4 common treatment techniques used by musculoskeletal physiotherapists

Physiotherapy is a broad and multi-dimensional treatment process designed and ever expanding to treat a huge number of conditions. While physiotherapy mostly focuses on the diagnosis and rehabilitation of musculoskeletal and circulatory system issues, a growing number of practitioners also treat conditions like sports injuries, various forms of arthritis and respiratory problems such as cystic fibrosis. From bone breaks to bursitis to Temporomandibular Joint Pain, physiotherapists have a special knack for canvassing the human body for the cause of pain and dysfunction and getting it back to full performance using a number of high-tech and low tech treatment options. For all the technology in the world, a musculoskeletal physiotherapist gets the best results with their hands.

Below are the 5 most common treatment techniques used by physiotherapists every day in order to get their patients back to optimal health and performance, free of aches and pains.

  1. Physical examination and assessment

The first and most important step in the treatment process is the physical examination and assessment your physiotherapist will complete on your first visit. Expect to have a real deep and meaningful chat with your physio where they will ask you a number of detailed questions about your general health, activities and how your aches or pain came about. It’s at this point a good physio becomes a bit like Sherlock Holmes, sometimes it takes a bit of sleuthing to get to the bottom of some injuries and pain as they can be the result of an injury that starts in another area of the body.

Following the getting to know you part, your physio will begin to lay out a treatment plan personalised to your current situation. Depending on where you are on the injury and pain scale, the first course of action might be a prescription for some recovery and icing of the affected area before moving forward with physical therapy.

  1. Joint and soft tissue mobilisation

Joint and soft tissue mobilisation techniques are forms of manual therapy that have been tried and tested over decades. When joints and other soft tissue become painful due of trauma, overuse or disuse, they can become dysfunctional and unable to perform the movements they were designed for. Soft tissue injury is an umbrella term used to describe injuries affecting your muscles, tendons, or fascia that usually occur as a result of sprains, strains, contusions, tendonitis, bursitis and stress injuries. Soft tissue mobilisation has also been called therapeutic massage and has been designed to relax a patient’s muscles and reduce swelling in certain areas, making it a perfect treatment for relieving pain associated with sporting injuries.

Joint mobilisation is a technique used by physiotherapists by performing a back and forth oscillation of the joint in order to restore full range motion and limit pain. Joint mobilisation is helpful in cases where pain and joint tightness limit motion such as frozen shoulder. Joint mobilisation treatment varies depending on your circumstances but will generally include gentle joint mobilisations, joint manipulation and none of the old school snap, crackle and pop techniques that have little long term benefit.

  1. Acupuncture and Dry Needling

Dry needling and acupuncture are two of those treatments that always raise my patient’s eyebrows. At first, not many people are keen on the prospect of being jabbed with tiny needles, it sounds counterproductive to kicking pain doesn’t it? But after one session, they’re converts.

Contrary to popular belief, dry needling is not the same as acupuncture, although there are similarities between the techniques. The main difference between dry needling and acupuncture is found in the theories behind why each of the techniques works. Dry Needling focuses on the reduction of pain and restoration of normal function by releasing myofascial trigger points in muscle. In contrast, acupuncture is dedicated to the treatment of medical conditions via the restoration of the flow of energy (chi) through key points in the body to restore balance.

  1. Ergonomic, biomechanical and sports specific technique correction

If your visit to the physiotherapist was brought about by suffering an overuse or acute injury at work, during sport or just by living your normal life, you’re really doing yourself a disservice and increasing your chances of re-injury if you don’t take adequate steps at changing your movement patterns or technique. Poor technique and posture are two of the most common sources of repeat injury observed by physios. Biomechanical assessment, technique observation and diagnostic skills are all part of the skill set of your musculoskeletal physiotherapist and allowing them to observe you in your environment or using your regular physical techniques will ultimately help you to avoid musculoskeletal and sports injuries in the future.

Think of your local musculoskeletal physiotherapist as a pain doctor, or body mechanic. They have at their fingertips a range of tried and true methods of getting you back into 100% health and kicking that pain to the curb. If you are experiencing any muscular, joint or physical pain don’t hesitate to make a booking at your local 5 star rated physiotherapist on the Northern Beaches. Your body won’t regret it.


Back to school tips to help children stay active and healthy

It’s that time of year again, the school holidays are over and that means heading back to school or heading to school for the first time for kids all over the Northern Beaches. The start of the school year can be filled with excitement or dread for both parents and kids. Going through booklists, getting all the right uniforms and planning getting everyone to school are all important parts of the new school year, but it can cause some other areas to be overlooked.

The start of the school year usually brings an increase in child patients in physiotherapist’s office across the Northern Beaches as a number of factors create the perfect storm for injuries and pain to arise.

Following these tips will help you and your child get through the back to school period as happy and healthy as possible.

Focus on good nutrition and hydration

Children are balls of energy at most ages, and balls of energy require the right fuel to keep them healthy and going throughout the day. Playing outside in the heat of the day dehydrates children faster than adults and without good hydration habits, kids can end up with heat stroke pretty quickly. Eating a good healthy breakfast and lunch will help your child to concentrate throughout the day as well.

Find the right backpack

Do you like the idea of carrying around an uncomfortable backpack filled with heavy objects that might as well be rocks? Try running and jumping with them on as most children do. The wrong school bags filled with heavy books and lunches are a prime cause of back pain in children and can even lead to long term damage and malformation of the bones. Usually this is due to inappropriately sized bags, not carrying the bag correctly (on one shoulder like the cool kids) and too much weight.

How do I choose the right backpack?

  • Forget good looks, put comfort and fit at the top of the priority list
  • Make sure the backpack is properly sized – no wider than your child’s chest
  • Choose a backpack with broad, padded shoulder straps

Once you’ve found the right backpack:

  • Place the heaviest items at the bottom, close to the spine for better weight distribution
  • Don’t overload the backpack – moderate weight IS NOT harmful to your child’s back
  • Don’t let your child sling the backpack over one shoulder
  • Any waist straps are there for a reason – use them!
  • Don’t wear the backpack any lower than the hollow of the lower back

Make sure your child has comfortable shoes

Good shoes for your child are just as important as getting good tyres for your car! The average kid spends over 1500 hours per year in their school shoes, running, jumping, and playing sport on hard surfaces. That’s a lot of time to be spending in shoes that are unsupportive or that are incorrectly sized for your child. Children are susceptible to ankle injuries while their bones and joints are strengthening and shin splints are no fun for anybody! Some tips to look out for when picking shoes for your child include:

  • Make sure they fit correctly – too much or too little space affects comfort and can potentially cause blisters or the foot to move too much within the shoe
  • Make sure the shoe has a firm heel counter to hold a firm support around the ankle
  • Make sure the shoe bends at the toes where the foot naturally bends to avoid extra stress underneath the foot

Limit time on electronic devices

Research shows that spending too much time on iPads, phones and other touchscreen devices could lead to the muscles and bones of young children not developing properly. A Curtin University study conducted in 2016 showed that poor neck posture with little neck movement and decreased physical activity could lead to neck pain and under-developed muscles and bones.

Outdoor games are not just a fun way for children to exercise with their friends – getting outside like the good old days, away from the iPad, will help children develop their bodies, sleep better and keep them active while also having fun. Which is the best part of being a kid!


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.


7 easy ways to find an expert Dee Why physio

Searching for and finding the right physio for your needs online can feel like searching for a needle in a haystack. You could spend hours searching through Google for the right sports physio, musculoskeletal physiotherapist; even narrowing down your search to Northern Beaches physios is likely to give yourself an extra headache! So how do you find the best physio for your condition? Like many other health professions, physiotherapists have a vast array of areas of expertise.  All practitioners have to be highly educated and officially registered to practice with the governing body, adhering to strict standards of service.  Working out which physiotherapist can treat your specific condition requires more than simply typing in to Google. Luckily there are a number of hints and tricks to finding the right local physio for your needs, by following these tips below you will go a long way to finding that special someone.

Check for what areas the physiotherapist specialises in

Physiotherapists cover a huge range of areas of practice and not all physios are experts in the type of pain or condition you are suffering from. You wouldn’t go to a podiatrist to get an eye test, so why visit a physio who doesn’t specialise in the area of pain you are experiencing? For example, when it comes to musculoskeletal physiotherapy, did you know that only 5% of practicing physiotherapists attain the rank of “Titled Musculoskeletal Physiotherapist”? The Australian Physiotherapy Association (APA) defines a Titled Physio as “highly qualified physiotherapists with expert knowledge and skills. They undergo a rigorous selection process to ensure that they achieve and maintain exceptional standards of clinical experience and knowledge. The APA Title serves as a professional mark of distinction.” For issues like Back and neck pain, Nerve pain (especially sciatica, carpal tunnel), Chronic injuries, Arthritis/osteoarthritis and other aging related pain, postural dysfunctions including scoliosis, kyphosis (hunched back) and flat feet – don’t sell yourself short by visiting a physio not ranked in that top 5%.

Ask your doctor for their advice

Many Northern Beaches doctors work hand in hand with highly trained physiotherapists to treat long term and immediate physical pain for their patients. They are some of the best people to give advice on who to see in the local area with the skills and specialisation to help you recover faster.

Phone a friend

There aren’t many better ways to finding the right physio than getting a referral from a friend. Getting confirmation from a friend on the skills of a physio will give you much more insight than Googling away aimlessly for hours. They’ll be able to give you firsthand knowledge of their expertise, bedside manner and obviously on whether or not they were able to help their own issues.

Check on the Australian Physiotherapy  Association

Not checking to see whether a physiotherapist is registered with the Australian Physiotherapy Association is like playing Russian roulette with your musculoskeletal system. If they aren’t registered on there, you might as well go and see Doctor Nick from the Simpsons.

Consult Facebook and have a look at relevant groups on social media

It’s become increasingly common today for Facebook groups related to sports and health and fitness to share stories about their injuries and post reviews of their tips and experiences with various sports or injury related professionals. If you’re uncertain, put a post up along the lines of “Does anybody know an awesome physio that specialises in lower back pain in Dee Why” and you’re bound to get a few bites. Always check and verify their advice with other methods though!

Consult Doctor Google

Once you’ve narrowed your search scope down, it is important to check Google reviews and other community reviewed websites to check what the word on the street about the physio is. Keep in mind again, Google reviews aren’t the be all and end all, but they do play an important part in finding a reputable and skilled physio for your needs.

Ask for a referral from your local sporting club

If you play in a team or individual sport, it is likely that your club has knowledge of physiotherapists that are reputable and skilled in specific areas of the body. Sporting clubs don’t just recommend any old physio either, because they are made up of trained and skilled individuals themselves, the last thing they’d be doing is recommending a physio with a Kelloggs Cornflakes degree.

Finding the right Dee Why physio can be a daunting task if you don’t know where to start. By following those tips and verifying claims and data between a number of different sources and referral points, you are much more likely to find a physio who is capable of looking after your pain or injury in the most professional and up to date way possible


4 Scoliosis tips from your local Physiotherapist

In my time as a physio on the Northern Beaches one of the most common concerns people bring up during their physical assessments is their ‘Scoliosis’. Scoliosis is one of those conditions that just sounds horrible isn’t it? I want to start by saying the likelihood of you ending up with a Quasimodo-like hump on your back due to the condition is AT LEAST a million to one. Scoliosis is simply derived from the Greek word for bent or curved and is used today to describe the lateral curve in the spine caused by the condition. Scoliosis commonly presents as one curve, called a C-curve, or two curves, called an S-curve and is classified as either structural or non-structural depending on whether or not there is an added rotation on the spine present with the curvature.

What are the signs of Scoliosis?

Unless you can turn your head 180 degrees to the back (in that case we have bigger problems than mere scoliosis) it might be hard to self-diagnose the possibility of scoliosis, but physiotherapists look for the following as indicators of scoliosis:

  • Your head is not centred directly over your body
  • One shoulder sits higher than the other
  • One shoulder-blade sits higher or is more prominently sticking out
  • You have unequal gaps on one side of your body between your arms and your trunk
  • One hip bone is more prominent than the other
  • You suffer pain around those areas that are imbalanced

What to do if you have been diagnosed with a scoliosis

Did you know that Usain Bolt was diagnosed with scoliosis early in his career? It’s certainly not a career ending condition by any stretch of the imagination. Depending on the position of the scoliosis in your spine, your physiotherapist will give you a number of exercises or stretches to regularly perform. There are also a number of things to avoid if you have been diagnosed.

  1. Getting sucked into buying lots of things to fix it

“When I first bought a tempurpedic pillow it made me realise I was basically sleeping on a pile of rocks up until that point.” Human being have been in our current form for at least 200,000 years. For how many of those years have we have nice soft mattresses and perfectly contoured pillows? There is no evidence to support the hype around sleeping paraphernalia. That being said, if you are having pain at night, it’s time to talk to your local musculoskeletal physio about it! Sleeping accoutrements aside, other nonsense things to avoid are posture braces, long term orthotics and consistently taping!

  1. Get strong

It is important to find yourself a local physiotherapist who is knowledgeable in a number of complementary treatment options. Recent studies have shown that clinical Pilates and Yoga can be an effective reliever of chronic discomfort along with other non-surgical options such as meditation, massage therapy and a well designed functional training program.

  1. Don’t sit for hours on end

You would be surprised at how much spine and neck pain is exacerbated simply by sitting and doing nothing. Unfortunately, whether you’re sitting at your work desk all day or on the couch watching cricket for hours on end, it’s likely that your neck and spine aren’t in their optimal positions. Get up at least every hour and stretch your body from side to side and have a walk around to avoid placing too much pressure on these areas constantly. If the pain is getting worse, walk on down to your Dee Why physio and pick my brain.

If you think you may have scoliosis, or you have been diagnosed with scoliosis but have been neglecting your exercises or you have never been given a full body assessment for your condition, it is important to visit a local physiotherapist with the skills and equipment to create an in depth program for you. Scoliosis is a relatively benign condition when treated correctly, but can lead to further complications in the future if it is neglected.


3 proactive tips for preventing common workplace injuries

Each year thousands of Australians suffer a work related injury that either causes them to miss time at work or diminishes their ability to carry out their role effectively. Safe Work Australia estimates that these injuries cost roughly $60 billion to the Australian economy.[1] Now that’s a lot of sick days (not to mention the sickies you chuck when the surf is up…) Not only that, but the way you carry out your job could be causing ongoing damage to your body that will eventually become painful, without you even knowing it. When most people think of workplace injuries, they think of one off accidents or injuries caused by repetition at physically demanding jobs. This couldn’t be further from the truth. With more people than ever working physically inactive jobs, many workplace injuries and illnesses are a result of poor posture, repetitive awkward movements and failing to identify aches and pains correctly to begin with.

With these tips you will be able to identify common workplace injuries and overuse problems, put in place proactive structures to avoid them and know when to see your local physio for further treatment.

Redesign your desk space

You’ve probably heard the term ‘ergonomic’ thrown around a lot in the last few years. There’s ergonomic keyboards, mouse pads, chairs, desks, pens, pencils, cups, water bottles, scissors and I bet somewhere somebody is trying to market ergonomic toilet paper to someone. Australians spend millions of dollars a year on ergonomically designed products that have no scientific facts behind them. Yep, you read that right. Most products are baloney. At its core, ergonomics is the study of how humans fit into their work environment. No fancy ergonomic pencils required. In fact, the most effective and proven ergonomic changes to your workspace don’t involve any new products at all. While people tend to focus on the type of chair they have, they tend to overlook how they hold their bodies while performing their work. For example, correcting your trunk position (or the position you end up in within that fancy chair), sitting with your body closer to your desk, having relaxed and symmetrical shoulders and feet flat on the ground can make a positive difference to your workspace. Try a few different positions for your most used items focusing on those principles and you’ll find that sore neck may just disappear.

Lift with your head (not literally)

About 30% of all workplace injuries are caused by manual handling tasks. Manual handling includes anything that involves lifting, pushing, pulling, holding, restraining, throwing and carrying. Manual handling related injuries can be minimised by a thorough and effective assessment of the risks. I know it’s easy to ‘just do it’ when it comes to the work, but that is often a sure-fire way to end up injured. Ensure you fully evaluate the layout of the workspace, the location of the item, the weight of the item, the duration and frequency of the tasks and try to streamline as much of the process as you can. Ask yourself ‘does it have to be done this way?’ Just because heavy boxes have always been delivered onto a high counter top for distribution does not mean that’s the best way to do it. Using mechanical aides such as forklifts, conveyor belts and wheelbarrows may be a better alternative. The importance of training how to do the task properly can’t be overstated. Inexperienced workers are much more likely to suffer a manual handling injury than well trained workers.

Recreate the work tasks for your physio to observe

It can be difficult for your local physio to get an accurate idea of exactly how a movement is being performed and under what conditions. As a musculoskeletal physiotherapist I regularly observe, evaluate and recommend alterations to the techniques of sportspeople who carry out a range of repetitive and awkward movements. Why should work tasks be any different? If you can’t start ‘a bring your physio to work day’, take some photos of your work area, or have someone take photos or video of you performing your regular duties in a work environment. This will allow your physiotherapist to evaluate your body movements, work area and advise of any possible changes that could be made. Plus, you’ll be able to feel like a professional sportsperson having your movements evaluated and corrected for optimal health and wellbeing. But seriously, if you work in a pub and want to bring your physio to work… I’m down!

Work doesn’t have to be one of the biggest causes of injury to Australians. Many injuries can be reduced or removed through simple alterations to your environment and being more aware of how you hold your body. A musculoskeletal therapist is perfectly trained to make these observations and give you the personalised tips to be able to go home every day happy and healthy. Without any of the gimmicks.