Cure back pain once and for all with expert physio treatment.

At this very moment 1 in 6 people on the Northern Beaches is suffering from back pain due to a variety of different back problems.[1] Back pain doesn’t discriminate and its causes are as varied as its symptoms. Back pain can be caused by sitting too much, by standing too much and by running too many loops of the Manly to Dee Why coastal walk. Back pain can affect your work, sports, mental health and especially your sleep. Getting a good night’s sleep is so important for recovery and back pain is notorious for being worse at night, creating a self-perpetuating loop of poor sleep that exacerbates the back pain.

What causes back pain?

Having spent my career as a musculoskeletal physiotherapist on the Northern Beaches, many of my clients suffering from back pain have injured a muscle in or surrounding the back. In fact, studies have shown that around 70% of all back pain is a direct result of muscular injury? Repeated heavy lifting and sudden awkward movements are the big causes of back pain and as we get older it gets easier to give it a twinge. Other common back pain causes we see here at Dee Why include:

  • Arthritis – Nobody likes the A word but it’s something that will affect around 1 in 7 Australians during their lives. Lumbar arthritis pain is caused by movement and inactivity so you can’t win and affects the lower back and can extend to the pelvic area, sides of the buttocks and can even be felt in the thighs.
  • Sporting injuries – Northern Beaches physios treat back pain every day that has been the result of an injury caused by playing sport. Sports like volleyball, gymnastics, surfing and running are the cause of plenty of sore backs between Manly and Dee Why, that’s for sure!

How do physiotherapists treat back pain?

How long have you got? Titled Musculoskeletal Physiotherapists can draw on years of study, observation and curing back pain of all varieties and use literally dozens of different techniques for treating back problems. First things first though, your physio will take you through an in-depth physical examination in order to determine the exact cause of your back pain – back pain can have a variety of root causes.

Titled Musculoskeletal Physiotherapists understand the complexity of lower back pain and use an evidence based approach to injury management in order to get results. Musculoskeletal physiotherapy is the most common form of intervention for chronic back pain and your back pain physio on the Northern Beaches will create and prescribe a bespoke program to not just combat the pain, but to protect and strengthen your back against future problems.

If you are suffering from back pain on the Northern Beaches and avoid seeing a physio you are increasing your chances of your back pain persisting longer and a recurrence of the injury in the future. Don’t wait until the pain becomes severe or chronic, give Fixio a call on (02) 8964 4086 or email us to book at




Treating knee injuries such as torn ligaments, fractures and dislocations

Knee injuries are among the most common type of injuries treated by physiotherapists on the Northern Beaches and are also at the top when it comes to re-injuries. I don’t know how many times I’ve seen a patient who ended up having a serious knee injury and they said they just tried to ‘run it out’. If you are involved in physical activity or sports such as netball, volleyball, beach volleyball, soccer, AFL and rugby league, you are at a much higher risk of suffering a serious knee injury compared to the rest of the population. If you are suffering from pain or swelling in the knee, please don’t try and run it out, jump in the car and head down to your local Northern Beaches physio for some hands on treatment and get a plan for recovery so you don’t end up suffering ongoing pain or movement issues.

These are the most common types of knee injuries treated by musculoskeletal physiotherapists:

Torn ligaments and ligament strains

Like a lot of musculoskeletal injuries, it’s the most active people who get the wrong end of the stick when it comes to suffering them. Your knee contains a number of ligaments connecting bones to other bones in and around the knee joint that are susceptible to damage when you take a sharp change in direction, land wrong from a jump, or commonly from force directly to the knee, such as in soccer or footy tackle. The knee is made up of 4 ligaments that can all be torn or strained:

ACL – The ACL is the big daddy of knee injuries, the most painful and also the most common. The ACL connects the thigh bone to the shin bone and is most likely to strain or tear when pivoting or landing from a jump, around 80% of ACL tears are non-contact injuries.

PCL – The PCL is there to stabilise the tibia and prevent it from being bent too far backwards, commonly tearing or becoming strained due to forced hyperextension. It is the least common of the knee injuries, accounting for around 10% of them in total.

MCL – Your MCL is located on the inner side of your knee and connects the medial femoral condyle and the medial tibial condyle. MCL injuries usually take place during a sharp change in direction, when the knee is twisted while your foot stays in place, landing incorrectly from a jump, or from a hard direct hit to the knee, commonly in a footy tackle.

LCL – Like the ACL and MCL, your LCL helps control the sideways motion of the knee, connecting your femur to the fibula. LCL injuries only account for less than 5% of knee injuries, but they are known to be pretty darn painful.

Once your physio has conducted a thorough physical examination, they will be able to give you a good idea of the grading of the injury (1 being the lowest, 3 the highest) and begin treatment. Depending on whether you have suffered a strain or a tear, you may be required to undergo surgery and your physio will be able to design an in-depth prehab and rehab program for you that will aim to:

  • Reduce pain and swelling
  • Return the joint to its full range of motion
  • Strengthen the area surrounding the knee such as hamstrings and quadriceps
  • Improve your proprioception, agility and balance
  • Improve your technique and function specific to any sports or your circumstances
  • Get you back into your sport, regular activities and exercises
  • Minimise your chance of re-injury


Fractures and dislocations

Musculoskeletal physiotherapists commonly see knee fractures and dislocations paired with ligament damage, they tend to go hand in hand unfortunately. Not only are patellar fractures relatively common, they are also painful and can take a good deal of healing time. A patellar fracture is a break in the patella, or knee cap which is a small bone sitting at the front of your knee. The knee cap acts like a shield for your knee joint and is vulnerable to fracturing if you fall directly onto your knee or cop a big hit in sport or commonly in a car crash.

A patellar fracture may be a clean and even two-piece break or the bone can break into many pieces (ouch). If you are lucky enough when suffering a patellar fracture and the pieces of bone are not displaced, you may not need surgery. [1] Because treatment for a patellar fracture includes a period of time where you need to keep your leg immobilized in a cast, it’s not uncommon for your knee to become stiff and your thigh muscles to shrink. During the rehabilitation your physiotherapist designs, will be given a number of specific exercises to help improve the range of motion in your knee, strengthen your leg muscles surrounding the knee cap and manual therapy in order to decrease stiffness.

The most painful part of dislocating the patella is the immediate time after; with most people having a sort of relief in the hours after it is re-located. Because a dislocation or fracture commonly occurs with a ligament strain or tear, your rehabilitation will take at least 8 to 12 weeks to successfully heal the area and decrease your chance of a recurrent dislocation.

If you have:

  • Sudden or severe pain in the knee
  • Heard a loud pop or snap during sport or exercise
  • Swelling in the knee after feeling pain
  • A feeling of looseness in the joint
  • An inability to put weight on the joint without pain, or any weight at all

Get down to your local physio ASAP. You’re only doing yourself further damage and increasing your chances of re-injury by putting it off.

[1] Schuett DJ, Hake ME, Mauffrey C, Hammerberg EM, Stahel PF, Hak DJ. Current treatment strategies for patella fractures. Orthopedics. 2015;38(6):377-84.


Putting up with chronic pain causes more problems

I was down at Manly Beach the other day sucking in some big ones having been worked for 90 mins solid by my beach volleyball coach Martine and couldn’t help but overhear a conversation two men were having. As a long practicing physio there are a few buzzwords I can’t help but tune into and when bloke 1 said to bloke 2 “hopefully my back sorts itself out soon, I haven’t had a surf in months” I was instantly hooked. Unfortunately, it’s common for me to see new clients who have been suffering a form of chronic pain or immobility due to a condition or injury for months, even YEARS, but every time I’m still shocked. Look, I know not everybody loves seeing the GP or attending to annoying medical issues when there are other things going on in life, but chronic pain is not something anybody should be living with for any extended period of time. It’s not only uncomfortable at the time, but chronic pain and the underlying causes can eventually cause permanent physical and even neurological damage to parts of the brain if left undiagnosed and untreated.

What is pain?

The simple version of pain as endorsed by The International Association for the Study of Pain is that it is as an unpleasant sensory and emotional experience associated with actual or potential tissue damage. But pain is not simple. Pain is not only a physical sensation, it can be influenced by a number of external factors such as personal attitude, personality, resilience and has the ability to negatively affect emotional and mental wellbeing. For example, take two people suffering the same ACL injury – they are experiencing the same condition, yet their experience of living with the pain will be vastly different and their recoveries will differ based on their physiological make-up along with their psychological attitudes.[1]

There are two main categories of pain that physiotherapists see and treat: acute and chronic.

Acute pain only lasts for a short time but can be incredibly intense. Commonly occurs after surgery or due to physical trauma such as a motor vehicle accident or a sporting injury. Acute pain is the body’s warning alarm telling you to seek help. Although acute pain usually improves as the body heals, sometimes it doesn’t.

Chronic pain is the type of pain that stays with you long after surgery or an immediate injury and is commonly caused by underlying conditions. Conditions like migraines, osteoporosis, arthritis and other musculoskeletal issues are all commonly diagnosed chronic diseases that musculoskeletal physiotherapists see all the time. Just to keep us on our toes, chronic pain can exist without a clear reason or underlying cause. Remember the definition above of pain; actual OR POTENTIAL tissue damage. Yes, you can have pain without any damage! Chronic pain is commonly a symptom of other diseases but can actually be a disease in its own right, caused by changes within the central nervous system.

How does pain work?

Your lower back pain, knee pain, neck pain, ankle pain and every other pain all the way to your little pinky pain comes from the brain itself. Pain is the end result of your brain evaluating information and coming up with a best guess of how to translate that information and to where. Your body contains nerves called nociceptors that detect any dangerous changes in temperature, chemical balance or pressure in your body and send alerts to the brain, but the pain you feel is all in the brain and controlled by the brain. Thanks heaps brain.

Most of the time your brain gets it right, but sometimes it doesn’t. For example, referred pain in your leg is common to experience when it is actually your lower back causing the issue. Another example of the brain’s power is phantom limb pains commonly experienced by amputees in limbs that are no longer there. If that’s not the perfect example of the power of the brain, I don’t know what is. They have pain when the limb doesn’t even exist!!

How can ignoring chronic pain lead to more problems?

I’m sure other physiotherapists on the Northern Beaches are just as sick of hearing ‘no pain, no gain’ applied to every painful scenario as I am. Even during and after short term bouts of experienced pain, your brain increases stress hormones in your body, which can make it harder to think, cause anxiousness, lethargy, fatigue, slower recovery and lead to muscle tightness. Even that “dicky knee when it gets cold”, that “sore back” or “dodgy shoulder” is capable of causing long term physical and psychological effects. Pain affects the proper functioning, strength and efficiency of the human body. This often leads to altered movement patterns, compensatory tightness in other areas of the body, limb weakness and can cause chronic stiffness and exacerbate the pain.

It is imperative to address any pain as soon as you realise that it is not just going to disappear in a couple of days. Your GP will agree with musculoskeletal physiotherapists that the evidence supporting early treatment in almost any acute injury or painful condition is well documented.

Don’t let your pain today progress and evolve into more than something that can be relatively easily fixed with physio intervention. Instead of thinking “no pain, no gain” when you get an injury, focus on allowing yourself to understand that we need to heal, we need to relax and we need to look after ourselves because putting your body and brain through continuous pain is doing much more harm than good.

[1] McArdle S. Psychological rehabilitation from anterior cruciate ligament-medial collateral ligament reconstructive surgery: a case study. Sports Health. 2010;2(1):73–77. doi:10.1177/1941738109357173


How to identify and treat a high ankle sprain or syndesmosis injury

If you’re a fan of AFL, NRL, Netball, Basketball or NFL, chances are the word ‘syndesmosis’ is one you’ve heard a lot of in the last few years. Syndesmosis injuries have been on the rise in contact sports in recent years as games are played faster by bigger and more agile players.

Your ankle is a complex hinge joint between the bones of the lower leg  and a bone of the foot and allows your foot to bend upwards (dorsiflexion) and downwards (plantarflexion). Because of the number of ligaments, muscles and tendons in the ankle region and the volume and variation in the tasks we complete on our feet, the ankle is one of the most commonly injured musculoskeletal zones treated by physiotherapists.[1]

What is a high ankle sprain?

The anterior talofibular ligament (ATFL), the posterior talofibular ligament (PTFL), and the calcaneofibular ligament (CFL) make their way along the outside of the ankle. The common ankle sprain, also known as an inversion sprain usually involves injury to the ATFL and CFL and occurs when you roll your ankle.

A high ankle sprain is a little bit different and much less common than a lateral sprain and involves the syndesmosis between the lower tibia and fibula just above the ankle joint.

The syndesmosis is a fibrous joint located where the two leg bones connect together by ligaments or connective tissue and usually have very little mobility. Syndesmosis injuries may not be as common as their lateral cousins, but they are more painful and debilitating.

A sports physio will generally grade ankle sprains on a scale of 1 to 3 – mild, moderate, and severe depending on the severity of any tearing to the ankle ligaments. In most cases, x-rays are performed to rule out a fracture or dislocation accompanying the tear.

Grade 1 strain – (mild)

  • Minor tear
  • Minimal pain
  • Little of no joint instability
  • Mild pain with weight bearing activities
  • Slight loss of balance

Grade 2 strain – (moderate)

  • Some tearing of the ligament fibres
  • Moderate to severe pain
  • Moderate instability of the joint
  • Swelling and stiffness
  • Possible pain with weight bearing
  • Poor balance

Grade 3 strain – (severe)

  • Complete tear of the ligament
  • Severe pain followed by minimal pain
  • Gross instability of the joint
  • Severe swelling
  • Pain with weight bearing activities
  • Poor balance

What causes high ankle strains?

Chances are, if you play any sport requiring jumping, turning and twisting movements like AFL, football, basketball, volleyball or explosive changes of direction such as soccer, tennis and hockey then you’ve likely already suffered an ankle injury of some kind. High ankle sprains can also be caused by slightly different mechanisms such as when the weight of a tackling opponent is put onto the ankle causing inversion or dorsiflexion trauma to the syndesmosis.

What does a high ankle sprain feel like?

Compared to lateral sprains, high ankle sprains do not “look that bad” in that they do not generally cause as much bruising or swelling. This lack of in your face swelling can cause many people to be unaware of how severely they have injured themselves, until the pain sets in. High ankle sprains are usually accompanied by a pain that radiates up your leg from the ankle. Each step you take will probably be very painful, especially so if you move your foot in the same way as when the injury occurred.

How are high ankle strains treated by a physio?

Your physio will ask you to describe the movement you were performing when your injury took place and under what circumstances, assess your symptoms, and conduct an in depth physical assessment including testing the syndesmosis. High ankle strains can be tricky to manage and are best treated by a sports physio or titled musculoskeletal physio.

In the immediate aftermath of your injury it is important to use the same “RICE” protocol used for the common ankle sprain:

Rest – Keep your weight off the affected leg. The amount of rest required for healing is usually much nearly twice as long as lateral ankle sprains

Ice – Apply ice to the area for about 15-30 minutes every few hours in the first couple of days after the injury, to reduce inflammation and swelling.

Compression – Wrap the lower leg with an elastic bandage to reduce swelling, but not tight enough to cut off circulation.

Elevation – Sit or lie down with your foot elevated to a position above the level of your heart to reduce swelling and pain.

If you have suffered an ankle injury or have pain in the ankle/lower leg region it is important to seek guidance and treatment before causing further harm to the area. Don’t end up spending more time on the sidelines through not getting timely treatment.

[1] Lin CW, Hiller CE, de Bie RA. Evidence-based treatment for ankle injuries: a clinical perspective. J Man Manip Ther. 2010;18(1):22–28. doi:10.1179/106698110X12595770849524


How to treat whiplash injuries

Whiplash injuries are common. Whiplash and whiplash-associated disorders (WAD) are frequently seen in motor vehicle accidents when the head is suddenly jerked back and forth beyond its normal limits, just like a whip.

Whiplash is a vertebral dysfunction that can also be described as a sprain of the joints in the neck. While many whiplash related injuries seen by physiotherapists are a result of car accidents, whiplash can also result from forceful sporting injuries that cause similar stress to the neck joints, ligaments, muscles and discs.

Up to 75% of people involved in car accidents develop neck pain, with even minor car bumps causing enough whipping of the neck to cause painful or noticeable symptoms in the muscles and ligaments supporting the spine[1].

What are the symptoms of whiplash?

Whiplash is a complex mechanism that can cause pain in the neck, shoulders, back, head and arms. The pain may come on immediately after the accident or come on slowly afterwards and be accompanied by symptoms including[2]:

  • Headache or pain in the jaw or face
  • Pain or reduced movement in the neck
  • Pain between the shoulder blades
  • Lower back pain or stiffness
  • Irritability, Fatigue, Dizziness
  • Pain in the feet and hands
  • Nausea
  • Ringing in the ears or Blurred vision

What is the best treatment for whiplash?

Research shows that the most effective way to treat the complexity of whiplash injuries is with a combination of treatment options tailored to your individual condition.[3] Physiotherapy management with an expert in rehabilitation such as a sports physio who specialises in neck injuries or whiplash is extremely effective.

Acute treatment consists of reducing your pain and inflammation in the localised area and stabilizing your neck to prevent any further damage from occurring.  You can’t beat ice when it comes to a natural anti-inflammatory and when your neck is painful you will be wanting to ice the region regularly.

Once you begin recovery treatment with your physio, you will be given a thorough physical history, orthopaedic, neurological and spinal examination to determine the exact location and mechanism of your neck pain.  Your physio may also refer you for an X-ray, CT or MRI in order to fully assess any damage that appears to be more serious.

Whiplash sufferers tend to get the best results when there is a combination of active range of motion exercises such as gentle mobilisation, massage therapy and gentle stretching in a recovery program. Other common treatment methods for whiplash include:

  • Exercise to promote flexibility, strength and good posture
  • Fine neck muscle and proprioception retraining programs
  • Acupuncture or dry needling
  • Joint mobilisation or manipulation to loosen stiff joints
  • Soft tissue massage for short-term muscle tension relief

How long does it take to recover from whiplash?

How long is a piece of string? Just as the symptoms and severity of whiplash vary from person to person and between mechanisms of injury, so can the recovery time. Research shows that most whiplash sufferers who participate in actively guided treatment with a physio take from a few days to several months to rehabilitate[4].

There are many other non-physical factors which can impact the length of your recovery, including depression and trauma-related anxiety, so it is important to raise any additional issues with a qualified health professional to give yourself the best chance of recovery[5].

Do you have a whiplash injury?

Don’t let a whiplash injury affect your ability to work or do the things you love. Book an appointment now by choosing physiotherapy and then by choosing a time that suits you, alternatively, please call us on 02 8964 4086.

[1] Sturzenegger M. et al. (1994). Presenting symptoms and signs after whiplash injury: The influence of accident mechanisms. Neurol., 44, pp. 688–693

[2] Stace R. and Gwilym S. « Whiplash associated disorder: a review of current pain concepts. » Bone & Joint 360, vol. 4, nr. 1. 2015.

[3] Sterling M. (2014). Physiotherapy management of whiplash-associated disorders (WAD). Journal of Physiotherapy, 60, pp. 5–12

[4] Gargan MF. Et al. (1994).The rate of recovery following whiplash injury. Eur Spine J, 3, pp. 162

[5] Phillips LA. Et al. (2010). Whiplash-associated disorders: who gets depressed? Who stays depressed?. Eur. Spine J., 19(6), pp. 945-956


Rotator cuff injuries; so common that even physiotherapists get them

You can get it spiking a volleyball

You can get it painting a wall

You can get it swinging a racquet

A sore rotator cuff needs an in depth assessment

And the best in depth assessment is Fixio

You can get it rowing

You can get it mowing

You can get it any old how

As a matter of fact I’ve got it now.


Rotator cuff pain and injuries are among the most common afflictions treated by sports physios. However, rotator cuff injuries are not just treated by physiotherapists; we can also suffer them ourselves. After a particularly grueling 3 hour straight beach volleyball session, I’ve found myself in the same position as many of our patients; nursing a sore shoulder and wondering what I did to deserve that as my birthday present?!

What Is a Rotator Cuff Injury?

Your rotator cuff consists of four muscles and their tendons – the supraspinatus, infraspinatus, teres minor, and subscapularis, with each attaching to the scapula (shoulderblade) and the humerus (the upper arm bone). These muscles stabilize the shoulder joint, rotate the shoulder and come together to lift your arm above your head. All movements involving the shoulder use the rotator cuff in some way.

Rotator cuff tendinitis is one of the most common forms of rotator cuff injury and typically begins with inflammation of the supraspinatus tendon and can progress from there to affect the three other tendons. Injuries to the rotator cuff usually develop as a result of repetitive motions over time, but can also happen as a result of direct trauma; causing the tendons to tear and become damaged.

The most common signs of rotator cuff injuries are:

  • Muscle weakness in the shoulder joint
  • Functional impairments; difficulty lifting, pushing and especially overhead movements
  • Painful external/internal rotation
  • Pain may be present, located either in the anterior or lateral area of the shoulder

What are the most common rotator cuff injuries?

Due to the nature of the Rotator Cuff, location to other muscles, range of movements it is used in and connection to other sensitive areas in the shoulder, there are many different rotator cuff injuries:

  • Rotator Cuff Tears; muscle or tendon tears of varying grades
  • Rotator Cuff Tendinitis
  • Rotator Cuff Tendinopathy due to chronic irritation (ie what happens if you let your tendinitis continue!)
  • “Impingement syndrome”

What are the causes of a rotator cuff injury?

If you play sports or have a job that uses repetitive overhead arm motions, you are at a higher risk of developing a rotator cuff injury. People over age 40 and anyone with weakened shoulder muscles from inactivity are also at higher risk of a rotator cuff injury. A rotator cuff injury may be caused by:

  • A direct blow to the shoulder
  • Repetitive overhead motions of the arm; volleyball, swimming, baseball and tennis are common culprits
  • Chronic degenerative wear and tear on the tendons
  • Falling on an outstretched arm

How are rotator cuff injuries diagnosed?

Most physiotherapists will be able to accurately diagnose rotator cuff tendinitis and other injuries by performing an in-depth examination and going through your physical history. Your physio will also perform tests for tenderness near the top of the upper arm in the subacromial space and will have you gauge your pain as your arm is lifted and moved in certain ways. Pain associated with normal muscle strength in the shoulder can suggest rotator cuff tendinitis; pain with weakness may indicate a tear.

If you’ve suffered a traumatic injury or if a tear is suspected, your physio may refer you for an x-ray or MRI may be ordered.

How to reduce your chances of rotator cuff injury

The best way to prevent rotator cuff tendinitis is to avoid or limit activities that irritate the shoulder. This one is easier said than done due to how much the rotator cuff dominates the movements of the shoulder. If you have a history of rotator cuff tendinitis, avoiding aggravating activities such as repeated overhead movements can reduce the number of flare-ups.

If you play sports that involve the shoulder, you should ensure that you are using the correct technique to limit irritation as much as possible. Speak to your sports physio about having them conduct an assessment of your movements and technique in order to get a better idea of any alterations you can make in order to help you stay pain free.

You can also help to prevent or manage rotator cuff tendinitis by:

  • Stretching the shoulders during the day and before any activity
  • Using a good posture when standing, sitting, or walking
  • Resting the shoulder as soon as you feel any pain or discomfort
  • Sleeping on your back or the unaffected side
  • Taking breaks from during activities that use repetitive motions and movements

How do I treat rotator cuff pain?

During the acute phase of rotator cuff tendinitis, apply an ice pack to your shoulder for no longer than 20 minutes every hour. If you are in a lot of pain, ibuprofen may be helpful during this time as well. While you’re in the pain phase, stay away from heavy lifting and reaching out overhead as much as possible. Once you’re through the acute phase it is important to keep the shoulder moving because that can lead to frozen shoulder; a condition that causes the tissues around the shoulder shrink and reduce its range of motion.

Your physio can then begin to work with you and utilise exercises that will aim to fix problems such as stiffness and weakness and correct any other underlying causes. Sports physios are experts in the retraining of movements and activities related to your sport, work and the day to day activities that were aggravating your shoulder so that you can get back to what you were doing before the pain.

Now, back to get the ice out of the freezer!


How seeing a musculoskeletal physio in the off-season helps prevent injuries

If you’re reading this, you’ve made it to the end of another winter sports season. Well done. How did your body hold up? If you were one of the dedicated (and lucky ones) you got through unscathed, but it’s more common than not to finish the season with at least a couple of bumps or niggles.

A little bit of Netflix and chill to reward yourself for another fine season is perfectly fine and rest is recommended after a long season of putting your body through the wringer, BUT spending the whole off-season on your butt is a ticket to an early injury next year. Putting you on your butt even longer.

Believe it or not, the seeds for an injury next season are being planted right now. Doubly so if you are carrying an injury into the off-season that you fail to have properly treated. Most social level players do not understand this or ‘have the time for it’ and by the middle of next season they’re on one leg and expecting miracles from their sports physio the week before finals.

The best approach is to address any issues or injuries now, work on treating them over the summer and hit the ground running next season well and truly rehabilitated.

Be like the professionals and get an in-depth physical assessment and treatment from a physio

As musculoskeletal physiotherapists with in-depth specific knowledge of a range of sports, we are skilled at assessing functional movement patterns, biomechanics, muscle control, muscle strength, and range of motion. These are all critical aspects of any sport and deficiencies in any of those areas can heighten your risk of doing yourself a mischief.

During your assessment we will analyse the way you move and the way in which your muscles and skeletal system are activating in relation to your movements. By addressing any deficits in your kinetic chain our physios can help prevent issues arising next season by implementing a prevention plan with appropriate exercises and management.

Seeing a musculoskeletal physiotherapist will help you to:

  • Get clear identification and advice about what’s causing your injury
  • Understand the activities/movements that cause pain
  • Understand a range of exercises that will minimise your risk of an injury

Before next season get a Pre-screening Assessment

Musculoskeletal Physiotherapists may not have a crystal ball, but we are trained to see into the future of your possible injuries. Musculoskeletal screening tests aren’t quite perfect but they are becoming increasingly backed up by science. 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.[1]  Once we have identified any possible deficiencies we can then devise an individualised and sport specific routine to address those biomechanical and muscular issues.

A musculoskeletal pre-screening before next season will help you:

  • Get a complete analysis of your movement and risk of injury
  • Monitor and understand load management and how to avoid injury as a result
  • Find out how to start training minimising your risk of injury
  • Undertake corrective exercises prescribed where needed

Train with your physio in a private gym

On top of this, at Fixio we provide access for our patients to our very own private boutique gym during rehab or for strength and conditioning purposes. There we provide end stage rehabilitation, Technical Lifting/Biomechanical Analysis sessions, and can further assist our patients with strength and conditioning programs with a focus on technique.

We have at your disposal;

  • NOHrD Slimbeam Pulley system
  • TRX suspension bodyweight training system
  • Pilates Reformer including jump board
  • Pilates equipment including magic ring and long box
  • Swiss balls and bosu
  • Self myosfascial release tools like rollers and crossfit release balls

If you have suffered an injury during the sports season or want to prepare for next season, 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.

[1] Reliability of common lower extremity musculoskeletal screening tests Belinda J. Gabbea, Bennellb, Wajswelnerc, Finch. Physical Therapy in Sport 5 (2004) 90–97


Find out all about Osgood-Schlatters Disease

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!


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.


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.


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.


Final preparations for the Sun Run & Cole Classic

In just over two weeks time, the Sydney Morning Herald Sun Run & Cole Classic kicks off again just across the road from your friendly neighbourhood Dee Why Physio. Let’s hope the Northern Beaches has a little less in common with the surface of the sun by then. Started in 1983 at Bondi Beach by the keen ocean swimmer, Graham Cole after returning from competing in Hawaii at the Waikiki Roughwater, the event has grown into a weekend starting with a 10km run. With its roots heavily invested in the belief that anyone could train and challenge themselves with dedication to swim a reasonable distance through the surf, the Cole Classic swim rewards each finisher with a memento of their achievement.[1]

Today the event is also a huge contributor to fundraising for a host of charitable causes such as, Kids Cancer Project, Cure Brain Cancer Foundation and Beyond Blue. As of today they have raised $65,000 of their target of $200,000 for 1100 different charities! Congrats guys and gals!!

Over to you. Hopefully you’re putting the final touches on your training regime and preparing yourself for the races, physically and mentally. But, I won’t judge if you’ve left your prep a little late… Being a Northern Beaches physio, I’ve seen it all when it comes to preparations and mis-preparations for runs, swims and everything in between. Don’t get caught out by failing to prepare, especially when extreme heat is involved. Follow these tips below to help prepare, and make sure your Sun Run is a fun run without any sink in your swim.

10 kilometres isn’t that far when you think about it

Ideally you want 12 weeks to prepare for a 10km run, but if you’ve only got 2 weeks… well damn, that’ll do! I know what you’re thinking: “how can I pack 12 weeks’ worth of training into two”? The answer is… don’t. No seriously, ask my cousin who decided to run a marathon without any prep. He was cactus for months afterwards. Going hell for leather is a quick way to end up with all kinds of overtraining injuries that you’d be on your way to your musculoskeletal physiotherapist to sort out. To avoid being fatigued and sore on the day of the run, don’t do any more than a handful of full length runs at race pace. Ease into your longer runs and focus on your breathing, technique and intervals of race pace running without overdoing it.

Undergo a biomechanical assessment with your physio

This is doubly important if you are starting from relative scratch. Having a musculoskeletal physiotherapist go through your body’s movements in depth will pick up on any areas of weakness that may indicate an injury is more likely. A further benefit of undergoing an assessment with your physio is that they will be able to assess your running and swimming style to help you get the most efficiency out of each movement.

Time to taper

If you’re not part of the “how can I prepare for a 10km race in 2 weeks” crew, it’s time to taper off from all that awesome training you’ve been doing. As a general rule runners should look to decrease their workload by 30-50% in the last 7 days before a race. Avoid throwing in any crazy new exercises to your routine too. If you haven’t been taking jazzercise classes and doing Romanian deadlifts daily, now is not the time to start. Don’t stop moving altogether though, keep up the light runs and stretching to keep your body active and moving.

Break up your training swim distances

You don’t need to swim 5km every training session. In fact, swimming this distance a few times in the safe environment of a pool will likely be all the confidence you will need to know in yourself that you can swim that distance on the day. Swimming 5km can be boring and repetitive, not to mention a great way to cause yourself a rotator cuff injury if you’re not used to it. Break up your training swims into more manageable pieces; a 1km swim session can be completed in 10x100m, 5x200m, 500m+200m+200m+100m… you get my drift.

Use the RICER method if you are feeling some soreness post race

Rest properly, but please resist the temptation to down too many celebratory alcoholic beverages. If you must go out, keep hydrating, don’t party too hard because you need to let your body recover.

Ice – this will help constrict the blood flow to sore areas and help to reduce inflammation and soreness. If you feel up to it, you can always take an ice bath.

Compression of the legs and arms will help flush out the lactic acid that has accumulated. Wearing compression gear will work great for this. Pairing compression and icing will ensure they work symbiotically and will shorten your recovery period.

Elevate your legs as you lie in bed thinking about how accomplished you feel.

Referral to your local sports injury expert if the soreness is over 5/10 or if the pain last more than 3 days (hint: you are on their website 😉)

The main thing is to make sure that you are comfortable, confident and prepared for whichever race you are participating in. Seeking the advice of a Dee Why physio with expert knowledge in preparation and recovery for these types of events is the best way to make sure you’re going in full armed with everything you need to crush your goals on race day.




Physiotherapy tips for those suffering Tennis Elbow

Going by name alone, you wouldn’t expect to see Tennis Elbow too far from centre court. But the reality is that lateral epicondylitis is currently causing thousands of painters, plumbers, carpenters and computer programmers alike plenty of pain and discomfort around the country. In fact, only 5% of tennis elbow cases are actually linked directly to tennis, most new cases are due to heavy computer use.  Talk about false advertising! Maybe it should be renamed for the 21st Century – Computer Elbow. Tennis elbow is one of the most common overuse injuries seen by musculoskeletal and sports physiotherapists. With many cases leading to joint compression, nerve inflammation, increased stress on the arm and pain when gripping and lifting things … due only to not getting it treated earlier!

Tennis Elbow pain is commonly focused where the forearm meets the elbow joint on the outside of the arm (not to be confused with Golfer’s Elbow which normally affects the inside of the arm). Excessive use of wrist extensors (those muscles that work all day when you have your hand on your mouse or raised keyboard) and forearm supinators can cause small tears to develop on the elbow end of the extensor carpi radialis brevis (ECRB) muscle. When this pain first starts to occur is when your local physio should hear about it, but the reality is that many people just grin and bear the pain, only causing more problems in the long run. With these tips you will be able to help stave off tennis elbow or cut down the length and intensity of your pain considerably.

Stop and recover

If you are currently experiencing pain, holding an ice pack (please wrap it in a chux or a towel… ice burns are awkward to explain!) against your sore elbow for a few minutes several times a day can help ease it. Tendons calm down slowly. Tennis elbow can last from anywhere between weeks and years, depending on how you manage it. The simplest way to recover from tennis elbow is to cut back on the movement/s causing it. This can be hard for those of you who perform this movement every day for work. You may need to modify your movements, focusing on using other muscle groups effectively. Tennis elbow CAN (though rarely) get better without treatment. Rarely! If you are at the point where your elbow has been experiencing ongoing pain, in the long term you statistically have a longer recovery period and more chance of recurrence than someone who undergoes a physiotherapy rehabilitation program[1]. A musculoskeletal physiotherapist has expert knowledge on recovery and prevention methods.

Have a coach or physio check out your form

For the 5% who do get their tennis elbow on the court, having your coach or a local sports physiotherapist with a tennis background observe and critique your technique and movements could help reduce the strain on your tendons. Incorrect technique can unequally distribute the power in the swing of a racquet to rotate through and around your wrist; creating a movement through the wrist instead of the elbow joint or shoulder. This can increase pressure on the tendon and cause irritation and inflammation, leading to tennis elbow. A sports physio will be able to observe these movements and offer advice on how to make adjustments to minimise this strain. Another simple thing to check is the size of your grip. Those playing with a fat overgrip are at a higher likelihood of developing elbow pain!

Make ergonomic adjustments to your workspace

If you are a heavy computer user, making some adjustments to your computer workstation may be all you need to kick the dreaded “computer elbow”. Keyboards are a large contributor to these issues, with many people raising the back of the keyboard so that it slopes downwards. Doing so cocks your wrists into an extension; causing the extensor muscles of your forearm to contract, extra pressure on your wrists and fast-tracking your way to pain. A gel pad is a good defender against this problem for both the keyboard and mouse, as is a comfortable chair with an ergonomic design.

Stretching and strengthening exercises

Musculoskeletal physiotherapists recommend and will take you through a number of stretches and strengthening exercises designed to help prevent a recurrence of pain. An effective stretch involves simply extending the painful arm with your palm down, bending your wrist so your fingers point toward the floor, with the other hand pull your fingers back toward your body. You will feel the stretch along the outside of your forearm. 30 seconds on. Rinse and repeat. Strengthening the wrist with a simple home exercise known as the ‘towel twist’ is also an effective preventative measure. Hold a loosely rolled-up towel with one hand at each end, twist the towel by moving your hands in opposite directions like you’re wringing out water. Give it 10 good twists holding for a few seconds in one direction and then 10 in the other.

Your Dee Why physio will ask you a number of questions on your first visit, try to note:

  • When your symptoms began
  • If any motion or activity makes the pain better or worse
  • Any recent direct injuries
  • What medications or supplements you take

This allows us to help build a profile of the injury and lets us get stuck into creating your personalised recovery program. If any of the above sounded like you, click the buttons above to book an appointment or just give us a call!


[1] Corticosteroid injections, physiotherapy, or a wait-and-see policy for lateral epicondylitis: a randomised controlled trial. Nynke Smidt, Daniëlle A W M van der Windt, Willem J J Assendelft, Walter L J M Devillé, Ingeborg B C Korthals-de Bos, Lex M Bouter – “At longterm follow-up, our findings suggest that physiotherapy becomes the best option, followed by a wait-and-see policy.”