Archive for 2013

Gardening Safety

Spring has sprung and it’s the time of year where the masses head to their gardens.  Most of us perceive gardening to be a relatively gentle activity.  However danger may lurk behind every bush and in every bed.

The reality is that at the first sight of blossom most of us get a rush of blood to the head.  We get into our gardens like there is no tomorrow.  Many of us suffer as a consequence.

A & E Clinics, Doctors and Physiotherapy rooms are full of these weekend warriors.

More often than not, it’s a case of too much too soon.  We spend the winter in our physical cocoon only to roar into a full day of heavy labour in the garden come spring.

Back injuries occur with prolonged stooping, bending and lifting.  Shoulder strains from over reaching and pulling stubborn weeds.  Tendonitis, tennis & golfers elbow from overuse on the secateurs.  The list is never ending.  There are a number of simple strategies that can not only reduce the risk of injury but make the job easier and more enjoyable.

Pre Season Training

  • Prepare these muscles and joints prior to the spring clean up.  A simple aerobic, walking and light resistance programme started a month before spring will help condition the muscles to the work ahead.
  • Warm up and stretch prior to picking up the tools.  Gardening is not unlike other forms of exercise, a simple 3-4 minute warm up (especially on cold days) and stretch helps prepare the muscles and joints for activity.


  • Plan to spread the load over a few sessions or days or take regular breaks from the heavier work to carry out lighter work.
  • Avoid high repetition for prolonged periods.  Pruning is the classic example, with many a gardener experiencing tendonitis from a few hours on the hand secateurs.
  • Plan regular breaks from the heavier work to hydrate or just step back and contemplate the work done to date.


  • Garden tools come in a variety of shapes and sizes.  Pick a tool with a handgrip that fits your hand.
  • Long handled tools require less trunk bending reducing the risk to your low back.
  • When in doubt use the loppers over the secateurs.
  • Wheelbarrows are a fantastic tool but remember you don’t have to fill it to overflowing.

Raised Beds & Soil Structure

  • Raised beds are a wonderful option for reducing the need to bend, lowering one risk of back injury.
  • Regular mulching of the soil allows for reduced weed growth and easier pulling of weeds.
  • Regular soil conditioning, especially for clay based soils, helps to loosen the soil structure making for easier digging and weed pulling.


  • It is pretty hard to beat a long handled hoe for removing weeds.  Most weeds are easily lifted by scraping the top 1-2 inches minimising the need to break up the deeper soil.
  • Avoid jerking to pull weeds especially those long grasses with deeper root structure.
  • Avoid constant gripping, overpowering the grip and end range joint positions, especially at the wrist.


  • Reduce the load and make a few more trips.
  • Plan the lift and lift to the plan.  Most lifting injuries occur from poor planning.
  • Bend at the hips not the low back.  This is the simple reason weight lifters rarely have problems with their backs.
  • Lift with a wide, stable base, keep the spine straight and tighten the abdominal during the lift.
  • Before and after lifting arch backwards 3-5 times.

Safe gardening.

Mike Stewart is a Physiotherapist at the Oamaru Physiotherapy Clinic.  He has Post Graduate qualifications in Manipulative Physiotherapy and Sports Medicine and is a registered Physiotherapy Acupuncturist

Source:  Oamaru Physiotherapy Clinic written by Mike Stewart and Michelle Sintmaartensdyk


Dealing With Overuse Injuries

Gradual Process Injuries

Gradual process injuries are those which occur over time.  They may occur over a week or even over a year.  They are sometimes called Occupational Overuse Syndrome [OOS] and earlier were called RSI.  However these terms do not really describe the injury.

The symptoms or what you feel vary from person to person.  Pain may be felt in one part of the body one day and in another the next.  Tingling and numbness may also be felt.  Stiffness is another symptom.

How do they occur?

They can occur from muscles and joints being held in one position over a period of time or tight muscles which over time eventually pull on tendons.  For example, holding the neck in one position while at work is enough to put tension on the structures supporting the neck and thus cause pain.  Running without stretching afterwards will cause the calf muscles to tighten over time, causing tension on the achilles tendons and eventually pain.

Constant tension on any soft tissue structures can cause a breakdown of the tissue which causes pain.

Examples of these injuries are shin splints, low back strain, tennis elbow, wrist and forearm pain, neck and shoulder pain.

How can physiotherapy help?

The sooner you see a physiotherapist the sooner your pain will be reduced.

  • The tight muscles need to be stretched again and loosened.
  • The tight nerves need to be stretched.
  • The joints which have been tightened causing a restriction in movement need to be moved and the range of movement restored.
  • Muscle imbalance needs to be corrected.  Sometimes the working muscles become so strong the other supporting muscles become weaker.  This is referred to as a muscle imbalance.
  • Posture needs to be improved.
  • Advice will be provided on preventative action in the future to reduce the chances of this occurring again.



Dazed and Confused

It’s the time of year when many players in all sporting codes take to the field. Some of these players will suffer a knock to the head or face, or fall heavily and sustain a concussion. Confusion exists as to what a concussion actually is and how it should be managed. Can someone be concussed if they haven’t lost consciousness? Should they be allowed to play on? And how long before the injured player can safely resume sport?

Concussion is a relatively frequent injury arising as a consequence of contact sport or falls, and is often poorly understood and managed. The outcome of repeated or poorly managed traumatic head injury can be serious and long term. This is particularly true for children and adolescents who may return to sport too early following a concussion, and who may suffer long term physical and learning consequences as a result.

Concussion is defined as a disturbance of brain function as a consequence of a direct or indirect blow to the head. It results in a variety of non- specific symptoms (such as those listed) and often does not involve a loss of consciousness. Concussion should be suspected in the presence of one or more of the following

–          Symptoms (headache) or

–          Physical signs (such as unsteadiness) or

–          Impaired brain function (confusion) or

–          Abnormal behaviour

Any athlete with a suspected concussion should be REMOVED FROM PLAY, medically assessed, monitored for deterioration (i.e. should not be left alone) and should not drive a motor vehicle.

(Taken from SCAT2 –Sport Concussion Assessment Tool).

These symptoms may last for a short time only, but if present, indicate that the player should not return to play.

Most (80-90%) concussions resolve within 7-10 days, although this time frame may be longer in children and adolescents. Recovery requires physical and “cognitive” (activities requiring brain concentration and attention) rest. This may mean some days off school or work and refraining from activities such as text messaging and playing video games. More serious concussions may require specialised medical testing and retesting to determine recovery and return to activity timeframes. It is important to realise that previous concussion makes you more susceptible and vulnerable if you receive a further injury. Return to sport before concussion symptoms have completely resolved puts you at risk of suffering a serious or potentially life threatening consequence if you suffer a further injury.

Return to sport will vary between individuals and be determined by the extent of the injury, whether this is the first episode of concussion, and how rapidly symptoms resolve. Current ACC and NZRU guidelines recommend a minimum of 3 weeks stand down from sport after concussion. This period should allow sufficient time for the resolution of symptoms in most concussions. However, should symptoms persist after this period of time further medical advice should be sought before return to sport.

The guidelines outlined in the following table (from Consensus Statement on Concussion in Sport: the 3rd International Conference on Concussion in Sport held in Zurich, November 2008, Br J Sports Med 2009;43:i76-i84 P McCrory , W Meeuwisse , J Dvorak , M Aubry , M Molloy , R Cantu ) provide a stepwise progression to guide return to sport. The player should proceed to the next level of activity only when he/she experiences no symptoms at the previous level. If symptoms are present the player should drop back to the previous level.  The player should not return to contact sport until completely symptom free. This is especially important for children and adolescents, and the time frame for recovery in these players may be longer than for adults.


Hit the ski slopes

Winter is here and many people will head to the snow for a well earned break.  While skiing comes naturally to some, others spend most of their time unsuccessfully negotiating the equipment and terrain.  Whatever your level of experience, skiing can be hazardous and contribute to injury.  The physiotherapists in our practice can help. We can ensure that you are prepared for the slopes by minimising your injury risk through specific exercise programmes, fitness regimes, strengthening and warm up, stretching and cool down techniques.

To avoid injury this snow season, the physiotherapists in our practice recommend you:

Be fit to ski

Begin to incorporate ski-specific exercises into your regular exercise routine at least eight weeks prior to your holiday.  This will promote use of the muscles and joints required for skiing.  Strengthen the muscles specific to snow sports (thighs, butts, core stabilisers and triceps) to reduce the risk of injury and increase your enjoyment and endurance on the slopes.  We can outline ski-specific exercises whilst prescribing a conditioning programme to improve your core stability and muscle strength.  Ultimately, your performance on the ski slopes relies on your fitness, so talk to us about how to achieve an optimal fitness level.

Look after your back

When travelling distances to reach the mountain, rest every two hours and stretch.  See one of our physiotherapists for effective stretching advice.

Warm up, stretch and cool down

Before hitting the slopes, warm up like you would with any other sporting activity.  Stretch your thigh, calf and arm muscles.  Start your day with easy runs to loosen up (make sure you also do this after each rest break.)  Once you have finished skiing for the day, remembers to cool down.  These activities will better prepare your body to avoid injury.  We can show you warm up, stretching and cool down techniques.

Ski within your capabilities

Beginners should take advantage of a ski lesson and not succumb to the pressure of keeping up with experienced skiers.  Don’t be afraid to rest when you find yourself getting tired.  Fatigue can increase your injury risk.  And remember, the more unfit you are, the more tired you will become.  Injuries often happen on that last run of the day!

To avoid injury on the snowfields this winter, consult one of our physiotherapists on how to best prepare your body and ensure your holiday is injury free!



We provide injury management for everyone wanting fast, effective help to return full activities.  We spend extra time to ensure complete recovery and prevention of recurrence to keep you at peak performance so you enjoy life to the full- because your body deserves the best of care.

 We know you have a choice.  Choose us for:

  1. Perfect central city location.
  2. Experienced team to treat a full range of injuries and conditions.
  3. Easy to get appointment times to suit.
  4. Seen on time, every time.
  5. Information on your progress from visit to visit.
  6. All appointments 30 minutes.

Winter is certainly here and for those of you who injure   out in the cold remember that hopping into a      hot bath           once you get home is likely to make matters worse not  better, especially if there is acute inflammation- better to stick to the RICE program (Rest, Ice, Compression,  Elevation).

If you are waiting for your injury to go away don’t wait more than 5 days or you may end up with more problems as a result of poor healing or compensation patterns.

Always best to get some advice from one of our team of Physios- even if you only need a couple of sessions, we can tell you how to get the best resolution of the problem.        

Ensuring your body gets the best of care- so you can get the best out of life.

 Here are some tips to help ensure a successful, speedy resolution.

  • Don’t wait too long before seeking help– excess swelling and inappropriate healing (e.g. scar tissue or lack of flexibility in the injured tissue) can lead to secondary problems.

  • Make sure you get the treatment you need initially– missing sessions in the initial phase can mean the whole thing just drags  on for longer – which is frustrating for everyone!

  • Rest from you sport if need be– the injured tissue needs to heal!  Your Physio will let you know how you can stay fit doing other activities.
  •  Do your homework! Your exercises and management of the injury is vital- we only see you a very short time out of the day so what you do the rest of the time is critical!
  • Make sure any long term management issues are dealt with– e.g. underlying muscle imbalances (like a weak core/tight muscles/weak muscles), the technique you are using to do an activity or even your day to day posture.                                          

For all appointments call 04 499 3504.


Core stability and back pain

What is Core Stability?

This is a term which describes the firmness and stability of your trunk muscles.  These are the muscles which wrap around your trunk like a cylinder or brace.  They lie between your ribs and your hip bones just like the corsets worn in Victorian times.

The core or trunk muscles are the foundations of the body.  The back, arms and the legs work much better if the trunk muscles are stable.  When the trunk muscles are working together they support your body when walking, bending, lifting and even sitting upright and give you more energy.

Once working correctly they will also help protect the back from injury.

Why is Core Stability useful in the treatment of back pain?

Pain has been shown to turn muscles off.  Pain encourages sufferers to adopt pain relieving positions but ultimately they add to the problem.  Improving core stability will help stop this pain or reduce it a lot and encourage better posture which will prevent further pain.  Improving posture may reduce pain immediately.  Improving core stability will reduce pain over time.

How can we help you?

We need to teach your muscles how to work again.  This training is done one on one with your physiotherapist.  Once the muscles are working correctly we can then give you a programme of exercises to improve your strength even further.  These need to be monitored and are progressed as the muscles slowly strengthen and work together correctly.


Computer ergonomics and physiotherapy

Does work give you a pain in the neck and back?

With the huge reliance on technology in the workplace an increasing number of people are working for long hours in relatively fixed positions, performing repetitive movements while working hard to meet deadlines.  Common problems are aching felt in the neck, shoulder, upper and lower back, wrist and elbow joints and in some cases pain, numbness and pins and needles felt in the arm and/or hands.  These symptoms can signal the onset of OOS (Occupational Overuse Syndrome) also called Repetitive Strain Injury (RSI), which may include damage to tendons, muscles, nerves and other soft tissues from repeated physical movements over time.

Make sure you pay attention to your posture both at home and at work, especially when using your computer.

Physiotherapy Can Help!

A physiotherapist with knowledge in ergonomics and work related conditions can perform an individual work station assessment.  Recommendations will be given such as the correct seating and workspace layout to prevent such conditions happening.  Risks will be identified and advice given on correct posture, height of the desk and chair, position of screen, mouse and keyboard.

Guidelines for healthy computer use

Start Moving and Stretching:  Get up from your work station for a short stretch or walk around to promote blood flow to fatigued muscles every hour.

Variety:  Add variety to your tasks.  Take every break as an opportunity to go for a short walk, exercise and relax.  Try to vary your tasks.

Reduce Strain:  Make sure you are sitting correctly with your back supported.  Speak to us about ways to ensure you are sitting in the best possible position.

Talk to your physiotherapist:  This pain and discomfort can be prevented, but if symptoms do occur, early intervention is the best form of treatment.  If you are experiencing regular or increasing discomfort while sitting at your computer, take early corrective action.  A physiotherapist will listen to your problems and concerns, and will enquire about your activities and life style.  They will then examine you, and discuss these findings with you.  Following this, together you will work out a plan of exercises and stretches, and importantly look at changes that can be made to prevent the problems, especially to avoid recurrence.



As in the fairy tale, the same shoe does not fit all feet. Shoe size is of course critical, but there are a number of other factors that need to be considered when purchasing shoes. In this article I will discuss the function of the foot, problems that may occur, and how choosing the right type of shoe can make all thedifference to normal foot function.

Most people are familiar with the terms “flat” and” high arched” feet.  In medical terms the flat foot is generally known as a pronated foot and the high arched foot as a supinated foot. Variance in degrees of pronation and supination is common between people and may occur from one foot to the other. The terms pronation and supination also describe the variable position the foot travels through with normal weightbearing. As we walk the foot moves through varying degrees of pronation and supination to allow our feet to adapt to changes in terrain, and the position required as the foot moves from striking the heel on ground contact to pushing off with our toes as we take a step. Pronation allows the body to absorb shock when it lands. When running, the heel takes the equivalent of five times your body weight on heel strike. This force is dissipated throughout the body. Supination is required to lock the foot when pushing off. This provides power in order to walk and run faster.

Most people can adapt for minor differences from the ‘ídeal’ foot posture but from time to time we all

get sore, achy, tired feet. There are a number of factors that can cause pain around our feet.

Changes in foot wear, the surfaces we stand or run on and activity levels are common factors seen when reviewing problem feet. An excessively pronated foot means that various tissues within the foot may be placed under greater stress with resultant pain in the arch, heel or into the achilles area and may be a factor in the development of a “bunion”. Likewise an excessively supinated foot is less able to absorb load and may be a factor in foot pain. Our foot posture can also influence a number of other areas in our body.  Shin, knee, hip and spinal pain can result from alterations in foot posture and function.

Correct choice of footwear is important. As there are many so different types of shoes on the market today it can be very confusing when deciding on which shoe to choose. Sports shoes are available in control and neutral designs to accommodate different foot needs. It is important to get the right shoe for your foot posture to ensure the maximum support for your foot.  Talk to your Physiotherapist or sports shoe retailer about issues you may have, and get advice on which shoe is right for you. In some cases an additional insert or orthotic may be required to assist with alteration in foot posture.

Selecting the right shoe does not always mean you have to buy the most expensive model .Generally the

more expensive models tend to have more stability control which will make a significant difference if your foot requires that control. Shoes are also designed for different function and it is important that you use the correct shoe type for your activity. Running shoes need to provide control and stability in a different plane than a court or squash shoe. Your sports shoe retailer will be able to advise you on what shoe is best suited for your needs. If you experience foot or leg problems, seek advice from your physiotherapist or a good sports shoe retailer before selecting your next pair of shoes.

Duncan Drew is a Physiotherapist at the Oamaru Physiotherapy Clinic .He is a credentialed McKenzie Physiotherapist and has a special interest in Sports injuries and Spinal conditions. He has played Cricket at National level and was a member of the successful North Otago Team who recently secured the Hawk Cup 

Source:  Oamaru Physiotherapy Clinic written by Mike Stewart and Michelle Sintmaartensdyk


Big toe – Trouble

The big toe is a critical part of the forefoot that allows us to walk, run, climb and balance.  It bears more weight than any of the other toes and plays a very important role in propulsion.

The base of the big toe is made up of a joint between the metatarsal and phalanges (toe) bones.  One disorder affecting this joint is a condition called Hallux Rigidus.

Hallus Rigidus is a degenerative condition mostly seen in middle age.  As the name suggests stiffness and pain are the major signs of this condition.  Sufferers find that both the stiffness and pain restrict any activity involving movement at the big toe.  Walking, running, squatting and climbing may get progressively more difficult as the condition progresses.

The most common cause of Hallus Rigidus is osteoarthritic change in the joint.  Poor foot biomechanics, previous joint trauma and family history may be some of the factors involved in its development.

In normal walking the big toe must extend prior to push off to assist with propulsion of the foot.  In the presence of Hallux Rigidus this is not possible affecting the efficiency of foot function and a shortening of the stride length.  As the degeneration progresses the joint will stiffen further and bony thickening around the joint margins may develop.

Apart from Orthopaedic intervention there are a number of management tools available to your physiotherapist experienced in dealing with this area of the foot.

A thorough examination of the foot function will be undertaken and your physiotherapist will discuss these findings with you.

An X-Ray may be indicated to determine the extent of any bony and joint changes.

Early intervention using very specific joint mobilising techniques can help maintain joint motion by reducing ligament contracture.  This helps keep the joint mobile and should reduce the pain associated with joint stiffness.

Orthotics may be prescribed to help normalise foot function which may be a contributing factor to developing the condition.  Footwear advice may include the use of stiff soled or rocker shoes to reduce the load on this joint during push off.

It should be noted that this conservative management will not cure the condition but should help to prolong the useful life of the joint and make walking more comfortable.

Mike Stewart

Mike Stewart is a Physiotherapist at the Oamaru Physiotherapy Clinic.  He has post graduate qualifications in Manipulative Physiotherapy and Sports Medicine and is a Registered Physiotherapy Acupuncturist.

He toured as a Physiotherapist with the Maori All Blacks for 14 years up until 2008.

Source:  Oamaru Physiotherapy Clinic written by Mike Stewart and Michelle Sintmaartensdyk


Avoiding Sports Injuries

Why you should warm up:

  • Raises your heart rate to prepare your body for physical exertion
  • Speeds up nerve impulses which improves your reflexes
  • Reduces muscle tension
  • Sends oxygenated blood to your muscles
  • Reduces your risk of injury and prevents tissue damage
  • Increases your flexibility and joint mobility

Why you should cool down:

  • Helps to gently return your heart rate, breathing and blood pressure to normal
  •  Improves your flexibility
  •  Reduces your risk of injury
  •  Removes naturally occurring waste products from muscles and helps reduce your risk of soreness


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