All physiotherapists want the best for their patients and we aim to provide the most effective treatment for each and every person on the Northern Beaches that walks through our doors. But how do we know that our physiotherapy is making a difference and that it is the best care for every individual’s circumstances?
Everybody and every body is different, which means there are going to be nearly an infinite number of ways to treat individuals suffering from chronic pain, musculoskeletal disorders and muscular or ligament injuries. It is up to physiotherapists to identify the best methods for each individual client and implement them in a broader strategy to meet their goals. This is where utilising evidence based practice techniques and taking a results based approach to treatment and injury management can shave weeks from your recovery period and result in less pain and a decreased risk of suffering a re-injury.
What is evidence based practice?
Evidence based practice (EBP for short) isn’t a new concept, it has been utilised in the medical world for a number of years now and has become a popular method of treatment for physiotherapists around the world over the last decade.
EBP utilises ‘the integration of best research evidence with clinical expertise and patient values’ in order to shape the treatment of patients and include them in the processes of treatment in order to prevent pain and injury in the future.
The goals of evidence based practice are:
- To improve the care for clients, resulting in more effective treatment and injury recurrence
- To use evidence from high quality sources to help shape physiotherapy practice
- To challenge treatment views based on anecdotal evidence
- To integrate patient preferences into the treatment and decision making processes
- To take the guess work out of treatments, using education to shape future activities
What are the 5 steps of evidence based practice?
Because evidence based practice relies on consistency and clinical fact in order to make diagnoses and frame the best treatment, a framework of steps has been outlined in order to help physiotherapists design and implement and evidence based approach to treating musculoskeletal conditions.
Step 1 – Ask an answerable and measurable question
One of the fundamental skills needed by musculoskeletal physiotherapists in designing an evidence based program is the asking of to the point clinical questions. By asking the right questions you can focus your efforts specifically on the areas needed, instead of non-important matters.
Step 2 – Acquire relevant research evidence
With the easy part out of the way, your physiotherapist will move onto extrapolating the answers to their questions in order to find relevant, recent and scientifically proven methods for treating your specific condition. Physiotherapists will use a combination of their own data collected over years of practicing in the field and scientific studies located in databases specifically designed to provide a workflow in order to come to the right conclusions.
Step 3 – Analyse the evidence
This is where the expertise and experience of your physiotherapist is really going to come in handy. For example, a Titled Musculoskeletal Physiotherapist has likely spent over a decade studying and practicing in the field and has gained an advanced insight into what evidence is important and what evidence may not be supported by clinical practice and other data. By critically analysing the scientific data your physio is already piecing together your treatment plan in their head and focusing on your goals in relation to the evidence for treatment techniques.
Step 4 – Implementation of the evidence
Now that your physio has conducted their full body assessment, questionnaire and compared data with high quality evidentiary sources, the real fun is ready to begin. Physiotherapists will implement their treatment plans usually by combining the best available evidence with their clinical expertise and their patient’s values and goals. During the implementation phase, your physio will be documenting and assessing your treatment and recovery in order to make any adjustments to your program and to ensure your recovery is progressing. Implementation isn’t a single process; it is the sum of all their experience and knowledge that can be altered and updated to suit your progress.
Step 5 – Evaluate the outcome
If your original treatment plan isn’t getting results, this is where your physio has the knowledge and flexibility to alter what’s required to get you back to 100% health. By documenting your progress and implementing evidence based methods, your physio is able to alter your treatment based on results and at the end of the day, that’s exactly why you see a physio in the first place. To get results. If it’s not working, fix it.
Evidence based practice in physiotherapy is a constantly evolving concept and allows for a flexible and science based approach to combating common musculoskeletal problems. Find yourself a Northern Beaches physio with the expertise and experience to create and implement an evidence based, patient-centred and results focussed program and you’ll be on the right track to a pain free future.
 Sackett DL, Rosenberg WMC, Gray JAM, Haynes RB, Richardson WS: Evidence based medicine: what it is and what it isn’t. BMJ 1996;312:71-2
Physiotherapy is a broad and multi-dimensional treatment process designed and ever expanding to treat a huge number of conditions. While physiotherapy mostly focuses on the diagnosis and rehabilitation of musculoskeletal and circulatory system issues, a growing number of practitioners also treat conditions like sports injuries, various forms of arthritis and respiratory problems such as cystic fibrosis. From bone breaks to bursitis to Temporomandibular Joint Pain, physiotherapists have a special knack for canvassing the human body for the cause of pain and dysfunction and getting it back to full performance using a number of high-tech and low tech treatment options. For all the technology in the world, a musculoskeletal physiotherapist gets the best results with their hands.
Below are the 5 most common treatment techniques used by physiotherapists every day in order to get their patients back to optimal health and performance, free of aches and pains.
- Physical examination and assessment
The first and most important step in the treatment process is the physical examination and assessment your physiotherapist will complete on your first visit. Expect to have a real deep and meaningful chat with your physio where they will ask you a number of detailed questions about your general health, activities and how your aches or pain came about. It’s at this point a good physio becomes a bit like Sherlock Holmes, sometimes it takes a bit of sleuthing to get to the bottom of some injuries and pain as they can be the result of an injury that starts in another area of the body.
Following the getting to know you part, your physio will begin to lay out a treatment plan personalised to your current situation. Depending on where you are on the injury and pain scale, the first course of action might be a prescription for some recovery and icing of the affected area before moving forward with physical therapy.
- Joint and soft tissue mobilisation
Joint and soft tissue mobilisation techniques are forms of manual therapy that have been tried and tested over decades. When joints and other soft tissue become painful due of trauma, overuse or disuse, they can become dysfunctional and unable to perform the movements they were designed for. Soft tissue injury is an umbrella term used to describe injuries affecting your muscles, tendons, or fascia that usually occur as a result of sprains, strains, contusions, tendonitis, bursitis and stress injuries. Soft tissue mobilisation has also been called therapeutic massage and has been designed to relax a patient’s muscles and reduce swelling in certain areas, making it a perfect treatment for relieving pain associated with sporting injuries.
Joint mobilisation is a technique used by physiotherapists by performing a back and forth oscillation of the joint in order to restore full range motion and limit pain. Joint mobilisation is helpful in cases where pain and joint tightness limit motion such as frozen shoulder. Joint mobilisation treatment varies depending on your circumstances but will generally include gentle joint mobilisations, joint manipulation and none of the old school snap, crackle and pop techniques that have little long term benefit.
- Acupuncture and Dry Needling
Dry needling and acupuncture are two of those treatments that always raise my patient’s eyebrows. At first, not many people are keen on the prospect of being jabbed with tiny needles, it sounds counterproductive to kicking pain doesn’t it? But after one session, they’re converts.
Contrary to popular belief, dry needling is not the same as acupuncture, although there are similarities between the techniques. The main difference between dry needling and acupuncture is found in the theories behind why each of the techniques works. Dry Needling focuses on the reduction of pain and restoration of normal function by releasing myofascial trigger points in muscle. In contrast, acupuncture is dedicated to the treatment of medical conditions via the restoration of the flow of energy (chi) through key points in the body to restore balance.
- Ergonomic, biomechanical and sports specific technique correction
If your visit to the physiotherapist was brought about by suffering an overuse or acute injury at work, during sport or just by living your normal life, you’re really doing yourself a disservice and increasing your chances of re-injury if you don’t take adequate steps at changing your movement patterns or technique. Poor technique and posture are two of the most common sources of repeat injury observed by physios. Biomechanical assessment, technique observation and diagnostic skills are all part of the skill set of your musculoskeletal physiotherapist and allowing them to observe you in your environment or using your regular physical techniques will ultimately help you to avoid musculoskeletal and sports injuries in the future.
Think of your local musculoskeletal physiotherapist as a pain doctor, or body mechanic. They have at their fingertips a range of tried and true methods of getting you back into 100% health and kicking that pain to the curb. If you are experiencing any muscular, joint or physical pain don’t hesitate to make a booking at your local 5 star rated physiotherapist on the Northern Beaches. Your body won’t regret it.
Osgood-Schlatter’s disease (OSD) is a few things (on top of being a bit of a mouthful); it’s a growth plate injury in children, notoriously difficult to diagnose and commonly mismanaged. Osgood-Schlatter’s is characterised by swelling and irritation of the growth plate at the top of the shinbone. The growth plate is a layer of cartilage located toward the end of a bone where the bone’s growth occurs. This is why adults cannot suffer this “disease”.
When it comes to kids, two things are pretty much certainties; they’re going to grow and at some point they’re going to hurt themselves. When these two certainties occur simultaneously, children can end up with painful growth-plate injuries that can be difficult to treat and manage effectively. Growth plate injuries are quite a common cause of pain in children and adolescents and Osgood-Schlatter’s causes pain in the front of the knee. Boys are more likely to suffer the condition than girls, and playing in sports that involve lots of running, jumping and kicking increases the chances of it popping up too. Musculoskeletal physiotherapists classify Osgood-Schlatter’s disease as an overuse injury, not a disease!
HOW IS OSGOOD-SCHLATTER’S DIAGNOSED?
Because children’s bodies are physiologically different than adults, it is not uncommon for the Emergency Department or a GP to misdiagnose a child’s pain as another injury. Your child’s physiotherapist will conduct a thorough assessment which will include checking movement patterns of the hip, knee, ankle and foot, assessing muscle strength and muscle length in order to pinpoint the cause of pain. X-rays and other medical imaging are usually not required.
If your child has Osgood-Schlatter’s, they will normally have pain close to where the patellar tendon connects to the shin bone slightly below the knee cap. It can also cause a painful lump to form in that area. For your child, their pain will probably be heightened during physical activity and the pain commonly gets worse with running, jumping and walking up hills. The pain and swelling tends to improve relatively quickly (in the short term) with a bit of rest.
WHAT CAUSES OSGOOD-SCHLATTER’S?
Osgood-Schlatter’s is an overuse injury, which is exactly like it sounds. During a child’s growth spurt, the bones, muscles, and tendons all grow at different rates. In OSD, the tendon connecting the shinbone to the kneecap pulls on the growth plate at the top of the shinbone. Activities and sports such as AFL, soccer and athletics can cause this movement to happen over and over, causing injury to the growth plate. When undergoing physical activity with strong, repetitive muscle contractions in the thigh, micro-fractures can occur due to the immature nature of the joint and bones. Another possible cause of Osgood Schlatter’s in adolescents is the lack of growth of the quadriceps in comparison to the femur bone. During a child’s growth spurt, the slow lengthening of the muscle is unable to keep up with the rapidly lengthening femur, which causes increased tensile force on the tibial tuberosity and more pain.
HOW IS OSGOOD-SCHLATTER’S TREATED?
I’ve seen mild cases of Osgood Schlatter’s Disease resolve themselves within a few weeks, but severe cases must be professionally managed to avoid permanent growth plate damage. Fortunately for the unfortunate child, Osgood Schlatter’s disease is very successfully managed via physiotherapy. Osgood Schlatter’s disease is a self-limiting syndrome which means that with time, complete recovery can be expected with the closure of the tibial growth plate. If OSD hasn’t been treated effectively during childhood, it is not uncommon for there to be recurring discomfort in the knee while kneeling due to enlarged lumps as a result of the distorted growth plate. Although symptoms of Osgood Schlatter’s disease can hang around for months at a time, surgical intervention is hardly necessary.
The goal of the treatment is to control your child’s knee pain and prevent the condition from worsening. Treatment usually includes:
- The tried and true RICE method (rest, ice, compression, and elevation)
- Medications such as anti-inflammatories for discomfort and swelling
- Wrapping or compression of the knee
- Limit on activity
- Physiotherapy to help lengthen and strengthen the thigh and leg muscles
What not to do:
- Stretching! Multiple sources online speak about stretching out the quadriceps, to help lengthen the muscle and alleviate tension on the growth plate. With additional tensile force pulling on a growth plate that is constantly being pulled, no child will thank you for stretching out their quadriceps!
Your child’s physio will also prescribe specific exercises for your child to complete depending on their assessment findings. One of the common reasons adolescents develop Osgood Schlatter’s syndrome is tight quads, hamstrings and calf muscles. In that case, manual therapy and soft tissue release will assist pain and quicker recovery.
If your child has been complaining of a sore knee or has been limping or showing signs of discomfort, don’t let the issue linger for too long. Call one of our musculoskeletal physiotherapy experts on (02) 8964 4086 and get a diagnosis and treatment plan before any long term damage occurs.
Sever’s disease, aka calcaneal apophysitis to musculoskeletal physiotherapists is the most common cause of heel pain in growing athletes. Sever’s Disease isn’t really a true disease per se and was actually first identified by Patrick Haglund in 1907, but it was James Sever’s characterisation of the disease in 1912 that led to it being named after him. Maybe it just had more dramatic ring to it? Sever’s disease is the inflammation of the calcaneal apophysisa, located on the heel close to where it connects into the Achilles tendon. Sever’s Disease most commonly occurs before or during a child’s peak growth spurt and is often seen when they begin a new sport or footy season. It is most common in boys between the ages of 8 and 12 and quite frequently in girls between the ages of 8 and 10 years old who are also active in sports.
How is Sever’s Disease diagnosed?
For your physio to find the cause of your child’s heel pain and rule out more serious conditions, they will ask some thorough questions about their medical history and ask questions about recent activities or injuries. There is rarely the need for any blood tests or x-rays, your physiotherapist will perform what’s called a squeeze test and some other tests to confirm the diagnosis of Sever’s Disease. During the squeeze test (which is exactly what it sounds like) if the child’s medial and lateral sections of the heel are tender and there are no symptoms such as red skin or swelling, almost always indicates a diagnosis of Sever’s disease.
- Pain in the back or bottom of the heel
- Walking on toes
- Difficulty running, jumping or participating in usual activities or sports
- Pain when the sides of the heel are squeezed
What causes Sever’s Disease?
When children (especially boys) are going through a growth spurt, the bones will grow first and the muscles and tendons can take a while to catch up. In Sever’s disease, the area around the heel bone can become quite sore and swollen where the Achilles tendon attaches to it. Children who participate in running and jumping sports such as AFL, soccer, Basketball and athletics are more likely to end up with Sever’s disease. Research has also shown that wearing boots with studs or spikes increases the risk of developing Sever’s disease.
Factors contributing to Sever’s Disease in children include changes to:
- Height and weight – high BMI children have higher rates of the disease
- The frequency of physical activity – AFL carnivals over a few consecutive days
- The type of physical activity – Changing sports or starting new ones eg. Netball, gymnastics
- Shoes and equipment – Many football boots have a lower heel that can add pressure to the apophysis by stretching the Achilles tendon slightly. Lots of barefoot running and even walking in thongs on the soft sand at Dee Why can cause the same increased load.
How is Sever’s Disease treated?
As with most soft tissue injuries, in the first stages of recovery your physio will recommend the R.I.C.E method – Rest, Ice, Compression, and Elevation. Unfortunately, no one treatment method has been definitively proven to be better than others in the long-term management of Sever’s disease. During the early phase your child will probably be unable to walk pain-free, so the first aim is to prescribe your child with some active rest activities and keep away from pain-provoking activities for the time being. Your physio will use and teach your child a range of pain relieving techniques including joint mobilisations for stiff ankles and give the area a good massage in order to restore full Range of Motion, reduce pain and regain full foot biomechanics. A good musculoskeletal physiotherapist will also want to see your child’s biomechanics and technique in action and if they have injured themselves playing AFL or another sport, getting your physio to check it out will help reduce flare ups in the future.
How does Sever’s Disease affect my child’s sport?
Sever’s disease is a self-limiting condition and will fully heal with the right treatment. The first important step is to seek treatment when early signs of Sever’s become apparent. Sub-optimally treated Sever’s disease can cause a permanent bone deformity at the rear of the heel bone which can be painful and annoying. For the time being, seeing a physio will be be helpful to learn ways to stretch the Achilles tendon and keep pain under control. Limit your child’s sport load during the initial period and monitor their return to sport closely afterwards.
If your child is between the ages of 8 to 12 and is complaining of heel pain with no exterior causes, you should suspect Sever’s disease until proven otherwise. Sever’s Disease is a common issue seen by your local Dee Why physio due to the high number of active kids on the Northern Beaches (a positive and a negative there) and they are the best people to speak to if your child is complaining of a sore ankle.
 HAGLUND P: Ueber fractur des epiphysenkerns des calcaneus, nebst allgemeinen bemerkungen ueber einige
aehnliche juvenile knochenkernverletzungen. Archiv fur
klinische Chirurgie 82: 922, 1907
 SEVER JW: Apophysitis of the os calcis. N Y Med J 95:1025, 1912
 Sever’s Disease: What Does the Literature Really Tell Us? Rolf W. Scharfbillig, PhD* Sara Jones, PhD† Sheila D. Scutter, PhD May/June 2008 • Vol 98 • No 3 • Journal of the American Podiatric Medical Association
Your feet are full of bits and pieces that can cause plenty of pain. 26 bones, 33 joints and over 100 ligaments, nerves, muscles and tendons that are all capable of causing varying degrees of feeling from ooh that tickles to CALL THE AMBULANCE!!! Each foot is intricately designed to absorb the forces of walking, running and jumping, morphing to the shape of the ground and transmitting these forces through the ankle to the legs. When everything is going smoothly, this process is seamless and unnoticeable, when it’s not, it can affect your day to day life. According to the 2017 Healthy Feet Survey around half of Australians experience heel/arch pain and 6% of people surveyed wake up every morning with foot pain. The same study also showed that despite having expert knowledge, musculoskeletal physiotherapists are only consulted by 5% of people suffering foot pain, with 80% heading to the GP for advice. GP’s commonly refer clients to musculoskeletal physios for foot and ankle pain, physios are really just doctors to manage and prevent pain.
So, what are the most common types of foot pain, and what do they mean?
Ball of the foot pain or Metatarsalgia
Pain and inflammation in the ball of the foot is referred to by physiotherapists as Metatarsalgia . Good news for people who are more active, you’re more likely to experience ball of foot pain due to your activities that involve a lot of running and jumping. It is also common for people to suffer Metatarsalgia due to the over-usage of improper fitting shoes.
Musculoskeletal physiotherapists recommend a number of conservative treatment methods for ball of the foot pain such as rest and ice therapy. It is also important to take an in depth look at your shoes. Ideally you participate in sports with shock absorbing arch supports or insoles to minimise future complications or recurrences of metatarsalgia. Signs and symptoms of ball of foot pain include:
- Burning or aching pain in the ball of the foot
- Pain around the big toe only
- Worsening pain with weight bearing activities such as standing, running or walking
- Numbness or tingling in the toes of the foot
- The pain improves with rest
Plantar Fasciosis aka Plantar Fasciitis
“Plantar fasciitis” (a common misnomer as there is rarely any inflammation!) is one of the most common causes of heel pain characterised by pain in the plantar fascia, a thick fibrous band of connective tissue running from the bottom surface of the heel bone extending along the sole of the foot towards the toes. Have you ever jumped out of bed in the morning only to feel a stabbing pain in your heel with each step? That’s probably plantar fasciitis. Plantar fasciitis is most commonly found in impact and running sports but can sometimes feel like it just popped out randomly out of nowhere. People with poor foot biomechanics and those with flat feet or weak foot arch control muscles are more likely to suffer heel pain.
One of the most important aspects of treating and preventing a recurrence of plantar fasciitis is assessing and correcting any issues in your foot and leg biomechanics, sporting technique and your shoes. Not all Dee why physio clinics are experts in foot control assessment and its dynamic biomechanical correction. After an initial in depth physiological assessment, your physiotherapist will likely prescribe manual therapy techniques such as joint mobilisations, soft tissue massage or release, muscle stretches for flexibility, foot taping and lower limb strengthening exercises.
Characterised by pain in the Achilles tendon or its covering, Achilles Tendonitis is an overuse injury that is most common in joggers, jumpers and other activities that require repetitive actions. Tendons are tough fibres that connect your muscle to bone but they are susceptible to overuse and injuries are usually caused by a number of micro tears occurring over a period of time. Common causes of Achilles tendonitis include:
- Tight hamstrings and calf muscles
- Walking on your toes (or excessive high heel wearing)
- Overtraining and failing to warm up or down
- Poorly supportive footwear
Foot pain is a common issue for Australians to put off until recovery includes being totally laid off your feet. It can be easy to write off foot pain as simple pain but it can also be caused by fractures, nerve compressions, loss of blood supply to the bone and even problems stemming from the lower back. The best way to pinpoint and treat foot pain is to undergo a full body analysis with your local physio. The good news if you are suffering foot pain is that research has shown that physiotherapy is effective management and will get you back to playing the sports and doing the activities you enjoy, free from pain.
We’re an active bunch on the Northern Beaches and you’ll find that injury prevention and recovery are 2 major aspects of sports physio clinics in Dee Why. Chances are at some point you’ve experienced an injury, whether you tore an ACL, strained a hammy or twinged your neck and if you’re one of the unfortunate many you’ve probably reinjured it at least a couple of times. Recurrent injuries aren’t confined to AFL players and other professional athletes. Computer programmers are more susceptible to a recurrence of tennis elbow than tennis players, remember? Unfortunately prevention can’t always prevent a hammy strain, but once an injury has occurred you have the power to start the prevention cycle all over again.
There are a number of factors that influence the statistical probability of suffering an injury recurrence; if you watch a sport regularly you can probably name 1 or 2 athletes that seem to suffer the same injury over and over again. NRL player Tautau Moga for instance is only 25 years old and has torn his left ACL 4 times, having a full reconstruction and rehabilitation after each occasion. Researchers are getting better at injury prevention and management every day and sports and musculoskeletal physiotherapists are experts in getting to the things that increase injury recurrence:
Insufficient rehabilitation from previous injury
Call it youthful exuberance in wanting to get back into it too quickly, call it being lazy and not completing your full rehabilitation but one of the most common reasons for suffering a recurrence of an injury is failing to rehab properly. Overloading is a great short term principle and is part of effective programming to allow for super-compensation and increase fitness and strength, but IT DOES NOT APPLY DURING INJURY RECOVERY. Any professional level athlete in any sport will tell you their recovery is just as important as their training when it comes to performance. Failing to follow your physiotherapist’s full rehabilitation program for your sore hammy is only going to end one way. Your guessed it – a pain in the butt!
Neglecting symptoms of pain
Speaking of pain, one of the next most popular reasons people reinjure themselves is failing to heed your body’s best warning signal; pain. “I’ll just run it off” doesn’t cut it as an effective treatment strategy for managing most musculoskeletal injuries but it’s still one of the most common things that people like to do for some reason. Most chronic back, neck, knee, hip, groin, ankle and hamstring injuries will usually give you some warning sign before they completely give up. Don’t treat that shooting pain in your leg like the check engine light in an old car and just put some tape on it either. Strapping and taping is good in some instances, but it can’t keep a hamstring in place for long.
Poor conditioning or fitness
Coming back from long term injury can be tough and it’s common to let fitness levels slip while injured which can often lead to poor performance or additional musculoskeletal injury upon returning to physical activity. Every bit of physical activity outside of your physically repetitive job is going to lower your chances of suffering a repetitive strain injury as well. While you are recovering from an injury, try and do all you can to keep moderately active, whether it be short walks, dumbbell curls or simple sit-ups.
Poor technique and movement control
Poor technique and movement control are probably the 2 most important factors that cause injuries in the first place and they continue to play a part in injury recurrences. I don’t know how many times I’ve seen someone load up weights to the max at the gym, lifting far too much and trading technique for weight. This principle can be applied to most physical activities. Most injuries occur when you go too hard, are fatigued and are using movements that you are not at the unconscious competence stage of performing yet.
Poor or no warm-up/warm-down
Be honest, do you spend 10 minutes warming up and down every time before and after sport and physical activity? A well performed warm-up before a workout is going to dilate your blood vessels, ensuring your muscles are supplied with enough oxygen while also raising your muscles’ temperature aiding in achieving optimal flexibility and efficiency. Cooling down after physical activity is every bit as important as warming up. Stretching while you’re cooling down is the way to go because your muscles, limbs and joints are still warm. Stretching is going to reduce the build-up of lactic acid, which is the leading cause of muscle cramp and stiffness.
If you have suffered an injury, don’t shirk your recovery. Speaking with an expert in sports and musculoskeletal physiotherapy and undertaking a custom made rehabilitation program is going to shorten the length of your recovery, minimise your risk of a recurrence of your injury and also help provide you with the knowledge you need to continue to prevent injury independently.
Are you suffering from a pain in the neck? I’m not talking about your latest electricity bill, or an annoying co-worker, I’m talking good old fashioned inescapable neck pain. Over the course of a lifetime there is a 50% chance you will suffer from neck pain at one point or another. This risk can be heightened by a number of factors: your age (another great part of getting older), your sex (women are more likely than men to experience neck pain) and the type of work you do (I’m looking at you, computer using people). For most Australians neck pain is something that usually lasts 6-8 weeks, but for around 30% of people, neck pain can become a chronic source of pain, limiting the activities you can take part in and disrupting sleep patterns which in turn can cause other problems. Neck pain is one of the most common complaints physiotherapists deal with and there are a number of scientifically proven exercises and treatments to ensure your neck pain doesn’t turn chronic.
What are common symptoms associated with neck pain?
To put it simply, the spine and neck are very complicated regions of the body and can cause a variety of symptoms and finding the right Northern Beaches physio is essential to pinpointing the cause. In all there are seven cervical vertebrae acting as building blocks of the spine in the neck and surrounding the spinal cord and canal. Within the neck, structures include the neck muscles, arteries, veins, lymph glands, thyroid gland, parathyroid glands, oesophagus, larynx, and trachea. This means that neck pain can present a wide array of related symptoms, requiring a skilled musculoskeletal physiotherapist to identify the source. Neck pain can culminate in the following symptoms:
- Numbness, weakness and tingling in the arms and fingers
- Surrounding muscle pain, commonly the shoulders
- Stiff neck
- Sore throat
- Even loss of bowel or bladder control
What are some of the causes of neck pain?
Neck pain just doesn’t come about for no reason, it is usually related to a specific issue with another part of the body, or begins as a direct result of an injury or overuse problem. When you first discuss neck pain with your physio they will conduct an analysis of your body in order to pinpoint the root cause in order to create the most effective program to treat it. Musculoskeletal physiotherapists and General practitioners have highlighted the following as the most common causes of neck pain:
- Degenerative disc disease
- Neck strain
- Cervical Spondylosis
- Poor posture
- Pinched nerve
Is your phone being a pain in the neck?
As more people spend their days scrolling mindlessly through Facebook, the average number of hours spent on our phones is increasing rapidly, with Australians clocking up 10 hours of mobile screen time PER DAY. Did you know that within 5 minutes of waking up over one third of Australians have already checked their mobile phone at least once, not even dinner time puts the brakes on mobile usage with around 70% checking their phones while eating with family and friends? They are some seriously crazy numbers. We’ve even had to give it a name, text neck. Staring down at your phone causes your neck extensors to stretch unnaturally causing them to weaken over time and can add nearly 30kg of pressure to the back of the neck. This unnatural forward head posture has also been shown to inhibit breathing capacity which can lead to migraines and cause brain fog throughout the day. If you also happen to have a job that requires you to stare at a computer screen or you spend a few hours a day watching television, your risk of suffering neck pain increases.
What are the best treatments for neck pain?
Your Dee Why physio will most likely recommend a multi-modal approach to tackling your neck pain, with studies showing that a combined process is the most effective at shortening the duration and intensity of the pain. A combination of strength and mobility exercises, postural and ergonomic changes, hands on treatment and dry needling have all been shown to be effective and are utilised by musculoskeletal physiotherapists around the world.
If you have been suffering from a sore neck, or any of the symptoms outlined above, you are only increasing your chances of your neck pain becoming chronic and affecting other areas of your body and daily life by not having it treated. It can be easy to shrug off neck, shoulder and back pain as a normal part of life, work and getting older, but nobody should have to put up with chronic pain. You might not be able to get rid of every pain in the neck in your life, but speaking with your Northern Beaches physio can certainly go a long way to getting rid of the actual pain.
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 William J. Hanney WJ, Kolber MJ, Schack-Dugre J, Negrete R, Pabian P, The Influence of Education and Exercise on Neck Pain. Am J Lifestyle Med. 2010;4(2):166-175.
With literally thousands of physiotherapists now at your fingertips and an infinite number of Google options to choose from, how do you know if the Dee Why physio you choose is appropriately qualified to treat your specific condition? Anyone who can legally call themselves a physiotherapist has studied for 4 years at university, covering multiple areas of practice including: Musculoskeletal injuries and conditions (joints, muscles, bones, tendons and ligaments,) Neurology (spinal cord and brain injuries) Cardio-respiratory conditions (heart and lungs) Paediatric issues (children). Fresh out of uni you could say a physio is a jack of all trades, but a master of none. It is after admission as a fully fledged physiotherapist that we can really delve into the more specific and advanced areas of practice and hone our skills to become experts in our field.
What is a Titled Physiotherapist?
If you think of a regular physiotherapist as a General Practitioner, a Titled Physiotherapist is the equivalent of a specialist. The Australian Physiotherapy Association (APA) defines a Titled Physio as “highly qualified physiotherapist with expert knowledge and skills”. That’s putting it pretty lightly. To be eligible to call yourself a “Titled Musculoskeletal Physiotherapist” you need to do your 4 years Bachelor of Applied Science (Physiotherapy), complete a 2 year Masters of Musculoskeletal Physiotherapy (making a substantial contribution to the field academically) followed by a minimum of 2 years full time clinical experience dealing primarily with musculoskeletal conditions. That’s nearly a decade of study right there.
What are the common areas of Titled Physiotherapy?
- Sports medicine
- Animal physiotherapy
- Musculoskeletal physiotherapy
- Neurological physiotherapy
- Gerontological physiotherapy
- Cardio respiratory physiotherapy
- Occupational Health and Safety
- Continence and Women’s Health
What does a musculoskeletal physio specialise in?
Musculoskeletal Physiotherapists have expertise in the treatment of muscular and joint conditions. These rockstars have a comprehensive knowledge of anatomy, physiology, pathology, injury assessment and utilise up to date evidence based approaches to treating spinal and joint injuries. Musculoskeletal Physiotherapists are the experts in assessing the structures, contributing factors and mechanics causing your pain. Think of them as the pain doctors.
How musculoskeletal physiotherapy can help you.
- Completely relieving or reducing your pain
- Helping you to avoid future injury recurrences
- Providing you with ongoing strategies and support to manage your injury or condition
- Improving your flexibility, muscle strength, quality of movement and co-ordination
- Enabling a quicker recovery and allowing you to your normal activities sooner
- Assisting you to achieve your exercise or functional goals
- Improving your fitness by structuring a personalised injury management training program
- Prescribing exercises to do at home or in the gym to enhance your recovery
How common are Titled Musculoskeletal Physiotherapists?
Not quite as rare as hen’s teeth, but not far off. Did you know that less than 5% of physiotherapists attain the level of Titled Musculoskeletal Physiotherapist? Your local Dee Why physiotherapist, Damien Glover combines an expert understanding of anatomy and human biomechanics, the latest scientific methods and years of practical experience in the field to provide a multi-pronged program designed to combat a number of common musculoskeletal issues.
The multifactorial approach of a musculoskeletal physiotherapist to your examination allows us to accurately diagnose your condition or injury and highlight further influencing factors of what is happening with you. This deep dive into your physical health allows your Northern Beaches physio to design a bespoke rehabilitation program with short, medium and long term outcomes to ensure success and a pain free future.
In previous blogs we’ve looked at some of the physical, psychological and social benefits that playing a team sport can have on children. Today we’re going to be looking specifically at Australian Rules Football (we’ll just call it AFL for ease of reading from here on in!) and some of the great effects it can have on kids’ physical and social development. As AFL continues to grow in NSW, so does physiotherapists’, Doctors’, psychologists’ and education expert’s knowledge of how AFL and other ball sports positively affect children and their development into young adults. Unfortunately my love of AFL can only be channelled through being able to support the physical needs of players and unashamedly cheering on the GWS Giants from the stands. Us sports physiotherapists aren’t much help to others when we’re injured, and I seem to be a target for big hits and big injuries (ask me any time about the number of surgeries I’ve been through).
This year I am going to be sponsoring the Balgowlah Suns Junior AFL Club and helping kids and parents to get a sports physiotherapists view of the biomechanics, preparation and recovery that go into every game. When prepared for properly, AFL is one of the safest sports children can play, with less physical contact than rugby league, more hand to eye co-ordination skills and more aerobic fitness. Getting kids into safe and fun sports is essential in combating childhood obesity and improving social development skills.
What are the physical benefits of AFL and programs like Auskick?
Children learn a variety of fundamental and advanced gross motor skills from kicking, handballing, catching, running, jumping and evading that will benefit them for future physical development and sports participation. Through regular training, children are also learning the basics of fitness conditioning and the basic principles and importance of health and nutrition.
- Improved physical fitness
- Increased hand-eye coordination
- Better aerobic capacity
- Strengthening muscles and bones
How does AFL improve psychological and social skills?
Children who play physically active team sports are more attentive, have a more efficient memory, enhanced creativity, better learning adaptability and problem solving and attitude regulations abilities. AFL Juniors have to make rapid and complex decisions during the game while remembering certain structures of play and achieving pre-defined goals. This allows children to adapt to a variety of situations off the field more efficiently with the neuroplasticity of the brain creating new neural pathways at an astonishing speed in young kid’s brains. Yes, you read that correctly, football gameplay learning makes kids more adaptable. There’s more good news though.
Children who participate in team sports develop important social skills, a sense of belonging and camaraderie much faster than kids who don’t. The President of the International Council for Sport Science and Physical Education, Professor Margaret Talbot once stated ‘Sports and other challenging physical activities are distinctively powerful ways of helping young people learn to ‘be themselves’. These benefits flow positively through children’s lives and the broader community is better for it too.
- Better communication skills
- Fosters a sense of self belief
- Improves concentration and cognitive function
- Increases teamwork skills
- Builds a sense of mateship/belonging
- Make a ton of new friends
Good preparation and recovery is vital
Preparation and recovery is much more than hitting the carbs the night before and a bottle of powerade in the morning (more on why you shouldn’t dose your kids with powerade in a following article). It is important to stay hydrated leading up to and on the day of the game and eating a balanced, nutritional diet is going to help keep kids fuelled up for the big game. Complete a warm up and cool down including stretching, slow jogging and running activities, with and without the football to minimise the risk of muscular and joint injuries.
Get a musculoskeletal screening test
Wouldn’t it be cool to be able to see into the future and prevent an injury before it happened? Musculoskeletal screening tests aren’t quite looking into a crystal ball, but they are becoming increasingly backed up by numbers and science. Do you think the pros step out onto the pitch and just hope that their body has it in it that day? They have an entire team of physiotherapists, sports scientists and strength and conditioning experts monitoring every step that they take. Musculoskeletal physiotherapists test a range of movements and take measurements to create a physical profile that will identify areas that may be more susceptible to an injury. Musculoskeletal screening tests have been shown to be an accurate and reliable indicator of specific injuries in AFL players. Finding a Dee Why sports physiotherapy expert is crucial to ensuring any musculoskeletal screening tests are comprehensive and accurate, otherwise you may actually be putting yourself or your child at risk of suffering an injury.
AFL is an all round awesome sport for children to help grow and adapt so many skills that are going to benefit them in later life, not to mention they get a real kick out of it! If you have any questions about all sports physiotherapy or musculoskeletal screening tests for AFL or other sports, get in touch with The Beaches Sports Physio on the Northern Beaches at firstname.lastname@example.org
 Erwin H, Fedewa A, Beighle A, Ahn S. A Quantitative Review of Physical Activity, Health, and Learning Outcomes Associated With Classroom-Based Physical Activity Interventions. Journal of Applied School Psychology. 2012;28(1):14–36.
 Reliability of common lower extremity musculoskeletal screening tests Belinda J. Gabbea, Bennellb, Wajswelnerc, Finch. Physical Therapy in Sport 5 (2004) 90–97
Photo: High five mum by Mike Hauser (2008) https://flickr.com/photos/35314767
Searching for and finding the right physio for your needs online can feel like searching for a needle in a haystack. You could spend hours searching through Google for the right sports physio, musculoskeletal physiotherapist; even narrowing down your search to Northern Beaches physios is likely to give yourself an extra headache! So how do you find the best physio for your condition? Like many other health professions, physiotherapists have a vast array of areas of expertise. All practitioners have to be highly educated and officially registered to practice with the governing body, adhering to strict standards of service. Working out which physiotherapist can treat your specific condition requires more than simply typing in to Google. Luckily there are a number of hints and tricks to finding the right local physio for your needs, by following these tips below you will go a long way to finding that special someone.
Check for what areas the physiotherapist specialises in
Physiotherapists cover a huge range of areas of practice and not all physios are experts in the type of pain or condition you are suffering from. You wouldn’t go to a podiatrist to get an eye test, so why visit a physio who doesn’t specialise in the area of pain you are experiencing? For example, when it comes to musculoskeletal physiotherapy, did you know that only 5% of practicing physiotherapists attain the rank of “Titled Musculoskeletal Physiotherapist”? The Australian Physiotherapy Association (APA) defines a Titled Physio as “highly qualified physiotherapists with expert knowledge and skills. They undergo a rigorous selection process to ensure that they achieve and maintain exceptional standards of clinical experience and knowledge. The APA Title serves as a professional mark of distinction.” For issues like Back and neck pain, Nerve pain (especially sciatica, carpal tunnel), Chronic injuries, Arthritis/osteoarthritis and other aging related pain, postural dysfunctions including scoliosis, kyphosis (hunched back) and flat feet – don’t sell yourself short by visiting a physio not ranked in that top 5%.
Ask your doctor for their advice
Many Northern Beaches doctors work hand in hand with highly trained physiotherapists to treat long term and immediate physical pain for their patients. They are some of the best people to give advice on who to see in the local area with the skills and specialisation to help you recover faster.
Phone a friend
There aren’t many better ways to finding the right physio than getting a referral from a friend. Getting confirmation from a friend on the skills of a physio will give you much more insight than Googling away aimlessly for hours. They’ll be able to give you firsthand knowledge of their expertise, bedside manner and obviously on whether or not they were able to help their own issues.
Check on the Australian Physiotherapy Association
Not checking to see whether a physiotherapist is registered with the Australian Physiotherapy Association is like playing Russian roulette with your musculoskeletal system. If they aren’t registered on there, you might as well go and see Doctor Nick from the Simpsons.
Consult Facebook and have a look at relevant groups on social media
It’s become increasingly common today for Facebook groups related to sports and health and fitness to share stories about their injuries and post reviews of their tips and experiences with various sports or injury related professionals. If you’re uncertain, put a post up along the lines of “Does anybody know an awesome physio that specialises in lower back pain in Dee Why” and you’re bound to get a few bites. Always check and verify their advice with other methods though!
Consult Doctor Google
Once you’ve narrowed your search scope down, it is important to check Google reviews and other community reviewed websites to check what the word on the street about the physio is. Keep in mind again, Google reviews aren’t the be all and end all, but they do play an important part in finding a reputable and skilled physio for your needs.
Ask for a referral from your local sporting club
If you play in a team or individual sport, it is likely that your club has knowledge of physiotherapists that are reputable and skilled in specific areas of the body. Sporting clubs don’t just recommend any old physio either, because they are made up of trained and skilled individuals themselves, the last thing they’d be doing is recommending a physio with a Kelloggs Cornflakes degree.
Finding the right Dee Why physio can be a daunting task if you don’t know where to start. By following those tips and verifying claims and data between a number of different sources and referral points, you are much more likely to find a physio who is capable of looking after your pain or injury in the most professional and up to date way possible