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Have you ever woken up with an inexplicably stiff and painful neck that will only turn to one side? You might have been suffering from acute wry neck, a painful condition following a typical pattern of symptoms. In the clinic, wry neck is classified as one of two different types – Facet or Discogenic wry neck. These have similar presentations, yet are caused by slightly different things and require different treatment.

With so much public education about the dangers of sun damage, the last thing you’ll be expecting to be told is that you’re not getting enough sunshine. However, in Australia up to 30% of the population have inadequate vitamin D status, increasing to more than 50% in women during winter and spring.

What does vitamin D have to do with sunshine?

Also known as the “sunshine vitamin”, vitamin D is essential for your health. With a typical western diet, most people will get about 10% of their daily vitamin intake through food and the other 90% is actually processed by the body through exposure to sunshine.

Why is it important?

Vitamin D is essential to maintain bone health and muscle function. Deficiencies in children can cause rickets, and over time it can cause osteoporosis in adults. It is also a predictor of falls, due to reduced muscle strength, which coupled with osteoporosis can lead to complicated fractures. Depression has also been linked to vitamin D deficiency.

Think you get enough sunshine?

You might be surprised at how much sun exposure you actually need to make enough vitamin D. Unfortunately the answer isn’t straightforward. During winter you’ll need to be in the sun for longer, and the further from the equator you are, the more sun you’ll need. Fair-skinned people are better adapted to process vitamin D and as such need to spend less time outside.

People who tend to avoid the sun or dress very modestly might be surprised to find that they are vitamin D deficient, along with office workers and those who spend a lot of time indoors, particularly the elderly who are in care.

Being overweight can also put you at risk of being vitamin D deficient as fat cells absorb vitamin D and prevent it from being released in a way that can be used by the body.

Vitamin D deficiency can be diagnosed with a simple blood test. To find out more about how much sun you should be getting and how to balance sun exposure with skin cancer risks go to….

Technology has changed our lives dramatically, and while it has made many difficult tasks much easier, it’s also made it much easier to be lazy. Here we identify a few key moments where you can sneak some exercise into your daily routine.

Boiling the kettle:

Provided you either have some privacy or don’t mind a few inquisitive stares, this is a great opportunity to do some standing exercises. In the 2-3 minutes it takes for the water to boil, take the time to do the following.


Stand with your feet shoulder-width apart. Look straight ahead and keep your back straight. Bend your knees as if you’re about to sit on a chair. Lower your body but see to it that your knees don’t extend beyond your toes. Then lift back up.


Look straight ahead, keeping your upper body straight and relaxed. Put one leg forward and slowly lower your body until the knee is bent 90 degrees. Then go back to your starting position.

Calf Raises

Stand with your feet together. Raise both heels. You can repeat this as many times as you are able to. Calf raises on only one leg are more difficult than both legs and also challenge your balance.

Watching TV:

If your evening routine involves watching 45 minutes of your favourite series, these exercises can be done while sitting. Make your guilty pleasure a little less guilty.

Leg Raises

Keeping your knee straight, raise your leg 5cm from the ground or chair. Aim to hold for 30 seconds. Increase your ability to hold the leg and aim for one, then two minutes.

Bicep Curls

Hold a two-litre bottle filled with water, then bend your elbow until the bottle touches your shoulder. Then straighten and repeat.

Triceps Curls

Keep your back straight. Lift your arms overhead, then bend your elbows (hold a bottle or canned goods). Slowly straighten your elbows, then bend them back down.


Too busy sweeping, mopping and vacuuming the floors to exercise? No problem. Perk it up with some upbeat music and dance. Try it and you'll enjoy doing those chores more. You could also add jumping jacks and side jumps for your cardio.

Incidental exercise is no replacement for a regular exercise routine, however it can help you find more time to move throughout your day.

What is Thoracic Outlet Syndrome?

The thoracic outlet is a small opening between the neck and shoulder that allows a variety of nerves and blood vessels to pass safely from the neck and supply the arm, chest and shoulder blade. As this can be quite a small space, any narrowing can cause these structures to become compressed and irritated. This phenomenon is commonly referred to as “Thoracic Outlet Syndrome”. This space can become compromised through trauma to the neck, overuse or repetitive stresses to the arm or the presence of an extra rib in the neck.

What are the signs and symptoms of Thoracic Outlet Syndrome?

Signs and symptoms of Thoracic Outlet Syndrome may depend on whether nervous tissue or blood vessels are involved. In most cases, symptoms will be caused by compression of nerve tissue rather than veins or arteries.

When neural tissue compression is the cause of the Thoracic Outlet Syndrome, reported symptoms may include pins and needles, tingling or numbness of the affected arm. Other symptoms include pain and weakness or tiredness of the arm that increases with work done overhead. Some people may experience neck pain or headaches in the base of their head.

If the vein is affected, there will be swelling and discoloration of the affected arm, as well as pain. When the artery is affected, cramping of the arm or hand during use may occur. Due to decreased blood flow, the arm or hand may feel cold and even change colour.

Who is usually affected?

It is common for people who work with their arms in an above-shoulder position to develop Thoracic Outlet Syndrome. For example, a teacher who writes frequently on a chalkboard, a construction worker hammering nails overhead, or a hairdresser.

How can physio help?

Your physiotherapist will assess a range of things including your posture, the flexibility of your spine, and length of your neck muscles. It is also important to assess the way you move your neck, back and arms.

Depending on the findings of the physical assessment, your physio will help you stretch appropriate muscles, assist with movement modification, and correct your posture. This may involve manual therapy techniques such as joint mobilizations, strapping techniques and soft tissue massage.

Treatment times may vary depending on symptom presentation and response, Thoracic Outlet Syndrome typically can take just a few treatments or several weeks to resolve as well as continuation of a home exercise program in order to resolve the issue.

Strains and sprains are words that are used almost interchangeably when describing injuries, however they each actually have quite distinct meanings. The most straightforward explanation is that a “strain” refers to a tear in a muscle or tendon, while a “sprain” refers to a tear in ligament fibers. Below we briefly describe what that means and how we treat sprains and strains differently.

Ligaments are fibrous tissues that connect and hold bones to other bones. These are very strong parts of your anatomy and, depending on the joint, provide large amounts of support and stability to the body.

Some ligaments are so strong, for example in the shoulder, that sometimes a bone will break before the ligament will tear. When ligament fibers do tear, the nearby joint can actually feel unstable.

Ligament tears will usually swell up and have a normal inflammatory reaction. Pain will be worse with movement or if the ligament is placed under more stress. Occasionally, if a ligament has torn all the way through, there is much less pain than with a less severe injury.

Your physiotherapist is able to grade the severity of a ligament sprain, which will help guide treatment and expected recovery times. Muscle strains are easy to confuse with ligament sprains, however there are a few telltale differences. Following a muscle tear, it is more likely that you’ll feel weakness rather than instability. The pain will also be isolated over the muscle or tendon body. An injury to a ligament will be tender over the site of the ligament and special tests can be done to show a laxity due to the injury.

Treatment is also slightly different as sprains will need more support and will sometimes even need to be braced, whereas muscle strains will benefit from gentle movements earlier. In both cases, following the basic principles of rest, ice, compression and elevation is great advice in the early stages of any injury. Heat is not recommended until at least two days after the injury.

It is important to seek professional opinion when recovering from both a strain and a sprain. It is very easy to re-injure an area while it is healing if undertaking strenuous activity too early and without correct rehabilitation. Speak to your physiotherapist for more information.

Orthopaedic surgery is any surgery performed primarily on the musculoskeletal system of the body. Common orthopaedic surgeries you may have heard of are joint replacements and reconstructions.

Physiotherapists have a large role to play in the recovery of these kinds of surgeries especially in the more extensive operations, such as a total hip or knee replacement. It is not unusual to wake up in the hospital a few hours post-op knee replacement, hip replacement or shoulder reconstruction to your hospital-based physio asking you to get out of bed for the first time. This may seem daunting and entirely too early, however there is very well researched evidence for why getting out of bed early is so important: your speedy return to normal health and wellbeing!

Hospital-based physiotherapy typically includes re-learning how to walk and making initial improvements on your range of movement and function of the affected joint. The physio will also help you maintain healthy respiratory function by checking your lungs regularly. Drugs administered during surgery change your breathing pattern, which can lead to complications in the days after surgery.

Following your in-patient stay, it is highly likely your surgeon will request for you to continue with outpatient physiotherapy either in an outpatient hospital-based setting or in a private-practice setting.

With your outpatient physio, your recovery will be measured and monitored, goals will be discussed and set, and you will be given an exercise program created to achieve those goals.

Physiotherapists use a variety of treatment methods to assist a post-operative orthopaedic surgery patients achieve their goals. These include soft tissue work, stretching, hydrotherapy, manual therapy and gym-based exercise.

Recovery from orthopaedic surgery can take up to 12-to-18 months to occur. During this time, it is not unusual to experience bouts of pain and swelling; however these episodes should reduce the further into rehabilitation you progress.

Many post-operative orthopaedic surgery patients can expect to return to a normal life following a period of rehabilitation guided by a physiotherapist. This includes return to some sport and regular exercise!

Note: Please seek professional advice prior to beginning a post-operative exercise program.

It is a well-accepted fact that smoking is bad for our health, however the effects of smoking are often far more complex than we realise. Healthcare professionals often suggest ceasing smoking prior to surgery or following an injury as it can significantly impact how long our body takes to heal.

First, it is important to understand how healing occurs. Skin, muscle, bone and other organs in our bodies are made up of multiple layers of tissue, all of which have different roles and require varying amounts of blood supply. Tissue is comprised of millions of tiny cells, which join together to form one layer. Layers of tissue form organs, such as skin.

Injury disrupts multiple layers of tissues, which subsequently stimulates the healing response - a complex process in which new cells are created to repair injured tissues.

In order for the healing process to be effective, blood supply to the injured area must be rich. Blood vessels must be healthy and able to constrict or open as needed. Blood is important because it delivers the essential nutrient needed for healing to occur: oxygen. Oxygen has the capacity to allow injured tissue to thrive and heal. Lack of oxygen has the opposite effect.

The toxins introduced into the body while smoking even one cigarette are enough to cause blood vessels to constrict for up to a few hours, which limits blood flow to the injured tissues. Smoking large quantities of cigarettes every day deprives the body’s cells of essential oxygen by chronically reducing blood flow.

As cells thrive off oxygen, just as we thrive off food, they weaken and begin to die when oxygen is not present. This limits the cells’ ability to function optimally, and reduces their ability to create new cells to repair the injured tissues. Without the development of new cells, tissues cannot bridge the gap between healthy tissues in an area of injury. This leaves the injured tissues exposed for longer than they should be, leading to an increased risk of developing infection.

The time it takes for an injury to fully recover in a smoker versus a non-smoker is usually longer. The integrity and strength of the tissue that is able to form to heal the injury also tends to be weaker. This means that the injury is more prone to becoming re-injured, or even not heal at all.

If you have any questions regarding smoking and injury healing, or if you are interested in quitting smoking, please contact your physician.

There is no doubt that the human body can be very resilient. Short of regenerating new limbs, the body is capable of recovering from amazing amounts of damage, including broken bones. Many people may feel that physiotherapy treatment will only speed up recovery and if they are not elite athletes then simply letting nature take its course is the best, and most cost effective choice for them.

Speed of recovery, however, is only one very small measure of physiotherapy success and fails to fully represent how important proper treatment is. Here are a few things about injury healing you may not have been aware of.

1. Scar Tissue is more likely to form without treatment.

Scar tissue can cause ongoing pain and stiffness in skin, muscles and ligaments. Physiotherapy can prevent excess scarring through advice regarding movement, massage and other hands on treatment.

2. Your ability to sense the position of your body, known as proprioception, is often damaged after an injury and can be retrained.

Impaired proprioception is a major factor in reinjury. If you’ve ever heard somone say “my knee/ankle/shoulder still doesn’t feel 100%” then this could be why. Physiotherapy treatment will aim to restore proprioception as a part of standard rehabilitation.

3. Once healing has finished, your body may not be exactly the same as before.

Ligaments may be looser, muscles and joints may be stiffer and almost always weaker. While the pain may be gone, there may still be some issues that need to be addressed to prevent ongoing and more complicated issues in the future.

4. You may have picked up some bad habits while waiting for the injury to heal.

While in pain, we often change the way we do things, this can lead to the development of poor movement patterns and muscle imbalances. Even though the pain has gone, these new patterns can remain and create further problems down the road.

5. Injuries don’t always heal completely.

On rare occasions, circumstances may prevent an injury from healing fully. The most serious example of this would be a fracture that cannot heal if the bone is not kept still enough. Other factors that may prevent an injury from healing include poor circulation, diabetes, insufficient care of the injury and poor nutrition.

Your physiotherapist can assess your injury and develop a treatment plan that will both restore you to the best possible function and prevent further injuries.

Many people use the term Chronic to convey just how excruciating a pain is. However, what the term really means is simply that the pain has been there for longer than three months, even if it’s not very bad. The distinction is made after three months because most injuries to tissues, either muscle, bone or joint has had a chance to heal and resolve by this time.

Why make the distinction?

The difference between pain that has just happened and pain that has been there for a long time has implications for treatment and the way you approach it. Chronic pain requires different management and is likely to be caused by more than one thing where as short-term pain (also known as acute pain) often has a distinct cause, such as a fall.

What are some examples of acute conditions?

A sprained ankle, torn muscle, a bruise and even a broken bone are all examples of injuries that occur suddenly and usually follow a typical pattern of healing. They usually go through an inflammatory reaction with the area being red, hot, swollen and painful to touch. This period usually lasts for a few days and is a normal part of the healing process as the body works to remove damaged tissue and repair the affected area. Different tissue types take varying amounts of time to heal. The severity of the injury will also affect healing times.

Some acute injuries can become chronic if something goes wrong in the healing process. Some acute injuries are so bad they won’t heal without medical care. For example, fractures need to be kept as still as possible to allow the broken bones to heal together in the correct position.

Some pain and illnessnes develop over time and are chronic in nature, usually starting insidiously and becoming progressively worse. Osteoarthritis, multiple sclerosis and rheumatoid arthritis are all examples of chronic conditions that cause chronic pain.

For some people, even though their injury has healed and no significant cause can be found, pain persists. This type of pain can be particularly distressing and requires a holistic approach to treatment, particularly addressing the emotional costs that come with suffering from long-term pain.

Certain factors will predispose someone to developing this type of pain including recent or past emotional trauma, anxiety and depression. Unfortunately chronic pain often causes people to adopt a vicious cycle of rest, which causes more stiffness and pain, which then leads to more pain and so on.

Your physiotherapist is well trained to help you cope with chronic pain and get you back to a more functional level and doing the things you love.

Chronic Pain Project

Sometimes the internet can be a confusing place, full of misinformation, particularly from people trying to sell you things. A recent website developed by the Department of Health in Western Australia aims to provide evidence-based support and education to pain sufferers.

Have a look here at


For many of us, a typical day can involve hours of sitting in front of a desk. When you have a seemingly never-ending list of tasks to complete, your long-term health can be the last thing on your mind. However, we know that prolonged sitting, especially in a poorly set-up workspace can have a huge impact on your body in the long term. Below are some tips that can help you set up your workstation properly.

Chair Setup

The height of your chair should be adjusted so your feet are flat on the floor and your thighs parallel to the floor. Your arms should be able to rest comfortably at the height of the desk. Arm rests should be low enough that elbows can be bent between 90-110 degrees and not winged out. Hands, wrists, and forearms should be in a neutral position and parallel to the floor. A cushion (like a rolled towel) may be added on the chair to add support for the lower back. If the chair is too high, you can use a footrest to make sure your feet are rested comfortably.

Desk Setup

A 20-to-40-inch distance of the monitor from your face is advisable to reduce eye strain. Place your keyboard at the center of your desk, which should be 1-2 inches above your thighs. You want the monitor and keyboard to be directly in front of you. Keep the mouse within easy reach of your keyboard. The top of the screen should be slightly below eye level..

Other tips for setting up your workstation include:

  • Put everything you need within easy reach.
  • Don't slouch. Practice moving in and out of a good posture.
  • Stand up to reach anything that can't be comfortably reached while sitting.
  • Take active breaks from sitting every half hour or hour. Set an alarm that reminds you get up and stand and stretch for ten seconds then sit back down.

Transitioning to a standing desk:

Even better than all these tips is to set up a standing work desk. Many people are making the switch to a movable working desk that allows you to spend periods of your working day on your feet with great results. Here’s some advice to make the transition a smooth one.

  • Get in the habit of standing for certain tasks and sitting for others. For example, complete repetitive tasks, phone calls or data entry while standing and more complex tasks while sitting.
  • Reconsider your footwear. When standing, your feet and their support become more important than when you’re sitting all day. More comfortable shoes might be a worthy investment.
  • Slowly increase the amount of time you spend standing to allow your body to adjust.
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