A ride on a 30-year roller coaster

It was 30 years ago this Monday – 9 May, 1991 – when a much younger, slimmer and darker-haired version of John Perrier first opened the doors to PhysioWorks. The ensuing three decades have been a roller coaster of change, so I invite you to take 10 minutes to wander though the memories with me.

The original Bulimba site was at 124 Oxford St, next to the old Commonwealth Bank– Grill’d Burgers operates there now. I had spent weeks painting, carpet laying, buying equipment and networking with local doctors. I turned the key, opened the door, and then waited nervously by the phone for … well, nothing.

It took all day, but eventually the phone rang and I had my first booking – a young swimmer named Nathan – and my life as a private physiotherapist was underway. I haven’t seen Nathan for some time, but I’m pleased to say that I still regularly treat his mother to this day.

original bulimba practice 01

The original Bulimba Physiotherapy Centre. Luxurious, isn’t it?

I had taken out a start-up bank loan at 17% interest – the going rate at the time – and my equipment was leased at 25% per annum. I had heard multiple warnings about how many small businesses closed in the first two years so I was determined not to fail.

Working alone, my tasks rapidly expanded beyond what my inexperienced mind had imagined – I had thought that being my own boss would give me control over my time. Ha! I could not have been more wrong.

Besides treating patients, taking payments and answering the phone, I had to squeeze the accounting, cleaning and admin into my lunch breaks. Three nights a week after work I would head off to the local AFL club for sports physio from 6-8 pm. On Saturday morning I would spend a few hours in the clinic and then try (but usually fail) to complete the financials and marketing. I’d sleep in on Sunday morning – that was my only real time off – before heading to the AFL to work the afternoon as the strapper and on-field physio. I’d love to have just a fraction of that energy now – I don’t – but in its place is hopefully a little more wisdom.

Because the rooms were next to the bank, break-ins were frequent in those first few years. The thieves’ usual plan was to bust open my back door and then smash through the adjoining wall into the bank. It never seemed to occur to them that the bank’s vault would be locked anyway. The first time I walked in after a break-in I was horrified. After the sixth such burglary, I barely paused to sweep up the rubble before registering the intrusion with the police and calling my plasterer, who by this stage I had on speed dial.

original bulimba practice 02

The practice location right next to the bank. This picture was taken about 1995 after a modest renovation.

After three years the business was humming along. I was struggling to keep up with patient demand, so I took the plunge and employed another physio to help me out. I thought it would make things easier and give me back some  time. Again, wrong!

When we were both working it was great, and our appointment books were both nicely full. However when one of us was away, either on holidays or sick, it was disaster. No matter how hard we tried we simply could not do the work of two people, each of whom were already busy. So for about 10-12 weeks a year it was stress-filled pandemonium.

What was the answer? I decided to expand so that I could employ even more physios and spread the load. Losing one physio out of two was horrible, but, I reasoned, if it was only one out of four then we could probably cope for a few weeks at a time.

To help decide the location of the proposed new premises I used the Yellow Pages phone directory, a huge table-sized paper map of Brisbane and a box of dressmakers pins. Just as I had done when setting up Bulimba, I mapped the location of every physio in the greater Brisbane area. Eventually, after much laborious cartography, I noted a sizable gap in the Mansfield-Wishart area.

I took a reconnaissance ride through the area on my old push bike and was heartened to discover a small retail shop for lease in a shopping strip called Aminya St. One phone call to the landlord is all it took to secure the premises – we didn’t even use a lease – and Mansfield PhysioWorks was soon underway.

By contrast, my current lease runs to over 200 pages, plus an additional 60 pages to outline a couple of rent free months at the start of each period. I guess those lawyers have to earn their keep somehow.  

I can clearly recall the first day I opened the doors at Mansfield: it was the same day that the Queensland Cricket team hosted the Sheffield Shield final. That might not seem like a big deal these days, but back then The Shield was passionately followed by just about every sports fan; Queensland had never won it despite over 100 years of trying, so it was considered the Holy Grail of sporting trophies. The final was at the ‘Gabba, and thousands of people, including most of my mates, were packing it to capacity.

I was faced with a decision. Should I attend the game, and thus fail to open the doors on my very first day of my new venture, or should show up at work and hope that some patients booked in?

I was determined and responsible, so I opted for the latter. Eight hours later, having listened all day to the celebrations on ABC radio as the Queenslanders romped home to win their first title after a century of failures, I dejectedly shut the doors and headed home. Zero patients for the day. I should have gone to the cricket!

The Aminya St precinct is a suburban shopping strip that was constructed in the 1960s. The original town planning idea was to position the shops in the middle of the residential area, rather than on corners of busy main roads, to act as the social and logistical hub for the local community.  Unfortunately all of the traffic on those busy main roads – that is, the potential customers – didn’t know the shops existed and drove right on by. So Aminya St meandered forward with a collection of small local businesses: a bakery, a doctors’ surgery, a supermarket, and, in 1994, a physio. 

My second day at Mansfield was also unusual. I arrived at work to see a hive of activity in the car park. Hundreds of people had invaded this quiet mid-suburban shopping strip. It turned out that they were filming a movie, called “Mr Reliable” starring Colin Friels. The movie was set in the 1960s and they had chosen the Aminya St shops because – as the producer told me over coffee later that day – they didn’t have to change anything about the centre except for the price tags on the supermarket shelves!

This image has an empty alt attribute; its file name is aminya-street.jpg

The Aminya Street shops – nothing much had changed since the 1960s!

The Mansfield practice grew slowly but steadily. A decade or so later we relocated to our current location at Wishart Square, and later bought the larger premises next door. We haven’t looked back since.  

Much has changed since I started in business, not just with physio, but with the local and wider world.

Mansfield/Wishart has gown exponentially, with four large schools now attracting hundreds of young families to the area every year. Some of the original residents from the early years remain, but each year I see fewer and fewer of them.  

Bulimba, too, has undergone a complete makeover. Its primary characteristics in 1991 were dilapidated old Queenslanders and dozens of industrial factories.  It’s hard to imagine now but many large companies, including Telecom, Rheem and Lloyd’s ships, all had major manufacturing facilities in the now-restaurant-filled Oxford St.  There was barely a coffee shop in sight. True.

The Balmoral Pub, then known affectionately as the “Balmongrel”, was not a place for the feint-hearted, with a motley collection of out-of-work tradies and old punters being the main clientele of its smoke-filled public bar. There were no TAB outlets in pubs in those days (and of course no on-line betting) and the nearest outlet was further down Oxford St (where Woolworths now stands). So the punters would regularly wander down the street, beer in hand, to place a bet.

Unfortunately there was a brick bench directly outside my practice door, where they’d stop for a breather or a cigarette. (You can see it in the photograph above, by which time it had been converted into the garden bed behind the lamp post.) At times their arguments would get quite rowdy, and I had to break up more than one fight.

As Bulimba’s old houses were renovated and the industrial land was snapped up for units, the suburb’s working class persona steadily disappeared. In the meantime, land values and rents soared: our rent has climbed from $250 per month to about $1000 per week – a 16-fold increase!

Technology has also completely transformed the way we do business. My first computer in 1991 had a hard drive capacity of only 512 Mb (that’s megabytes). I recall paying extra to upgrade to a top-of-the-range RAM chip, which was 64 Kilobytes. Yes, kilobytes – you may have to google that term if you’re under the age of 35. To put this into perspective, you would have to link 1000 similar computers to match the capacity of a single modern smart phone.

My original business card includes only the shop address and a phone number: 899 1226. (Note the missing initial ‘3’, which was not introduced until eight years later.) There were no other contact methods; faxes were the domain of big business and hot-shot lawyers, while electronic communication was still a few years away.

By comparison, we now have three phone lines (including the fax line), multiple email addresses, mobile numbers, EFTPOS and HiCaps payments, text out services, Skype contacts, a 200-page web site, e-commerce capability, online booking systems and social media pages. Of course most of these things come with a monthly account fee….

original business card

The last surviving copy of an original business card. Sometimes I long for these simpler times…

Thankfully, one thing that hasn’t changed much in all those years is the human body. In hindsight, I was fortunate to choose a profession that is amenable to accumulating skills and experience over time. Things that I learned way back in 1991 are still 100% relevant today – backs, knees and shoulders haven’t changed at all. By contrast, the knowledge gained in 1991 by say, a computer programmer, would now be largely worthless.

But of course treatment methods have progressed. In 1991 most joint surgery was performed by the old “open ‘em up” method that more resembled carpentry than the surgical precision of a modern arthroscopy. MRI scanners and the like weren’t invented yet, so we had to diagnose injuries with scant help from technology. This was sometimes like a mechanic trying to pinpoint your engine problem without opening the bonnet, but at least it gave us a solid grounding to develop diagnostic skills.

In this matter I’d particularly like to thank those patients who trusted me and persisted when things didn’t always improve as they’d hoped over the first few sessions. Sometimes it was only after we changed diagnosis or treatment that results flowed, and my physio bag of tricks subsequently grew each time. So thank you for your patience, patients!

At last count, our practice have now helped a combined total of 350,000 clients – I’d like to think we’ve learned something from every one of you!

We physios are also fortunate that we have plenty of time to talk while we’re working. Can you think of any other occupation in which you can chat for 20 minutes or so to every client without impeding your time or theirs? Even better, our patients are from all walks of life: both blue and white collar workers, kids, stay at home parents, retirees, elite sports people, soldiers, you name it; everyone gets sore sooner or later. So we are exposed to a variety of problems, ideas and opinions, all of which provide for an interesting and varied work day.

The internet didn’t exist in 1991, and Google was still eight years away, so finding information was far more difficult than today; you couldn’t just type a search phrase into a computer. For most people this meant either a trip to the library or just asking around until you found someone who knew that subject.  But we physios had a big advantage: with about 100 people per week coming in for treatment, it was only a matter of time until an expert on gardening, car engines, mountain climbing or whatever came through the door. We had our own ‘mini-internet’.

We’ve also expanded our staffing levels over the years. Obviously the enterprise began with just one inexperienced soul. In 1994 I married and my wife started helping out in the office; she would work her day as a schoolteacher and then come in to help with the admin until late. We ate a lot of take-way for a few years! In 1997 our first baby daughter came along, and we took the big step (well, it seemed like a big step at the time) of employing a part time receptionist. We have been slowly expanding since.

We now employ five physios, two practice managers and three casual receptionists. Many co-workers have come and gone, but I’m grateful that I still count most of them as friends. Some, like our practice manager Melany at Bulimba, have been here for almost a decade, and is just as much a part of the place as the walls. Our super-physio Moto has also been here since 2016 and has performed miracle cures than I can count. I’m also proud that my daughter is now a qualified physio as well; her weekly phone requests for advice on patients certainly keeps me mentally on my toes. 

With the enormous changes that have taken place in 30 years it’s hard to imagine what our working lives will be like in another decade or two. But it should be fun finding out.

Yes, it has been a roller coaster ride, but one with more ups than downs. Thank you again to you for your support, and I hope you continue to trust us at Bulimba and Mansfield PhysioWorks to help you feel better for many years to come.

It was 30 years ago this Monday – 9 May, 1991 – when a much younger, slimmer and darker-haired version of John Perrier first opened the doors to PhysioWorks. The ensuing three decades have been a roller coaster of change, so I invite you to take 10 minutes to wander though the memories with me.

The original Bulimba site was at 124 Oxford St, next to the old Commonwealth Bank– Grill’d Burgers operates there now. I had spent weeks painting, carpet laying, buying equipment and networking with local doctors. I turned the key, opened the door, and then waited nervously by the phone for … well, nothing.

It took all day, but eventually the phone rang and I had my first booking – a young swimmer named Nathan – and my life as a private physiotherapist was underway. I haven’t seen Nathan for some time, but I’m pleased to say that I still regularly treat his mother to this day.

original bulimba practice 01

The original Bulimba Physiotherapy Centre. Luxurious, isn’t it?

I had taken out a start-up bank loan at 17% interest – the going rate at the time – and my equipment was leased at 25% per annum. I had heard multiple warnings about how many small businesses closed in the first two years so I was determined not to fail.

Working alone, my tasks rapidly expanded beyond what my inexperienced mind had imagined – I had thought that being my own boss would give me control over my time. Ha! I could not have been more wrong.

Besides treating patients, taking payments and answering the phone, I had to squeeze the accounting, cleaning and admin into my lunch breaks. Three nights a week after work I would head off to the local AFL club for sports physio from 6-8 pm. On Saturday morning I would spend a few hours in the clinic and then try (but usually fail) to complete the financials and marketing. I’d sleep in on Sunday morning – that was my only real time off – before heading to the AFL to work the afternoon as the strapper and on-field physio. I’d love to have just a fraction of that energy now – I don’t – but in its place is hopefully a little more wisdom.

Because the rooms were next to the bank, break-ins were frequent in those first few years. The thieves’ usual plan was to bust open my back door and then smash through the adjoining wall into the bank. It never seemed to occur to them that the bank’s vault would be locked anyway. The first time I walked in after a break-in I was horrified. After the sixth such burglary, I barely paused to sweep up the rubble before registering the intrusion with the police and calling my plasterer, who by this stage I had on speed dial.

original bulimba practice 02

The practice location right next to the bank. This picture was taken about 1995 after a modest renovation.

After three years the business was humming along. I was struggling to keep up with patient demand, so I took the plunge and employed another physio to help me out. I thought it would make things easier and give me back some  time. Again, wrong!

When we were both working it was great, and our appointment books were both nicely full. However when one of us was away, either on holidays or sick, it was disaster. No matter how hard we tried we simply could not do the work of two people, each of whom were already busy. So for about 10-12 weeks a year it was stress-filled pandemonium.

What was the answer? I decided to expand so that I could employ even more physios and spread the load. Losing one physio out of two was horrible, but, I reasoned, if it was only one out of four then we could probably cope for a few weeks at a time.

To help decide the location of the proposed new premises I used the Yellow Pages phone directory, a huge table-sized paper map of Brisbane and a box of dressmakers pins. Just as I had done when setting up Bulimba, I mapped the location of every physio in the greater Brisbane area. Eventually, after much laborious cartography, I noted a sizable gap in the Mansfield-Wishart area.

I took a reconnaissance ride through the area on my old push bike and was heartened to discover a small retail shop for lease in a shopping strip called Aminya St. One phone call to the landlord is all it took to secure the premises – we didn’t even use a lease – and Mansfield PhysioWorks was soon underway.

By contrast, my current lease runs to over 200 pages, plus an additional 60 pages to outline a couple of rent free months at the start of each period. I guess those lawyers have to earn their keep somehow.  

I can clearly recall the first day I opened the doors at Mansfield: it was the same day that the Queensland Cricket team hosted the Sheffield Shield final. That might not seem like a big deal these days, but back then The Shield was passionately followed by just about every sports fan; Queensland had never won it despite over 100 years of trying, so it was considered the Holy Grail of sporting trophies. The final was at the ‘Gabba, and thousands of people, including most of my mates, were packing it to capacity.

I was faced with a decision. Should I attend the game, and thus fail to open the doors on my very first day of my new venture, or should show up at work and hope that some patients booked in?

I was determined and responsible, so I opted for the latter. Eight hours later, having listened all day to the celebrations on ABC radio as the Queenslanders romped home to win their first title after a century of failures, I dejectedly shut the doors and headed home. Zero patients for the day. I should have gone to the cricket!

The Aminya St precinct is a suburban shopping strip that was constructed in the 1960s. The original town planning idea was to position the shops in the middle of the residential area, rather than on corners of busy main roads, to act as the social and logistical hub for the local community.  Unfortunately all of the traffic on those busy main roads – that is, the potential customers – didn’t know the shops existed and drove right on by. So Aminya St meandered forward with a collection of small local businesses: a bakery, a doctors’ surgery, a supermarket, and, in 1994, a physio. 

My second day at Mansfield was also unusual. I arrived at work to see a hive of activity in the car park. Hundreds of people had invaded this quiet mid-suburban shopping strip. It turned out that they were filming a movie, called “Mr Reliable” starring Colin Friels. The movie was set in the 1960s and they had chosen the Aminya St shops because – as the producer told me over coffee later that day – they didn’t have to change anything about the centre except for the price tags on the supermarket shelves!

This image has an empty alt attribute; its file name is aminya-street.jpg

The Aminya Street shops – nothing much had changed since the 1960s!

The Mansfield practice grew slowly but steadily. A decade or so later we relocated to our current location at Wishart Square, and later bought the larger premises next door. We haven’t looked back since.  

Much has changed since I started in business, not just with physio, but with the local and wider world.

Mansfield/Wishart has gown exponentially, with four large schools now attracting hundreds of young families to the area every year. Some of the original residents from the early years remain, but each year I see fewer and fewer of them.  

Bulimba, too, has undergone a complete makeover. Its primary characteristics in 1991 were dilapidated old Queenslanders and dozens of industrial factories.  It’s hard to imagine now but many large companies, including Telecom, Rheem and Lloyd’s ships, all had major manufacturing facilities in the now-restaurant-filled Oxford St.  There was barely a coffee shop in sight. True.

The Balmoral Pub, then known affectionately as the “Balmongrel”, was not a place for the feint-hearted, with a motley collection of out-of-work tradies and old punters being the main clientele of its smoke-filled public bar. There were no TAB outlets in pubs in those days (and of course no on-line betting) and the nearest outlet was further down Oxford St (where Woolworths now stands). So the punters would regularly wander down the street, beer in hand, to place a bet.

Unfortunately there was a brick bench directly outside my practice door, where they’d stop for a breather or a cigarette. (You can see it in the photograph above, by which time it had been converted into the garden bed behind the lamp post.) At times their arguments would get quite rowdy, and I had to break up more than one fight.

As Bulimba’s old houses were renovated and the industrial land was snapped up for units, the suburb’s working class persona steadily disappeared. In the meantime, land values and rents soared: our rent has climbed from $250 per month to about $1000 per week – a 16-fold increase!

Technology has also completely transformed the way we do business. My first computer in 1991 had a hard drive capacity of only 512 Mb (that’s megabytes). I recall paying extra to upgrade to a top-of-the-range RAM chip, which was 64 Kilobytes. Yes, kilobytes – you may have to google that term if you’re under the age of 35. To put this into perspective, you would have to link 1000 similar computers to match the capacity of a single modern smart phone.

My original business card includes only the shop address and a phone number: 899 1226. (Note the missing initial ‘3’, which was not introduced until eight years later.) There were no other contact methods; faxes were the domain of big business and hot-shot lawyers, while electronic communication was still a few years away.

By comparison, we now have three phone lines (including the fax line), multiple email addresses, mobile numbers, EFTPOS and HiCaps payments, text out services, Skype contacts, a 200-page web site, e-commerce capability, online booking systems and social media pages. Of course most of these things come with a monthly account fee….

original business card

The last surviving copy of an original business card. Sometimes I long for these simpler times…

Thankfully, one thing that hasn’t changed much in all those years is the human body. In hindsight, I was fortunate to choose a profession that is amenable to accumulating skills and experience over time. Things that I learned way back in 1991 are still 100% relevant today – backs, knees and shoulders haven’t changed at all. By contrast, the knowledge gained in 1991 by say, a computer programmer, would now be largely worthless.

But of course treatment methods have progressed. In 1991 most joint surgery was performed by the old “open ‘em up” method that more resembled carpentry than the surgical precision of a modern arthroscopy. MRI scanners and the like weren’t invented yet, so we had to diagnose injuries with scant help from technology. This was sometimes like a mechanic trying to pinpoint your engine problem without opening the bonnet, but at least it gave us a solid grounding to develop diagnostic skills.

In this matter I’d particularly like to thank those patients who trusted me and persisted when things didn’t always improve as they’d hoped over the first few sessions. Sometimes it was only after we changed diagnosis or treatment that results flowed, and my physio bag of tricks subsequently grew each time. So thank you for your patience, patients!

At last count, our practice have now helped a combined total of 350,000 clients – I’d like to think we’ve learned something from every one of you!

We physios are also fortunate that we have plenty of time to talk while we’re working. Can you think of any other occupation in which you can chat for 20 minutes or so to every client without impeding your time or theirs? Even better, our patients are from all walks of life: both blue and white collar workers, kids, stay at home parents, retirees, elite sports people, soldiers, you name it; everyone gets sore sooner or later. So we are exposed to a variety of problems, ideas and opinions, all of which provide for an interesting and varied work day.

The internet didn’t exist in 1991, and Google was still eight years away, so finding information was far more difficult than today; you couldn’t just type a search phrase into a computer. For most people this meant either a trip to the library or just asking around until you found someone who knew that subject.  But we physios had a big advantage: with about 100 people per week coming in for treatment, it was only a matter of time until an expert on gardening, car engines, mountain climbing or whatever came through the door. We had our own ‘mini-internet’.

We’ve also expanded our staffing levels over the years. Obviously the enterprise began with just one inexperienced soul. In 1994 I married and my wife started helping out in the office; she would work her day as a schoolteacher and then come in to help with the admin until late. We ate a lot of take-way for a few years! In 1997 our first baby daughter came along, and we took the big step (well, it seemed like a big step at the time) of employing a part time receptionist. We have been slowly expanding since.

We now employ five physios, two practice managers and three casual receptionists. Many co-workers have come and gone, but I’m grateful that I still count most of them as friends. Some, like our practice manager Melany at Bulimba, have been here for almost a decade, and is just as much a part of the place as the walls. Our super-physio Moto has also been here since 2016 and has performed miracle cures than I can count. I’m also proud that my daughter is now a qualified physio as well; her weekly phone requests for advice on patients certainly keeps me mentally on my toes. 

With the enormous changes that have taken place in 30 years it’s hard to imagine what our working lives will be like in another decade or two. But it should be fun finding out.

Yes, it has been a roller coaster ride, but one with more ups than downs. Thank you again to you for your support, and I hope you continue to trust us at Bulimba and Mansfield PhysioWorks to help you feel better for many years to come.

“How to get rid of joint pain that is bought on by cold and rainy weather.”

With autumn now approaching and the temperature starting to drop, you may hear a lot of people complain that their bone and joint discomfort worsens. This is a common statement around this time of year. This change can be due to a drop in barometric pressure.

rainy day

How does air pressure relate to joint pain? When there is less pressure on the outside of the joint it allows the swelling inside to increase just a tiny bit. This extra swelling can be the difference between a good day and a bad one.  Air pressure tends to drop even more when it is raining, so cold wet days often feel the worst.  

A hot bath or heat pack married with a good anti-inflammatory cream is often enough to ease the symptoms, but if you find your aches and pains are overstaying their  welcome then your best  treatment is, of course, a few sessions of physiotherapy.

The Role of Physiotherapy

Patients with arthritic or wear-and-tear  disorders may benefit from joint mobilization, electrotherapy,  hydrotherapy and muscle strengthening exercises. Localized, specific massage techniques can also break up the ’rust’ from the joint, greatly reducing the pain.  When done together, these techniques not only reduce the swelling and inflammation in a joint but they loosen it up, giving everything more room to move. This extra space means that the joint does not ache as much, even if the weather outside is cold or rainy.

The Role of Exercise

Moderate, regular exercise has been proven to aid in the prevention of arthritis and joint stiffness, and offers a host of benefits to  sufferers.  Exercise can reduce joint pain and stiffness, builds strong muscles around the joints and increases flexibility and endurance.

What type of exercise should I be doing?

  • Water exercise- such as aqua aerobics or swimming laps—especially if done in a warm pool. This non-weight bearing exercise provides the fitness without the joint pounding associated with land-based activities.
  • Tai chi, yoga, and stretching will help to get you looser if done on a  regular basis
  • Pilates will help to strengthen your core muscles and make sure that you are balanced. When your muscles are balanced your joints will move properly, minimizing the wear and tear.
  • Walking or light jogging, depending on your body’s general condition and specific problems such as knee or hip wear-and-tear.

Please contact us if you have any queries, especially aches that appear as the weather cools.

What has a Mythical War Hero got to do with Heel Pain?

In Greek mythology, Achilles was a Greek hero of the Trojan War. Achilles was the greatest warrior of Homer’s Iliad. Legend states that Achilles was invulnerable in all of his body except for his heel. He even died because of a wound on his heel. The term Achilles’ heel has come to mean a point of weakness.

However, most runners and athletes who need to run or jump will know that Achilles heel is better known as Achilles Tendinitis and it is both painful and effects your sporting performance.
Achilles Tendonitis
What is Achilles Tendinitis?

Achilles Tendinitis is a term that commonly refers to an inflammation of the Achilles tendon.  It is an overuse injury that is common in sports that require running or jumping. Most experts now use the term Achilles tendinopathy to include both inflammation and micro-tears. But many doctors may still use the term tendonitis, tendinitis or tendinosis out of habit.

What are Tendons?
Tendons are the tough fibres that connect muscle to bone. Most tendon injuries occur near joints, such as the shoulder, elbow, knee, and ankle. A tendon injury may seem to happen suddenly, but usually it is the result of many tiny tears to the tendon that have happened over time.

What Causes Achilles Tendonitis?

Most tendon injuries are the result of gradual wear and tear to the tendon from overuse or ageing. Anyone can have a tendon injury, but people who make the same motions over and over in their jobs, sports, or daily activities are more likely to damage a tendon.

Sometimes a tendon injury can happen suddenly. You are more likely to have a sudden injury if the tendon has been weakened over time.

Common Causes of Achilles Tendonitis

  • Over-training or unaccustomed use – “too much too soon”
  • Sudden change in training surface – e.g. grass to bitumen. Soft sand works your calves and achilles very hard
  • Flat (over-pronated) feet
  • High foot arch with tight Achilles tendon
  • Tight hamstring (back of thigh) and calf muscles
  • Toe walking (or constantly wearing high heels)
  • Poorly supportive footwear, or changing from shoes with a high heel cup to a lower one, which puts more stretch and strain on the achilles.
  • Hill running.
  • Poor eccentric strength

What are the Symptoms of Achilles Tendonitis?

  • Achilles tendonitis may be felt as a burning pain at the beginning of activity, which gets less during activity and then worsens following activity. The tendon may feel stiff first thing in the morning or at the beginning of exercise.
  • Achilles tendonitis usually causes pain, stiffness, and loss of strength in the affected area.
  • You may have more pain and stiffness during the night or when you get up in the morning.
  • The area may be tender, red, warm, or swollen if there is inflammation.
  • You may notice a crunchy sound or feeling when you use the tendon.
How is Achilles Tendonitis Diagnosed?
Your physiotherapist can usually confirm the diagnosis of Achilles tendonitis in the clinic. They will base their diagnosis on your history, symptom behaviour and clinical tests.
Achilles tendons will often have a painful and prominent lump within the tendon.
Achilles tendinitis Further investigations include US scan or MRI. X-rays are of no use in the diagnosis.

What are the Aims of Achilles Tendonitis Treatment?

Achilles tendonitis is one of the most common problems that we see at PhysioWorks and it is unfortunately an injury that often recurs if you return to sport too quickly – especially if your rehabilitation program is not completed.
Your calf muscle is a large powerful group of muscles that can produce sufficient force to run, jump and hop. Your achilles tendon attaches your calf muscle to your heel bone. It is a tendon or non-contractile soft tissue structure, which does have a different level of blood supply and function, which does alter the rehabilitation from a calf tear.
Researchers have concluded that there are essentially 7 stages that need to be covered to effectively rehabilitate these injuries and prevent recurrence.

Phase 1 – Early Injury Protection: Pain Reduction & Anti-inflammatory Phase

As with most soft tissue injuries the initial treatment is RICE – Rest, Ice, Compression and Elevation.
In the early phase you may be unable to walk without a limp, so your Achilles tendon needs some active rest from weight-bearing loads. You may need to be partial-weight-bearing, and use crutches, a wedged achilles walking boot or heel wedges to temporarily relieve some of the pressure on the Achilles tendon. Your physiotherapist will advise you on what they feel is best for you.
Ice is a simple and effective modality to reduce your pain and swelling. Please apply for 20-30 minutes each 2 to 4 hours during the initial phase or when you notice that your injury is warm or hot. Anti-inflammatory medication (if tolerated) may help reduce your pain and swelling. However, it is best to avoid anti-inflammatory drugs during the initial 48 to 72 hours when they may encourage additional bleeding. Most people can tolerate paracetamol as a pain reducing medication.
As you improve a kinesio (stetchy) style supportive taping will help to support the injured soft tissue.

Phase 2: Regain Full Range of Motion

If you protect your injured Achilles tendon appropriately the torn tendon fibre will successfully reattach. Mature scar formation takes at least six weeks. During this time period you should be aiming to optimally remould your scar tissue to prevent a poorly formed scar that will re-tear in the future.
It is important to lengthen and orientate your healing scar tissue via massage, muscle stretches, neurodynamic mobilisations and eccentric exercises. Signs that your have full soft tissue extensibility includes being able to walk without a limp and able to perform Achilles tendon stretches with a similar end of range stretch feeling.

Phase 3: Restore Eccentric Muscle Strength

Calf muscles work in two directions. They push you up (concentric) and control you down (eccentric). Most Achilles injuries occur during the controlled lengthening (eccentric) phase. Your physiotherapist will guide you on an eccentric calf strengthening program when your injury healing allows.

Phase 4: Restore Concentric Muscle Strength

Calf strength and power should be gradually progressed from non-weight bear to partial and then full weight bear and resistance loaded exercises. You may also require strengthening for other leg, gluteal and lower core muscles depending on your assessment findings. Your physiotherapist will guide you.

Phase 5: Normalise Foot Biomechanics

Achilles tendon injuries can occur from poor foot biomechanics eg flat foot. In order to prevent a recurrence, your foot will be assessed. In some instances you may require a foot orthotic (shoe insert)  Your physiotherapist will happily discuss the pros and cons with you.

Phase 6: Restore High Speed, Power, Proprioception & Agility

Most Achilles tendon injuries occur during high speed activities, which place enormous forces on your body (contractile and non-contractile). In order to prevent a recurrence as you return to sport, your physiotherapist will guide you with exercises to address these important components of rehabilitation to both prevent a recurrence and improve your sporting performance.
Depending on what your sport or lifestyle entails, a speed, agility, proprioception and power program will be customised to prepares you for light sport-specific training.

Phase 7: Return to Sport

Depending on the demands of your chosen sport, you will require specific sport-specific exercises and a progressed training regime to enable a safe and injury-free return to your chosen sport.
Your PhysioWorks physiotherapist will discuss your goals, time frames and training schedules with you to optimise you for a complete return to sport. The perfect outcome will have you performing at full speed, power, agility and function with the added knowledge that a through rehabilitation program has minimised your chance of future injury.

What Results Should You Expect?

There is no specific time frame for when to progress from each stage to the next. Your Achilles tendonitis rehabilitation status will be determined by many factors during your physiotherapist’s clinical assessment.
You’ll find that in most cases, your physiotherapist will seamlessly progress between the rehabilitation phases as your clinical assessment and function improves.
It is also important to note that each progression must be carefully monitored as attempting to progress too soon to the next level can lead to re-injury and frustration.
The severity of your tendon injury, your compliance with treatment and the workload that you need to return to will ultimately determine how long your injury takes to successfully rehabilitate.

Can Your Achilles Tendon Rupture?

The worst case scenario is a total rupture of your Achilles tendon. Treatment in this case usually requires surgery, plaster or a walking boot for at least six weeks. Most of these injuries take six months or more to adequately rehabilitate.
Achilles tendon rupture

The best advice is to seek early advice from your physiotherapist to do all you can to avoid this nasty rupture happening in the first place.

More info about Achilles tendon rupture.
Contact our clinic directly

“How to avoid and treat running injuries”

Although one of the most popular and convenient ways to stay fit, running is also one of the easiest ways for you to develop an injury. The impact and stress of running can be hard on your muscles and joints, commonly resulting in injuries to your hips, knees, ankles, and feet.

How to Avoid Running Injuries?

There are several simple techniques to help you avoid running injuries.

  • Perform a Warm Up & Cool Down. You may have specific stretches that have been prescribed by your physio—your warm up/down is an ideal time to per-form them. However, general static stretching is not as effective as once thought. A better method of warming up is to start very gently—perhaps with a walk—and gradually increase your pace.
  • Wear appropriate footwear suitable to your foot structure. Recent research indicates that softer, pad-ded footwear may actually be worse for your joint than a harder sole. Keep this in mind when buying your next pair of shoes.
  • If your foot has biomechanical problems, you would probably benefit from orthotics, which can be fitted on-the-spot at either of our PhysioWorks clinics.
  • Avoid over training – ask us for advice. As a general rule, do not increase your training by more than 10% each week. Do not try to beat your previous times every day! Take it easy, enjoy yourself, and gradually get into the habit of running.
    running injuries
    Common running injuries

Early Warning Signs of Impending Injury

If an ache or pain develops, do not ignore the early warning signs. While some injuries can be immediately evident, others slowly and progressively get worse, making it even more important to act early before chronic problems develop. So what are the early warning signs you should look for?

  • Joint pain: Pain that lasts longer than 48 hours needs physiotherapy diagnosis.
  • Tenderness: If pressing your finger into a specific point causes pain, and the same pain is not produced on the opposite side of the body, please ask for advice.
  • Swelling: Usually obvious, swelling often co-exists with pain and heat. The area will feel “full”.
  • Reduced Range of Motion: Compare with opposite side of body.
  • Weakness: Perform tasks on both sides of body to identify weakness.

Other warning signs that you have overtrained include

  1. Pain that does not go away when you warm up
  2. Aching that persists for more than 30 minutes after you have cooled down, or
  3. Stiffness and pain the following morning.

If you experience any of these signs or symptoms, please give us a call. We will save you months of pain and frustration. We’ll have you back jogging pain free again in no time!

For more information on running injuries, please see http://www.physioworks.com.au/Injuries-Conditions/Activities/running-injuries or visit us directly at http://www.physioworks.com.au/Bulimba/bulimba.htm or http://www.physioworks.com.au/Mansfield/mansfield.htm

 

 

“Hip pain: what goes wrong and how to fix it”

The hip is a large weight-bearing joints. It consists of two main parts: a ball at the top of your thighbone that fits into a rounded socket in your pelvis. The bone surfaces of your ball and socket have a smooth durable cover of articular cartilage that cushions the ends of the bones and enables them to move easily.

hip joint

The hip joint

Bands of tissue called ligaments connect the ball to the socket and provide stability to the joint.The hip joint is also covered by a thin, smooth tissue called synovial membrane. In a healthy hip, this membrane makes fluid that lubricates your hip joint.

What Goes Wrong?

The main injury that affects your hip is arthritis. This commonly occurs in the form of osteoarthritis. Osteoarthritis usually occurs after age 50, and often in an individual with a family history of arthritis. In this form of the disease, the articular cartilage cushioning the bones of the hip wears away and the bones rub against each other, causing pain and stiffness. Eventually even rest will no longer relieve the pain in your hip.

Sometimes the bones to rub directly against each other, resulting in hard bumps, called bone spurs, that reduce motion and cause pain.

Physiotherapy techniques to improve hip mobility, strength, and how you move, have been shown to ease the pain associated with hip arthritis. Special exercises to make the hip and pelvis more stable can also help.

bridging exercsie

Some exercises, such as this bridging manouvre, can help to strengthen and stabilise the hip joint.

Failing a successful physiotherapy-based rehabilitation, major surgery to replace the hip may be required.

To read more about hip arthritis and other hip injuries, please see http://www.physioworks.com.au/Injuries-Conditions/Regions/hip-pain-joint-injury  or visit our practices directly at http://www.physioworks.com.au/Bulimba/bulimba.htm or http://www.physioworks.com.au/Mansfield/mansfield.htm

A new approach to workplace fitness

From the Courier Mail, Brisbane, Friday 22 February 2012

TREADMILLS in the office, seats that beep after 30 minutes of use and adjustable standing-sitting desks are the latest weapons being deployed in the battle of the bulge.

With the negative health effects of prolonged sitting making it the smoking of our generation, bosses are now encouraging walking meetings and even installing treadmills in offices to get their staff literally thinking on their feet.

Treadmill

National treadmill distributor Workout World Camperdown general manager, Steven To, said there have been a number of companies calling on them to install treadmills in office spaces.

“We have found it is law firms and offices located next to industrial sites that have asked for them,” he said.

“Most of the time they are asking for two treadmills at a time instead of just the single ones.”

A range of studies has found sitting for prolonged periods increases the risk of cardiovascular disease, obesity and cancer because of increased blood pressure and sugar, excessive body fat and abnormal cholesterol levels.

 Employers are also becoming increasingly aware of links between better health and wellbeing and improved productivity.

Australian company Get the World Moving, which runs the Global Corporate Challenge to get sedentary office workers off their backsides, last month installed two office treadmills facing each other so employees can have walking meetings.

Appliance giants Miele Australia are another company conducting some of their meetings while walking.

Global Corporate Challenge marketing manager Jayne Foot said they are already seeing the benefits.

“We decided to install the treadmills to cater for bad weather and facilitate the opportunity for staff to take a walking meeting, rain, hail or shine,” she said.

“It’s also great for individual employees who want a quick energy charge, as they can jump on and get active whenever they feel like it.

“We find walking meetings especially helpful for brainstorming sessions or meetings later in the afternoon, when energy levels can naturally slump.”

The University of Queensland late last year developed a device dubbed the “sitting pad”, which emits a loud beep when its occupant should get up and move around.

Google, Commonwealth Bank and Macquarie Bank are also providing workers with both sitting and standing desks.

For more information on walking for fitness, see our previous blog post https://mansfieldphysioworks.wordpress.com/2013/02/15/an-easy-way-to-keep-your-aches-and-pains-at-bay/ or visit us at http://physioworks.com.au/Bulimba/bulimba.htm or  http://physioworks.com.au/Mansfield/mansfield.htm

Golf: How to prevent injuries, lower your scores, and increase your enjoyment

Golf is a wonderful sport that offers many great benefits, including increased fitness, more social interaction, and, of course, the enjoyment that comes from whacking a long drive down the centre of the fairway. PhysioWorks can offer a lot to golfers; we not only help you prevent injuries, but also to improve your scores, and increase your enjoyment of the game.golf shot

So how do you do this? We have four main suggestions:

(1)   Improve your fitness and general conditioning.  This strategy will also help improve your performance.  if your body cannot move properly, you cannot develop a good swing. For example, if you have poor spinal flexibility, this may prevent you from turning adequately during your golf swing, leading to reduced power and accuracy. The same theory applies to tight neck and shoulder muscles, or worn-out hips and knees.

(2)   Have your physio screen you to evaluate your muscle balance. Your body has many deep muscles that help to stabilise your limbs and trunk during movement. If these muscles weaken, your movements will be less controlled, even though you still feel strong.  A thorough program of stability muscle exercises, aiming at your trunk, shoulders, hips and knees, will provide a massive boost to your movement control, and take many strokes off your handicap.

(3)   Make sure your equipment is correct.  Ask a professional to evaluate your clubs; technology in this area is improving all the time. Also, put some thought into your shoes. Are they flexible enough? Do you need orthotics to support your foot arches over 18 long holes?  Check your bag – can you clear out some clutter, and thus reduce its weight? Plenty of golfers have hurt their back, simply retrieving the clubs from the boot of the car.

(4)   Warm up before you play. A good warm up will not only prepare you for your game, but it also helps prevent injuries.  If you have a previous trouble spot, spend more time warming this up, e.g. an old back injury.  Do some full-range movements for your back, arms and legs. Your physio can help with some suggestions. Hit a bucket of balls on the practice fairway or nets, but don’t use maximum effort straight away. Start with a gentle swing of a short club, and build up to your driver.  Do about 5-10 minutes of putting.

Using these tips, you will not only reduce your chance of injury, but you will also improve your performance, and heighten your enjoyment of the game. Now all that’s left is to hit the fairways. Fore!

To read more specific information on golf injuries, go to http://physioworks.com.au/Injuries-Conditions/Activities/golf-injuries

Or visit us directly at http://physioworks.com.au/Bulimba/bulimba.htm or http://physioworks.com.au/Mansfield/mansfield.htm

“An easy way to keep your aches and pains at bay”

Walking improves your health and fitness and is suitable for most people. Walking is low impact, requires minimal equipment, and can be done at any time of day, at your own pace.

Almost everyone can do it. Some of walking’s main benefits include:

  • Increased heart & lung fitness
  • Decreased blood pressure and cholesterol
  • Decreased joint and muscular pain
  • Stronger bones and improved balance.
  • Increased muscle strength and endurance.
  • Reduced body fat.

How long should I spend exercising?

Olympic athletes use a system of a ‘hard day’ of training followed by an ‘easy day’ that allows their body a partial recovery. You can use this system too! Refer to the table below. First, select your current fitness level from the green column. The blue column will tell you how long you should exercise on your hard and easy days. You can allow one day per week for a complete rest.

Time and pulse rate data

Time and pulse rate data

How hard should I exercise?

Taking your heart rate is an ideal way to gauge if you are exercising with the correct intensity. Locate your age category in the yellow columns on the chart. The numbers below indicate the pulse rate that you should aim for during exercise., depending upon your fitness level. For example, a sixty year old with intermediate fitness should walk for 20 minutes on an easy day, 30 minutes on a hard day, with a pulse rate of 112 beats per minute.

Others ways to encourage yourself to walk include walking with friends, family or pets. Most large shopping centres have walking groups, where you can walk in air-conditioned comfort with like-minded people. With so many beautiful walking tracks around the Brisbane area, you can be sure to always enjoy great scenery.

As your fitness improves, you’ll find yourself covering greater distances in shorter times and becoming less puffed when walking at speed or up hills. Don’t stop there! Keep setting yourself new goals and enjoy all that new found energy.

walking

Walking – a great way to get fit, spend time with family, and get those stiff joints moving. And it’s free!

 

 

“Heavy school bags: How to prevent back pain in your child.”

Every day, your child may lug more than five kilograms to and from school in their backpack. Often this can lead to unhealthy spinal symptoms including lower back, shoulder and neck pain.  With the school year now in full swing, we thought some timely tips regarding school backpacks would be useful for parents.

Choose a backpack that:

  • Doesn’t extend above the shoulders when seated.
  • Has shoulder straps that are broad, well padded and adjustable.
  • Has straps attached to the top of the pack at separate points.
  • Has a waist strap to keep the load balanced and in place.
  • Has separate compartments to allow heavy items to be packed close to the body.
  • Is padded where it touches your back and made of firm material to prevent it from sagging backwards.

backpack

A well-designed school back pack

Pack Smart

  • Try not to pack too many heavy books on the same day.
  • Plan ahead—don’t carry lots of equipment at the same time (eg sports gear, musical instruments  or arts material).
  • Pack heavier items close to the body and lighter ones further out.

With some simple planning and the correct equipment, your children can safely and efficiently carry their school bags without injury or undue fatigue.

“Headaches: A new cure.”

Headaches can be one of the most frustrating and debilitating types of pain. They can be unbearably intense, and can last for hours, days or even weeks. What causes these awful pains?

Headaches have six main varieties.

  1. Viral headaches, such as those associated with the ‘flu.
  2. Headaches from ‘nasty’ causes, such as tumours or brain haemorrhage. These types of pains are usually prolonged and severe, and thankfully, they are rare.
  3. Drug induced headaches. This group includes the common hangover.
  4. Vascular headaches – migraines. This type of pain is usually associated with vomiting and blurred vision. Although migraines are commonly diagnosed, recent studies have shown that they are often neck-related headaches.
  5. Stress headaches, and …
  6. … neck-related headaches. Although they appear to be unrelated, these two types of headaches often overlap. Sometimes, emotional stress or poor postures tighten the muscles in the upper back and neck. These muscles then pull on the neck joints, which become inflamed and subsequently refer pain into the head.

neck pain and headache

A headache can be a real pain in the neck….

Other causes of neck-related headaches include poor posture, an unsuitable pillow or mattress, previous neck injuries, muscular imbalances or spinal degeneration.

What can be done? Plenty. Obviously, the first step is to exclude the first three causes above. Then, it is a matter of correcting the faults in your neck. By loosening the joints in your neck and stretching tight muscles, physio can usually relieve the pain of a headache quite quickly. Then, by strengthening the muscles and paying some more attention to postural problems, the problem can usually be resolved. Permanently.

Wouldn’t that be nice!