What is high blood pressure?

Blood pressure is the measure of how strongly your blood presses against the walls of your arteries as your heart pumps it around your body.

This number is split into systolic blood pressure and diastolic blood pressure[1].

  • Systolic pressure refers to the maximum pressure within the large arteries when the heart muscle contracts to propel blood through the body.
  • Diastolic pressure describes the lowest pressure within the large arteries during heart muscle relaxation between beating.

If your blood pressure is too high, it may put a strain on your arteries and heart, increasing your risk of a heart attack, stroke and kidney problems.

The good news is that your blood pressure can be brought down to, and maintained at a normal level with lifestyle changes that physiotherapy can help with.

What is hypertension?

Borderline hypertension or high blood pressure is for the adult, a systolic blood pressure between 140 and 159 mmHg or a diastolic blood pressure between 90 and 95 mmHg. While a systolic and diastolic pressure of 160 and 96 mmHg respectively or greater is considered to be absolute hypertension.[2]

Hypertension and its complications (stroke, congestive heart failure, kidney failure and heart attack) are major medical problems all over the world.

High blood pressure can have several causes

Modifiable risk factors include:

  • unhealthy diets (excessive salt, a diet high in saturated fat, low intake of fruits and vegetables)
  • physical inactivity
  • consumption of tobacco and alcohol, and
  • being overweight or obese.

Non-modifiable risk factors include:

  • a family history of hypertension
  • age over 65 years and
  • co-existing diseases such as diabetes or kidney disease.

What will happen when I see a physiotherapist?

Your physiotherapist will work with you to identify what changes in your lifestyle are necessary and achievable. In particular, they will develop a programme of exercise to increase your physical activity safely and effectively.

How can physiotherapy help manage high blood pressure?

Your physiotherapist can advise you about how to lower your risk of developing high blood pressure and also about how to reduce your risk of health problems once you have been diagnosed.

A well-being review delivered by a physiotherapist with knowledge of pulmonary hypertension can identify simple lifestyle changes that can help prevent you having to take medication.

Supervised exercise training has been shown to be beneficial in patients with pulmonary hypertension. exercise in patients with pulmonary hypertension is safe and leads to improvements in functional ability and quality of life.[3]

In particular, your physio can tell you which exercise programmes are suitable for you, depending on how high your blood pressure is, how fit you are and how any other health conditions or disabilities you may have will affect your ability to exercise.

How can I help lower blood pressure myself?

The main advice is to have your blood pressure checked regularly, take regular exercise and eat a healthy diet.

  • Go for a walk every day. Start with short distances and build up gradually.
  • Get advice from your physiotherapist or GP before you start doing more energetic and exercise
  • Stop smoking
  • Lose weight if you need to
  • Eat a balanced diet with plenty of fresh fruit and vegetables and oily fish
  • Reduce the amount of alcohol, salt and animal fat in your diet
  • Take your medication as prescribed.

[1] Shahoud JS, Aeddula NR. Physiology, Arterial Pressure Regulation. InStatPearls 2019 Feb 11. StatPearls Publishing.Available from:

[2] Guidelines Committee (2003) European society of hypertension European society of cardiology guidelines for the management of arterial hypertension. J Hypertens. 21-1011-53.

[3]Leggio M, Fusco A, Armeni M, et al. Pulmonary hypertension and exercise training: a synopsis on the more recent evidences. Ann Med 2018; 50(3): 226–233.


What is spinal stenosis?

Spinal stenosis is a condition that can cause pain, numbness, or tingling in the back or down the legs. Spinal stenosis is a narrowing of the spinal canal or of the spaces between the vertebrae where spinal nerves pass through. This narrowing is usually caused by arthritis or injury, and can cause symptoms for different reasons.

Your back is made up of bones, muscles, nerves, and other tissues that work together to help you stand and bend

There are four main regions of the back;

 The cervical, thoracic, lumbar, and sacral zones.

  1. There are 7 cervical vertebrae located in the neck
  2. There are 12 thoracic vertebrae located in the upper back
  3. There are 5 lumbar vertebrae located in the lower back
  4. The sacrum and coccyx are fused bones, found at the base of the spinal column

The vertebrae are stacked on top of one another with the spinal cord passing through openings in the back of the vertebrae, and small nerves exiting from the spinal cord and passing through spaces on the sides of the vertebrae. The vertebrae are held together by ligaments and tendons, allowing the vertebrae to move together as the spinal column bends forwards, backwards, and side to side.

The spinal cord is the highway of nerves running through the vertebrae that connects the brain to the rest of the body (this is why problems in the back can cause leg pain or bladder and bowel problems.)

Between each stacked pair of vertebrae in the spinal column is a disc made of a tough outer tissue and a gel-like inner pulp. These discs protect the bones, acting like cushions or shock absorbers.

The vertebrae can form bone spurs – small growths that pinch the spinal cord or the nerves branching from the spinal cord and discs can shrink and make the space between the vertebrae smaller. This can cause the vertebrae to pinch the nerves that pass through them.

What are the symptoms of spinal stenosis?

Spinal stenosis does not always cause obvious symptoms, when it does they are usually worse when the person is walking or standing upright, getting better if they sit down or bend forward at the waist.

Other common symptoms are back pain and tingling or numbness that spreads down the legs. Severe spinal stenosis can cause leg weakness or even trouble controlling your bowels or bladder.

How is spinal stenosis diagnosed?

Imaging tests, such as an X-ray, MRI, or CT scan, can show what’s going on inside your back.

How is spinal stenosis treated?

A small number of people end up needing surgery to treat a spinal stenosis. But most people do well with a combination of physiotherapy to teach you special exercises and stretches to improve your strength and flexibility, hands-on massage and pain medication for flare-ups.

What can I can do on my own to feel better?

People instinctively think that bedrest is the best treatment for a bad back. The truth is, bedrest can actually make back problems worse because the back can get weak and stiff with too much rest.

Even if you have some pain or discomfort, stay as active as possible. One of the most important things not to do is to stay in bed or rest too long.

Find physical activities you like to do and slowly do more. While working with your physio to avoid any activities, such as bending or lifting, that you shouldn’t do for a while.


We’re tough on our shoulders here on the Northern Beaches

The shoulder joint has evolved to give us mobility, sacrificing some stability along the way and volleyballers, footy players and plenty of others (myself included) in my Dee Why office have felt the effects of that.

Dislocation and subluxation of the glenohumeral joint occurs relatively frequently in active populations, with 9 out of 10 first-time shoulder dislocations resulting from forceful collisions, falling on an outstretched arm, or a sudden wrenching movement.

In populations under 25 it has been estimated that the recurrence of dislocation after an initial injury could be up to 90%.[1] This means that the treatment of a dislocation and focus on rehabilitation could save you plenty of pain down the road.

When the shoulder is moving normally, the ball stays centred against the socket. With chronic shoulder instability this mechanism goes wrong.

What is chronic shoulder instability?

Shoulder instability occurs when the ligaments and muscles providing stability and mobility to the joint are unable to keep the humeral head in the glenoid fossa.

This is where your shoulder can feel ‘loose’ and dislocate or subluxate with little or no force applied. You might even dislocate your shoulder by reaching across your body to pull the blankets over you!

Poor posture, weak core stability and dysfunctional motor control of the rotator cuff muscles or surrounding shoulder muscles can all effect stability.

People with shoulder instability will often notice a clicking or popping sensation in the shoulder during certain movements, a loss of power in the affected shoulder and a feeling of weakness during certain activities.

There are several factors that can contribute to the development of shoulder instability.

Some of these factors may include:

  • history of previous shoulder subluxation or dislocation
  • inadequate rehabilitation following a shoulder dislocation
  • intensive participation in sports or activities placing the shoulder at risk of developing instability
  • muscle weakness (particularly of the scapular stabilizers and rotator cuff)
  • muscle imbalances
  • poor posture
  • abnormal biomechanics or sporting technique
  • thoracic spine stiffness
  • poor posture
  • fatigue
  • inadequate warm up

People who have chronic shoulder instability commonly experience:

  • Pain when reaching backward or above shoulder height
  • Glenohumeral joint pain
  • Shoulder stiffness
  • Tingling or burning in the lower arm and hand or localised numbness of the skin overlying the deltoid muscle
  • Rotator cuff weakness

How can physiotherapy treat shoulder instability?

Physiotherapy treatment for shoulder instability is vital for the healing process and ensuring the best outcome for you. Anxiety, fear and avoidance of movement are all common emotional reactions to shoulder instability, and physiotherapy can help to minimise their impacts.

Physiotherapy looks to strengthen stabilising muscles like the trapezius, rhomboids, and serratus anterior, and increase scapular stability which is required for proper rotator cuff function.[2]

We may use a combination of the below to treat shoulder instability:

  • Short term use of a sling for pain relief only
  • Postural re-education
  • Soft tissue therapy
  • Dry needling
  • Joint mobilisations
  • Motor control training of specific muscles and
  • Manual therapy
  • protective shoulder taping
  • progressive exercises to improve rotator cuff strength, shoulder blade stability, shoulder strength, posture and core stability
  • activity modification advice
  • biomechanical correction (correction of throwing technique, swimming stroke, volleyball serve)
  • clinical Pilates


Be sure to follow your bespoke treatment plan. Although it is a slow process, your commitment to physiotherapy is the most important factor in returning to all the activities you enjoy without pain or fear of instability.

[1] Hovelius L, Eriksson K, Fredin H, et al. Recurrences after initial dislocation of the shoulder. Results of a prospective study of treatment. J Bone Joint Surg Am 1983;65:343-9.

[2] Kibler WB, Sciascia A. The role of the scapula in preventing and treating shoulder instability. Knee Surg Sports Traumatol Arthrosc 2016; 24:390.



What happens if you leave whiplash symptoms untreated?

Has your head recently been jolted backwards and forwards in a whip-like movement? It might have been in the classic rear-ender car accident, falling down the stairs or in a forceful rugby tackle, but all cause similar stress to the neck joints, ligaments, muscles and discs.

Whiplash is effectively a sprain of the joints in the neck and occurs when an acceleration-deceleration event causes sudden extension and flexion of the neck. Whiplash injuries are also commonly referred to as cervical strains or sprains.

Whiplash neck sprains are common, with about 2 in 3 people involved in car accidents developing neck pain. But the good news is that physiotherapy treatment is very effective in the treatment of whiplash.

How do I know if I have whiplash?

Whiplash symptoms can vary between individuals, but the most common symptoms include:

  • Neck pain
  • Muscle tightness or spasm
  • Being unable to move your neck or turn your head
  • A headache, especially in the back of the head
  • Shoulder pain
  • Dizziness

Whiplash injuries are classified according to the associated signs and symptoms[1]

The extension-flexion mechanism may have injured intervertebral joints, discs, and ligaments; cervical muscles; and nerve roots. Injury to the zygapophyseal joint, commonly referred to as the facet joint, is likely the most common cause of whiplash-related upper neck pain and headaches.[2]

  • Grade 1 – Complaint of neck pain or stiffness only; no physical signs
  • Grade 2 – Complaint of neck pain or stiffness with associated musculoskeletal signs (eg, decreased range of motion, point tenderness)
  • Grade 3 – Complaint of neck pain or stiffness with associated neurologic signs (eg, decreased or absent deep tendon reflexes, weakness, sensory deficits)
  • Grade 4 – Complaint of neck pain or stiffness with associated fracture or dislocation

Physiotherapy treatment of whiplash

Research shows the most effective way to treat your injury is with a combination of treatment options which are tailored to your individual needs. Physiotherapy management of whiplash is extremely effective when started rapidly after the injury occurs.

Early treatment consists of reducing pain and inflammation and stabilizing your neck to prevent further damage.  Ice is the best natural anti-inflammatory and it is also very soothing when your neck is painful.

Most whiplash patients will start to feel better within a few weeks of the injury. Your physiotherapy treatment will aim to:

  • Reduce neck pain, headaches and inflammation.
  • Normalise joint range of motion.
  • Strengthen your neck muscles.
  • Strengthen your upper back muscles.
  • Improve your neck posture.
  • Normalise your muscle lengths and resting muscle tension.
  • Minimise your chance of future neck pain or disability.

If you are able to support your head and neck, it is important to keep your neck mobile rather than immobilizing it in a soft cervical collar.   Studies have shown that you are more likely to make a quicker recovery if you do regular neck exercises, and keep your neck active rather than resting it for long periods in a collar.

Red Flags

Due to traumatic nature of a whiplash injury; there is a risk of more sinister injuries which need to be ruled out before undergoing treatment. Please notify a health professional if you have (or develop) any of the following:

  • Bilateral pins and needles
  • Gait disturbances
  • Progressively worsening weakness or sensation problems
  • Pins and needles or numbness in the face
  • Difficulty speaking or swallowing
  • Drop attacks/fainting
  • Bladder or bowel problems

Because whiplash injuries are complex and require time to heal and rehab, don’t waste time before you seek treatment. Whiplash is one of those injuries that can hang around for years if not treated properly.

[1] Spitzer WO, Skovron ML, Salmi LR, et al. Scientific monograph of the Quebec Task Force on Whiplash-Associated Disorders: redefining “whiplash” and its management. Spine (Phila Pa 1976) 1995; 20:1S.

[2] Lord SM, Barnsley L, Wallis BJ, Bogduk N. Chronic cervical zygapophysial joint pain after whiplash. A placebo-controlled prevalence study. Spine (Phila Pa 1976). 1996 Aug 1;21(15):1737-44; discussion 1744-5. doi: 10.1097/00007632-199608010-00005. PMID: 8855458.

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