3 Types of Tendinopathies: Tendonitis, Chronic Tendinopathy and Tenosynovitis

Tendinopathies are conditions that affect the tendons, the flexible bands of connective tissue that attach muscles to bones. The three main types of tendinopathy are reactive tendinopathies, also commonly known as tendonitis; chronic tendinopathy; and tenosynovitis. While all three affect the same area of the body, they have their own distinctions and should be treated accordingly.

What are tendons?

how tendons work

Tendons are bands of connective tissue that attach muscles to the bones and help them move. The tendon itself does not contract in the way that muscle does, rather it just transfers the force that the muscle is producing through to the bone. This is how muscles are able to move bones; through their connection with tendons.


The large tendons in the body that are well known are the Achilles tendon, which connects the calf muscles to the heel, and the patellar tendon, which connects the thigh muscle to the kneecap.


How do tendons work?


Tendons are made up of tendon fibers and tendon cells. The tendon fibers are the main component that gives tendon its strength. These tendon fibers are put together like a rope, with the tendon cells acting as a glue to hold them all together.


The most important thing that we need to understand about tendons, from a functional standpoint, is that they have the ability to store load within them. This means that the tendon itself can absorb some of the force that is being generated by the muscle and help in storing this energy until it is needed.


The best example of this is jumping, where the tendon is storing the energy generated by our muscles and then releasing it. Think of the tendons in this case as a rubber band, being stretched as we hit the ground and then being released as we jump. This allows us to jump higher than we would be able to do without tendon’s help.

How do tendons stay healthy?

Tendons are load dependent organs. This means that for them to stay healthy, they need to be loaded regularly. Regular loading of the tendon helps keep it strong and flexible. Additionally, tendon health can be improved with proper nutrition and adequate rest.


How does a tendinopathy (a grumpy tendon) occur?


Tendinopathies, or tendon diseases, can occur when the tendon is over-loaded. This can happen for a variety of reasons such as repetitive strain, poor posture and lack of exercise.

There are 2 main reasons why an overload occurs:

1) A recent increase in load. For example someone who has just started getting into a running program. They were doing little to no running 6 weeks ago and now they are running 3x 5km per week. From a tendon perspective, this may be too much too soon for the tendon to handle.


2) People who are fit and active who have time off and then attempt to return to their normal activity loads. This is quite common in people who go on holiday or have a bout of illness that prevents them from training. When they recommence training the tendon undergoes a local increase in load in a very short period of time.


What are the symptoms of tendinopathies?


The most common symptoms of tendon disease are pain, tenderness and loss of flexibility in the tendon. Pain can often be felt during normal activities such as walking or running for tendons in the legs or doing simple activities such as hanging out the washing for tendons in the elbow or shoulder. Pain can definitely still persist at rest. Tenderness may be present with gentle touching of the tendon and swelling may also appear around it.

tendinopathy vs tenosynovitis

I though there was only tendonitis, what are these other types of tendinopathy?


Reactive tendonitis, or tendonitis for short, is an acute tendon disorder caused by overuse of the tendon in question. Symptoms usually appear quickly, with pain that can range from mild to severe. This type of tendon inflammation often responds well to rest in the short term and should not be ignored.


Chronic tendinopathy (also known as Tendinosis) is a more long-term tendon disorder that typically appears as a result of repetitive strain from activities such as running, jumping, and weightlifting. It usually manifests itself as pain that increases with movement but doesn’t necessarily cause inflammation or swelling. Tendinosis causes the tendon to become weak and painful, leading to decreased strength. In athletes this appears as a decrease in performance, in us mere mortals it may be the difference between and enjoyable holiday and a nightmare. Treatment for chronic tendinopathy requires more intervention than reactive tendonitis, including tendon loading exercises prescribed by a physiotherapist. The timeframes that we are looking at for treatment tend to be measured in months as opposed to weeks.


Tenosynovitis is tendon inflammation caused by a tendon sheath becoming inflamed. A tendon sheath is like a protective coating around the tendon, helping to keep it lubricated and reduce friction. When this tendon sheath becomes inflamed, it can cause pain due to reduced range of motion in the joint as well as causing weakening of the tendon fibers themselves. Treatment for tendon sheath inflammation usually involves anti-inflammatory medication, rest and light tendon loading exercises in the short term, before a more rigorous regime is implemented.


How do they get better?

Great question! We detail that in our next blog on “How do Tendons get better?”

sciatic nerve pain

7 Warnings Signs You Have Sciatica: And What to Do Now!

If you’re experiencing pain, tingling, or numbness in your lower back and down one leg, you are probably suffering from sciatica. This is a common condition that can cause a lot of discomfort, especially if left untreated. In this blog post, we will discuss the seven warning signs that you might have sciatica and what to do about it. We’ll also explain how physiotherapy can help to relieve your symptoms and get you back to feeling like yourself again!

How do I know if I have sciatica?

If you’re experiencing any of the following symptoms, it’s time to contact your spinal physiotherapist:

– Persistent pain in your lower back or down one leg

– Numbness or tingling in your leg or foot

– Weakness in your leg or foot

– Difficulty moving your leg or foot

– Pain that is deep in the buttocks

– Pain and stiffness that is worse in the morning

– Pain in your leg when bending forwards


What is causing my sciatica?

There are a few different things that could be causing your sciatica, but contrary to popular opinion and what most of the internet will tell you, the most common cause is not a herniated disc. In reality the most common cause is referred pain from the lower back or gluteal muscles. In summary though, sciatica us caused by pressure being placed on the sciatic nerve. Other causes include:

– Piriformis syndrome: This is when the piriformis muscle, which is a small muscle in your buttocks, spasms and puts pressure on your sciatic nerve.

– Spondylolisthesis: This is when one of the vertebrae in your spine can slightly move and puts pressure on your sciatic nerve.

– Pregnancy: This is because the growing baby can put pressure on the mother’s pelvis and sciatic nerve.

– Trauma: This can happen if you fall or are in a car accident and bruise or fracture your hip, pelvis, or spine.

7 Warning sign you have sciatica and what to do about it

What are the risks of leaving sciatica?

If you’re suffering from sciatica, it’s important to seek treatment as soon as possible. This is because the longer you leave it, the greater the risk of developing chronic back pain. Sciatica can also lead to other problems such as muscle weakness, loss of sensation, and difficulty walking. If you’re experiencing any of these symptoms, don’t delay in seeking help from a Northern Beaches physiotherapist.


How can physiotherapy help?

Physiotherapy is the most effective treatment for sciatica. Our experienced team at Fixio Physio Dee Why will work with you to develop a tailored treatment plan that includes exercises, stretches, and manual therapy. We’ll also give you advice on how to manage your pain and prevent further injury. The key, naturally, is to decrease the pressure that is being placed on the sciatic nerve. A musculoskeletal physiotherapist will be able to identify what structures are compressing the nerve and how best to alleviate this pressure.

If you’re experiencing any of the above symptoms, don’t wait any longer to seek help. Contact our team at Fixio Physio Dee Why today to book an appointment.


How Pelvic girdle pain is caused during pregnancy

Pelvic girdle pain refers to musculoskeletal conditions affecting the sacroiliac joints, symphysis pubis and surrounding ligaments and muscles. It will affect about 1 in 5 Northern Beaches mothers but can also develop outside of pregnancy.[1]

The pelvic girdle is a ring of bones around your body at the base of your spine and when the three joints in your pelvis work together normally, they move slightly. Pelvic girdle pain is usually caused by the joints moving unevenly, which can lead to the pelvic girdle becoming less stable and more painful.

What does pelvic girdle pain feel like?

“I’m normally like a socially active person. It has made me the most miserable anti-social person. . .cos I’m in too much pain”

 “Constantly feeling like your pelvis is going to fall off.[2]

Pelvic girdle pain used to be known as symphysis pubis dysfunction (SPD), but it still causes the same high level of pain it always did.

Pelvic girdle pain can affect your mobility and sharp pain when you are walking, climbing stairs and turning over in bed are common symptoms.

What are the symptoms of PGP?

Symptoms include:

  • pain in the pubic region, lower back, hips, groin, thighs or knees
  • clicking or grinding in the pelvic area
  • pain made worse by movement

However, early diagnosis and treatment can relieve your pain. Treatment is safe at any stage during or after pregnancy.

What causes Pelvic girdle pain?

As your baby grows in the womb, the extra weight and the change in the way you sit or stand can put more strain on your pelvis. You are more likely to have pelvic girdle pain if you have had a previous back or pelvis condition or have hypermobility syndrome; a condition in which your joints stretch more than normal.

What are my treatment options?

Your Fixio physio will be able to suggest the right treatment for your needs. This may include:

  • advice on avoiding movements that may be aggravating the pain
  • exercises that strengthen your abdominal and pelvic floor muscles and can help relieve your pain and allow you to move around more easily.
  • manual therapy to gently mobilise the joints and help them move normally again. This should not be painful.
  • warm baths, or heat or ice packs
  • acupuncture or dry needling. Women receiving acupuncture or physiotherapy reported less intense pain in the morning or evening than women receiving usual antenatal care[3]

Pelvis girdle pain is not something you just have to put up with until your baby is born. The outcomes for women with pelvic girdle pain during pregnancy are good, with 9 out of 10 of women reporting most symptoms subside after about 3 months of giving birth. However, pelvic girdle pain frequently recurs in subsequent pregnancies, with the painful symptoms no less painful.


[1] Chou LH, Slipman CW, Bhagia SM, Tsaur L, Bhat AL, Isaac Z, et al. Inciting events initiating injection-proven sacroiliac joint syndrome. Pain Med 2004;5(1): 26e32.

[2] Clarkson, C. E., & Adams, N. (2018). A qualitative exploration of the views and experiences of women with Pregnancy related Pelvic Girdle Pain. Physiotherapy, 104(3), 338–346.

[3] Pennick V & Young G (2007) Interventions for preventing and treating pelvic and back pain in pregnancy. Cochrane Database Sys Rev 2007 Issue 2. Art. No.: CD001139.


One on One Clinical Pilates at Fixio

When Joseph Pilates created his new method of physical training in the 1920’s, he named it ‘Contrology’ due to the immense focus on control of the body and mind. The goal being to improve your balance, core stability, and posture while strengthening your muscles and increasing flexibility.

Pilates was developed over the course of many years, with a combination of anatomy training, acrobatics, Yoga principles, and ancient Greek and Roman methods of training all adding up to what we see as modern Pilates.

In the hands of a highly trained professional, it can also be used as a treatment for specific musculoskeletal conditions.  Unlike Pilates for fitness, one-on-one sessions of Clinical Pilates Dee Why are used by qualified Physiotherapists who have completed extensive training to help treat:

  • Neck pain
  • Lower back pain
  • Pre and postnatal conditions
  • Prehabilitation and rehabilitation when surgery is needed
  • Shoulder pain
  • Hip and Knee pain
  • Arthritis pain
  • Poor posture

This is an unprecedented time for most Australians, but we have to remember we don’t have to do it all alone.

One-on-One Pilates instruction is safe and hygienic.

Since COVID-19 was officially declared a pandemic by the WHO on March 11th, Governments have shutdown non-essential services, essentially halted the economy and implemented strict social distancing protocols.

Clinical Pilates sessions at Fixio on the Northern Beaches adheres to all of them.

Keeping our distance on your first visit we will:

  • Take you through a thorough, private assessment of your body
  • Assess your neuromuscular control and identify your natural movement patterns
  • Then, our trained physiotherapist will directly address your body’s imbalances through prescribed exercises.

Fixio’s One-on-One Clinical Pilates prescriptions are designed to:

  • Improve your flexibility and balance
  • Help you find your ideal posture and body tone
  • Strengthen important muscles during and post pregnancy
  • Improve your pelvic floor function

A one-on-one Pilates Dee Why class includes a full assessment so that our Physiotherapists can tailor an individual programme that targets your specific condition, needs, and limitations.

Clinical Pilates helps to increase Core strength and reduce back pain

Spine stabilisation and keeping a correct posture is essential to keeping recurring back injuries at bay.[1] Strengthening your core is the key to ensuring this process is maintained regularly. During your one-on-one  Clinical Pilates session at Fixio, your physiotherapist will focus on targeting those muscles that are most important, while bringing your attention to the control and feel of how the exercises affect your muscles to increase your own awareness of your body. Many people are not aware that core strength plays a large part in a number of everyday activities including: sitting for long periods of time, lifting weight, playing sports and even standing.[2] The more you work on and are aware of your core the less pain will suffer.

One-on-One Clinical Pilates sessions may also be eligible for a rebate from your health insurer

Those looking for a one-on-one Pilates classes on the Northern Beaches can find them at our clinic. Our Sports physios are experts on how the body functions and moves, making Clinical Pilates safe for anyone of any age or fitness level.

Clinical Pilates sessions at Fixio Dee Why are designed and run by experienced physiotherapists, experts in musculoskeletal function and rehabilitation. Clinical Pilates at Dee Why has never been so personalised. Each session is conducted as an individualised program suitable for all ages and levels of fitness.

For more information on Pilates for your condition, give us a call on (02) 8964 4086 or book an appointment.

[1] Lis, A. M., Black, K. M., Korn, H., & Nordin, M. (2006). Association between sitting and occupational LBP. European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 16(2), 283-98.

[2] Hsu, S. L., Oda, H., Shirahata, S., Watanabe, M., & Sasaki, M. (2018). Effects of core strength training on core stability. Journal of physical therapy science, 30(8), 1014-1018.


Junior AFL is beneficial for children in more ways than one

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.[1] 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’.[2] 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.[3] 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 us.

[1] 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.

[2] http://www.icsspe.org/

[3] 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)
Attribution (http://creativecommons.org/licenses/by/2.0/)

Why you should choose a Titled Physiotherapist

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
  • Paediatrics
  • 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.


Chronic neck pain: Physiotherapy treatments

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.[1] 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[2]) 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.[3] 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:

  • Headaches
  • Numbness, weakness and tingling in the arms and fingers
  • Surrounding muscle pain, commonly the shoulders
  • Fever
  • 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[4]:

  • Degenerative disc disease
  • Neck strain
  • Osteoarthritis
  • 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.[5] 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?[6] 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.[7] 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.


[1] Hogg-Johnson S, Van der Velde S, Carroll L, Holm L, Cassidy D, Guzman J, Côté P, Haldeman S,
Ammendolia C, Carragee,14,15 Eric Hurwitz E, Nordin, M, Peloso P. The Burden and Determinants of Neck Pain in the General Population: Results of the Bone and Joint Decade 2000–2010 Task Force on Neck Pain and Its Associated Disorders. Eur Spine J. 2008 April; 17(Suppl 1): 39–51.

[2] Ostergren PO, Hanson BS, Balogh I, Ektor-Andersen J, Isacsson A, Orbaek P, Winkel J, Isacsson SO; Incidence of shoulder and neck pain in a working population: effect modification between mechanical and psychosocial exposures at work? Results from a one year follow up of the Malmö shoulder and neck study cohort. Malmö Shoulder Neck Study Group. J Epidemiol Community Health. 2005 Sep; 59(9):721-8.

[3] Mehanical Neck Pain and Cervicogenic Headache. Neurosurgery 2007: 60:S1-21–S1-27

[4] Bot SD, Van der waal JM, Terwee CB, et al. Incidence and prevalence of complaints of the neck and upper extremity in general practice. Ann Rheum Dis 2005:64(1):118–23.

[5] Australian consumers spending more than 10 hours of every day on their digital devices’, 2016, Ernst & Young, www.ey.com

[6] Mobile Consumer Survey 2017: The Australian Cut, Deloitte, https://www2.deloitte.com/au/mobile-consumer-survey

[7] 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.


Injury Management: reduce your chances of an injury recurrence

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.


The most common types of foot pain and what it means, and what you can do about it

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[1] 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.

Achilles Tendinopathy

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.

[1] https://www.myfootdr.com.au/wp-content/uploads/2017-Healthy-Feet-Survey-by-My-FootDr-Balance-Podiatry_web.pdf


Why do some children get Sever’s Disease and how is it treated?

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[1], but it was James Sever’s characterisation of the disease in 1912 that led to it being named after him.[2] 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.

       Symptoms include:

  • Pain in the back or bottom of the heel
  • Limping
  • Walking on toes
  • Difficulty running, jumping or participating in usual activities or sports
  • Pain when the sides of the heel are squeezed
  • Tiredness

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.[3]

     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.

[1] HAGLUND P: Ueber fractur des epiphysenkerns des calcaneus, nebst allgemeinen bemerkungen ueber einige

aehnliche juvenile knochenkernverletzungen. Archiv fur

klinische Chirurgie 82: 922, 1907

[2] SEVER JW: Apophysitis of the os calcis. N Y Med J 95:1025, 1912

[3] 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