Services

Back Pain	We are all different. You need treatment according to your presentation and treatment goals.
Acute	In the acute situation, symptoms commonly arise due to to Inflammation of the spine and stiffness of the intervertebral and facet joints, a bulging disc due to overuse, poor posture or an injury at home ,at sport or at work. Treatment of your back pain will include a variety of methods of manual therapy, specific exercises and education so that you understand how your problem has developed. The aim is to help you return to your desired activity level and to help prevent to prevent recurrence. You will be instructed in a graduated program of core strengthening exercises that will assist to stabilise the spine and enable you to return to your activities of choice. In regard to the question as to how much load can I safely lift without hurting my back? This question often comes from the notion that backs are weak and vulnerable. If you have previously experienced back pain, this is a very pertinent question as there is a innate concern not to re-injure your back. It is important to realise that backs are well designed to bend and take load. How much we can lift and carry depends on the strength of our muscles. Both our muscles and our discs increase in strength with loading. Strong muscles and a safe approach allow us to safely lift greater loads.
Chronic Back Pain	Whilst physiotherapy is primarily about recovering the mobility and strength in your spine, it is important to be aware that pain that has persisted for more than 3 months is not necessarily all coming from tissues in the back. It is noteworthy that approximately 80% of us will have back pain at some point in our lives, and a significant proportion will develop an ongoing problem. It is now known that it is not just if at all due to the disc bulge or facet joint arthritis. It has been determined that X-ray or scan findings don’t correlate well in many situations. You might have a disc bulge, and not have pain. Input to our brains from a variety of sources can influence whether we feel pain. Typically, whether we feel down, have had stressful events during out lives, or believe pain indicates we are damaging our spines are associated with pain because they can be seen by our brain as a potential danger. This increases the state of arousal in a part of the brain which lowers the threshold for pain to be experienced unrelated to muscle or joint damage. Other potential contribution factors include how you move, other illnesses, being overweight, poor sleep. Recent research tells us that there is so much flexibility in our complex brains, that each individual has their own set of dangers stimulating their brain, and maintaining their back pain.
Neck Pain & Headaches	Neck pain may arise for various reasons. Frequently symptoms may originate from the joints, muscles or nerves of spine possibly due to poor posture or arthritis. Perhaps, you have been injured at work or in a motor vehicle accident (whiplash) or playing sports. You may also be suffering a condition such as prolapsed or bulging disc. The cause of your symptoms will be identified, you will get advice on how to best manage the condition and a variety of treatments will be employed to assist resolution of symptoms.
Sports Injuries	Injuries at sports, at dance practice, the gym can happen to any part of the body. Joan will accurately diagnose your injury and get you back to your chosen pursuit as soon as it is possible. It is best to start rehabilitation early. It reduces injury time and help prevents future re-injury. The rehabilitation program will include prevention advice, monitoring of graduated loading of the injured area. Your program will be tailored to your injury and needs. She will work with your coach, personal trainer and/or doctor throughout your recovery process.

Shoulder Pain	Shoulder problems can arise for a variety of reasons and can be quite debilitating. The shoulder is very flexibly relative to other joints and hence vulnerable to injury particularly the muscles. The most common problem is damage to the rotator cuff muscles. Apart from overuse and injuries, they undergo age related changes which render them vulnerable to strain. Other contributing factors include, poor posture, repetitive strain injury (RSI), wear and tear or accidents and sport related injury. There is often an underlying biomechanical cause for the development of the shoulder problem. Hence, early treatment and understanding your shoulder pain is very important and can prevent a problem from worsening. Physiotherapy is particularly helpful in the management of common shoulder conditions such as dislocated shoulder, rotator cuff tears or bursitis, and frozen shoulder. Specific exercise are significant in the treatment of these shoulder conditions.
Hip pain	Problems with the hip can be complex to diagnose, as pain does not always present in the hip but may be felt in the buttock, lower back, thigh and or groin. Joan is particularly interested in helping resolve acute or persistent hip and groin pain or injuries be they related to muscle or tendon strain, bursitis, tendinopathy, labral tears or congential hip conditions..... with activity modification, self management advice and graduated exercise programs, to improve core stability in the pelvis and strength of the muscles and their tendons that attach to the pelvis.
Knee pain	Knee pain is caused by injury or wear and tear of the ligaments, the meniscus or the muscles and joint surfaces. Diagnosing the cause of your pain is the first step. Acute injuries from sports and falls require rest and rehabilitation. Some ligament injuries require surgery and physiotherapy is required to regain optimal knee strength and function with a combination of massage, manual therapy and a specific exercise program. Most knee problems are caused by poor biomechanics and long term loading issues. Many knee injuries are easily treated with retraining of correct movement patterns and wearing suitable footwear with or without orthotics. Typical conditions that respond to physiotherapy include ligament deficiency , patellofemoral pain syndrome, Iliotibial band syndrome, meniscal or cartilage tears, fat pad impingement. The the most commonly diagnosed cause of knee pain in individuals over 50 is osteoarthritis It occurs because there has been cumulative, uneven or excessive loading of the joint so the lining of the joint (cartilage) wears out and places more force through the bone. If your doctor has looked at your x-ray and said you have “bone on bone”, this does not mean there is nothing you can do. A study of 750 people over 50 found 90% had structural abnormalities on MRI, consistent with knee OA, but only 30% complained of pain. So, pain intensity does not correlate with the severity of change found on x- ray. As the knee joint cartilage has no nerve fibres, your knee pain is not coming from the wearing of the cartilage. It is not true that the only treatment for an arthritic knee is panadol osteo and waiting until it is bad enough to have a joint replacement.Your doctor may recommend aspirating the fluid from the joint and/or an injection of Cortisone or less frequently of Hyaluronic Acid to help with pain relief.Degenerative knee conditions such as arthritis respond well to specific exercise therapy which yields better functional tolerances. It has been shown that weakness of the quadriceps muscles causes increased patellofemoral (knee-cap) cartilage loss, tibiofemoral (thigh and shin bone) joint space narrowing and can lead to an inability to fully straighten the knee. Decreased quadriceps strength means you can’t go up and down stairs easily and you often need to use your hands when you get out of a chair. If the quadriceps muscle is stronger then the load on your cartilage will be reduced and the wear of the joint will be decreased. Finally,if you need a total knee replacement, the stronger your muscles are going into the surgery, the better your outcome. Joan can show you how to get your muscles stronger beforehand – this is called prehabilitation and you will benefit greatly from this knowledge during your rehabilitation. Do not let your knees prevent you from an active lifestyle. Physiotherapy can help.
Elbow and Wrist pain	Pain in the wrist or elbow may be caused by injury or overuse and result in tendinitis, ligament strain, arthritis or bone fracture..... Joan will be able to identify the source of the symptoms or refer you for further investigations or medical help if indicated. She will provide treatment including taping/splints if indicated to assist the healing of the injury/condition, self management advice in terms of self treatment and activity restrictions and graduated exercises to recover full function.
Foot and Ankle pain	Lower leg injuries commonly occur on the sports grounds as a result of injury or overuse. Typical condition presenting for physiotherapy include sprained ankles, stress fractures of the foot, heel pain, tendo achilles pain, plantar fascitis, shin splints. Joan will identify the source of the symptoms or refer you for further investigations or medical help if indicated. Early diagnosis and treatment give the best outcomes and graduated return to activities and strengthening exercises are an important part of management.
Temporo-Mandibular Joint	The Temporo-mandibular joint (TMJ) is the joint that attaches the jaw to the skull and there is one on each side of the face. It permits opening and closing of the mouth. Disorders of the TMJ can result from bruxism (teeth grinding), tension in the jaw and or upper neck muscles, malocclusion, uneven jaw alignment related to muscle tension or dental issues. They can be very distressing in that it is difficult to eat, talk or yawn. There is a disc in this joint that can cause the joint to lock which can be acutely painful. MRI reveals if there is synovitis, perforation or subluxation of the disc. Joan has an interest and up to date training in the arthro and osteo kinematics of this joint and the management of related pain, clicking and locking and associated headache. Teamwork is essential in managing these disorders and Joan always works in collaboration with the treating dentist. The goal of treatment is to improve articulation of the joint and relieve associated pain. Joan uses muscle, joint and neural techniques and instructs on self massage and exercises for the jaw, tongue and neck to improve alignment and relax tight muscles. As part of her assessment and she also identifies primary and secondary contributing factors to the presenting issue.