaet, S., Paungmali, A., Pirunsan, U., & Sitilertpisan, P. (2011). Effects of Pilates Training on Lumbo-Pelvic Stability and Flexibility. Asian Journal of Sports Medicine, 2(1). doi:10.5812/asjsm.34822In‑text: (Shamsi, Sarrafzadeh, & Jamshidi, 2014, p. xx)

Shamsi, M. B., Sarrafzadeh, J., & Jamshidi, A. (2014). Comparing core stability and traditional trunk exercise on chronic low back pain patients using three functional lumbopelvic stability tests. Physiotherapy Theory and Practice, 31(2), 89-98. doi:10.3109/09593985.2014.959144

Physiotherapy and Prostatectomy

Physiotherapy for Urinary Incontinence following surgical prostate gland removal.

Evidence shows that physiotherapy-guided pelvic floor retraining and exercise helps men regain continence significantly faster and more effectively than men not receiving treatment.

Urinary incontinence, or bladder weakness or leakage, is an unfortunate but very common result for men who undergo surgical removal of their prostate gland as treatment for prostate cancer. Rates of incontinence for men post-surgery vary greatly across the literature but can be as much a 70% in the short term. This number decreases with time post-surgery, however up to 5% of men may require surgery to help them recover their continence. It is estimated that 1 in 7 men will be affected by prostate cancer in their lifetime.



The cause of urinary incontinence following surgical prostate removal is the disruption of two muscles acting like valves, called urinary sphincters. One is around the bladder neck, the other is around the urethra and is part of the pelvic floor. These muscles act together to control the flow of urine by opening and closing the bladder ‘door’ on automatic command from your brain. The prostate is a walnut-sized male reproductive organ located at the base of the bladder and alongside the urethra. If the sphincters or pelvic floor are damaged or weakened during removal of the prostate gland then urinary incontinence can result. As well as these surgical side-effects, radiotherapy treatment can cause irritation, inflammation and swelling to the bladder, prostate, urethra and rectum and this may cause urinary issues, although this is much less common.

There are two main forms of urinary incontinence. Stress urinary incontinence (SUI) occurs on an action or movement that causes stress to the pelvic floor such as coughing, sneezing, laughing, lifting or jumping. This is due to an increase in abdominal pressure on these activities. Urge urinary incontinence (UUI) can occur when the person feels unable to hold their urine once they decide they need to seek out the toilet/on a full bladder ie a sudden strong urge with the inability to delay it. Individuals may experience one or many of the following:

  • Urgency (as per UUI)
  • Frequency (needing to urinate every two hours or less)
  • Pain (any discomfort such as burning, stinging or pain while urinating)
  • Nocturia (need to urinate overnight)
  • Intermittency (a stop/start urinary stream)
  • Dribbling (slight urinary leakage after urinating is completed)
  • Straining (having to push or strain to begin your urinary stream)
  • weak urinary stream (slow flow with minimal force).

The other unfortunate side effect of pelvic floor damage or weakness following prostate surgery is erectile dysfunction as this control involves the same muscles and nerves. Men may experience problems in this area following surgery.

Many men find that their symptoms can resolve or minimise within 12 months after surgery but research has proven that early pelvic floor retraining involving education and strengthening exercises can significantly shorten the time period for full recovery. This is where physiotherapy comes in and is recommended by the Prostate Cancer Foundation of Australia.

The pelvic floor is a sling of muscles and connective tissue that spans the area at the base of your pelvis. It provides support to our organs including bladder and intestines (and uterus in females). It helps control our bladder, as discussed above, as well as our rectum. It also works in conjunction with our abdominal muscles to form our ‘core.’

Our pelvic floor muscles can be trained and strengthened like any other muscle in our body. If we want strong biceps what are we going to do? Bicep curls! Want strong quads? We’re going to squat. So if we want stronger pelvic floor muscles, we need to exercise them. The trick is learning how to activate them correctly, as for many men it’s not something they’ve ever had to do or think about before. If we are doing the contractions incorrectly or imperfectly then the desired results will not be forthcoming. One of our professionally trained physiotherapists will be able to work with you to teach you the appropriate cues and techniques for your individual case to ensure correct activation of the pelvic floor muscles and monitor your progress with the goal of normalising function to allow you to return to regular daily activities and your favourite exercise or leisure activities.

In our clinic the assessment of your pelvic floor activation and the subsequent education and practice is done in a completely non-invasive manner, where the physiotherapist may simply palpate your tummy muscles, which also contract when we correctly activate our pelvic floor. Once the physiotherapist ascertains that you are able to engage the right muscles with the correct technique, they will then provide you with a personalised strengthening exercise program for you to continue at home. We will then follow you up regularly to check that progress is being made and to ensure correct technique is maintained. At these times we will also progress the difficulty of your exercises as you improve, and guide you through returning to any more demanding sports, exercise and leisure activities you may be eager to get back to.

Physiotherapy and pelvic floor strengthening exercises can be very beneficial prior to prostate removal surgery for those men who have some warning and preparation time between diagnosis and potential surgery. In this instance we would perform the same assessments and provide strengthening exercises to do to help strengthen your pelvic floor in the lead up to surgery with the idea of minimising weakness post-surgery. This is very similar to what we do with a lot of clients in the lead up to their total hip or knee replacements, strengthening the quadricep and gluteal muscles to provide a good base strength for their post-surgical recovery.

If you or someone you know are dealing with a prostate cancer diagnosis and are facing prostate gland removal, please consider seeking physiotherapy treatment in the lead up. If you have undergone prostate removal and are experiencing any adverse side effects please don’t suffer in silence, we are here to help.

Written by: Laura Black



  1. Cornel, E. B., de Wit, R., & Witjes, J. A. (2005). Evaluation of early pelvic floor physiotherapy on the duration and degree of urinary incontinence after radical retropubic prostatectomy in a non-teaching hospital . World Journal of Urology , 23(5), 353-355.
  2. https://www.pelvicpainrehab.com/male-pelvic-pain/4630/what-does-physical-therapy-do-for-men-following-prostatectomy/
  3. https://www.continence.org.au/pages/continence-management-following-prostate-surgery.html
  4. http://prostate.org.au/media/743467/physiotherapy-before-and-after-prostate-cancer-surgery.pdf
  5. Santos NA et al. Assessment of physical therapy strategies for recovery of urinary continence after prostatectomy. Asain Pac J Cancer Prev 2017;18(1):81-86. doi:10.22034/APJCP.2017.18.1.81
  6. https://www.continence.org.au/pages/continence-management-following-prostate-surgery.html
  7. Wolin, K., Luly, J., Sutcliffe, S., Andriole, G. & Kibel, A. (2010) Risk of Urinary Incontinence Following Prostatectomy: The Role of Physical Activity and Obesity. J Urol, 183(2): 629–633.
  8. http://www.prostate.org.au/ (Prostate Cancer Foundation of Australia)
  9. http://www.prostate.org.au/media/468680/understanding-urinary-problems.pdf

New GPs guideline recommends physio over opioids

A new guideline released by the RACGP today addresses the growing community concern over opioid misuse and addiction. A key recommendation is that GPs refer patients to physios early for acute musculoskeletal pain.

Prescribing drugs of dependence in general practice – part C recognises that drugs of dependence (ie opioids) have important therapeutic uses, but that prescription of these medicines must always be clinically appropriate and supported by national and state laws.

One of its recommendations to GPs is to engage a physio early in more severe acute musculoskeletal injuries, as well as look at multidisciplinary care options for their patients suffering chronic pain.

APA member Lorimer Moseley, who is Professor of Clinical Neurosciences and Chair in Physiotherapy at the University of South Australia, was involved in the review process for the new RACGP guideline. Professor Moseley is at the forefront of chronic and complex pain treatment approaches internationally. He said, “That physiotherapists are critical in delivering evidence-based care is accepted and not surprising; modern physiotherapists are field leaders in their understanding of contemporary pain science. They have an ideal skill set to facilitate recovery and to prevent chronic pain.”

APA National President Phil Calvert welcomed the new guideline, but also went a step further. “Our members work with patients who suffer acute pain on a daily basis, so we know that early and regular physio treatment leads to beneficial outcomes for them. But to really address the issue of reducing opioid prescriptions, patient referrals to physios needs to be supported by a government funding mechanism.”

“This will allow patients to be active participants in their recovery from injury and chronic pain. Short term medicine prescription may be a part of this, but it doesn’t have to be the only solution. Physio is a highly viable, evidence based treatment for acute and chronic pain conditions, and is also less costly to the health system – and the economy as a whole – when compared to long term opioid use and the complex personal and social issues that go with this.”

Source: APA News Media Release 27th October 2017

Straighten Up

“Ooh but it won’t happen to me”…..Is that what you thought when you looked at this photo?…… A common thought these days when we hear about cause and effect when it relates to yourself is to think exactly that. What is it that makes you think that way? Is it the fact that you’re only young and that is so far away? Is it shear stubbornness or neglect of the natural progression from where you currently are? Or is it the comfort of knowing that you hold yourself well and are doing as much as you can to prevent that happening?

So the real question then becomes, what are YOU doing to support the thought “ooh but it wont happen to me”? That’s where the cause can be altered to create a different effect.

Research abounds with information regarding the change in our body tissues over the course of time. Many of these changes occur from quite early in our life and slowly change, whilst others seemingly occur overnight (how many of you almost overnight noticed a change in your vision, perhaps with some initial neglect, and now can see the light again once you were prescribed glasses). Whilst we cannot altogether stop the natural age related change within our tissue, we can in many cases, slow the progression or deterioration of this tissue with age. A great example of this is the effect that resistance training (strength) can have upon muscle tissue and the bodies metabolic processes to save off insulin resistance changes and diseases like diabetes, for cardiovascular and respiratory benefits and of course falls prevention.

So how does the way we move affect our body and it’s tissue? The answer is it can have a positive influence (as for the example above) or a negative influence (for example how bending or sitting poorly can effect the loading on the lower back). The below Figures (McGill, 1997) show how the repetitive effects of small loads (top Figure) or the sustained effect of a small load (bottom figure) can result in tissue fatigue, reducing the failure tolerance and leading to failure. This can also increase the risk of a single event (a single higher load) causing a tissue failure (eg. a fall to the ground resulting in a fracture from a seemingly quite low force). Part of good musculoskeletal health is having the ability to resist force and create force without causing tissue failure. A key feature is the positioning of our body in space in such a way that the joints, muscles and other tissue can create their desired effect with minimal energy production or force absorption thereby reducing their risk of injury. Therefore, if your thought was “it wont happen to me” then make a change now because without perfect mechanics the effect of gravity is such that the cumulative effect can result in this change occurring slowly and then before you know it it’s either a lot harder to change or it can’t be changed.

repeated load

sustained load


The opening picture depicts how slouching, sitting poorly/too long, failing to stand tall when younger can effect the body in such a way that by the time your older it’s impossible to stand up straight. It may not happen overnight but it does happen!

I have the picture of a teenager sitting in front of me slouching all day at school/studying at home, standing slouched and thinking “it won’t happen to me”. My advice is let’s try and keep what you have before it breaks as opposed to trying to fix it once it is broken. That young flexible spine with repetitive or prolonged loading in this way is subjected to altered loading and becomes stiff to straighten. The soft-tissue at the front of the body shortens and ties the body down making it harder to straighten up whilst the tissue at the back is lengthened and working hard just to counter gravity and try to keep some resemblance of upright so we can see where we are going. This tissue gets tired and cranky as it’s not designed to work in this way, whilst our stabilising muscles become weak (we haven’t been using them to hold us up but rather relying on ‘hanging’ off our joints to do so).

Before long we are in our 30’s and 40’s going through “beautiful chaos” and we start noticing, most of the time, pain somewhere. Professional help is sought and guess what, you find that your spine’s not as mobile as it once was, you’re a bit weaker in places you should be stronger and your tight in areas you once had good flexibility. The bad news is it takes longer to correct than when you were a teenager and might not be fully reversible requiring personal diligence to stay where you are and not regress further. The good news is that what you need to do now is easier than what you might need to do in another 20-30 years if you hadn’t attended to it. Seek assistance now if this is you!

Then without attention you reach the stage of the gentleman pictured. You can’t stand up straight, your neck hurts because it’s having to look up all the time just for you to see where you are going, you can’t reach as high, you have arthritis throughout your body, your not as balanced on your feet (may be complicated by diabetes or vascular effects reducing sensation in the feet) and need an aide to prevent falling. It doesn’t happen overnight but it does happen! To combat this I get clients of mine to stretch their chest through a doorway and then lie on a rolled towel across their upper back to open their chest and extend the spine. Similarly when sitting it’s not only important to break it up regularly by moving (see ‘Sitting is the New Smoking’) but also to make sure you sit well. This can be done by sitting to maintain a slight curve in the small of your back with your knees higher than your hips, pelvis tilted forward, chest lifted and head over your shoulders lengthening towards the ceiling. 

Make the change now and seek the advice and correction of a trusted physiotherapy professional to set you in the right direction. A small investment in time now will have much longer lasting effects for your entire life to help you “live your whole life better”. The truth is too, the sooner and younger the start, the easier any change is and the more you can do that will make a difference. That’s important, seek professional advice but remember the professional is there to help you but ultimately you are the main player! 99% of the time you are out living your life (not with the professional having treatment) and so the professional needs to educate you and arm you with tools (eg. Exercises) to help you maintain and improve you in their absence. Without active engagement, passive treatment is never going to achieve the results that could be achieved. So if you are motivated but feel that your care is purely reliant on what the practitioner does with you (ie. you haven’t been given any tools to help yourself as well) then I would recommend you seek a trusted professional with a more wholistic view of your health.

Written by: Scott Ward

Disclaimer: These are general comments and do not take into account your specific health condition. It is extremely important to get advice before undertaking any new exercises but one thing is sure though, it is very important to have a professional who can help you plan ahead. You can contact our team on the following details to arrange a meeting to look at your current circumstances.

Sitting is the new smoking?

It’s partly true!……..but it’s not all about sitting. It’s more about how a sedentary lifestyle, including sitting, is perhaps the new smoking. However, unlike smoking which has no health benefits to anyone and I would be happy to eradicate, sitting is something that we don’t want to eradicate and is in fact something that we should have some of, in some capacity. Just not too much!

We know that prolonged sitting is not good for our health, because people have picked up this new message (‘sitting is killing you’) and sales of standing desks have rocketed. Anecdotally however, there are people who also have musculoskeletal problems from standing all day. In short people hear the message that sitting is bad so they stand for long periods instead. It’s important to note prolonged standing can also have adverse health effects. Compared to sitting, when we stand, our hearts and circulatory systems work harder to maintain blood flow to the brain, because they are countering the effects of gravity. Standing still for long periods of time can lead to swelling, heaviness or cramping of the legs. Enforced standing has actually been used as an interrogation technique. That is why sitting is still a part of what we need to do each day but just not in the volume that we do it!

The following is a combination of journal research, blogs, press articles and my thoughts on this topic. I hope you enjoy the read and it creates a call to action for yourself if it’s relevant.

Scary Facts

  • Physical inactivity contributes to over three million preventable deaths worldwide each year (that’s 6 per cent of all deaths). It is the fourth leading cause of death due to non-communicable diseases.
  • It is also the cause of 21–25 per cent of breast and colon cancers, 27 per cent of diabetes cases, and around 30 per cent of ischaemic heart disease. In fact, physical inactivity is the second highest cause of cancer in Australia, behind tobacco smoking.
  • The researchers linked four or more hours a day of television watching with an 80 per cent increased risk of death from heart disease, and a 46 per cent increased risk of death from all causes. That’s compared to people who spent less than two hours a day in front of the box.

So let’s have a look at general activity levels within Australia.

According to ‘Australia’s Health In Brief report 2016’ in 2014–15, almost half (45%) of adults aged 18–64 were inactive or insufficiently active for health benefits, which was similar to the proportion in 2011–12.

In 2009 the “Stand Up Australia” report found:

  • 77% of office-based, call centre and retail employee behaviours during their working day was spent sitting (equated to 70% of the day on work days).
  • Individuals who spend high amounts of time sitting at work also tend to spend high amounts of time sitting on non-work days. (equated to 62% of the day on non-work days).
  • Participants in the study perceived they had much higher levels of physical activity than they did when measured objectively (accelerometers).
  • Only 5% of the time on work and non-work days was performing moderate-to-vigorous intensity physical exercise (recommended in the current National Physical Activity Guidelines) with the remainder occupied with light-intensity (incidental) physical activity.
  • Significantly more time was spent in light-intensity activity on non-work days compared with work days.
  • Interestingly, more moderate-to-vigorous intensity activity occurred on work days compared with non-work days.

If you live a sedentary lifestyle, you have a higher chance of developing:

  • Obesity
  • Type 2 diabetes
  • Heart disease
  • Depression and anxiety.

Therefore, living a sedentary lifestyle can be dangerous to your health!

Many people know when they’ve been sitting too long because their back or neck gets sore. These are effects many can relate to because we can actually feel them. But it’s what you can’t feel or see that you may need to be concerned about. Canadian researcher Dr Peter Katzmarzyk, for instance, found that those who sat almost all of the time had nearly a one-third higher risk of early death than those who stood almost all of the time.

University College London researcher Dr Emmanuel Stamatakis found similar results among women in the United Kingdom: those whose work involved mostly standing/walking about had a 32% lower risk of early death than those who worked in sitting jobs.

 How does a sedentary lifestyle affect your body?

Humans are built to stand upright. Our heart and cardiovascular system work more effectively this way. Therefore when sitting for long periods of time the following can happen:

Legs and gluteals (bum muscles)

Sitting for long periods can lead to atrophy of large leg and gluteal muscles, where they weaken and waste away. If you don’t use them, you lose them! These large muscles are important for walking and for stabilising you. If these muscles are weak you are more likely to injure yourself from falls, and from strains when you do exercise.

One study reported 2.5 times higher average muscular activity of the thigh when standing compared to sitting. This is important for improving blood sugar profiles and vascular health, reducing the risk of early death.


Moving your muscles helps your body digest the fats and sugars you eat. If you spend a lot of time sitting, digestion is not as efficient, so you retain those fats and sugars as fat in your body.

The latest research suggests you need 60–75 minutes per day of moderate-intensity activity to combat the dangers of excessive sitting.

Hips and back

Just like your legs and gluteals, your hips and back will not support you as well if you sit for long periods. Sitting causes your hip flexor muscles to shorten, which can lead to problems with your hip joints.

Sitting for long periods can also cause problems with your back, especially if you consistently sit with poor posture or don’t use an ergonomically designed chair or workstation. Poor posture may also cause poor spine health such as compression in the discs in your spine, leading to premature degeneration, which can be very painful.

Anxiety and depression

We don’t understand the links between sitting and mental health as well as we do the links between sitting and physical health yet, but we do know that the risk of both anxiety and depression is higher in people that sit more.

This might be because people who spend a lot of time sitting are missing the positive effects of physical activity and fitness. If so, getting up and moving may help.


Emerging studies suggest the dangers of sitting include increasing your chances of developing some types of cancer, including lung, uterine, and colon cancers. The reason behind this is not yet known.


Studies have shown that even five days lying in bed can lead to increased insulin resistance in your body (this will cause your blood sugars to increase above what is healthy). Research suggests that people who spend more time sitting have a 112 per cent higher risk of diabetes.

Varicose veins

Sitting for long periods can lead to varicose veins or spider veins (a smaller version of varicose veins). This is because sitting causes blood to pool in your legs. This is why you here of people getting DVT’s with flying, fluid flows better through a straight pipe than one with a ‘kink’ in it.

Deep vein thrombosis

Sitting for too long can cause deep vein thrombosis (DVT). A deep vein thrombosis is a blood clot that forms in the veins of your leg.

DVT is a serious problem, because if part of a blood clot in the leg vein breaks off and travels, it can cut off the blood flow to other parts of the body, this is a medical emergency that can lead to major complications or even death.

Stiff neck and shoulders

If you spend your time hunched over a computer screen, this can lead to pain and stiffness in your neck and shoulders.

Epidemiological studies show that neck pain is:

  • greatest in females
  • peaks in the 40’s (although age is not a risk factor, it is a prognostic factor)
  • unmodifiable risk factors are;
    • female
    • previous neck pain
    • number of children
    • previous LBP
    • self-assessed poor health (?modifiable)
    • poor psychological health (?modifiable)
  • risk factors for office workers are:
    • low workplace satisfaction
    • keyboard close to the body
    • low work variation
    • self perceived muscular tension
  • not risk factors for office workers:
    • frequency of physical activity during leisure
  • preventative (risk and prognostic factors) in office workers:
    • greater cervical ROM
    • greater Cx extensor endurance
    • a program of cervical strengthening exercises

How can you save your health from the dangers of sitting?

If you’re not getting enough activity in your day, it’s not too late to turn it around and gain great health benefits in the process.

To obtain the health benefits of standing and reduce the potential adverse effects, the best option is to alternate between sitting and standing. Our message is to stand up, sit less and move more.

Alternating between sitting and standing will increase muscular contractions, stimulating blood flow and resulting in more calories burnt and healthier blood sugar levels. Recent findings from a lab show that alternating between 30 minutes of sitting and standing can improve blood sugar levels after a meal.

The point is that our physical activity guidelines promote breaking up sitting time. We can debate whether standing is better for you than standing but what is most important is that people need to move more. Remaining in one posture for long periods is not good for muscles that are not trained to do that. The other important thing is no matter what you do, there is a difference in doing the right way versus doing it the wrong way and often what we see are the effects of doing it the wrong way.

??Purchase a standing desk??

Now, if you’re leaning towards getting a standing desk but are concerned about your concentration and productivity, there’s some good news. Research shows task performance such as typing, reading and performing cognitive tests is largely unaffected by standing desks. A study by Commissaris et al., (2010) measured both objective and perceived work performance during the performance of five standardised but common office tasks in an office-like laboratory setting. With the exception of high precision mouse tasks, short term work performance was not affected by working on a dynamic or a standing workstation. The participant’s perception of decreased performance might complicate the acceptance of dynamic workstations, although most participants indicate that they would use a dynamic workstation if available at the workplace.

Build more activity into your day

The key is to avoid sitting as much as possible or at least break up your sitting time – even if only by standing, which uses more muscles than sitting. Research shows that people who break up their sedentary time throughout the day, regardless of their total sedentary time, have a better health profile.

Some ways you can incorporate activity into your day are:

  • Walk or cycle, and leave the car at home.
  • For longer trips, walk or cycle part of the way.
  • Use the stairs instead of the lift or escalator, or at least walk up the escalator.
  • Get off the bus one stop early and walk the rest of the way.
  • Park further away from wherever you’re going and walk the rest of the way.
  • Walk to the printer

Be active at work

 You can move around at work more than you think:

  • Take the stairs instead of the lift.
  • Walk over and talk to your colleagues instead of emailing them.
  • Take your lunch break away from your desk and enjoy a short walk outside if you can.
  • Organise walking or standing meetings.
  • Stand up or walk while on the phone
  • Stand up every 30 mins
  • Try a simple exercise program at work

– forward raise, lateral raise (deltoid) – (use water bottle for weight) 10 X2

– shoulder shrugs 10 X 2

– resisted neck flexion, extension and lateral flexion – 5 sec holds 70-80% MVC

Reduce your sedentary behaviour

 Here are some simple ideas to keep moving while you’re at home:

  • When you’re tidying up, put items away in small trips rather than taking it all together.
  • Set the timer on your television to turn off an hour earlier than usual to remind you to get up and move.
  • Walk around when you are on the phone.
  • Stand up and do some ironing during your favourite television shows.
  • Rather than sitting down to read, listen to recorded books while you walk, clean, or work in the garden.
  • Stand on public transport, or get off one stop early and walk to your destination.

And if you work in an office:

  • Stand up while you read emails or reports.
  • Move your rubbish bin away from your desk so you have to get up to throw anything away.
  • Use the speaker phone for conference calls and walk around the room during the calls.


Moving around is good for you. It’s good for your physical health as well as your mental health.

Sitting or lying for too long increases your risk of chronic health problems, such as heart disease, diabetes and some cancers.

Being active is not as hard as you think. There are lots of simple ways to include some physical activity in your day.

Consult us at Nelson Bay Physiotherapy & Sports Injury Centre to receive personalised recommendations around your best sitting position, chair set-up, workstation, driving position, computer, keyboard or even standing work-station set-up. We have a range of products to demonstrate and recommend to you to help make your day easier. 

Written by: Scott Ward


Andersen L.L., Christensen K. B.,  Holtermann A., Poulsen O.M., Sjøgaard G., c , Pedersen M. T., & Hansen E.A. (2010). Effect of physical exercise interventions on musculoskeletal pain in all body regions among office workers: A one-year randomized controlled trial. Manual Therapy 15 (2010) 100–104.

Australian Government: Australian Institute of Health & Welfare. Australia’s Health In Brief (2016). https://www.nelsonbayphysiotherapy.com.au/wp-content/uploads/2015/05/Australias-Health-In-Brief-2016.pdf

Commissaris D. A. C. M., Konemann R., Hiemstra-van Mastrigt S., Burford E., Botter J., Douwes M., & Ellegast R. P. (2014). Effects of a standing and three dynamic workstations on computer task performance and cognitive function tests. Applied Ergonomics 45 (2014) 1570e1578

Medibank Private. Stand-up Australia: Sedentary Behaviour in Workers, August 2009. https://www.nelsonbayphysiotherapy.com.au/wp-content/uploads/2015/05/Stand-Up-Australia.pdf

The Sydney Morning Herald http://www.smh.com.au/technology/sci-tech/health-check-sitting-versus-standing-20140818-105jfq.html

Victoria State Government Better Health Channel https://www.betterhealth.vic.gov.au/health/healthyliving/the-dangers-of-sitting


Greater Trochanteric Pain Syndrome

Greater Trochanteric Pain Syndrome (GTPS) refers to pain originating from various structures in the lateral hip; mainly tendons and muscle tears. Traditionally lateral hip pain has been diagnosed as ‘Trochanteric Bursitis’, but imaging, histological and surgery studies have challenged this diagnosis by disproving the presence of any inflammation in this condition.

Lateral hip pain is termed GTPS as an umbrella term as several muscles insert on or near the greater trochanter (hip bone) that could be the cause of pain (gluteus maximus, gluteus medius, gluteus minimus, piriformis, tensor fascia late, iliotibial band, obturator externus, and obturator internus).

Who is affected?

Lateral hip pain affects 10% to 25% of the general population. GTPS most frequently occurs in late middle-aged women.


Patients with GTPS will present with lateral hip pain, which is aggravated with pressure on that side of the body, such as while lying down. They often complain of pain with walking, stairs and may admit that pain is worse while standing on the affected leg. There may be associated pain radiation down the outside thigh but rarely below the knee.

How is it caused?

The cause of greater trochanteric pain syndrome is not completely understood, although rheumatologists and orthopeadic surgeons are becoming increasingly aware that local microtrauma leading to tears of the abductor (Gluteus minimimus/ maximus) tendons may be a leading cause of this syndrome.

It is hypothesised that excessive hip adduction (crossing over of legs) during functional activities may compress the gluteus medius and minimus tendons against the greater trochanter (hip bone) causing damage. Examples include standing with one hip in adduction (hanging on one hip), sitting with knees together or crossed over, and poor pelvic stability in dynamic single leg loading tasks. Running with a midline or cross-midline foot-ground contact pattern, on the camber of a road or in the same direction around a track are examples of dynamic activities that also adduct the hip, and could increase risk for development of lateral hip pain.

Additionally, the increased prevalence of GTPS in post-menopausal women suggests that deficits in female sex hormone may be implicated in the condition.


Research shows that an exercise program targeting gluteal strength and correction to the kinetic chain is superior to cortisone injection, shockwave therapy and rest alone.

Here at Nelson Bay Physiotherapy we perform comprehensive clinical examinations to correctly diagnose and treat GTPS. From these assessments, we are able to provide tailored exercise programs, manual therapy, electrotherapy and taping to correct kinetic chain dysfunction and gluteal weakness. We ensure an appropriate and progressive loading program to ensure the tendon not only recovers, but the pain does not come back again. We work with your lifestyle and movement patterns to ensure that you’re not aggravating your tendons on a day to day basis, and modify your activities as needed.


Hip pain is a major impediment to good health, capacity for physical activity, quality of life and mental health. Activity limitation because of hip pain is especially disturbing in older women (most commonly affected) due to known issues of loss of bone and muscle strength associated with menopause and increasing age.

Don’t put up with your uncomfortable hip – come and see us today to live your whole life better.

Written By: Nicole Pereira


Allison, K., Vicenzino, B., Wrigley, T.V., Grimaldi, A., Hodges P.W. & Bennell, K.L. (2016). Hip Abductor Muscle Weakness in Individuals with Gluteal Tendinopathy. Medicine & Science in Sports & Exercise, 48(3), 346-352. doi:10.1249/mss.000000000000078

Fearon, A. M., Cook, J. L., Scarvell, J. M., Neeman, T., Cormick, W., & Smith, P. N. (2014). Greater Trochanteric Pain Syndrome Negatively Affects Work, Physical Activity and Quality of Life: A Case Control Study. The Journal of Arthroplasty, 29(2), 383-386. doi:10.1016/j.arth.2012.10.016

Fearon, A. M., Scarvell, J. M., Neeman, T., Cook, J. L., Cormick, W., & Smith, P. N. (2012). Greater trochanteric pain syndrome: defining the clinical syndrome. British Journal of Sports Medicine, 47(10), 649-653. doi:10.1136/bjsports-2012-091565

Grimaldi, A., Mellor, R., Hodges, P., Bennell, K., Wajswelner, H., & Vicenzino, B. (2015). Gluteal Tendinopathy: A Review of Mechanisms, Assessment and Management. Sports Medicine, 45(8), 1107-1119. doi:10.1007/s40279-015-0336-5

Are you Stable or ?

What is Stability?

Clinical stability can be defined as the spines ability under load to limit patterns of displacement in order not to damage or irritate the spinal cord and nerve roots, and to prevent deformity or pain caused by structural changes. Spinal stability is the basic requirement for the transfer of movement between the upper and lower extremities used for tasks of daily living, exercise and sports. Studies show that without any forms of ‘stability’ the human spine collapses easily.

How Does it Work?

Stability is provided in a coordinated manner by the active (e.g. muscles), passive (e.g. lumbar spine/ ligaments) and control (e.g. neurological) systems. The deep core muscular system is a 3 dimensional space comprised of:

Transversus Abdominus

  • Acts to compresses the abdominal cavity, by doing so it acts as a lumbar stabiliser in that it doesn’t actually move the trunk, but rather supports and stabilises each individual vertebrae.
  • Assists in breathing.


  • This muscle lies in between either side of the spinous processes of the spinal vertebrae, and runs along the entire length of the spine.
  • The multifidus provides stiffness, stability, and support to the spinal column.

Pelvic Floor

  • Forms the floor of the deep core, aids in supporting pelvic organs ( e.g. bladder,  intestines).
  • Assists with continence control.
  • Helps to maintain optimal intra-abdominal pressure.


  • Forms the roof if the deep core.
  • Helps control intra-abdominal pressure for optimal stabilisation support of the lumbar spine.


Why is it so important?

The inherent nature of these muscular boundaries is to produce a corset like stabilisation effect on the trunk and spine. This is important in the prevention of early biomechanical deterioration of the spine components (e.g. arthritis) and reduction of energy expenditure during muscle activity.

More over substantial evidence exists demonstrating that people with lower back pain have insufficient activation and weakening of transversus abdominus and multifidus than those without lower back pain.

Here at Nelson Bay Physiotherapy and Sports Injury Centre we believe that stability is an integral part in injury rehabilitation and prevention. As part of our services we run tailored Pilates programs to target your individual needs. For more information please ask our friendly reception staff, click here ‘Clinical Pilates’ or read our previous post ‘Personalised Pilates Men too’.

Written by: Nicole Pereira


Eunyoung, K., & Hanyong, L. (2013). The effects of deep abdominal muscle strengthening exercises on respiratory function and lumbar stability. Journal of Physical Therapy Science, 25(6), 663-665.

Chang, W.D., Lin, H.Y., & Lai, P.T. (2015). Core strength training for patients with chronic low back pain. Journal of Physical Therapy Science, 27(3), 619-622.

Izzo, R., Guarnieri, G., Guglielmi, G., &Muto, M. (2012). Biomechanics of the spine. Part 1: spinal stability. European Journal of Radiology, 82(1), 118-126.

Ramos, L.A., Franca, F,J., Callegari, B., Burke, T.N., Magalhaes, M.O. & Marques, A.P. (2015). Are lumbar multifidus fatigue and transversus abdominus activation similar in patients with lumbar disc herniation and healthy controls? A case control study. European Spine Journal, 25 (5), 1435-1442.

Southwell, D.J.; Hills, N.F.; Mclean, L. & Graham, R.B. (2016). The acute effects of targeted abdominal muscle activation training on spine stability and neuromuscular control. Journal of NeuroEngineering and Rehabilitation, 13(1), 19.

Running Injuries and Gait Analysis

Running is a popular fitness choice for many Port Stephens residents. It is inexpensive and requires minimal equipment and allows us to take advantage of some of our beautiful natural surrounds.

However, research suggests that between 30% and 80% of recreational runners sustain a running-related injury at some point in their training. These injuries can cause disruption to training and prevent participation in events.

Risk factors for running injuries:

Having a previous running-related injury

This is a risk factor for further injury for two reasons. Firstly, the ‘new’ injury may be an exacerbation of an old injury that was not completely recovered, or secondly, a new injury may be caused by runners changing their running pattern (gait) to protect an older injury and therefore cause a new problem.

High amount of training per week

Higher volumes of running per week are associated with an increased risk of injury due to the heavier load on joints and tissues.

‘Too much too soon’

If we gradually increase the distances that we run, our muscle, tendon, and bone cells can respond to this increased workload and increase their ‘strength’ and endurance. However, if we increase this workload too quickly, these structures can start to break down. The chart below shows the increased injury risk associated with higher rates of increased training load per week. Note that if a runner tries to double their training load each week they put themselves at a 50% chance of creating an injury!



Speed training and hills

Incorporating speed training and hill runs into training too soon or too quickly also increases the stress on our joints and soft tissue making them more prone to injury. Speed work and sprinting tends to place the runner into more of a tip-toed running gait, increasing the strain on their calf and other muscles. Hill running does a similar thing by forcing us to propel ourselves upwards, using greater amounts of force.

Gait Analysis

Gait analysis can be used to assess gait abnormalities that lead to injury.

One of our highly trained physiotherapists will be able to identify abnormalities in your gait simply by watching you run on our treadmill. Video can be used to slow down your running action for both assessment and correction purposes.

Running gait analysis can show us the following variables:

  • Cadence (step rate): This is how many steps a runner takes per minute. A lower step rate per minute has been shown to increase the load or impact through your joints when running.
  • Crossover gait: runners who tend to have a narrow step width and cross their feet over their midline have an increased risk of ITB problems and shin splints (see injuries below).
  • Alignment: this may be an excess of rotation of the runner’s hips or shoulders, or a lot of side-to-side (lateral) motion of the hips. This can be suggestive of poorer core control in running.
  • Arm swing and knee lift: variations of these can make us more or less effective in our running.
  • Stride length/foot landing: the drawing below shows the three variations in how runners land on their foot during running. A rear-foot strike has us landing on our heel, a forefoot strike has us more on our toes, and mid-foot strike is landing more on the middle of our foot. The different striking positions are associated with different injuries, and the perfect landing position is individual to each runner.


  • Posture/hip position: it is important to align our posture in running before trying to change other elements of our gait.

Common Injuries We See:

Approximately 50% of injuries we see in runners are knee injuries. Some examples are:

  • Patellofemoral pain: pain in the front of the knee and associated with the quadriceps and ITB.
  • ITB friction syndrome: friction of the iliotibial band on the outer side of the knee.

Other common running injuries include:

  • Achilles tendinopathy: damage to the Achilles tendon at the rear of the ankle.
  • plantar fasciopathy: pain in the arch of the foot, often associated with calf problems.
  • Shin splints (medial tibial stress syndrome): pain in the front of the shins, also associated with calf issues.
  • Stress fractures: can be in any loaded bone but often in the foot. Usually associated with the ‘too much too soon’ concept.
  • Ankle sprains
  • Muscle strains or tears

Early signs of an injury

  • Joint pain
  • tender to touch
  • swelling
  • Reduced ROM
  • weakness


  • Identification of modifiable risk factors .eg with a running gait analysis, can allow us to help you change elements of your gait or running style to decrease the load on certain muscles or joints and make you more efficient.


  • gait analysis to assess and correct running gait anomalies
  • Manual (hands-on) therapy.
  • Strengthening exercises tailored to the findings of your gait analysis. Your physiotherapist may diagnose a weakness in particular muscles which is causing you to fall into the poor gait patterns described above. Specific and targeted strengthening exercises will help you combat this problem.
  • modifying your footwear to suit you. Your physiotherapist can recommend the best running footwear for your foot shape, running mechanics and training load. Footwear ranges from minimalist, meaning there is minimal material beneath your foot and no change in elevation between your heel and toes, to full support which has up to an 8mm variation in the sole from heel to toe and offers a lot more cushioning.
  • Orthotics prescription. Some people who are found to over-pronate in their gait (ie. their foot rolls in and arch flattens) may benefit from the fitting of orthotics to suit their feet. The orthotics can help support these runner’s feet and assist in properly aligning their lower limbs in their running gait.

Written by: Laura Black

More of the Same or Balance?

Have you ever considered what you do each day from a movement and positioning point of view? Are you static or dynamic in your movement? Do you sit or are you on your feet during the day at work or home? For those on your feet, are you walking around, standing still, doing lots of bending and lifting?


As our day-to-day life becomes more technologically involved, the Western world is becoming more sedentary with more and more time spent sitting. Research has identified the benefits of standing versus sitting, and similarly the benefits of movement versus static positioning, to our overall health. So do you need to do more moving in your day, should you consider a change in your exercise habits to balance your spinal position better through the day or week?


• Activity 1: list the physical positions you spend your day/week in, in the order of events. Take into account the time from when you rise to the time you return to bed each day but exclude any exercise.

• Activity 2: list all your exercise during the course of a typical day/week, again listing the activities in order of most to least.

• Activity 3: analyse your exercise activities and write down the position of your body during these activities. For example, are you standing/upright, sitting, lying, bending, etc.

• Activity 4: analyse the results. Are you balancing and countering the positions of your body during your normal daily activities with the positions of your body during your exercise?

There is a lot to be said for the old saying of ‘everything in moderation’ when it comes to movement. The Australian Physiotherapy Association slogan ‘Move Well Stay Well’ is an excellent memory verse for this area of your life. Many of the injuries that we incur happen through an accumulation of moving poorly until finally we hit breaking point and seek help. Can you avoid this by paying more attention to your movement habits?

Thoughts by Scott Ward

Exercise alone is not enough

Reading the cover of Time Magazine several years ago I noticed a title: ‘The Myth of Exercise and Weight Loss’. Naturally it captured my attention and I read the article. It went on to explain that many people perform great exercise but quickly undo their good work with a coffee and cake or similar afterwards, effectively consuming near enough or more calories in 5 minutes than they burnt off in their entire bout of exercise. Remember that maintaining a healthy weight and level of fitness is not possible without the combination of consistently having a good exercise regime, a healthy diet and a strong mind.

Thoughts by Scott Ward

What happens to your body when you stop exercising?

Story at-a-glance

  • Just 20 minutes of daily exercise leads to dramatic increases in brain
  • Endurance runners who skipped exercise for 10 days had reductions in blood flow to their brain’s hippocampus, which is a region associated with memories and emotions
  • After about two weeks of not exercising, your endurance may suffer because of decreases in your VO2 max (also known as maximal oxygen intake)
  • Exercise benefits to blood pressure and glucose levels are also among the first to go if you skip too many workouts

Read the full story here. A nice easy read with plenty of useful information. You can also check the article out via our Facebook page.

Source: Peak Fitness

Exercise programmes can reduce fall rates

Systematic reviews show that older people who exercise have 21% fewer falls than controls – and in some clinical groups exercise programmes can halve fall rates.

In a seminar on bone health and fall prevention, Catherine Sherrington from the University of Sydney, Australia, said that falls in older people are common – around one in three community dwellers over 65 fall each year.

They result from an interaction of physiological, behavioural and environmental factors, she said. Exercise has a clear impact on preventing falls. But it is not clear that, as a single intervention, exercise can prevent falls in settings such as care homes, where environmental factors might be more important.

An update of systematic reviews in 2016 indicated that exercise programmes challenging balance, and involving more than three hours of exercise a week, work best. But getting older people to take part in exercise can be a problem, said Catherine Sherrington, who is Professorial Research Fellow at the George Institute for Global Health.

“We wanted to understand what factors affect participation in exercise programmes,” she said. “Themes identified as important include social influences and interaction with peers, physical limitations, competing priorities, access difficulties – both environmental and financial – and motivations and beliefs.”

Jennifer Bottomley from the United States, who is currently President of the International Association of Physical Therapists working with Older People, emphasised that fall prevention involves managing frailty as a long-term condition. However, fraility is not routinely identified and physical therapists have a role in improving its profile.

To keep people in their own homes, physiotherapists need to make sure they maximise functional capabilities, and that their homes are safe.

Attending to posture, joint mobility and functional activities are all important, she said.

“There are remarkable benefits from exercise in all conditions contributing to long-term fraility,” she said. “And if anyone asks you how much activity is needed, anything above rest works.”

Source: World Confederation for Physical Therapy July 2017

Why is sitting so bad?

SafeWork NSW has just released a new video about the dangers of being sedentary at work and ways people can move more and sit less.

On average, Australian adults spend an estimated five hours a day being sedentary, which can lead to health effects including lung stress, reduced blood flow, poor mental health and even some cancers. The good news is there are some easy ways to get moving at work.

The release of the video coincides with SafeWork NSW’s commitment to move more and sit less and to encourage workers to be less sedentary at work. Standing, walk-and-talk meetings or face-to-face exchange rather than email and sit-stand workstations are just some of the ways we’re ‘losing the chair!’ Make your own pledge and watch the video now.

Source: APA News 5th July 2017

Future Proofing Your Knees

Continuing on from our previous posts regarding knee osteoarthritis and arthroscopic surgery comes this recent piece from Paula Goodyer in the Sydney Morning Herald. With knee joint replacements increasing by almost 30% in the last decade, find out what you can do to help reduce load on your knees and therefore decrease the likelihood of a total knee replacement in the future.

Source: APA News July 19th 2017

Arthroscopic Surgery and Knee Degeneration

A review of the research evidence suggests knee arthroscopic surgery is no better than exercise therapy and is not recommended for people with degenerative knee conditions. Does this sound like your knee? Read a brief commentary or access the full clinical guidelines that have stemmed from the systematic research review. Similarly, read this link to learn specifically what else you can do to manage your knee osteoarthritis and the role that physiotherapy led conservative exercise therapy leads in your quality of life.

Juicy Discs

Here’s an interesting one. Research has just come out suggesting that walking at fast speeds or running at slower speeds results in intervertebral discs that are thicker and juicier. Don’t be tricked because despite the title, the evidence only exists for speeds below 2.5m/s and is only relevant to a particular group of ‘trained’ individuals. Nevertheless quite interesting findings and perhaps contrary to popular belief. More evidence for tissue adaptation and the need to load our body in a controlled fashion. Click here for a brief commentary on the findings or click here to read the full report.

Low Back Pain in Schoolchildren Often Nonspecific, Musculoskeletal

An interesting piece of commentary from a general practitioner following evidence-based care. The best place to go for knowledgable professional diagnosis and treatment is here with one of our physiotherapists. Have a read by clicking here, the article reflects the truth and emphasises again that Imaging is often an expensive waste-of-time. Spend your money wisely and see us. If we think something extraordinary is occurring then you will be referred to the appropriate place.

Exercise benefits for older Australians with cognitive impairment

Whilst exercise training has been shown to be helpful in institutionalised older people with cognitive impairment, the effect of exercise on the equivalent population living in the community was less clear.

To gain more insight into this cohort a group of physiotherapists from Melbourne recently examined the effect of long-term home and community based exercise programs on people with cognitive impairment who live independently in the community.

Physiotherapists Michelle Lewis, Casey Peiris and Nora Shields from Northern Health scoured published literature and identified 11 trials with data relevant to that topic. By pooling the data from these trials, the researchers were able to show that exercise training improves balance and independence with activities such as dressing and feeding. The data also showed that more demanding activities such as shopping and cleaning were also improved by a regular exercise training program. Additionally, there was some evidence of a reduction in falls in this group, which potentially has flow-on effects for healthcare costs.

The findings were published in the Journal of Physiotherapy, whose editor, Associate Professor Mark Elkins, noted that “This study cleverly used existing data to identify how physiotherapists can help older people living with dementia in their own homes”. He continued, “Lots of research generates further research, but this is one study with immediate applicability and benefits for older people with dementia”.

The full article can be read here. ExerciseCognitiveImpairment

Source: APA News , 9 February 2017

Science of the sauna

Why sweating it up might be more beneficial than you think.

What you think about saunas depends largely on where you’ve grown up: here in Australia they’re largely seen as the domain of the gym’s creepy old men, but in Finland they’re revered as an almost spiritual experience. Read more…..

7 Ways To Prevent Back Pain

Do you suffer daily from back pain? You are most definitely not alone!

Four out of five people suffer back pain each year, and ten per cent of those experience significant disability as a result. So don’t take your back for granted and follow these simple tips from the Australian Physiotherapy Association to help you protect your back.

1. Make sure you’re lifting correctly
From groceries through to lifting goods at work, stand with your feet shoulder-width apart, and bend at the hips and knees. Grip the load firmly and hold it close to your body, tightening your stomach muscles and using the strong muscles of your legs to lift. Always keep your back as straight as possible, and gently breathe out. Avoid twisting – turn by using your feet, not your back.

2. Focus on your standing posture
Think tall: chest lifted, shoulders relaxed, chin tucked n and head level. Your posture should be stable, balanced and relaxed, when sitting, walking or standing.

3. Don’t stay seated for too long
Don’t stay seated for too long, ideally no more than 20 minutes. Even if you’re at work, stand up, stretch and walk around. The right back support will also help. Ensure your work station and computer are correctly positioned.

4. Driving
Good support from your car seat will prevent back pain. Adjust your seat to sit comfortably – and make sure you take regular breaks on long journeys. If you need more lower back support, use a lumbar roll or a rolled-up towel.

5. Sleep support is key
Your mattress should be firm enough to support your natural shape.

6. Exercise to keep your back strong
Stay in shape – maintaining a healthy body-weight will lessen the strain on your back. Your physiotherapist can show you how to keep your back flexible and strong with correct back and abdominal exercises.

7. Don’t Ignore The Pain
Last but not least, if your back hurts, don’t ignore the pain. Physiotherapists have the training to correctly assess the problem and provide safe, effective treatment. For rapid recovery, see your physiotherapists early!

Source: The Carousel

Instagram Butt??

We often hear about poor sitting posture and it’s effect on the lower back particularly. This article makes good mention of the effect of poor standing posture and how the ‘instagram butt’ or ‘sway back’ as it’s also well known as, is in fact often a postural habit rather than a structural abnormality. APA Sports Physiotherapist, Holly Brasher, comments on this all to commonly adopted standing position.

If you are interested in building your gluteal muscles up rather than making them look bigger by changing your pelvic tilt, then here’s an article to give you an insight. What are the signs you’ve forgotten to use your bottom muscles properly?

For all things buttock related (posture and strength), consult us at Nelson Bay Physiotherapy. It is well established that the hip/gluteal musculatures strength has a significant role in reducing other lower limb injuries and lower back pain.

Sleep: Reduce Injury and Improve Performance

Mick Hughes (Physiotherapist & Exercise Physiologist), has published a great blog summarising some of the effects of sleep on the body. An interesting read for all on a topic that is underestimated for it’s effects on injury and performance. Thanks Mick.

If your not happy with your pillow and are finding it hard to find the right one for you, come and see us. We stock and recommend a completely adjustable pillow. What a concept, so why not sleep with something that you can adjust to find the right shape and comfort for you.

World Physiotherapy Day

Each year, on 8 September, we celebrate World Physiotherapy Day, a global event recognising the incredible role physiotherapists play in the community and the relationships that patients have with their physiotherapist.

The theme for this year’s World Physiotherapy Day is ‘add life to years’—aligning with the World Confederation for Physical Therapy. The message builds on the findings of WHO’s World Report on Ageing and Health and a range of reports indicating the contribution and cost effectiveness of physiotherapy in healthy ageing.

Physiotherapists are health professionals who have a key role in helping people with long-term conditions achieve their goals, fulfil their potential and participate fully in society. They work with people to maximise movement and functional ability. If you have problems that affect your mobility, ask a physiotherapist, the qualified experts in movement and exercise.

Please find below a few resources focused on falls prevention.

Get Up & Go

Cochrane Falls Evidence

Falls Prevention Evidence


Source: Australian Physiotherapy Association, World Confederation for Physical Therapy, Physiotherapy New Zealand, Chartered Society of Physiotherapy

A Pain in the Neck

Pregnancy often causes marked lower back and pelvic pain as a consequence of the extra weight carried, the changes in the spinal curvature and the presence of pregnancy hormones that increase joint laxity. Once the baby comes along you’d be excused if you thought “phew, glad that’s over now my pain can go”.

However, many women have found that whilst their lower back pain can settle after childbirth, many Mums (and Dad’s) report the presence of neck, shoulder and thoracic spine pain as a consequence of caring for their child.

So what can you do about it? Here’s some tips to help Mums and Dad’s in that situation…..click here to find out more.

Persistent Pain

It’s the symptom that motivates people to seek professional help, it’s often the last symptom to present to make you aware of a problem and sometimes it can be the first to disappear. For some however it can be a much greater and longer lasting symptom. Recently, there was an interesting piece on the ABC’s Catalyst regarding pain and advancements in medical engineering to help bring relief to many of these people.

Similarly Radio National had a great piece on explaining pain and how it works. Click the link to read more and hear Lynne Malcolm reports on the latest developments in chronic pain research.

At Nelson Bay Physiotherapy & Sports Injury Centre, we also offer the Pain Book for sale to anyone wishing to learn more about their pain and how to better manage it.


Paracetamol – Placebo

Research from 12 months ago has finally hit the media in Australia with regards to the effectiveness or rather ineffectiveness of Paracetamol for spinal pain and osteoarthritis. To hear a snippet of what was found click here to see what Channel Ten reported briefly within the news or click here to read the Paracetamol research paper. This evidence forms the highest level of evidence available in guiding what is evidence-based treatment, something we strive to provide you with at Nelson Bay Physiotherapy & Sports Injury Centre.

Are sit-ups bad for you? The US Navy seems to think so

Sit-ups are an abdominal exercise often mistaken to be reflective of having good core strength. The US Navy is reviewing their  presence in fitness testing protocol because of the loading on the the lower back.

The presence of a six-pack and the performance of sit-ups and other more generalised ‘global’ abdominal exercises such as the ‘plank’ can create a false reading of someone’s true core stability.

What is ‘core stability’? Core stability refers to your deep abdominal muscles (transverses abdominus, and internal oblique), pelvic floor and deep lower back muscle (multifidus) ability to stabilise the spine in it’s neutral lordotic backwards curved position during task performance.

The body has muscles that stabilise and muscles that move the body. The further the muscles lie away from joint over which they cross the greater the movement force they produce at the joint. Whereas, the closer they are to the joint the greater they compress the joint and stabilise it. This is the difference between the deep muscles of your body and the more superficial muscles (in most cases) and therefore the reason why the muscles that are the prime movers of the body are the muscles we can often see. Sometimes what’s out of sight is out of mind!

Therefore, like an apple that you pick up in the supermarket with a firm skin and take home to find later when you bite in that it’s rotten inside, the perception of core stability can be very similar. For your health and true core stability you need to start on what’s inside and deep to stabilise your spine and then work out towards the more superficial and movement muscles of your body. So it’s deep first working on specifics in a safe and neutral position, then once mastered adding global strength via these movement muscles. This is true core strengthening.

Part of muscle training and strength is neuromuscular training. Training to reinforce the same incorrect muscle recruitment patterns will create more harm than good. So not only do you need to train the deep muscles first, you need to often work on disengaging the other muscles as well before moving forward.

Plank may be safer and easier to monitor but it trips the brain into turning everything on and can reinforce those same poor muscle recruitment patterns. True training requires specific instruction, expert supervision AND small classes (no greater than 3-5). There is no one in our community that has the level of knowledge and expertise in body biomechanics and core stability as our physiotherapy pilates teachers. We speak with the best knowledge available and often treat many clients who have been elsewhere with adverse effects.

What do you think of the linked article? Click here to read. Correct about neutral with the plank but we need to train core strength to stabilise your spine as your limbs move, not just in a set static position. This sort of training only improves strength at the joint position you train.

Be more specific and enrol in our Pin Point Pilates classes today. Give us a call or e-mail reception today with your interest. Classes run most days of the week including Saturdays.

The Physiopak

Initial research in the late 1990’s at the University of South Australia was of great interest to the Australian Physiotherapy Association (APA) and revealed alarming figures regarding the weight that children were expected to carry in their backpack.

The APA then asked Spartan to develop a bag that limited the load that a child could carry, so the bag wasn’t too big in terms of volume and also reduced the amount of sag that the load caused in the bag.

Through it’s deisgn the Physiopak aims to limit the amount of load that a child can carry and also reduce the amount of sag the load can cause. Its base, constructed from ethylene-vinyl acetate (EVA) foam, and waist belt were designed to distribute load more effectively across the body in an effort to combat damage to the wearer’s hips and backs.

The main features of the Physiopak are:

  • lightweight moulded EVA foam padding
  • unique multi-fit sliding waist belt mechanism
  • contoured adjustable shoulder straps
  • internal laptop pocket
  • tufflite fabric

For further information refer to physiopak.com or spartanss.com.au

Courtesy of APA InMotion February 2016

Is your child’s backpack causing them permanent damage?

Riding and walking to school – avoiding injuries and pain from school bags

Children walking or riding to school need to have the correct school bag to avoid injury, as about 70 per cent of Australian school children may suffer back pain from school bags.
To avoid back, neck and shoulder pain, postural changes and injuries, school bags should be backpack style, should be less than 10 per cent of the child’s body weight as well as being appropriate for each child’s size with padded and adjusted straps over the shoulders.
As experts in movement and health, physiotherapists can play a vital role in ensuring children using backpacks and undertaking physical activity do these activities safely, to minimise their risk of injury.

Poorly fitting backpacks – what’s the impact on children?

  • Fatigue (reported by 65.7% Australian children) [12]
  • Muscle strain [13-15]
  • Joint injury [13]
  • Back pain [12-15] (reported by 46.1% Australian children) [12]
  • Neck and shoulder pain [13]
  • Lower back pain lasting into adulthood [16]
  • Postural changes [13-16]
  • Injuries to head/face, hand, wrist/elbow, shoulder, foot/ankle as a result of tripping, wearing and being hit by backpacks [17]

Children’s backpacks – injury warning signs and key recommendations

Injury warning signs

  • Posture changes when backpack on [12, 14]
  • Pain [13, 14]
  • Pins and needles in arms/hands [13, 14, 16] or legs [16]
  • Red marks on shoulders [14] especially at the front [16]
  • Difficulty getting backpack on/off [13, 16]

Choosing the right backpack for your child

  • Less than 10 per cent of your child’s body weight [12, 14, 16]
  • Appropriate for your child’s size (examples: purchase new as they grow, no wider than child’s chest) [12, 14, 15]
  • Two straps over the shoulders [12-16]
  • Wide straps [13, 15]
  • Hip strap [12-14, 16] and/or moulded frame [12, 14] and/or waist strap [15]
  • Separate compartments for load distribution [12, 14, 16]
  • Padded straps [12, 14, 15]
  • Adjustable straps [12]
  • Padded back [13, 16]
  • Endorsed by a professional association such as the APA [12, 14]
  • Agreed between yourself and your child [12, 14]
  • Comfort and fit over looks [13]

Recommendations for backpack wear

  • Sit just above the waist; don’t hang low over the buttocks [12, 14]
  • Sit no lower than the small of the back [15]
  • Contour snugly to the back/load carried close to the back [12-14]
  • Heavy items placed closest to the spine [12, 14, 16]
  • Items packed snugly to minimise items/load moving [12, 14]
  • Bend knees when lifting to pick up and put on backpack [12, 13, 16], or put on using a bench [14]

What back pack would be good?


Physiotherapists, with their education, training and competence – in physical activity, therapeutic exercise, behaviour change, anatomy and biomechanics – are ideally suited to assess children’s backpacks and make recommendations to avoid injuries. They can also identify, manage and prevent children’s health conditions associated with physical inactivity and sedentary behaviours.

Physiotherapists play a key role in enhancing children’s physical activity participation and reducing their sedentary behaviours by educating children and their families about the:

  • types of physical activity that are safe and appropriate for their unique needs
  • consequences of physical inactivity and sedentary behaviours
  • levels of physical activity and sedentary behaviour required for their childrens’ health

Read more 7 News Sydney Online  17 January 2016

Reference list

  1. Australian Government Department of Health, Australia’s physical activity and sedentary behaviour guidelines 13-17 years, Department of Health, Editor. 2014, Department of Health: Canberra, Australia.
  2. Australian Government Australian Institute of Health and Welfare, Australia’s health 2006, Australian Institute of Health and Welfare, Editor. 2006, Australian Institute of Health and Welfare: Canberra, Australia.
  3. Centre for Community Child Health. Movement and exercise for kids. 2015; Available from:http://www.rch.org.au/ccch/growthrive/movement_exercise/movement_exercise_for_kids.
  4. Better Health Channel. Obesity in children – causes. 2013; Available from: https://www.betterhealth.vic.gov.au/health/healthyliving/obesity-in-children-causes.
  5. Australian Government Department of Health, National physical activity recommendation for children 0-5 years, Department of Health, Editor. 2014, Department of Health: Canberra, Australia.
  6. Australian Government Department of Health, Australia’s physical activity and sedentary behaviour guidelines 5-12 years, Department of Health, Editor. 2014, Department of Health: Canberra, Australia.
  7. World Health Organization, Global recommendations on physical activity for health 5-17 years. 2010, World Health Organization: Geneva, Switzerland.
  8. Buhlert-Smith, K., N. Hagiliassis, and J. Pegler, Move, Play & Thrive. Literature review in preparation. 2016, Scope: Melbourne, Australia
  9. Rimmer, J.H., et al., Physical activity participation among persons with disabilities: barriers and facilitators. American Journal of Preventive Medicine, 2004. 26(5): p. 419-425.
  10. World Health Organization, Global recommendations on physical activity for health. 2010, World Health Organization: Geneva, Switzerland.
  11. Active Healthy Kids Australia, The road less travelled. The 2015 progress report card on active transport for children and young people. 2015, Active Healthy Kids Australia: Adelaide, South Australia.
  12. Better Health Channel. Back pain – school bags. Available from: http://www3.betterhealth.vic.gov.au/bhcv2/bhcpdf.nsf.
  13. American Academy of Orthopaedic Surgeons. Ortho info. Backpack safety. 2015; Available from: http://www.orthoinfo.aaos.org/topic.cfm?topic=a00043.
  14. Education Queensland. Health and Safety Fact Sheet. Heavy school bags. 2012; Available from: http://www.education.qld.gov.au/health/pdfs/healthsafety/factsheet_hevbags.pdf.
  15. Osteopathy Australia. Back(pack) to school – tips on how to pick a backpack for your child. 2014; Available from: http://www.osteopathy.org.au/data/Media/PressReleases/Packpack_to_School__Tips_How_To_Pick_a_Backpack_For_Your_Child.pdf.
  16. American Occupational Therapy Association. Backpack safety: stats on injuries. 2015; Available from: http://www.aota.org.au/conference-events/backpack-safety-awareness-day/handouts/infographic-injury-stats.aspx.
  17. Wiersema, B., E. Wall, and S. Foad, Acute backpack injuries in children. Pediatrics, 2003. 111(1): p. 163-166.

Back to school: Start the new year active and healthy

Almost all young Australians , including pre-schoolers, are not as physically active as they should be with 9 out of 10 young Australians sitting too much and not moving enough, according to the recommended Australian guidelines. A change towards sedentary lifestyles has happened for many people in many developed countries, including Australia [Australian Institute of Health and Welfare (2004) as cited in 2]. With improved access to mobile phones and the internet, children do not need to leave home to keep in contact with their friends outside of school. Children today are far less likely than children of earlier generations to walk or cycle to get from A to B, or to play outdoors [2].

Instead, children are spending more than the recommended two hours each day using electronic media. The SPANS study in New South Wales found that 61 per cent of boys and 45 per cent of girls in year six (aged approximately 11–12 years) were using more than two hours per day of electronic media. This percentage was higher in older age groups: in year 10, 78 per cent of boys and 67 per cent of girls fell into this group [2].

This increased screen time, combined with a lack of physical activity, can lead to young children being overweight, which often continues into adulthood [3]. In Australia, more than 1 in 4 children and adolescents are overweight or obese and it is predicted that 65 per cent of young Australians will be overweight or obese by 2020 [4]. Increases in the number of overweight and obese children leads to an increasing number of children who suffer with illnesses – including diabetes, asthma and mental health problems -as well as physical pain in muscles and joints, such as back pain [2]. Even type 2 diabetes – a chronic disease traditionally diagnosed only among adults – is now increasingly being detected in Australian children. Research also shows that overweight and obese children are more likely to be overweight or obese adults. Around 80 per cent of Australia’s obese adolescents will become obese adults [4]. This in turn can lead to a number of serious chronic conditions and even premature death [2].

Keeping children physically active

National guidelines for physical activity recommend infants and preschool children be physically active for at least three hours daily [5] and older children at least one hour [1, 6, 7]. The benefits of physical activity are enhanced further when children are more physically active than these recommended times [7]. The guidelines also provide recommendations for the types of physical activity that are appropriate for children.

National guidelines for sedentary behaviour recommend infants and preschool children should not be sedentary, restrained, or kept inactive for more than one hour at a time [5], and for older children these sedentary activities should be broken up as much as possible [1, 6]. These guidelines also recommend that the amount of time children spend sitting and watching television and using other electronic media (DVDs, computer and other electronic games) should be limited to one hour daily for infants [5] and preschool children and two hours daily for older children [1, 6].

Participation in physical activity

It is widely accepted that being physically active provides numerous health benefits. These have been described in a review by Buhlert-Smith, Hagiliassis [8] whose summary is based on works of the Australian Government Department of Health [6], the Centre for Community Child Health [3] and the World Health Organization [7], including:

Social benefits:

  • creates opportunities for social interaction, making friends and having fun
  • reduces anti-social behaviours
  • develops cooperation and teamwork skills

Emotional and intellectual benefits:

  • improves self-expression
  • improves self-esteem, confidence and independence
  • improves management of anxiety, stress and depression
  • improves concentration
  • promotes relaxation

Health benefits:

  • improves physical fitness by improving heart and lung functions
  • improves balance, coordination and movement skills
  • improves posture
  • improves flexibility
  • builds stronger muscles and bones
  • promotes healthy joint tissues
  • promotes healthy growth and development
  • reduces the risk of unhealthy weight gain by controlling the expenditure of energy
  • reduces the risk of developing type 2 diabetes and cardiovascular diseas

An active commute – walking or riding to school

Increased use of cars and the associated reduction in physical activity participation is a crucial factor in the rise in childhood obesity [4]. An easy way for school children to increase their physical activity participation is to walk or ride to school, but this type of commute is also in significant decline, with the 2015 Active Healthy Kids Australia [11] study finding:

  • 42 per cent decline in children walking or riding a bike or scooter to or from school, in the past 40 years, with no signs of this decline slowing down [11, p.18]
  • only 50 per cent of children and young people in Australia use active transport (bike, scooter) at least once a week to travel to or from school [11, p.11]
  • just 11 per cent of children ride a bike to or from school, however 90 per cent of Australian households have at least one child’s bike in working order [11, p.6]

The Australian Physiotherapy Association (APA) strongly advises parents to encourage their children to walk, ride a bike or scooter to school daily as an easy way for them to increase their physical activity participation. The study also found that active transport (through walking or riding a bike or scooter) provides a key contribution to the overall physical activity levels of children and young people in Australia and is feasible, given it can be easily incorporated into daily routines with minimal planning prior and involves little to no financial cost [11].


Reference list

  1. Australian Government Department of Health, Australia’s physical activity and sedentary behaviour guidelines 13-17 years, Department of Health, Editor. 2014, Department of Health: Canberra, Australia.
  2. Australian Government Australian Institute of Health and Welfare, Australia’s health 2006, Australian Institute of Health and Welfare, Editor. 2006, Australian Institute of Health and Welfare: Canberra, Australia.
  3. Centre for Community Child Health. Movement and exercise for kids. 2015; Available from:http://www.rch.org.au/ccch/growthrive/movement_exercise/movement_exercise_for_kids.
  4. Better Health Channel. Obesity in children – causes. 2013; Available from: https://www.betterhealth.vic.gov.au/health/healthyliving/obesity-in-children-causes.
  5. Australian Government Department of Health, National physical activity recommendation for children 0-5 years, Department of Health, Editor. 2014, Department of Health: Canberra, Australia.
  6. Australian Government Department of Health, Australia’s physical activity and sedentary behaviour guidelines 5-12 years, Department of Health, Editor. 2014, Department of Health: Canberra, Australia.
  7. World Health Organization, Global recommendations on physical activity for health 5-17 years. 2010, World Health Organization: Geneva, Switzerland.
  8. Buhlert-Smith, K., N. Hagiliassis, and J. Pegler, Move, Play & Thrive. Literature review in preparation. 2016, Scope: Melbourne, Australia
  9. Rimmer, J.H., et al., Physical activity participation among persons with disabilities: barriers and facilitators. American Journal of Preventive Medicine, 2004. 26(5): p. 419-425.
  10. World Health Organization, Global recommendations on physical activity for health. 2010, World Health Organization: Geneva, Switzerland.
  11. Active Healthy Kids Australia, The road less travelled. The 2015 progress report card on active transport for children and young people. 2015, Active Healthy Kids Australia: Adelaide, South Australia.
  12. Better Health Channel. Back pain – school bags. Available from: http://www3.betterhealth.vic.gov.au/bhcv2/bhcpdf.nsf.
  13. American Academy of Orthopaedic Surgeons. Ortho info. Backpack safety. 2015; Available from: http://www.orthoinfo.aaos.org/topic.cfm?topic=a00043.
  14. Education Queensland. Health and Safety Fact Sheet. Heavy school bags. 2012; Available from: http://www.education.qld.gov.au/health/pdfs/healthsafety/factsheet_hevbags.pdf.
  15. Osteopathy Australia. Back(pack) to school – tips on how to pick a backpack for your child. 2014; Available from: http://www.osteopathy.org.au/data/Media/PressReleases/Packpack_to_School__Tips_How_To_Pick_a_Backpack_For_Your_Child.pdf.
  16. American Occupational Therapy Association. Backpack safety: stats on injuries. 2015; Available from: http://www.aota.org.au/conference-events/backpack-safety-awareness-day/handouts/infographic-injury-stats.aspx.
  17. Wiersema, B., E. Wall, and S. Foad, Acute backpack injuries in children. Pediatrics, 2003. 111(1): p. 163-166.

Keeping your New Year’s resolutions on track

It’s January and just the beginning – February will come quickly and we will be right in the middle of the “danger zone” where most of us will start wavering on our New Year’s resolutions, according to Australian Physiotherapy Association (APA) Sports Physiotherapist, Aidan Rich.

“Losing weight or getting fit are popular New Year’s resolutions – not surprising given that fourteen million Australians are overweight or obese and that obesity is now the leading cause of premature death and illness in Australia,” Mr Rich said.

“If you are starting to lack motivation to eat healthier and move more, research shows that the best way to stay committed is to start off small and to be kind to yourself.”

Mr Rich said that the following eight tips will help people stay on track.

  1. Make ‘SMART’ goals – Specific, Measurable, Achievable, Relevant and with a Time Frame.
  2. Put your goal in writing – This helps to give you a visual reminder of what you are working towards. You may choose to keep this to yourself, or put it in an open space (such as on the fridge) to help keep it at the front of your mind.
  3. Plan a gradual increase – The body is great at adapting to new stimuli – it just needs time! Look to gradually increase time, and intensity of activity.
  4. Build change into your existing lifestyle – find what works best for you and your lifestyle and then build your new actions or behaviour into an existing habit.
  5. Have short, medium and long term goals.  Research shows that goals are more likely to be achieved if they are within an 8-10 week timeframe or less. If you have a long term goal, have interim targets along the way.
  6. Recruit a friend to help you achieve mutual goals.  Arranging to meet a friend for an early morning walk, run, boot camp or swim is much easier that going it alone
  7. Get a screening performed by a physiotherapist.  Have you been limited with niggling hip, knee or ankle pain when you’ve tried to exercise previously? A physiotherapist can help identify why these niggles occur, and give you strategies to avoid them being problematic in the future.

An APA Physiotherapist can help design exercise programs suited to your lifestyle and fitness level, while also helping you to stay on track. Visit www.physiotherapy.asn.au

Read previous content on this topic from our news archives 

Antibiotics – not always the answer for Mastitis

Source: APA website news February 9th 2016

Treating mastitis with antibiotics is often not required, leading women’s health physiotherapist, Melinda Cooper, said today.

Antibiotics are designed to treat infection, however new mothers can have the symptoms of mastitis – including fever, swelling and pain – and have no infection, so antibiotics are not always required, Ms Cooper said.

“Pain doesn’t always mean infection and antibiotics transfer to babies through the breast milk, sometimes giving babies’ tummy pains, so it’s important to have alternatives that are safe and effective for mothers and their babies,” she said.

“Pain and inflammation is nature’s way of saying that something is not right and to get help .”

Ms Cooper said that most new mums might not be aware that physiotherapy – including therapeutic ultrasound – can successfully treat mastitis with immediate reduction in pain, redness and swelling.

“It is unfortunate that with lactation and breastfeeding, there is a lot of advice that is not tested in studies and symptoms can get worse quickly if it is not treated properly,” Ms Cooper said.

“Women are also being advised to massage the breast firmly to decrease swelling, redness and pain but in many cases this will actually increase pain and can make symptoms worse.

“You wouldn’t massage a swollen ankle or put it in a hot bath as that would hurt; the same applies with the breast, but even more so.

“There is no strong evidence from good quality research that shows that firm ‘massage’ and hot baths and showers work to relieve pain and swelling in the breast it is possible that they can do more harm than good.”

Ms Cooper said it’s important to see a Women’s Health Physiotherapist as soon as any of the main symptoms of mastitis are experienced; including breast pain, redness, swelling, and fever.

“Women need to understand that their breast pain is serious and it needs urgent treatment before it gets worse,” she said.

“You don’t need to have all of the symptoms to have mastitis and new mothers should seek help if they have just one of the symptoms.

Solving sleep struggles – the APA’s top tips for choosing the right pillow 

29 May 2015

Do you sometimes suffer headaches or wake up feeling fatigued? It could be that the very place you look forward to resting your head at night is causing the problem.

Australian Physiotherapy Association (APA) National President Marcus Dripps says: “Selecting the right pillow will help ensure you sleep well, and wake up feeling rested, without pain or stiffness.

“Sleeping on a pillow that is the wrong shape, size or density can cause neck pain and headaches due to incorrect spinal posture, which is a major contributor to poor quality sleep.

“We know people spend approximately a third of their life asleep, which is essential for healing and rejuvenation. If people don’t choose the right pillow they could compromise their quality of sleep and put themselves at risk of poor health outcomes,” he says.

Dripps also warns sleeping on a pillow that is worn or has lost its support can also cause pain, explaining: “It’s as important to keep track of how old your pillow is, as it is to buy a good quality pillow that will last. Pillows should be replaced every 18 months to make sure they are providing adequate neck and back support.”

While there is no simple option for choosing a pillow, and what is right for someone else may not necessarily work for you, the APA is encouraging all Australians to follow these basic principles to help select the right pillow:

1. Seek advice from your physiotherapist 

The ideal pillow for you will depend on many factors, particularly preferred sleeping position. If you have a neck or shoulder condition, you may need to discuss pillow options with your physiotherapist.

2. Consider your sleeping habits

If you sleep on your back, you may benefit from something that “fills the curve” in the back of your neck: a flatter pillow with a small contour, for example.

If you sleep on your side, your shoulders are wider than your neck and head, so you may need something higher.

3. Try before you buy

If your need for a different pillow relates to a temporary issue, try putting a small rolled towel inside your pillowcase as a trial.

Nelson Bay Physiotherapy & Sports Injury Centre recommends and stocks the Complete Sleepr adjustable pillow…….an adjustable pillow, what a concept and better still one that works! Call in today to grab your peaceful sleep. 

About the Australian Physiotherapy Association (APA)

The APA is the peak body representing the interests of Australian physiotherapists and their patients. It is a national organisation with state and territory branches and specialty subgroups. The APA represents more than 17,000 members who conduct more than 21 million consultations each year.

Australian Physiotherapy Association’s top tips for preventing back pain

7th September 2015

With World Physiotherapy Day taking place on Tuesday 8 September, the Australian Physiotherapy Association (APA) is urging Australians to take an active interest in protecting themselves from injury and chronic pain.

Up to 80% of Australians experience back pain each year, with 10% having significant disability as a result. There are many different causes for back pain— from postural stress, through to muscle strains, ligament sprains, disc problems and muscle weakness.

In line with World Physiotherapy Day, the APA has provided their top tips on how to move well and stay well, to prevent back pain.

1. Make sure you’re lifting correctly: from groceries through to lifting goods at work, stand with your feet shoulder-width apart, and bend at the hips and knees. Grip the load firmly and hold it close to your body, tightening your stomach muscles and using the strong muscles of your legs to lift. Always keep your back as straight as possible, and gently breathe out. Avoid twisting— turn by using your feet, not your back.

2. Focus on your standing posture: think tall—chest lifted, shoulders relaxed, chin tucked in and head level. Your posture should be stable, balanced and relaxed, when sitting, walking or standing.

3. Don’t stay seated for too long: ideally, don’t stay seated for more than 20 minutes. Even if you’re at work, stand up, stretch and walk around. The right back support will also help. Ensure your workstation and computer are correctly positioned.

4. Driving: good support from your car seat will prevent back pain. Adjust your seat to sit comfortably—and make sure you take regular breaks on long journeys. If you need more lower back support, use a lumbar roll or a rolled-up towel.

5. Sleep support is key: your mattress should be firm enough to support your natural shape.

6. Exercise to keep your back strong: stay in shape— healthy body-weight is less strain on your back. Your physiotherapist can show you how to keep your back flexible and strong with correct back and abdominal exercises.

If your back hurts, don’t ignore the pain. Physiotherapists are trained to correctly assess the problem and provide safe, effective treatment. For rapid recovery, see your physiotherapist early.

APA top tips for setting up your workspace

26th May 2015

Are you spending hours slouching over a computer, and feeling the strain in your muscles? With all the time we spend staring at our screens, it’s important we don’t turn a blind eye to the importance of how our work space is set up.

Incorrect posture at your desk can lead to many problems including neck pain, back pain and headaches, so it is vitally important the area where you spend a lot of time each day, is set up correctly.

To assist, Australian Physiotherapy Association (APA) National President Marcus Dripps has provided his top tips and tricks:

1. Place your screen at eye level

Dripps recommends positioning your screen so it is directly in front of you, about an arm’s length away, with the top of the screen at eye level. “This ensures your head is in line with your torso so your neck and shoulder muscles are less fatigued. If you’re using a laptop, it might be best to get a stand for your monitor,” he says.

2. Support your back

“This is key. Adjusting your chair so your lower back is supported will reduce strain on your back. Ensure your knees are level with your hips too–this will help to relax your shoulder and neck muscles.”

3. Check placement of your elbows, arms and wrists

According to Dripps, placing your keyboard in a position where you can reach it comfortably and at a height where your wrists and forearms are straight and level with the floor is imperative. “Your elbows should be by the side of your body so the arm forms an L-shape at the elbow joint. This will help prevent repetitive strain injuries,” he says.

4. Refine your keyboard location

“Be sure your keyboard is directly in front of you when typing, leaving a gap of about 100–150mm at the front of the desk to rest your wrists between tasks. Keep in mind, your wrists should be straight when using a keyboard.”

5. Keep your mouse close

Dripps says a simple tip is to keep your mouse and the keyboard close to you–this will help avoid strain and support your arm on the desk when using the mouse. “A mouse mat with a wrist pad can also help keep your wrist straight and avoid awkward bending.”

6. Rest your feet on the floor

Both of your feet should be comfortable, either flat on the floor or supported by a footrest. He strongly recommends not crossing your legs as it could result in bad posture with resultant harmful effects’ on the back, hip and pelvis.

7.Take a break

“Finally and importantly, take regular breaks every hour to stretch your legs, drink plenty of water and remember to regularly do some simple neck and back stretches,” Dripps concludes.

About the Australian Physiotherapy Association (APA)

The APA is the peak body representing the interests of Australian physiotherapists and their patients. It is a national organisation with state and territory branches and specialty subgroups. The APA represents more than 17,000 members who conduct more than 21 million consultations each year.

Is Yoga actually beneficial for you?

Yoga is one of those activities that can be difficult to get a handle on. There’s a lot of different types, it means different things to different people, and there are a lot of unique preferences. So is yoga actually good for you?

Breaking down yoga styles might take a while. Bikram is ‘hot’ yoga, where the temperature of the room is purposefully higher. Power yoga is more about strength, while classes like Ashtanga are focused on athletics. There’s a range of others – often marketing or westernising the traditional practice that originated from India.

While there are different types, the general premise of yoga is building strength, flexibility, and balance, as well as mental and spiritual practices.

We’ll take a look at how yoga can help in those areas (and what might be a little bit of an exaggeration).

What yoga can do for your body

Good for: Strength, balance and flexibility

Yoga can work to build strength in some poses, especially if your current level of fitness is low. If you’re starting from nothing, it will be a challenge. Yoga’s progress involved holding a pose with better form, or for longer, or doing a more advanced version. Yoga via Youtube can take you some of the way, but it’s likely you’ll hit a limit..

It can be hard to progress without an instructor. And that’s where the line is blurred between a ‘practitioner’ who happens to have found themselves teaching yoga, and someone more like a physiotherapist, who has studied and trained for years at university to understand the human body.

It’s worth looking into whom your potential instructor might be.

Yoga is decidedly good for muscle flexibility and joint range of motion, with most styles focusing on stretching and flexibility training. This reduces your chances of injury; the next time you need to leap over something, you won’t be in danger of tearing a hamstring from the sudden effort. It’s also much easier to put socks on in the morning.

Another benefit mentioned by Vitals is that yoga helps with neuromuscular training. In particular, studies have shown that ACL knee injuries can be reduced by deliberately training the connection and coordination between your brain and your muscles.

Yoga is one way to do this – there’s also more rigid training techniques such as the PEP programme developed by Santa Monica Orthopaedics and Sports Medicine Research Foundation. It’s sort of a side-benefit.

What yoga can’t do for your body

Not good for: Cardio, weight-loss, ‘toxins’.

Your cardio might improve slightly, but you won’t see the marked improvement that running, cycling, swimming or aerobic training would offer. You suffer in certain yoga poses and you know you’ve worked out, but you don’t breathe as hard or get your heart rate up as high as you do when embarking on a tough run or a couple of laps of some hills on two wheels.

Techly spoke with Australian Physiotherapy Association sports physiotherapist Holly Brasher, who holds a Bachelor of Applied Science (Physiotherapy), a Masters in Sports Physio, and is Managing Director of SquareOne Physiotherapy, to discuss more.

She agreed with the summaries and confirmed that yoga isn’t the ‘ideal choice’ for weight-loss, given other activities will burn more calories faster – such as running.

As for removing toxins and the like these are a complete myth. Your body has a liver, which is precisely made for removing toxins.

Beliefs around chakras and reiki and ‘vital energy’ of ‘qi’ and others haven’t been proven in any peer-reviewed science experiment – but they’re more related to spirituality, and not directly related to the physical qualities of yoga discussed here.

What’s the harm with yoga?

To get to the bottom of if yoga isn’t suitable for some people, we asked Ms Brasher what she’d recommend for people considering yoga for their general fitness.

“Yoga is great for improving flexibility. If you are a person who’s flexibility is poor then regular yoga classes will help.

“Conversely, if you are a person who is hypermobile (very flexible) then yoga is not the best choice of exercise. By further increasing an already large range of motion you are putting your body at risk of injury, as often the case is that you will not have the strength to control so much movement.”

“That is, if you are really flexible you need to be really strong to reduce your risk of injury. If you are after a gentle form of exercise then something like Pilates would be more appropriate as it works more on strengthening the postural muscles.”

In terms of yoga resulting in injuries, there are some potential problems. Holly Brasher again:

“Unfortunately there are many problems with yoga as a form of exercise.

“The problem is that “gurus” claim who believe their form of exercise i.e yoga is going to “cure everything and everyone.

“Each person needs to be dealt with individually, so whilst I would recommend yoga to one person I would tell another to stay away based on their pathology.

“Back pain is often grouped into one solid lump when the causes of back pain are very varied and the treatment and management of them is also. Some conditions need to avoid bending forward (eg. acute disc injury) and some need to avoid leaning backwards (eg. spondylolithesis).

“A yoga teacher would not have this knowledge so you can see how easy it is for someone to do a yoga class that involves everyone doing the same thing in the class to make their back pain worse.

“Overall, we mainly see problems with neck, back, knee and shoulder pain that is stirred up by yoga.

“My advice would be, if you have an injury, get advice from a health professional as to what you can and can’t do, as the same recipe does not work for everyone.”

Techly http://www.techly.com.au/2015/07/03/is-yoga-actually-beneficial-for-you/

Active workstations to fight sedentary behaviour

The impact of active workstations has been studied in several settings, and several outcomes have been investigated. However, the effects on health, work performance, quality of life, etc., have never been systematically reviewed.

To evaluate the existing literature about active workstations and their possible positive health and work performance effects.

We searched the electronic databases PubMed and Web of Science (up until 28 February 2014). The search terms we used were ‘active workstation’, ‘standing workstation’, ‘standing desk’, ‘stand up workstation’, ‘stand up desk’, ‘walking desk’, ‘walking workstation’, ‘treadmill workstation’, ‘treadmill desk’, ‘cycling workstation’, ‘cycling desk’ and ‘bike desk’, in combination with ‘health’, ‘quality of life’, ‘cognition’, ‘computer task performance’, ‘absenteeism’, ‘productivity’, ‘academic achievement’, ‘cognitive decline’, and ‘independent living’. In addition, we searched the reference lists of relevant published articles.

Randomized controlled trials, non-randomized controlled trials and non-randomized non-controlled trials investigating the introduction of active workstations in humans were included in this systematic review. Only original studies were included, and we did not accept studies combining the introduction of active workstations with other interventions. Outcomes concerning health, energy expenditure, cognition, quality of life and work performance were included.

We included 32 studies, of which five were longitudinal studies in school-aged children, 10 were longitudinal studies in adults and 17 were non-longitudinal studies in adults. Sixteen studies investigated standing desks, 15 investigated walking desks, and one investigated a cycling workstation. The general findings were decreased sitting time, increased energy expenditure, a positive effect on several health markers, no detrimental effect on work performance, no acute effect on cognitive function and no straightforward findings concerning computer task performance.

The implementation of active workstations might contribute to improving people’s health and physical activity levels. The effect of the use of these active workstations on cognition and applied work tasks, such as computer task performance, needs further investigation before conclusions can be drawn. Another aspect that needs further investigation is the implementation of the different active workstations in all age groups.

PMID: 24842828 [fusion_builder_container hundred_percent=”yes” overflow=”visible”][fusion_builder_row][fusion_builder_column type=”1_1″ background_position=”left top” background_color=”” border_size=”” border_color=”” border_style=”solid” spacing=”yes” background_image=”” background_repeat=”no-repeat” padding=”” margin_top=”0px” margin_bottom=”0px” class=”” id=”” animation_type=”” animation_speed=”0.3″ animation_direction=”left” hide_on_mobile=”no” center_content=”no” min_height=”none”][PubMed – in process][/fusion_builder_column][/fusion_builder_row][/fusion_builder_container]

Physiotherapists share tips to help make your new year’s resolutions stick

The New Year brings the incentive to get our health and wellbeing back on track. But for many of us, the resolutions we set on 1 January often turn into a challenge not long after, with mixed motivation and results.

The Australian Physiotherapy Association (APA) supports all those keen to kick start the New Year with goals to get physically active.

Research shows more than 6.4 million Australians are doing less than one and a half hours of physical activity per week. Time spent sitting is associated with being overweight or obese, chronic diseases and premature death.i

To avoid losing our start of year energy and momentum we have, APA Physiotherapist Taryn Jones (who is writing a PhD in self-management for physical activity at Macquarie University) and APA National President Marcus Dripps share tips to maintain lasting good health habits.

1. Getting started and preparing for change
“Use this time of year when we’re generally more motivated to build a solid action plan. Implement strategies to help make future behaviour easier and prepare for times when motivation fades,” Ms Jones said.

“Good preparation increases the likelihood of making changes. Write down your goal and how you want to get there,” APA National President Marcus Dripps added.

2. Start small and build steps to achieve your goal
“While this is a great time to revaluate priorities and harness motivation, make sure you’re realistic in managing your expectations,” Ms Jones said.

“Quite often people focus on the ‘all or nothing’ approach with their New Year’s resolutions. We have a natural flux in motivation – being mindful of this is important.

“With big picture ideals such as losing weight or getting fit, be specific with the behaviour you’re focussing on to get to these ideals. If your goal is to get fit – what activities are you going to do? When, where and how?” Ms Jones said.

“And remember to celebrate small successes when you reach small targets,” Mr Dripps added.

3. Remove barriers that may hinder achieving your goal
Before trying to achieve a goal, target potential pitfalls and troubleshoot them Ms Jones said. “Modern life is busy; we need to be realistic in what we can achieve and problem-solve solutions to obstacles in our way.”

“If you haven’t managed to reach your targets within a particular timeframe, do a self-check and make adjustments to your goal to be more achievable,” Ms Jones said. “If you begin to lose motivation, evaluate what’s not working: is it a realistic goal? How can I make changes to achieve my goal?”

4. Build your targets into an existing habit and lifestyle pattern
“Remember old habits are hard to break and new habits are hard to form,” Mr Dripps said. “Research shows behavioural patterns we repeat most often are etched into our neural pathways. Through planning, repetition and the right processes in place, it’s possible to form new habits and maintain them as well,” Mr. Dripps said.

Ms Jones said the best way to stick to a goal is to build your new behaviour into an existing habit. “Research tells us less conscious effort is required when incorporating into the right cue you do every day – it helps the behaviour become more automatic,” Ms Jones said.

“Some of the best cues are a stable event in your routine that’s in the right context for the desired behaviour. iv,v For example after I get out of my bed I will put on my running clothes,” she said.

“Being a mother of two, I know afternoons get particularly busy so setting a goal to exercise at this time wouldn’t work for me. Mornings are a more stable time to establish routines and when I find it easiest to weave in exercise as part of my everyday life. Everybody’s’ lifestyles and routines are different. It is important to find what works best for you and your lifestyle.”

5. Enlist support to stay on track and prevent set backs
Whether it’s quitting smoking, standing more or doing 30 minutes of exercise a day, research shows people who have the best chance of making changes are those who get some support.  “Whether its friends, family or a professional, enlist the support of those who want to see you succeed from the outset. They can help you when your motivation begins to wane,” Mr Dripps said.

“An APA Physiotherapists can help design exercise programs for people from all walks of life suited to your medical condition, while also helping you to stay on track.”

Call Nelson Bay Physiotherapy & Sports Injury Centre on 4981 3461 to arrange an appointment now. 


About Taryn Jones
Taryn Jones has been a physiotherapist for 18 years. She is passionate about creating a framework that empowers all individuals to achieve an active lifestyle, enhancing physical and emotional well being. In 2012 Taryn was awarded a Macquarie University Research Excellence Scholarship to undertake her PhD in Health Professions which she commenced in December 2012. Her PhD involved a series of studies to design, develop and test an innovative self-management course to increase physical activity in people with Acquired Brain Injury. It involves the design of an Active Lifestyle Model with four core areas to build and sustain physical activity for the long term – ‘managing activity levels’, ‘managing barriers’, ‘managing expectations’ and ‘managing habits’.

i   Monash University, Obesity in Australia, accessed at http://www.modi.monash.edu.au/obesity-facts-figures/obesity-in-australia/
ii  Psychology Today, Understanding Habit Formation, accessed on 11 December 2014 at http://www.psychologytoday.com/basics/habit-formation
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