Tennis Elbow, what is it & how do i fix it?

posted Jan 19, 2017, 7:18 PM by Rebecca Smith

With the tennis season now in full swing, it’s quite fitting that this next blog is focused on the condition known as “tennis elbow”. Tennis elbow affects the outside portion of your elbow when the muscles that attach to the bone located in this region become overused, inflamed and/or go through some wear and tear. Contrary to common belief, tennis elbow is not just caused by playing tennis, but rather can be caused by anything that overuses these muscles, including but not limited to office work (e.g. typing), repetitive lifting and carrying, and even writing.

Your physio can usually diagnose tennis elbow from a thorough assessment, but can also be confirmed by having an ultrasound completed. Once diagnosed as tennis elbow, your physio will discuss with you possible causes of this, and will provide strategies to either perform the aggravating task differently or rest from it altogether until the pain subsides.

Initial treatment usually involves education, rest, ice pack (especially if inflammation is present), massage, joint mobilisations and taping. A brace may also be recommended especially if the taping has been effective. Dry needling, ultrasound therapy and shockwave therapy may also be provided.

Once some of the pain has subsided, an exercise program will be initiated to improve the strength of the affected muscles in order to help in further reducing the pain and prevent future reoccurrences. These exercises include stretches, lifting a small dumbbell up and down moving just your wrist, turning a stick around back and forth, grip squeezes, and upper arm strengthening. Your physio will individually prescribe these exercises to you to ensure that you are performing them correctly and are using a suitable weight.

With proper management, your tennis elbow pain will subside and allow you to return back to your everyday activities, whether it’s holding a coffee mug with no pain, being able to work in the office, or playing a full game of tennis.

If you have been suffering with tennis elbow, then book yourself an appointment with any of our team.


Physiotherapist Narellan
Difference Physiotherapy Narellan & Camden


Achilles tendinopathy - what is it?

posted Nov 13, 2016, 3:14 PM by Rebecca Smith

Other than being associated with Greek mythology and the weak point of the body, the Achilles is the large tendon that sits behind your ankle and attaches the calf muscles to the heel. Due to the tendon being large and responsible for high load activities (including walking, running, jumping etc.), the Achilles tendon takes on a lot of tension on a regular basis especially for those who are active and involved in sports. While some people’s Achilles tendons can manage these tasks without any issues, other people’s Achilles tendons can go through a process of wear and tear (microtraumas) which can lead to tendinopathy. 

Achilles tendinopathy is made up of 2 types of conditions, which are tendinosis and tendinitis. Tendinosis describes the tendon going through a process of degeneration, while tendinitis describes the inflammation of the tendon. Due to the similar nature of both conditions and the fact that they are treated very similarly, the term "Achilles tendinopathy" is used. 

Specific causes of Achilles tendinopathy can include overuse (e.g. playing too much sports), inappropriate footwear, poor walking/running technique, tightness of the calf muscles/tendon, and weakness of the calf muscles/tendon. Generally speaking, Achilles tendinopathy occurs when a load from a specific activity consistently exceeds the tendon’s load-tolerance. 

Initial management of an Achilles tendinopathy includes rest, ice pack (especially if inflammation is involved) and taking anti-inflammatories. This aims to allow the tendon some time to recover and prevent further damage from taking place. Once the pain has settled a bit, your physiotherapist will continue with other treatments to further reduce pain in the Achilles tendon. 

If tightness of the calf muscles are present, your physio will provide massage to the calf, as well as teach you some stretches and foam roller exercises. In the case of poor footwear and poor walking/running technique, orthotics may be recommended along with exercises designed to improve your walking/running technique. A referral to a podiatrist may also be advised especially if custom-made orthotics are necessary. 

Strengthening exercises are also provided in the management of Achilles tendinopathies. Strengthening the muscles allows the load-tolerance of the Achilles tendon to improve so that usual activities that may cause pain, such as running, don’t end up causing pain (or cause less pain). This is the same principle behind plyometric exercises (such as jumping and hopping) except these are introduced later on, due to these exercises producing a higher load on the tendon. 

Other treatments that may be utilised include dry needling and shockwave therapy. 

Your physio will continue working with you until you can manage all of your usual activities with minimal to no pain, where they will set you up on an independent management plan in order to prevent it from occurring again in the future. 

If you have been suffering with Achilles pain, then book yourself an appointment with any of our team. 

Physiotherapist Narellan
Difference Physiotherapy Narellan & Camden

Fractures – How does a physio help?

posted Feb 20, 2016, 2:30 PM by Rebecca Smith   [ updated Feb 22, 2016, 7:42 PM ]

During this time of summer when people are out and about more, injuries from playing sports and other pastimes
(e.g. jumping on the backyard trampoline) are more prevalent. Breaking bones (fractures) are just one of a number of injuries that can take place. When someone does sustain a fracture, it’s usually off to the hospital emergency room where an X-ray is undertaken and in the case of a fracture being confirmed, a cast/splint being placed on the affected area. Sometimes, surgery may even have to be undertaken in order to insert a rod into the bone for increased support. This then involves the fractured area being out of action while the bone naturally heals. Even though rest is important during this time, early physiotherapy intervention is also necessary to ensure that the maximum benefits and outcomes are achieved in the minimum amount of time possible, as well as being another way to monitor progress and ensure there are no setbacks along the way.

After a fracture is sustained, the healing process begins with the bone and surrounding tissue bleeding from the impact to the small blood vessels (capillaries). Within a few days, the small blood vessels would have formed a hematoma (clotted blood) which will eventually be cleared away. After this, spongy bone forms at the fracture site that then turns into compact bone, a type of bone which is similar to the original bone. During this process, it is vital that rest is undertaken otherwise complications can take place. These complications may include but are not limited to malalignment of the bone and poor union of the fracture. The time it takes for a fracture to heal depends on many factors and should be guided by clinical timeframes, imaging (e.g. X-rays) and your health professional.

While the fracture is healing, your physiotherapist will firstly help you regain full range of motion of the surrounding joints and then help you regain your strength to what it was prior to the fracture. They may also help relieve any pain that you may be experiencing. Various treatments that physiotherapists can utilise include range of motion exercises, stretches, strengthening exercises, massage, mobilisations, and electrotherapeutic modalities. If you have fractured one of your leg/foot bones, they may also educate you on the correct way to use crutches and provide advice on when to begin walking without the use of crutches.

If you have recently had a fracture, then book yourself an appointment with any of our team.

Physiotherapist Narellan
Difference Physiotherapy Narellan & Camden

Are you having trouble balancing?

posted Dec 9, 2015, 1:35 PM by Rebecca Smith   [ updated Feb 22, 2016, 9:37 PM ]

Balance is a state where a body/object is in equilibrium (i.e. stable). Balance varies between each person with some people having adequate balance and being able to stand on one leg with their eyes open, while some people have an enhanced level of balance compared to the average person, such as gymnasts who can walk and do flips on a balance beam.

However, there are various conditions or injuries that someone can suffer from that will reduce their level of balance, so that basic tasks such as walking can be a challenge. These conditions/injuries can include (but are not limited to) Vertigo, Meniere’s disease, Labyrinthitis, Parkinson’s disease, hip/knee replacements, knee injuries, ankle injuries (e.g. sprains) and inadequate muscle strength.

Balance is thought to consist of the following components:
  • Cognitive (state of mental awareness and concentration)
  • Motor control
  • Muscle strength
  • Vestibular (sense of balance within the inner ear)
  • Proprioception (ability to sense the position/location/orientation/movement of the body and its parts)
  • Visual
If one of these components is impaired or eliminated, then your level of balance will also be impaired. This is why if you ever stand on one leg and find it harder to remain stable when you close your eyes, you are finding it harder because you are challenging your balance while eliminating the visual component.

But it is not all bad news. With specific exercises, your balance can be improved even when some components such as the vestibular system are not easily fixed. Such balance exercises include general lower limb strengthening, standing on one leg, tandem walking, and incorporating equipment such as wobble boards, balance discs and trampolines.

If you have been experiencing difficulties with your balance and find it affecting your day-to-day activities, then book yourself an appointment with Arron or myself, or contact the Southwest Wellness Centre for more information on the “Stable, Steady and Able” balance exercise program.

Physiotherapist Narellan
Difference Physiotherapy Narellan & Camden

How Should I Be Sitting?

posted Oct 21, 2015, 10:59 PM by Rebecca Smith

With a major percentage of the population currently working in occupations that require them to be sitting at a desk most of the time, and with more people using computers both at work and at home recreationally, it is now more important than ever that people know how they should be sitting at their desk and using their computer. This field is known as ergonomics (“the study of people's efficiency in their working environment”) and aims to optimise posture and workstation layouts. Posture can relate to many aspects, from foot placement to wrist position when using a mouse to back posture. Poor ergonomics can cause a range of avoidable conditions, including but not limited to: lower back pain, carpal tunnel syndrome, tennis elbow, and headaches. However, it can be hard to know what “correct posture” is. So please find below a basic list of recommendations, starting from the top of the body and going to the bottom:

Head and eyes – The computer monitor should be 0-20° below the horizontal line of sight, neck should be kept in a neutral position

Elbow – A bend in the elbow of 90°, give or take 10°, is recommended

Wrist – The wrist should be kept in a neutral position i.e. no bending. This is especially important when using a mouse and keyboard.

Lower back – The lumbar curve should be present in the lower back. Chairs do sometimes provide support for the lumbar curve, otherwise invest in a lumbar roll.

Hips – 90° bend, give or take 10°

Knees – 90° bend, give or take 10°, knees should not be touching the seat edge

Feet - Flat on the floor or on a footrest

If you have been experiencing pain from sitting for long periods of time, or want specific advice on ergonomics, then book yourself an appointment with Arron or myself.


Physiotherapist Narellan

Difference Physiotherapy Narellan & Camden

Carpal Tunnel Syndrome

posted Oct 6, 2015, 4:51 PM by Rebecca Smith

Carpal tunnel syndrome is a condition of the hand where excessive pressure is placed on the median nerve, hence
resulting in hand (and sometimes arm) symptoms. These symptoms can include pain, numbness, pins and needles, and weakness, especially on the palm side of the hand excluding the little finger.

The carpal tunnel essentially is a narrow passageway in the wrist. This passageway is made up from the bones, ligaments and fascia of the wrist. It is this tunnel where the median nerve travels through, as it travels from the arm and into the hand. Sharing this tunnel with the median nerve are also various tendons. If the tunnel reduces its diameter and/or the tendons take up more room of the tunnel, then the median nerve is compressed, hence causing excessive pressure on the nerve.

Causes of the tunnel itself narrowing include arthritis and wrist fractures, while causes of the tendons taking up more of the tunnel include overuse injuries, poor ergonomics of the hand and general muscle tightness. Other causes of carpal tunnel syndrome are pregnancy, which results in excessive fluid being built up in the carpal tunnel (hence leaving less room for the median nerve), and simply people just having a smaller carpal tunnel by genetics.

Although anyone can develop carpal tunnel syndrome, it is most likely to develop in women, those aged between 40-60 years, pregnant women (as per reasons listed before), those who experience rapid weight gain, and people who are involved in daily strenuous manual work. It has also been found that people who use hand operated machinery on a regular basis, especially if the machinery causes vibrations in the hand, are at a higher risk of developing the condition.

While corticosteroid injections and surgery are sometimes necessary for treating carpal tunnel syndrome, the following is going to be focused on conservative treatment by physiotherapists, which is the first pathway taken for managing this condition.

Initial treatment of carpal tunnel syndrome consists of resting the hand as much as possible, and wearing a wrist splint at night. By wearing a splint, the wrist is kept in a neutral position throughout the night to prevent bending movements causing further compression to the nerve. Evidence shows that wearing a wrist splint during the day provides no further benefits compared to just wearing it at night.

If after a few weeks symptoms are still present, then other treatments are considered to provide additional relief. Stretches, massage and dry needling will help to relieve the tendon swelling, and may even help remove excess fluid from the tunnel. At this point, a heat pack may also be trialled to see whether the person responds well to heat therapy. Median nerve glides are also beneficial for treating symptoms as it stretches the median nerve so that there is less tension placed on it, as well as providing a glide to the nerve as it travels through the tunnel. Think of this as “flossing” the median nerve. Joint mobilisations can also be utilised in order to loosen up the carpal bones so that the tunnel space is not as restricted. Strength exercises of the hand may also be provided but this is only as symptoms significantly improve, making it a lower priority in the entire course of carpal tunnel syndrome management.

If you have been experiencing pain or other symptoms in your hands, then book yourself an appointment with Arron or myself, and let physiotherapy help you.


Physiotherapist Narellan

Difference Physiotherapy Narellan & Camden

Foam Roller vs. Stretches – Which is Better?

posted Sep 8, 2015, 2:48 PM by Rebecca Smith

Have you ever been to the gym and seen someone rolling their legup and down on something that is essentially just a roll and thought to yourself “What on Earth are they doing?” Well to answer that question, they are using what is called a “foam roller” and they are stretching out a muscle/structure of their body. But you may be asking “Why don’t they just do stretches?” Well, that’s a good question, but to answer that, let’s take a look at what stretches are and how they can be beneficial in their own right.

Stretches can basically be defined as “exercises” that extend a muscle and/or structure of the body to its full length. Stretches can be classed as either static, dynamic or PNF.

Static stretches are when you stretch and hold that position for an extended amount of time without moving. These are typically what everyone thinks about when they hear the word “stretch”.

Dynamic stretches on the other hand are when you stretch and relax and then repeat for a certain duration of time. Think what the football players do when they continuously kick their legs up and down before a game.

PNF stretches involve a person contracting the muscle that needs to be stretched, followed by then stretching the muscle. As a physiotherapist, whenever I conclude that my clients have tight muscles, I usually prescribe static and/or PNF stretches as these result in optimal improvement in extensibility, while dynamic stretches are more preferable to warm up before exercising or playing sports.

Most muscles and structures of the body are easy to stretch and most of the time stretches will result in optimal improvement in range of motion. However, there is always one structure of the body that is always difficult to stretch, especially if you don’t have someone around to assist you in stretching: And that is the ITB (Iliotibial band). This structure is not a muscle, rather it is a thick band of fascia that runs along the outside of your thigh. ITB syndrome is an overuse injury that causes leg and knee pain, and has been commonly seen in my physiotherapy clinical experience. Although there are many causes of the condition, a tight ITB is one of the main reasons, which means stretch, stretch, and more stretching. However, there are some of you, especially those that have had ITB syndrome that realise how difficult this structure can be to stretch. So if your usual stretches can’t help, then how can you extend the ITB.

This is where the foam roller comes in and can help save the day. By rolling out the ITB on the foam roller, the ITB is stretched out hence increasing its extensibility and improving the symptoms associated with ITB syndrome and preventing its reoccurrence in the future. In a way, a foam roller can be thought of a mixture between getting a massage and doing a stretch. Seeing your physiotherapist whenever you have muscle pain and tightness is the best option. This is because your physio will provide you with a massage and will know which parts of the muscle/structure need more attention. However, doing stretches and using a foam roller in between appointments will enable you to continue the stretching process. In addition to providing you with a massage, your physio will also be able to teach you the correct stretches and foam roller exercises to do.

So to answer the overall question of foam roller or stretch: stretch first; foam roller if the stretches are not doing enough; but see your physiotherapist for the best advice since every person and their situation is different.

Have you been experiencing muscle tightness or would like to know more about the best stretches and foam roller exercises for yourself, then book yourself an appointment with Arron or myself.


Physiotherapist Narellan

Difference Physiotherapy Narellan & Camden

Should I Use an Ice Pack or a Heat Pack?

posted Aug 28, 2015, 1:54 AM by Rebecca Smith   [ updated Aug 28, 2015, 1:54 AM ]

Have you ever had an injury or experienced pain and wondered whether you should use an ice pack or a heat pack to manage it? Have you ever asked around to find out what people would recommend and ended up being even more confused? Then refer to the lists below to get a better idea of when an ice pack is useful and when a heat pack would be more beneficial:


  •          First 48 hours after sustaining an injury (e.g. ankle sprain)
  •          Reduce swelling
  •          Bruises
  •          Inflammatory conditions


  •          Arthritis
  •          Joint stiffness
  •          Neck pain
  •          Back pain
  •          Chronic pain (e.g. 3 month history of tennis elbow) 

Hopefully this list has provided more clarification. However, it still isn’t this simple as everyone responds differently and various factors can be involved that changes whether to use an ice pack or a heat pack. This is why your physiotherapist is the best person to give you advice in this area, as well as being able to provide it to you as part of your consult, hence providing you with a trial in a safe environment.

Have you been experiencing pain or have recently sustained an injury, then book yourself an appointment with Arron or myself.



Physiotherapist Narellan

Difference Physiotherapy Narellan & Camden

Neck Pain – A Physio's Insight

posted Jul 21, 2015, 7:45 PM by Rebecca Smith   [ updated Jul 21, 2015, 7:50 PM ]

Along with lower back pain, neck pain is a common reason as to why someone will visit their physiotherapist. Sometimes, it simply isn’t just neck pain rather it presents with another set of issues, including headaches (or even worse, migraines), dizziness, stiffness/tightness, difficulty sleeping, and pain referring down the arm. It can be felt either as a dull ache, a sharp stabbing pain or even a burning pain, particularly when it refers down the arm.  This can limit people in their day-to-day lives, with simple tasks such as using the phone or looking back to reverse the car being unbearable.

Most of the time, neck pain doesn’t begin with a specific event, rather it starts out of the blue.  However, there are times when neck pain is the result of a precise cause, the most well-known example being whiplash. Due to this, each case of neck pain must be managed differently, although similar principles are followed.

During the first appointment, your physio will investigate a number of factors related to your neck pain, which include:

  • Possible causes (e.g. recent increases in stress)
  • Range of motion

  • What movements/activities cause the symptoms

  • Neck posture when sitting (particularly if you sit at a desk all day)

  • Stability and strength of the neck muscles

After determining more information about your neck pain, your physio will provide you with various treatments based on what will help you the most. These treatments may include:

  • Advice about posture, stress management etc.

  • Massage (which can definitely help with stress management as well)

  • Mobilisations

  • Stretches

  • Exercises

  • Nerve glides

  • Postural Taping

While all treatments are helpful and effective, I have found in my clinical experience that it is exercises that help with the management of neck pain in the long term as well as preventing any future episodes. Most exercises are aimed at strengthening the deeper muscles of the neck, also known as the “postural muscles”. These muscles work to stabilise your neck rather than move it. How strengthening these muscles helps resolves neck pain can be thought of in the same way that strengthening the core muscles can help with lower back pain.

After your neck improves, your physio will continue to work with you to see whether there are any other factors that can be addressed to ensure that you are feeling 100% better and are not in any way limited by your symptoms. Although every case is different, I would like to share with you a couple of handy tips.

As for pillow set up goes, there is no one prescription but generally speaking, whichever way you sleep, your neck should be in a neutral position (i.e. not bending back, forwards or to the side). And finally, avoid neck braces and collars unless prescribed by your GP.

If you have neck pain or want to find out more about neck pain and what you can do to prevent it, book yourself an appointment with me or Arron our other physio.



Physiotherapist Narellan
Difference Physiotherapy Narellan & Camden

Physiotherapy for Veterans (DVA)

posted Mar 4, 2015, 11:46 PM by Rebecca Smith   [ updated May 29, 2015, 4:30 AM ]

DVA holders make up quite a portion of patients attending physiotherapy with me at the Southwest Wellness Centre. These individuals have sought help in regards to physical, neurological and respiratory conditions, which are all treated by physiotherapists. By seeking help with their problems, DVA holders’ well-being and overall health have improved rapidly and many patients are achieving things that they haven’t been able to in the past few years.

My most common approach to the management of DVA holders usually involves a combination of manual therapies such as massage, joint mobilizations and traction as well as an individualized exercise program.

This exercise program is personalized to address the needs of the person, rather than a generic program used for anyone. These needs are established between the therapist and patient by setting goals. Your goals may vary from strengthening a certain body part, increasing balance for falls prevention or being able to walk 5km to get the 18 hole round of golf in every week. No matter how simple or small the goals may be, we work together closely in order to achieve them.

Here at Southwest Wellness Centre our focus is not only to treat your existing problem and achieve your goals but we also work on preventing any further complications or reoccurrence. A prime example of this is an individual is treated for lower back pain, becomes pain free and then we work towards preventing further problems by ensuring you are independent with your own management whether it be an exercise-based program, stretching or avoiding aggravating activities.

Important information regarding DVA access:
  • Referral can be from your GP, medical specialist, doctors in hospitals or a physiotherapist with the current referral
  • Referrals remain active for 24 months for gold card holders
  • Physiotherapy and chiropractic treatment may not be performed at the same time for the same condition
  • You do not need to pay, we inform DVA of the treatment sessions and the cost will be covered by the DVA
Fortunately for you as a DVA holder at Southwest Wellness Centre you will also have access to a dietitian, podiatry, exercise physiology, psychology, gym access and child minding while you are in your consult.

If you are or you know anyone who is a DVA holder, make sure that you are getting the health care that you deserve as a DVA member.

For more information visit

Physiotherapist Narellan
Difference Physiotherapy Narellan & Camden

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