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.

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.

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

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

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.

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

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.

Internet-based physiotherapy study shows benefits in patient pain relief

Innovative research released today proves that digitally enabled physiotherapy consultations are effective in treating patients with chronic knee pain.

Chronic knee pain, also known as knee osteoarthritis (OA), is a debilitating condition affecting more than two million Australians. OA has no cure, so helping patients manage their symptoms is an important part of their overall treatment, which includes diet and exercise programs.

Often, people living with OA get important support by visiting a physiotherapist at their clinic. However, for many people, particularly those living in regional/remote areas or with mobility issues, getting to a clinic can be difficult.

Currently, Medicare and health insurers rarely pay patient rebates unless the physiotherapist and patient are in the same place. This poses a significant financial barrier to effective treatments becoming available to Australians living remotely and/or with mobility issues.

The APA is calling on the Australian government to use the opportunity of the Medicare Review to change the rules so that all Australians can receive reimbursement for their health consultations, whether they be literally in the same room with their physiotherapist or in contact via a secure, digitally enabled connection. Private health insurers also need to do the same thing. This will ultimately lead to affordable and equitable health care across the country for all Australians.

A new study, published today in the prestigious Annals of Internal Medicine, shows some promising signs for people living with this debilitating pain. Effectiveness of an Internet-Delivered Exercise and Pain-Coping Skills Training Intervention for People With Chronic Knee Pain: A Randomized, Controlled Trial provides clear evidence that internet-delivered treatments are effective in managing chronic knee pain.

The study investigators recruited 148 people with chronic knee pain and allocated them into an intervention group or control group. The intervention group had seven appointments with a physiotherapist via Skype for prescription of a home exercise program and also independently completed an online pain coping skills training program over three months. The control group received online educational material only.

The results showed that the intervention group had significantly greater improvements in pain and physical function at three months which were sustained at their nine month follow up. Both participants and physiotherapists were highly satisfied with the treatment, with one physiotherapist saying, “I had a very positive experience with this study. I would rather embrace a new method if it’s proven to be successful than to continue doing something old.”

The study, conducted equally in cities and regional areas around the country, showed definite evidence-based effectiveness for this innovative digitally based consultation process.

The abstract for the clinical trial article can be read here.

Research like this is why The Australian Physiotherapy Association is pushing for changes to allow reimbursement for health consultations conducted both in-person or online. The research supports it!

Source: APA News, 21st February 2017

Sport and Activity during childhood and adolescence

Continuing our focus on physical activity in youth from our previous post (2nd April 2016 titled Organised sport doesn’t effect sedentary time in youths), comes recently published research in the Journal of Science and Medicine in Sport. A recent study titled “The influence of sport club participation on physical activity, fitness and body fat during childhood and adolescence: The LOOK Longitudinal Study” examined the effect of sports club participation on physical activity, cardiorespiratory fitness and body composition annually from 8 to 12 years of age and again at age 16 years.

The results found that Australian youth taking part in club sports are more active, fitter and have less body fat that non-participants. However, the majority of sports participants did not meet recommended levels of physical activity with the effect of organised sport on physical activity diminishing during adolescence, especially in girls.

The study raises discussion round two main points:

  • that coaches, parents and teachers should direct more attention to sports training and game strategies that promote greater involvement for girls
  • greater support for sport inside and outside of school hours could enable more children to meet recommended daily amounts of physical activity

Click the link above to read the research in full and it’s findings and stay tuned for our next instalment on this topic that is coming very soon.

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

Organised sport doesn’t effect sedentary time in youths

A recent study examined Physical Activity in Youth and whether participation in organized sports is related to achieving physical activity recommendations, body mass index (BMI), objectively measured physical activity intensity and time spent sedentary. Click the link above to read the research and it’s findings. It may surprise you but is certainly worth a read if you have teenagers or are involved in your work with teenagers.


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.

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 or

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:
  4. Better Health Channel. Obesity in children – causes. 2013; Available from:
  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:
  13. American Academy of Orthopaedic Surgeons. Ortho info. Backpack safety. 2015; Available from:
  14. Education Queensland. Health and Safety Fact Sheet. Heavy school bags. 2012; Available from:
  15. Osteopathy Australia. Back(pack) to school – tips on how to pick a backpack for your child. 2014; Available from:
  16. American Occupational Therapy Association. Backpack safety: stats on injuries. 2015; Available from:
  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.
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  3. Centre for Community Child Health. Movement and exercise for kids. 2015; Available from:
  4. Better Health Channel. Obesity in children – causes. 2013; Available from:
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  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.
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  15. Osteopathy Australia. Back(pack) to school – tips on how to pick a backpack for your child. 2014; Available from:
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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.

Childhood obesity study emphasises importance of exercise for young and old

16 April 2015

The Australian Physiotherapy Association (APA) welcomes VicHealth’s recent study: Influencing Children’s Health: Critical Windows for Intervention, which reports that lack of exercise, poor diet and overuse of technology are key drivers of childhood obesity.

Parents’ crucial role in modelling and enforcing healthy behaviour is highlighted in the study, which reveals that many parents use technology as a reward system and inadvertently reinforce excessive screen time. The study also finds that parents who model being active and eating well are more likely to positively influence their children.

The Australian Physiotherapy Association (APA) affirms VICHealth’s findings and supports the important role of regular physical activity for all members of the family, the importance of physiotherapists in prescribing appropriate activity for patients, and the role of community education in changing attitudes.

APA CEO, Cris Massis, says: “Physiotherapists with their education, training and competence in behavior-change, biomechanics and therapeutic exercise are ideally suited to identify, manage and prevent obesity. They can develop a program of exercise to increase physical activity safely and effectively for patients at risk of becoming overweight or obese, as well as for people already managing obesity-related illness.

“By identifying necessary and achievable changes in lifestyle for children, adolescents and adults, physiotherapists are at the frontline of managing obesity and its related conditions in our community. Healthcare professionals including physiotherapists, GPs, psychologists and dieticians need to work more in partnership to support individuals who are or are at risk of being overweight and obese,” Massis says.

The APA recently launched its Australia’s Biggest Killers health awareness campaign, which aims to educate Australians young and old about the real dangers of sedentary living.

With headlines like “Australia’s Biggest Killers” accompanied by a startling montage of a shark, crocodile, snake, spider, and the low fatality rates from attack by these creatures compared with the more than 7,000 deaths per annum that are related to obesity, the APA hopes to spur people into action.

“The APA’s new Australia’s Biggest Killer campaign aims to get Australians off the couch – to get moving, embrace a healthy, active lifestyle, and to see their physiotherapist if they need help with motivation or finding the appropriate level and type of physical activity,” Massis says.

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.

Physiotherapist misdiagnosis non-existent in emergency departments, according to new research

2 September 2015

New research released by the Australian Physiotherapy Association (APA) has found that physiotherapists have displayed a 0% misdiagnosis rate in emergency departments across Australia.

Released in conjunction with World Physiotherapy Day, taking place on Tuesday 8 September, the research from the Journal of Physiotherapy looks to highlight the important contribution of physiotherapy to the health and wellbeing of Australians.

The study found that physiotherapists have made a significant impact in mitigating misdiagnoses, reducing time spent in emergency departments and the subsequent need for further imaging procedures such as CT scans, X-rays and ultrasounds.

Patients who presented to emergency departments with minor trauma experienced a 0% rate of misdiagnosis and subsequent adverse events, when managed by the physiotherapy service.

Cris Massis, CEO of the APA, believes that the significant impact of physiotherapists in emergency departments and wider communities across Australia is one that needs to be commended.

“World Physiotherapy Day is all about celebrating the important role that physiotherapy plays in the lives of people and these positive statistics really underscore the impact physiotherapists make in assessing, treating and preventing diseases and disability.

“The fact that there were no misdiagnoses from physiotherapists in emergency departments is testament to the high level of skill, expertise and quality of care that physiotherapists can provide both on their own and as part of an integrated treatment plan with other health care professionals,” said Massis.

This significant impact made by physiotherapists was further compounded by findings that these patients also spent an average of 83 minutes less in the emergency department when diagnosed by a physiotherapist and significantly less follow up imaging requests.

With over 27,543 qualified physiotherapists practising in public hospitals, rehabilitation centres, sporting clubs, community health centres and the private sphere, Australian’s are spoilt for choice when it comes to selecting a qualified physiotherapist to help them recover from injury, pain, stiffness and increase their overall mobility.

“Many people don’t realise the diversity of the physiotherapy profession in helping to alleviate everything from head, neck, shoulder, knee and patellofemoral pain, through to a broad range of injuries and conditions spanning ankle pain, arthritis, depression, diabetes and sports injuries.

“We hope that World Physiotherapy Day will help to educate the public on the diversity and importance of the industry,” said Massis.

To find out more about World Physiotherapy Day, or to find a suitable physiotherapist, visit

World-first physiotherapy trial targets hip pain

Article by: Karen Keast

A Melbourne physiotherapist is conducting a world-first study into a crippling condition that causes pain on the outside of the hip, particularly common in post-menopausal women.The Gluteal La Trobe (GLoBE) trial is investigating whether a hormone supplement and targeted exercise programs can improve the symptoms of greater trochanteric pain syndrome (GTPS).The syndrome causes pain on the outside of the upper thigh or side of the hip, which can lead to difficulty exercising or completing general activity, from walking up and down stairs and ramps to lying in bed and sitting for long periods at a time.Risk factors for GTPS include the female gender, age, weight, lifestyle changes, back pain and a reduced angle of hip joint to thighbone in women.Women can experience changes in their tendon structure due to reduced oestrogen levels and collagen production during menopause, resulting in poorer tendon structure.

A change in activity, from taking up a new exercise program, starting new stretches and increasing exercise frequency, can overload and compress an already vulnerable tendon and lead to GTPS.La Trobe University PhD candidate Charlotte Ganderton, a physiotherapist at Mill Park Physiotherapy and Eastern Health, said the study involves two randomised controlled trials – one examining the effect of a targeted exercise program while the other investigates the use of a hormone therapy cream coupled with targeted exercise.Ms Ganderton, a member of the Australian Physiotherapy Association, said most research into lateral hip pain has focused on medical interventions such as cortisone injections and surgery.“We know exercise helps other tendon conditions such as in the Achilles, patellar and hamstring yet very little has been explored into similar management of GTPS,” she said.“Studies into supplemental oestrogen have found that it is beneficial for increasing skeletal muscle strength, reducing fractures, preserving bone mass and preventing a decline in the collagen content of the skin.

“Studies have also suggested that tendon cells contain hormone-specific receptors, suggesting the tendon is responsive to oestrogen.

“Investigating the role of hormone supplementation as a treatment for GTPS is a world-first, and is also a very important step towards helping patients manage this debilitating condition.”

The study provides participants with free physiotherapy sessions, education about managing GTPS and a home exercise program that includes three simple exercises. The interventions span a three-month timeframe and the study monitors participants’ progress over a year.

Ms Ganderton said the study, which began in January, is already producing encouraging results with participants reporting reduced pain and improved hip movement.

“I had a participant ring me the other day and say – ‘the next time I see you, I’m going to give you a big hug, you’ve changed my life’,” she said.

“It seemed a little bit unbelievable that just a small amount of education and a few exercises has completely changed her outlook on life.

“Impacting upon people’s day to day life is probably the most rewarding thing to come out of the study.”

Ms Ganderton said while 24 women are enrolled for the hormone study and another 56 are enrolled in the exercise study, more participants are needed.

“Our aim is to get about 80 for the exercise study and 120 for the hormone study,” she said

“We are administering the hormones via a cream and we’re also making sure that these participants have had a consultation with a sports physician, they’ve had a full medical, blood test and an ECG before they commence the study.”

Ms Ganderton said lateral hip pain is often misdiagnosed as back pain, bursitis or hip arthritis, leading to poor management of the condition and ongoing issues for those affected.

“These women bounce from health professional to health professional, from injections to sports doctors to imaging, and they never really get on top of what’s going on,” she said.

“We hope we can change that and help women get back on with living a much better quality of life with a lot less pain.”

Ms Ganderton said a diagnosis of GTPS involves an understanding of the interplay between gluteal tendon and bursa.

“There are more options than medical management. Physiotherapy can be a fantastic tool to use to reduce pain in the area and increase their day to day function,” she said.

“Women with the condition need to access the right physio, someone who really understands the condition and can treat it accordingly, to really get better.”

Results of the study will be presented to the APA at the end of the year.