Headaches

Firstly, knowing that physiotherapy can help headaches is a good start.

With any headache a full physiotherapy assessment is required to provide an accurate diagnosis for the correct course of treatment.

Headache is a pain in any region of the head. Headaches can range from an ache, throbbing pain or sharp pain that is on one side of the head or both. It can be isolated in one area or radiate to a large vague area around the head. While there are many types of headaches, tension type headaches, migraines and cervicogenic headaches are the most common. Below we will provide some insights into these headaches.

Tension type headache

Tension type headaches are the most common type headaches (commonly known as stress headaches). These headaches are more common in females than males (3:2 ratio). They are a dull pain, tightness or pressure around the forehead or the back of your head – it is commonly described like a clamp squeezing the skull.

Common symptoms

• Mild to moderate pain/pressure in the front, top or sides of the head
• Headache that progressively gets worse throughout the day or starts later in the day
• Difficulty sleeping
• Feeling tired
• Trouble focusing
• Mild sensitivity to light or noise
• Muscle aches

Tension headaches do not have nerve symptoms such as weakness or blurred vision. They do not have sensitivity to light or noise, stomach pain, nausea or vomiting.

Causes of tension type headache

• Emotional tension, anxiety, tiredness or stress.
• Tiredness
• Physical tension in the muscles of the scalp and neck
• Eye strain – long periods of reading, typing or concentrating
• Poor posture
• Hunger / missing meals
• Physical factors such as bright sunlight, cold, heat, noise, etc.
• Drinking too much alcohol or caffeine.

Physiotherapy treatment for tension headaches

• Joint mobilisation for stiffness in the neck and thoracic spine to help postural recovery
• Addressing postural imbalances
• Strengthening programs for weaker muscles (deep cervical flexors)
• Stretches for tight muscles (levator scapulae + deep cervical extensors)
• Muscle release of tight structures (temporalis + deep cervical extensors)
• Ergonomic corrections to workstation, sleeping, driving positions etc

Physiotherapy and ongoing posture correction helps to prevent chronic problems. If you have excruciating pain in the head, or if it is your first or worst headache, you should consult your GP or attend the nearest emergency department to rule out any serious condition.

Cervicogenic headaches

Cervicogenic headaches are a referred pain arising from irritation to the neck. They are caused by problems with the nerves, bones or muscles in neck. This type pf headache affects males and females similarly (1:1 ration).

Cervicogenic headaches can be aggravated and relieved by certain neck movements. The headache presents as a steady ache or dull feeling with varying pain intensity. Usually mild to moderate and always accompanied by neck pain that moves to the head or face.

Common symptoms

• Pain on one side of the head or face, area like a ram’s horn
• Made worse with neck movements or posture
• Tenderness in the upper neck
• Restricted or stiff movement of the neck and associated neck pain
• Increased tightness in the neck muscles and upper shoulder muscles
• Pain around the eyes

Causes of cervicogenic headache

• Poor posture, unknowingly pushing chin forward,  putting your head in front of your body, such as hairdressers, carpenters, drivers, office workers
• Trauma due to sports or recreational injury or whiplash from a car accident
• Degenerative conditions such as arthritis or prolapsed disc in the neck
• Pinched nerve in or near neck

Physiotherapy treatment strategies for cervicogenic headaches

• Spinal mobilisation of aggravated structures in the neck
• Soft tissue release of irritated structures
• Offloading irritated structures
• Strengthening of deep neck stabilisers
• Dry needling
• Postural correction and ergonomic corrections to workstation, driving station etc

Migraine headache

A migraine can be episodic or a chronic headache. It is thought to be caused by an overactive nerves cell that cause sensations to be felt over the head and face. As a result of this overactivity, the body responds by releasing various chemicals causing increased swelling/inflammation leading to pain.

Prevalence of migraine

• Women have migraines 3 times more often than men
• Common between the ages of 10-40 (most women find they go away after the age of 50)
• Increased likelihood if a parent has migraines
• Often experience comorbid depression and anxiety

Common symptoms of migraine

There are many different types of migraine with varying symptoms and severity. Migraines may present either with or without aura. The headache can last between 4 hours and 3 days and have a mixture of symptoms.

Symptoms include:

• Severe pain usually on one side of the head
• Dull ache growing into a worsening throbbing headache
• Sensitivity to light and noise
• Pain increases with physical activity
• Nausea, as well as vomiting
• Pale and feeling faint

Often feel vaguely unwell for a day or two beforehand (prodromal) with symptoms including:

• Increased sensitivity to light, sound, or smell
• Fatigue
• Behaviour changes
• Difficulty in concentrating, confusion
• Neck and shoulder stiffness
• Constipation or diarrhea
• Changes in food cravings

Physiotherapy treatment for migraine headaches

The use of medicines to manage acute pain and symptoms is effective. In addition, prophylaxis is often needed to prevent recurrence and chronic migraine is often needed. Physiotherapy treatment can help in the ongoing prevention of migraines.

• Reducing muscle tension in neck shoulder and back.
• Education of relaxation of tight muscles over the head/neck – biofeedback
• Addressing muscle imbalances that stabilise the neck/head with physical therapy
• Advice on avoidance of triggers to reduce frequency/onset of the attack
• Increasing activity and exercise in everyday life

What is frozen shoulder?

Frozen shoulder is also called adhesive capsulitis. It presents as difficulty or inability to raise the arm above the head, or move the arm in different directions due to pain or stiffness. It is one of the most painful musculoskeletal conditions. Frozen shoulder occurs in up to 5% of people.

It is common to present with a lot of pain and stiffness. The shoulder capsule becomes inflamed and fibrotic resulting in pain and progressive stiffness. There is a significant restriction in range of motion (typically external rotation). It can take up to 2-3 years to recover.

Signs and symptoms of frozen shoulder

The main symptom is sharp, eye-watering shoulder pain when moving the shoulder, especially in movement of turning shoulder inward, outward and lifting above the head. There is a progressive loss of range in moving the shoulder.

In the early stages, there are difficulties with sleep due to the pain in the shoulder

People with frozen shoulder may have, difficulty:

• reaching behind back to fasten a bra or tuck in a shirt
• taking wallet out of a back pocket
• reaching to put on a seat belt
• throwing a ball
• reaching above shoulders

How to confirm a diagnosis

Involving a physiotherapist in the diagnosis and management plan is best practice.

1. Complete a thorough examination and assessment.
2. Differentiate the diagnosis from rotator cuff injury as the treatment is different.
3. Identify whether there is limited range of movement secondary to mechanical restriction or secondary to pain.

3 Stages of frozen shoulder

It is fairly well understood that frozen shoulder involves several stages. These stages reflect the series of processes from capsular inflammation and fibrosis to spontaneous resolution of this fibrosis.

1. Freezing (pain) phase: from 2 – 9 months.

• gradual onset of severe shoulder pain at rest
• sharp pain at extremes of motion
• pain at night & interrupted sleep.

2. Frozen (stiffening) phase: from 4 – 12 months

• pain starts to subside, stiffness remains
• progressive loss of glenohumeral movements and loss of external rotation
• pain only at extremes of movement.

3. Thawing (resolution) phase: from 4 – 24 months

• spontaneous, progressive improvement in functional range of motion
• resolution of stiffness.

All 3 phases of frozen shoulder overlap by varying amounts

Some studies suggest that frozen shoulder is a self-limiting condition, but can last up to three years. However, other studies have shown that up to 40% of patients may have persistent symptoms and restriction of movement beyond three years. It is estimated that 15% of people may have persistent pain and long-term disability. However, effective treatments which shorten the duration of the symptoms and disability will have a significant value in reducing morbidity.

Risk factors for frozen shoulder

• Diabetes
• thyroid dysfunction disease
• cardiovascular disease
• prolonged immobility
• Parkinson’s disease
• Stroke
• Dupuytrens contracture
• age 40 and 65 years
• females are more commonly affected than males

Managing frozen shoulder

Find a physiotherapist who understands your body’s anatomy and condition and start rehabilitation as soon as possible to speed up the recovery.

• Reducing the pain and starting to get movement back in the shoulder is the first step.
• Starting treatment early and progressing with a tailored treatment and exercise plan will get the best effect.
• Achieving a healthy and strong shoulder with full use is the long-term aim of treatment.

Treatment strategies

Strategies will vary depending on the phase and will include:

• mobilisation
• massage
• taping
• trigger point therapy
• dry needling
• lifestyle modification advice eg for sleeping, dressing
• stretching exercises
• stability exercises
• strengthening exercises

All exercise activities must be in the pain-free range and not provoke pain.

Does physiotherapy work for frozen shoulder?

Yes. physiotherapy is effective for frozen shoulder. Physiotherapy can help speed up the recovery process by reducing pain, improving stiffness and range of motion as well as strengthening the shoulder.

If you think you have a frozen shoulder call us to book an assessment. Our physiotherapists at Hurstville Physio Plus understand your condition and we will get you back on your road to recovery. We will plan your shoulder rehabilitation and give your body the treatment it deserves.

At Hurstville Physio Plus we prioritise building an exceptional team of physios. This allows us to continue to provide excellent physiotherapy services to our clients. We wouldn’t have it any other way!!

Meet Heath, our newest but not youngest member of our team. Hear him share his insights to what it’s like to work at Hurstville Physio Plus.  An enthusiastic, energetic and driven young guy who just loves being a physio. So he certainly manages to brighten everyone’s day!

Heath has a Master of Physiotherapy from the University of Sydney. He believes in a holistic approach to better health, using hands-on treatment, exercise prescription and coaching to help motivate clients to achieve their goals.

With a passion for treating sports injuries, he easily gains a great rapport with our sports injury clients. He has experience working with National Premier League soccer teams so, soccer injuries and rehabilitation are right up his alley. He will soon have you safely back on the playing field.

He has also worked in a variety of different physiotherapy settings including geriatrics and neurological rehabilitation.

He enjoys training in the gym, spending time with his friends and family and has a keen interest in Formula 1 racing and Rugby League.

The knee is one of the most complex joints in the human body. Early in the season it is important to prevent knee injuries to make sure you can last the sport season. Many sports place extreme stress on the knee so they are very vulnerable to injury.

The smart choice is to do what you can to prevent a knee injury so you can keep playing what you love this sports season. Hopefully, you have put in enough training in the preseason so you now should focus on injury prevention while playing.

9 tips to prevent knee injuries:

1. Warm up, stretch and cool down at training and game day.
2. Focus your training program on developing strength, balance, coordination and flexibility.
3. Gradually increase the intensity and duration of training as the season progresses
4. Allow adequate recovery time between training sessions and games.
5. Wear the correct protective equipment including footwear – good shoes will help to keep knees stable, provide cushioning and support the knees and lower leg.
6. Check your training and playing environment for hazards eg uneven surfaces.
7. Avoid activities that cause pain.
8. Drink plenty of water before, during and after play.
9. See your physiotherapist if you need advice about your training or injury concerns.

Immediate management of a knee injury:

RICER protocol – Rest – Ice – Compression – Elevation – Referral

Continue RICE for 48–72 hours to reduce the bleeding and damage within the joint.

Rest the knee in an elevated position with an ice pack applied for 20 minutes every two hours (wrap the ice in a towel/cloth – do not apply ice directly to the skin).

Wear a compression bandage to limit swelling and bleeding in the joint.

Also use the No HARM protocol to decrease swelling and bleeding in the injured area.

No Heat – No Alcohol – No Running or activity – No Massage.

See your physiotherapist or sports medicine professional as soon as possible to determine the extent of the injury and any treatment required.

For more information on preventing and managing knee injuries see: Sports Medicine Australia, ligament injuries, cartilage injuries

With gyms reopening this week you need to have a plan for how to safely return to your pre-isolation gym exercise routine. A lot can happen to your body in 3 months and you need to be kind to it to get the rewards you’re looking for.

How will isolation affect your return to the gym?

Many people have continued with regular exercise at home but the type and intensity may have been quite different from what they were doing before, leading to reduced strength and conditioning. For those who used their extra time to increase walking, cycling or running their cardiovascular fitness may have dramatically improved however their strength may have deteriorated. Many have been more sedentary and significantly reduced their energy output leading to reduced overall fitness.

Your muscles and tendons are likely to have shrunk during COVID-19 isolation and this makes you more susceptible to injury. You may feel great after your first few sessions, however, niggles may appear or you may get a flare-up of a previous injury. This is your body telling you to slow down, decrease frequency, intensity and duration, or take a rest.

If you start off by placing too large of a demand on your body, you run the risk of injury and a return to isolation – exercise isolation!!

Tips for a healthy return to the gym and to avoid injury

• don’t expect to start where you left off
  • ease back into your exercise regime
  • start with flexibility workouts in order to increase blood flow and circulation while assisting in range of motion and joint mobility
  • add in light cardiorespiratory workouts if you have taken a serious break from all exercise
  • drop your weights for the first few weeks by at least 20% and up to 30% if you have not been training at all
  • be realistic with the number of days you exercise
  • trial 3 days per week for the first few weeks
  • rest between sessions to allow sufficient recovery
  • listen to your body and slow down or stop exercises that give you ‘niggles’
  • look after your form and keep a check on your posture
  • get your technique checked.

Most of all you need to look after your own health and safety in the gym. You may choose to drop your weights rather than have a spotter or do exercises you are familiar with rather than trying something new and having poor technique.

Be mindful of your end goal and do your best to stay on track – avoiding injury setbacks.

You know where we are if you need us to check your technique and advise you on safely returning to your pre-COVID exercise program.

Get Footy results with dynamic exercises

Start your Footy season ahead of the game by mastering dynamic strength and control exercises for the legs and hips. Achieving this will not only make your body stronger but enable you to play at your absolute best.

There are many ways to improve dynamic strength and control through the lower limbs, however, the exercises listed below focus upon the essential areas most athletes lack for performing at their best.

#1 Dynamic single-leg balance on a Bosu ball

Challenge your single leg balance – important for running, sidestepping and passing a ball.

Stand in the centre of the Bosu ball on one leg, or simply stand on one leg. Extend your non-standing leg forwards and then back to centre, sideways and then back to centre, and behind you and back to centre to challenge your stability.

Tips – control both the glutes and quadriceps muscles to achieve functional strength and stability in the lower limbs – keep the pelvis straight and still, increasing the activation in the target muscle groups – don’t let the hips drop to either side, keeping them level is essential in maintaining control and muscle activation.

Perform this exercise for 30-second intervals, progressing up to a few minutes as your balance improves.

#2 Pistol squats (from chair height)

Functionally strengthen the quadriceps and gluteal muscles – essential for explosiveness in the lower limbs.

Use a regular size chair for this exercise, hold your hands out in front, lift one leg off the ground and stand up by leaning forward. Control through the hips and knees until standing. Slowly lower back down onto the chair, again controlling through the hips and knees.

Tips –  don’t allow your knee to collapse inward as this decreases the activation of the quadriceps and gluteal muscles.

Start with 10 repetitions for 3 sets, progressing to more repetitions as your lower limb strength improves. 

#3 Pistol squat and pass/catch

Challenge your leg strength with the added challenge of passing and catching a ball, putting your stability to the test.

Start by performing a pistol squat at a right angle to a wall (a few meters away) – hold a ball in front of you, lift one leg off the ground and stand up by leaning forward. Control through the hips and knees until standing.  Rotate your body sideways throwing the ball into the wall and catching it upon return. Lower yourself back down slowly keeping control through your glutes and quadriceps. 

Tips – don’t allow your knee to collapse inward as this decreases the activation of the quadriceps and gluteal muscles.

Perform between 8-12 repetitions for 3 sets, progressing the number of reps and sets to continue challenging your dynamic stability.  

Physiotherapy is an essential healthcare service during the COVID-19 pandemic. Mobile physiotherapy home visits to clients in their own homes and Aged Care facilities are encouraged to continue. It is essential that vulnerable patients with chronic health conditions or those recovering from operations or injuries continue to have the best physiotherapy treatment they deserve.

We provide mobile physiotherapy service to St George and Sutherland Shire. Our experienced physiotherapists visit clients in their own home to help them continue moving well and following their path to recovery. This may be particularly helpful for clients who are strongly advised not to leave the house for their own protection during the COVID-19 crisis:

• > 70 years old
• > 60 years old and have pre-existing medical conditions
• > 50 years old and Aboriginal and Torres Strait Islanders and have pre-existing medical conditions.

Our experienced physiotherapists can visit you or your ageing loved ones in the convenience of your own home to support healthy and mobile living. We provide effective physiotherapy treatment in the comfort of the client’s own home for:

• after surgery rehabilitation
• stroke rehabilitation
• chronic disease management for osteoarthritis, respiratory conditions etc
• maintaining mobility
• falls prevention.

Making sure you or your loved ones remain safe, mobile and happy is now more important than ever because usual social arrangements have been cancelled and visits from relatives and neighbours are now restricted. We can develop balance, strengthening and mobility exercise programs to help you or your loved ones be more confident and safe at home.

Our caring and experienced team will guide you and your loved ones through how we can work together.

Keep up to date with the latest COVID-19 news

The advice from the Australian Physiotherapy Association is that the Federal Minister for Health, Hon Greg Hunt, has advised that all allied health businesses can continue to operate and are encouraged to do so. We are therefore open for business and are working very hard to ensure the health and safety of our staff and clients.

Current advice to all Australians

Everyone must practise good hygiene to protect against infection and prevent the virus spreading How to handWASH
International travellers or those who have had ‘direct contact’ with an infected person should self-isolate for 14-days to prevent the spread.

If you develop a fever, a cough, sore throat or shortness of breath within 14 days of overseas travel, seek medical attention. Stop the spread

If you have a confirmed case of COVID-19, you need to isolate yourself to prevent it spreading to other people.

What we are doing

First and foremost we have increased the frequency of our infection control procedures in the clinic and we are adapting to national recommendations daily as needed.

Here are some of the things we are doing in the clinic as our response to stopping the spread:

• practicing excellent hygiene/infection control
• screening patients
• looking out for symptoms Know the signs
• staggering appointment times
• practicing social distancing
• offering home visits
• staying healthy
• being extra kind

What next?

Watch out for our posts on social media (Instagram and Facebook) over the next few days/weeks as we share how we continue to adapt to the recommendations provided by Australian Government, Health Minister and NSW Government and the challenges currently facing us all.

Keep up to date: Department of Health Updates

The health and safety of our staff and clients is of the utmost importance to us. Continuing to provide excellence in physiotherapy services to our valued clients is at the core of what we do every day and we will continue to that while we can.

Physical activity and exercise every day are important for preschoolers to help their growth and development.

Preschoolers (3 to 5 years) should spend at least 3 hours a day doing physical activities with at least 1 hour being energetic play such as running, kicking, jumping and throwing. Getting outdoors, running around with them and showing them ball skills will keep the whole family fit and healthy and can be so much fun!!

Sitting for extended periods or being restrained in a car seat or stroller should ideally be for no more than 1 hour a day. Screen time may keep your young ones quiet for a while but only up to an hour is recommended each day. During sedentary time (quiet time) parents are encouraged to engage them in reading, singing, telling stories or doing puzzles.  

If your little ones are kept busy and active during the day then getting the recommended 10 to 13 hours good quality sleep each day should be easier.

Recommended activities:

• walking
• dancing
• swimming
• gymnastics
• playground activities
• climbing
• skip
• active play, like hide and seek
• throwing and catching
• riding a bike or scooter
• outdoor activities
• skipping.

Benefits of exercise in children:

• develop healthy bones, muscles and joints
• develop healthy heart and lungs
• improvement in coordination, strength and muscle control
• maintain a healthy body weight
• develop flexibility
• improvement in balance and posture
• develop vital brain connections, leading to improved concentration and thinking skills
• less likely to develop chronic diseases, such as heart disease and type 2 diabetes.

For further details see Australia’s Physical Activity and Sedentary Behaviour Guidelines and the Australian 24-Hour Movement Guidelines

From kindergarten to high school our kids are carrying daily stress in their backpack that can lead to unnecessary back pain. Too often they include things that are not really needed adding to the weight being carried.

Carrying excessive weight in a backpack can cause wear-and-tear on the joints, ligaments and muscles. The body works to compensate for the extra weight being carried but the body can’t sustain the strength needed for prolonged periods of time. Degeneration, stiffness, loss of range of motion and pain can occur in the back and other parts of the body as other muscles start to compensate for the extra strain. This can lead to chronic back pain, compression of the discs in the spine, neck pain, poor posture and gait and even foot pain.

How much should kids carry?

As a general guide, children should only carry about 10% of their body weight although this does vary depending on their need for the day.

It’s not just the weight of the backpack that can be a problem, it’s also the load shape and size, how it is positioned on the body and the time spent carrying it.

Ten tips for safely carrying your backpack to prevent injuries and longer-term musculoskeletal problems

1. Choose a backpack with broad, padded shoulder straps, sturdy and appropriately sized and no wider than the student’s chest
2. Use a waist or chest strap if the backpack has one.
3. Shorten the straps until the bottom of the backpack is just above the waist and not sitting on the buttocks. The backpack should lie flat on the back.
4. Keep good posture: ears above your shoulder, shoulders back, chest open, and back straight.
5. Lift the backpack up from the ground by bending the knees. Bending over puts more strain on the lower back.
6. Pack only what is necessary.
7. Distribute the weight evenly: wear and tighten both straps of the backpack. Never sling the pack over one shoulder.
8. Pack heavier items at the base of the pack, close to the spine, for a better distribution of the weight
9. Leave textbooks at home and use a digital copy.
10. Use lockers at school to avoid carrying everything at once.

Help out your kid’s bodies by helping them get organised as the new school year starts.

If your child is experiencing pain and you think it’s from carrying a heavy backpack, see your physiotherapist for assessment and treatment.