What is Physiotherapy?
Physiotherapy is a therapeutic health profession that assists people with injuries, pain, stiffness, weakness, and other movement problems. Physiotherapists are university trained and are experts in injury diagnosis, injury treatment, exercise prescription, injury prevention, rehabilitation and many other areas of sport and musculoskeletal health and fitness. Physiotherapists also have the expertise to assess the underlying causes of musculoskeletal injuries and provide effective, evidence based treatment so you can resume your normal lifestyle as soon as possible with the least likelihood of recurrence. Physiotherapists educate patients and teach them the skills required to take care of their bodies using various tools and methods.
Following injury, physiotherapists use a variety of treatment techniques to hasten the body’s natural healing process and speed recovery. These treatment techniques may include:
- exercise prescription
- clinical Pilates
- dry needling
- ice or heat therapy
- advice and education
The techniques used for each individual are carefully selected by the treating physiotherapist based on research demonstrating maximum benefit for their particular condition.
Aside from dealing with musculoskeletal and sports conditions, physiotherapy is also vital to ensure an optimal outcome in patients suffering from conditions in the following medical areas:
In Australia you do not need a doctor’s referral to see a physiotherapist, unless you wish to be claiming the injury through insurance as a workplace injury or motor vehicle accident.
All physiotherapists are university educated health practitioners, with entry to the profession being at either Bachelors or Masters Degree level. Many physiotherapists also undertake further qualifications at Masters or Doctoral level in specialist clinical areas.
When should I see a Physiotherapist?
There are many instances when it is appropriate and beneficial to consult a physiotherapist. Some of these include:
- If you have sustained an injury
- If you have swelling, bruising or deformity of a body part
- If you are experiencing joint stiffness, pain or ache (particularly if your symptoms have persisted for greater than 3 days)
- If you are limping or protecting a limb due to pain
- If you are experiencing pins and needles or numbness
- If your limbs collapse or give way occasionally
- If you have postural problems
- If you need advice on improving strength, flexibility, balance or fitness
- If you need advice on injury prevention or other aspects of musculoskeletal health
- If you require treatment for an injury
- If you wish to improve your physical performance for sport
- If you are planning a return to sport or activity following a prolonged period of inactivity
As a general rule, if you are unsure, it is always better to consult a professional rather than not seek advice.
What does a Physiotherapy Appointment involve?
An appointment with a physiotherapist will involve taking a relevant clinical history. The injured area is assessed as well as other areas that may be contributing to the problem. You are then informed of the results of the assessment and a suitable treatment program is devised. Treatment programs are individualized and evolve based on your needs and stage of recovery. Treatment may encompass modalities, i.e. ultrasound, “hands on” treatment, specific exercises, or simply advice on how to manage the problem.
Is treatment covered under Medicare?
Physiotherapy is generally not covered under Medicare; except under the Enhanced Primary Care Plan. This requires a special referral from your G.P. and allows up to 5 Medicare funded treatments. However, many people have cover through their “extras” cover health care benefits package. Check your benefits policy. There also may be cover under work cover or transport accident insurance.
How do I pay?
We accept Visa, EFTPOS, cheque or cash. We also have HICAPS for direct billing of your private health fund – you only pay the gap.
Do I need a doctors' referral?
No, you do not need a doctor’s referral to access a physiotherapist at our clinic. However, TAC, Work Cover or DVA clients who would like to be bulk billed require a referral from their Doctor.
Do I need to take anything or wear anything in particular?
Please bring any scans (i.e. ultrasound, x-ray, MRI) you have had that may provide additional information about your condition to your physiotherapist.
If you are attending physiotherapy, it would be beneficial to wear loose comfortable clothing that allows easy access to your area of concern (e.g. a low tank top for a shoulder injury, shorts for a knee injury). However, we do have freshly washed tank tops, shorts and gowns that you may use for your session. Also, you should bring anything else that you think would help your physiotherapist make an accurate diagnosis (i.e. running shoes, picture of your work space etc).
If you are attending clinical Pilates, loose fitting clothing is best as it will promote ease of movement. Health and safety regulations also require that you wear socks while using the Pilates equipment. We also have several pairs available on site for you to borrow if you have forgotten your own. Alternatively, you can purchase some Pilates grip socks from reception.
Will I see the same physiotherapist at each visit?
We prefer that you stay with the physiotherapist that assessed your condition initially, because this will ensure that you are receiving treatment from someone familiar with the full extent of your injury.
If, for some reason, you would prefer to see another physiotherapist, please do not hesitate to ask.
Do all physiotherapists have the same qualifications?
All physiotherapists have completed a university degree and must be registered with the Australian Health Practitioner Regulation Agency in order to be eligible to practice physiotherapy in Australia.
All our physiotherapists are members of the Australian Physiotherapy Association (APA). The APA requires members to complete a specified number of professional development courses each year in order to stay up-to-date with the latest research and physiotherapy techniques.
Physiotherapists may also specialise in their chosen area of interest (i.e. musculoskeletal, sports, women’s health) by completing a coursework Masters Degree. This provides additional critical thinking and evidence based practice skills, as well as advanced assessment and treatment techniques.
What is your cancellation policy?
If you cannot keep your appointment, please call us as soon as possible. We realize that sometimes emergencies come up and your plans may change. When you call, we will help you reschedule your appointment. Giving us as much notice as possible helps us better serve you and our other patients. Should you cancel a session with less than 3 hours notice, you will then be liable for the $50 cancellation fee. If you miss a session without notice you will be charged the fee for that session.
How can physiotherapy help my injury?
Physiotherapy can ensure your injury is thoroughly assessed and diagnosed correctly. This is essential to ensure the correct treatment techniques are chosen for your condition. Physiotherapy treatment can hasten your body’s natural healing process, accelerating your return to sport or activity. Appropriate treatment will also reduce the likelihood of recurrence by addressing factors which may have contributed to the development of your condition. Physiotherapists are experts in advising patients on which activities are appropriate for their injury to maximize recovery and ensure an optimal outcome.
Which physiotherapy clinic should I go to for treatment?
Choosing the right physiotherapy clinic for treatment can be difficult. Whilst all physiotherapists are university trained and qualified, it is important to select a physiotherapist who is trusted, knowledgeable and friendly and can provide the best quality treatment for your injury. When it comes to choosing a physiotherapist there are no hard and fast rules, but some things worth considering include:
- How long has the physiotherapist been qualified for?
- Is the physiotherapist a member of the Australian Physiotherapy Association?
- Does the physiotherapist have a particular area of expertise?
- Does the physiotherapist have post-graduate qualifications?
- Does the clinic have a multidisciplinary team of professionals i.e. are there services for massage, clinical Pilates, Myotherapy etc.?
- Have you seen the physiotherapist before and did you achieve a good outcome?
- Have your friends or family had a good experience from that physiotherapist or clinic before?
- If you are already seeing a physiotherapist, is your condition getting better and staying better?
Some additional information which may assist you in making your decision may include:
- How long is an initial consultation?
- How long is a follow-up consultation?
- What is the cost for an initial consultation and follow-up consultations?
- Are there any discounts for concession?
- Am I able to claim on private health insurance?
- Are there HICAPS facilities?
What is Pilates?
Pilates is a form of physical exercise that focuses on posture, core stability, balance, control, strength, flexibility, and breathing. The Pilates Method was developed by Joseph Pilates in the early 20th century in Germany. These days, Clinical Pilates is often used in conjunction with physiotherapy as a means of treating a variety of injuries, particularly those of the neck and back. This is based on literature that demonstrates strong evidence to support the use of therapeutic exercise in the management of patients with injuries, particularly low back pain. Recent research advocates the retraining of the deep stabilizing muscles for patients with low back pain. Clinical Pilates focuses on the retraining and recruitment of these stabilizing muscles (core stability) as well as improving posture, strength and flexibility.
Although Pilates can be extremely beneficial for patients with certain injuries it needs to be specific to the individual and not used as a generic tool for everyone. Clinical Pilates (as distinct to generic Pilate’s classes) identifies this key issue by applying carefully selected exercises to patients with specific injuries. This ensures optimal gains whilst minimizing the likelihood of injury aggravation. If you are interested in commencing Pilates for your injury, it is essential to have a review with a physiotherapist to assess the suitability of a core stability program for you.
When should I use ice?
Ice treatment should always be used during the inflammatory phase of an injury. This occurs in the first 72 hours following injury or injury aggravation.
How do I use ice?
The injured area should be iced for 20 minutes every 2 hours. This can be accomplished by using crushed ice or an ice pack wrapped in a damp tea towel.
When should I use heat?
Heat should be used to speed injury healing once the injury has completed the inflammatory phase. The inflammatory phase normally lasts up to 72 hours following injury or injury aggravation. It is therefore, generally safe to use heat treatment after the initial 72 hour period following injury or injury aggravation. Heat is also an effective way to help reduce muscle tightness or joint stiffness.
How do I use heat?
Apply a heat pack for 10 – 30 minutes at comfortable warmth to the injured area. This can be repeated 2 – 5 times daily or as required and should ideally be used before exercise. Ensure your heat pack is not hot enough to cause a burn. Wrapping your heat pack in towels can help to reduce the temperature.
When is an x-ray, MRI, CT scan, bone scan or other investigation appropriate for my injury?
There are many investigations that doctors and physiotherapists can utilize to help determine a patient’s diagnosis. These are usually used to help confirm or eliminate a suspected diagnosis following clinical examination and are frequently indicated in the following scenarios:
- Severe or traumatic injury
- Suspicion of serious pathology
- Unusual clinical presentations
- Unknown diagnosis following examination
- Injuries that are unresponsive to treatment
As a general rule, investigations are only indicated if the outcome is likely to change treatment and should be discussed on an individual basis with your doctor or physiotherapist. It is usually unnecessary to perform expensive investigations to confirm an already obvious clinical diagnosis.
In addition, there are many instances when a thorough examination from a qualified professional is more accurate in determining a diagnosis than an investigation. This is due to the fact that many investigations are unreliable or have inaccuracies due to a variety of factors. Nonetheless, they have their place in the clinical setting and should be used at the discretion of the treating physiotherapist or doctor.
Do I need orthotics?
The use of orthotics is often indicated in patients with abnormal lower limb alignment and biomechanics, particularly of the feet. That is, they stand, walk or run, with less than ideal posture or movement patterns. Lower limb biomechanical abnormalities are often associated with the development of lower limb, pelvic or lower back injuries.
One of the most common biomechanical abnormalities seen in clinical practice is overpronated feet (flat feet). Flat feet frequently contribute to the development of numerous injuries. However, if you have flat feet, you don’t necessarily need orthotics. Many people who have flat feet never develop an injury associated with their foot posture. Usually orthotics are only indicated when a patient presents with abnormal lower limb mechanics AND they have an injury that is related to their poor biomechanics.
It is important to note that other factors related to the development of the injury also need to be addressed to ensure an optimal outcome. Wearing orthotics alone is usually inadequate to completely recover from an injury. Physiotherapy assessment and treatment can assist in identifying other contributing factors (such as muscle tightness, weakness, joint stiffness or lifestyle factors etc) and can correct these through appropriate treatment and exercise.
The prescription of orthotics in patients suffering from injury is usually indicated if foot postural taping (i.e. supporting the arch) causes a reduction in symptoms. Physiotherapists and podiatrists are experts in assessing the need for orthotics and should be consulted to assess the suitability of orthotics for a particular condition.
Appropriate footwear is also important and needs to be specific for the particular orthotic. There is a variety of orthotics available on the market, both “off-the-shelf” varieties and specifically casted orthotics designed for your individual feet. If you think you may need orthotics, a review with a physiotherapist or podiatrist is recommended.
Is it better to tape my ankle or use a brace when I am returning to sport following an ankle sprain?
Is it better to tape my ankle or use a brace when I am returning to sport following an ankle sprain???
Following an ankle sprain, the ankle joint is usually less stable and has an increased likelihood of further injury, particularly when returning to sport. This is due to disruption of the ligaments which normally act as a passive restraint and support for the ankle with sideways or twisting movements. In addition, patients normally suffer reduced balance following injury, further increasing their probability of injury recurrence. As a result, patients are recommended to use either rigid strapping tape or an ankle brace when returning to sport. Both of these supports improve the stability of the ankle, protecting it from sideways and twisting movements, therefore reducing re-injury likelihood.
The decision to use either tape or a brace is usually a personal choice. Tape has the benefit of being less cumbersome than a brace allowing the foot to sit more comfortably in a shoe. It may also assist with improving proprioception (joint position awareness). Tape, however, can sometimes cause skin irritation or circulatory problems and tends to be more expensive than bracing in the long term. In addition, tape is usually more difficult to apply than a brace by one person, it requires some expertise in applying it correctly, and it may lose its effectiveness faster than bracing. Bracing on the other hand has several advantages over tape in that it can easily be applied by the patient, is a lot cheaper in the long-term, and, if reasonable quality, will usually last a long-time. Some disadvantages include the heaviness of the brace itself, the brace potentially slipping or moving around in the shoe and the occasional difficulty ensuring the brace fits appropriately both to the foot and into the shoe. Ideally, a patient should try both options before deciding upon the most suitable support, prior to their return to sport.
How long should I spend warming up before sport and what is the best way to do this?
One of the best ways to prevent injury is with an effective warm-up prior to sport or activity. A proper warm-up should be at least 15-20 minutes in duration and progress through a variety of stages. The purpose of an effective warm-up is to increase heart rate and facilitate blood flow to the muscles to be used during the activity. This increase in blood flow, heart rate and body temperature improves the elasticity of both muscles and joints, alerts neural pathways and stimulates muscles in preparation for performance.
A warm-up should gradually progress through four phases:
The first phase of a warm-up should involve a low intensity cardio exercise such as light jogging or walking to increase the heart rate and to start getting blood flow to muscles. This should last for approximately 5-10mins.
The second phase of the warm-up should involve dynamic range of movement exercises to loosen up the joints and muscles to be used. This phase of the warm-up should focus on those specific body parts to be used for that particular sport. These stretches should be dynamic rather than static as static stretches will start to decrease heart rate and thus cause a cooling down effect – rather than a warming up effect which is what we are trying to achieve. Some examples of dynamic stretches could include lunges, squats, lower back rotations, trunk rotations, leg kicks, arm rotations etc.
The third phase of a warm-up up should progress into agility, acceleration, deceleration and speed drills, preparing your body for faster movements that will be required for your particular sport. This should involve a gradual progression starting off at low intensity and building up to greater intensity. This phase of the warm-up may involve for example, repeated strides, initially in straight lines and at low intensity and then progressing to change of direction and greater intensities.
The fourth and final phase of a warm-up is the sport specific phase. This is where you perform the skills involved in your particular sport, initially at low intensity and then building up to greater intensity. For example footballers may perform running, jumping drills and kicking for goal, basketballers may perform dribbling, passing, shooting and rebounding etc. By the end of this phase you should be performing your particular skill at 100%, thereby ensuring your body is ready to perform the required skills in a match situation at 100%.
Does stretching before sport help to prevent injury?
Maintaining good flexibility is an important aspect of athletic performance and injury prevention. It is widely accepted that poor flexibility and inadequate joint range of movement are significant factors contributing to the development of numerous injuries.
If performed correctly, stretching is an excellent way to improve flexibility. There are two main techniques used to stretch – static stretching and dynamic stretching. Static stretching involves taking a particular muscle towards its end of available range and holding it for a period of time. This enables the body to relax into the stretch. Dynamic stretching involves movement and takes the muscle and joints through their available range without stopping for prolonged periods.
Stretching before sport is important to loosen the muscles and joints through their available range in a controlled environment. The stretches selected, however, should primarily involve dynamic stretches, rather than static ones. This is because the main aim prior to sport is to conduct a thorough warm up of the body preparing it for the skills required for that particular sport. Dynamic stretches increase the temperature of the affected body parts assisting the warm up process. Static stretches on the other hand, cause a cooling effect thus counteracting the purpose of a warm-up. In addition, static stretching prior to sport has been shown to decrease muscle performance and may contribute to decreased athletic performance.
Recent research has demonstrated that static stretching before sport does not reduce the likelihood of injury during that particular activity. However, as mentioned previously, maintaining good flexibility overall does. It is therefore recommended that prior to exercise or sport, a thorough warm up including dynamic stretching should take place to reduce injury likelihood. Then, following sport or exercise, static stretches should be used to reduce muscle tightening, improve flexibility and assists with the recovery process.
My injury causes pain when I play sport, but I can play through it. Usually the warmer I get the less painful it becomes. However after rest, it is sometimes sorer. Should I keep playing through the pain or is it better to stop?
One of the most effective ways to hasten the healing of a particular injury is through avoidance of aggravating activities. Generally an activity aggravates a condition if:
- There is pain during an activity OR
- There is pain upon rest following an activity OR
- There is pain upon waking the following morning after an activity
Usually, when pain decreases as you warm up and then increases with rest following activity, this suggests you have inflammation. Inflammation generally lasts for 48 to 72 hours following injury or injury aggravation provided the injured part is rested. Continuing to play through this is likely to cause further damage and can contribute to the development of chronic injury, reducing the likelihood of a full recovery. Usually in these circumstances, a period of rest from the aggravating activity is indicated to allow your body to begin the healing process.
Inflammatory pain is also managed effectively with an anti-inflammatory approach such as the R.I.C.E. regime and the use of anti-inflammatory medication. Your physiotherapist can guide you on which activities to avoid, how best to manage your injury, and when it is appropriate for you to return to sport or activity.
Why do I get cramps and how can I prevent them?
Muscle cramps are painful, involuntary muscle contractions that occur suddenly and can be temporarily debilitating. Research suggests the mechanism of cramps is related to disturbances within the nerves and muscles. There are many factors that may contribute to the development of cramps. These include:
- low salt levels (potassium and sodium)
- inadequate carbohydrate intake
- muscle tightness
- muscle or neural fatigue
- muscle weakness
- a lack of fitness or conditioning
- training conditions
- equipment or footwear
- certain medications
- poor recovery between training sessions or matches
- lack of sleep
Strategies to try and prevent cramps include:
- ensuring your fluid, carbohydrate and electrolyte intake is adequate
- avoiding any alcohol or caffeine intake
- performing regular stretches to improve muscle length
- ensuring you are adequately rested and recovered between training sessions and matches
- implementing a strength and conditioning program to improve muscle function
- ensuring your footwear, equipment and training surfaces are appropriate
- obtaining advice from your doctor in regards to any medications you are taking that could be contributing to the development of cramps