Patient receiving ultra sound diagnosis.

Physiotherapy

Our aim is to work together to provide a high level of professional care in a safe and friendly environment. All of our physiotherapists are committed to continuing education and strive to remain up to date with evidence based best practice. This means you can expect excellence in service when it comes to assessment, diagnosis, treatment, and education regarding the condition being treated and self-management strategies.

Physical Agents Physiotherapists Use

Skilled observation and movement analysis, including the use of video analysis, is used to identify abnormal movement patterns and identify weak muscles or stiff joints contributing to the altered movement.

For example a stiff painful hip joint due to arthritis or bursitis will cause movement away from the side of pain and gradual weakening of the muscles around the affected hip and thigh and overuse of muscles on the other side. A joint that is too flexible becomes unstable under too much load and protective movement patterns are adopted.

During movement analysis your physiotherapist can identify exactly which joints are stiff and which muscles are tight and weak as well as those that are overused. Once identified, techniques such as mobilisation of stiff joints and surrounding soft tissues, graduated strengthening of weak muscles, appropriate stretching and re-education of a more normal movement pattern can be initiated.

Common areas that we treat include shoulder rotator cuff injuries or degenerative changes, jaw pain, knee pain due to abnormal tracking of the knee cap or abnormal loading of the patellar tendon, tennis and golfer’s elbow, headaches due to poor posture and overuse of the muscles that elevate the shoulder, pain at the lateral aspect of the hip and thigh due to a bursitis or tendinopathy, pain and swelling of the Achilles tendon, pain swelling and altered movement due to osteoarthritis of the hip or knee.

Musculoskeletal Screening

This is a service we provide for those about to embark on an exercise regimen or new sport but are concerned that they may need to identify areas of risk that could result in injury.

Some athletes also like to have a full screening at the beginning of a new season especially if they have not been as active during the ‘off season’.

Through a comprehensive musculoskeletal assessment the likelihood of injury can be reduced considerably if potential imbalances in muscle strength and flexibility are identified.

Other bio-mechanical factors, which may affect performance such as joint range, stability or hyper-mobility – especially of those joints most likely used in your sport or activity, can also be assessed with advice given on how to address any possible risks factors and so be better prepared.

Ultrasound

The function of ultrasound varies according to the frequency of the sound waves.  At hawker Place Physiotherapy we use diagnostic ultrasound to observe, assess the function of, and rehabilitate certain muscle groups such as the deep abdominal and pelvic floor muscles.

Ultrasound at a higher frequency can also be used to stimulate cellular activity and promote healing as well as relax very tight and tender muscles.

Stretching Programs

Stretching is aimed at increasing flexibility of muscles and joint range of motion (ROM) following a period of inactivity or rest after an injury or surgery, contracture after a burn, or built up tightness due to prolonged overuse of a muscle or groups of muscles.

It is the muscles of the body that control movement of a joint and stretching is the process of placing particular parts of the body into a position that will lengthen, or elongate the muscles and associated soft tissues. Upon undertaking a regular stretching program a number of changes begin to occur within the body and specifically within the muscles themselves such as an increase in the length of muscle cells.

Other tissues also adapt to the stretching process include the fascia or connective tissue, tendons which join muscle to bone, ligaments that join bone to bone, skin and scar tissue.

Dry Needling

Dry Needling is a physical modality that has become very popular with physiotherapist over the past few years. It appears to be successful in relieving trigger points. It should not be confused with the oriental practice of acupuncture, dry needling is being used successfully by physiotherapists who are suitably trained in this technique.

There are two categories of dry needling-superficial dry needling and deep dry needling. As the name implies, superficial dry needling does not reach the myofascial trigger points and is painless. With deep dry needling the needle goes directly into the myofascial trigger points, eliciting a twitch response, similar to what occurs when the knots are palpated.

The twitch response shows that the needle has reached the knot and pain is reduced or relieved immediately although in some cases the full pattern of referred pain may be elicited first. This practice seems to be taking over from ‘electrotherapy’ as a form of pain relief. Just as electrotherapy does not treat the bio-mechanical source of pain, nor does dry needling.

Exercise Programs

Exercise and stretching form an integral part of most rehabilitation programs. Exercise helps to increase energy and range of motion, strengthen the muscles, bring blood to the extremities and improve cardiovascular health.

Stretching is essential not only for muscle, but for the soft tissue as well. Stretching helps to elongate muscles, increase range of motion, provide flexibility, promote healing and prevent future injury. In the rehabilitation of many sports injuries such as plantar fascitis, shin splints, iliotibial band syndrome to name a few, stretching is recommended.

In order to increase strength, the muscle must contract against its maximum resistance. The number of repetitions, rest intervals, rate of movement and frequency of treatment must be geared toward the patient’s capacity to adapt to the exercise. In order to gain optimum results, exercise should be graded with small loads initially, working up to the maximal power that the muscle can accommodate. This is known as progressive resistive exercise and is best done under the direction of your physiotherapist.

In the beginning of treatment you may not know what your muscles are capable of, therefore you may not exert the amount of force that you should. Pain or fear of injury may also inhibit you from reaching your maximum. Based on the muscle test results, your therapist can estimate the amount of resistance the muscle can take and add or subtract resistance until you can perform the repetitions properly.

Therapeutic Massage and Soft Tissue Therapy

For century’s people depended on massage to improve circulation, ease aches and pains and promote a sense of well being.

Physiotherapists use soft tissue therapy and therapeutic massage to deliver these same benefits and more, to patients who suffer from chronic pain, poor circulation, sprains and strains.

Combined with an exercise program, massage therapy can be an important adjunct to any physiotherapy program. Some conditions that benefit from massage therapy are postural headaches, neck and back pain, general muscle tension following sporting injuries.

We may combine different techniques depending on your needs. The degree of touch, pressure and movement may vary depending on your sensitivity to the massage. For example, to relieve trigger points (knots of muscle tension), deep pressure is often required to loosen the knots, increase blood flow and relieve pain.

Lighter touch with long, gliding strokes in the direction of blood flow to the heart is another effective technique. When combined with passive and active range of motion it can greatly improve circulation, promote relaxation, restore range of motion and relieve muscle tension.

It is not uncommon to feel very relaxed tired and sleepy after some forms of massage.

Trigger Point Therapy

Trigger point massage also known as neuromuscular therapy or ‘ischaemic pressure’ involves concentrated finger or ball pressure to trigger points – the tight, painful knots in muscles that cause pain and spasm.

Myofascial Release

Myofascial release is a form of soft tissue manipulative therapy that stretches the thick fibrous bands of tissue beneath the skin to remove tightness and reduce tension. Sustained pressure combined with deep frictions decreases the tight areas within the muscle and fascia.

Jaw Pain

Jaw Pain is often caused by abnormal temporo-mandibular joint alignment (TMJ). Place your second and third finger tips just in front of the lower end of your earlobes – now open and close your mouth. You are palpating your temporo-mandibular joints.

These joints often develop faulty movement patterns after such things eating a large very hard apple, having a series of dental appointments with your jaw open for prolonged periods or after prolonged periods of very poor head forward posture.

Dysfunction of this joint can also be a source of headaches. If your jaw locks, grates, clicks or is painful and stiff to open you probably have TMJ dysfunction.
Some physiotherapists are trained to assess your jaw function and to aid in the restoration of normal movement of this joint.

This generally involves internal mouth mobilisation (gloved hand technique) to restore any stiff or restricted motion, trigger point therapy and massage as well as initiation of appropriate home program exercises to address the specific direction of tightness or weakness. It also involves advice regarding posture that improves TMJ position and function.

If left untreated, TMJ dysfunction can accelerate osteoarthritis and chronic pain and in some cases where the specialised cartilage in the joint called a meniscus becomes trapped – surgery may be indicated.

Shoulder Pain and Stiffness

Shoulder pain and injury is common. The shoulder is the most mobile of all your joints but this mobility comes at the expense of stability. It is your shoulder muscles that are vital in providing dynamic stability in a normally functioning shoulder.

If your rotator cuff muscles are weak your shoulder becomes vulnerable to injury. In most cases, if you are suffering shoulder pain it is because your muscles are simply not strong enough or they are not working in a well coordinated and controlled manner. Research shows that managing shoulder injuries conservatively with physiotherapy is quite successful.

Accurate assessment of the shoulder can determine if your shoulder pain is related to instability causing subluxation (partial dislocation) or dislocation (most often cause of shoulder pain in those under 30), rotator cuff injury or disease, Frozen shoulder, fracture, or arthritis.

Other conditions include acromioclavicular joint or ACJ injury or arthritis, Biceps tendinitis, Bursitis, Muscle strain, a pinched nerve, impingement, or RSI.

Hip Pain & Injury

Hip pain and joint injury is common for all age groups. The hip joint and its integration with your pelvis, sacro-iliac joint or SIJ and lumbar spine (lower back) make it a complex region to correctly analyse and assess any dysfunction.

Your hip function can also be affected by lower limb biomechanics involving your knee, foot and ankle plus your thigh and calf muscles.

Typical hip conditions physiotherapists treat include Gluteal tendinopathy or trochanteric bursitis, groin or adductor pain (adductor tendinopathy) osteitis pubis, hip flexor or adductor muscle strain, Pirifomis syndrome, sciatica, stress fracture SIJ pain often associated with pregnancy, hip cartilage tear and hip arthritis.