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Mitchell Physiotherapy

Mitchell Physiotherapy

Leading Hunter Physiotherapy since 1971

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Blog

Tendinopathies: Surgery vs Physiotherapy

Tendinopathies: Surgery vs Physiotherapy

There are many uncertainties over the exact pathophysiology of tendinopathies. With the emergence of new treatment modalities making decisions regarding management can be difficult. A systematic review conducted over the past 12 months highlights the benefits that surgery and physio have. Though the study shows very little difference between the two management techniques. The management techniques target the reduction of patient symptoms and improving function. The study has moderate level evidence and concludes that loading exercise treatment should be encouraged for at least 12 months before the idea of surgery is entertained.    
Posted in Blog, Physio Blog
Understanding Yoga

Understanding Yoga

Yoga is an ancient practice, with records indicating that it has been practiced in India some form for close to 4,500 years. Since being introduction to Western culture in the 1960's, it has remained a popular form of physical activity. A physical Yoga practice usually consists of an opening sequence called a sun salutation. It is then followed by a sequence of standing and floor postures. The primary reason for commencing a yoga practice is to improve general health and well-being, and to improve muscle flexibility, strength, and endurance. Recent studies have found that a regular Yoga practice significantly improves isokinetic and isometic muscle strength. The same study also established that a regular practice can increase cardio-respiratory capacity by 6-7% in 8 weeks. This is the ability of the circulatory and respiratory systems to supply oxygen to muscles during physical activity. It has also been established that in peri-menopausal populations, a regular long-term practice has a positive effect on bone formation. Similar results have been seen in this patient population with respect to Tai Chi and bone formation.
Posted in Blog, Physio Blog
Pelvic Pain Course

Pelvic Pain Course

This two-day course teaches skills in assessment and approaches in management of the patient with pelvic pain, and contributing factors to the presentation of pelvic pain outside of the pelvis itself. There is a strong anatomy and bio-mechanics component to the course, with insights into medical considerations by an OB-GYN and Radiologist with clinical interest in women's health imaging. ​ Presented by Caroline Cooper, Dr Oliver Brown and Dr Amanda Woodward
For more information or to book visit https://www.gemtinfo.com.au/pelvic-pain.html
Posted in Blog
Tendinopathy: a runner’s achilles heel.

Tendinopathy: a runner’s achilles heel.

This weekend Mitchell Physiotherapy once again ran a pop up information stand at Maitland Parkrun. One of the most common injuries runners wanted to talk about was achilles tendinopathy. This occurs when the achilles tendon is overloaded repeatedly (such as running far or often). Without allowing sufficient rest and recovery the tendon becomes swollen and painful. This may initially only occur after a run, but continually training means the pain will likely occur earlier into your run, eventually becoming continuous. In order to treat this condition we need to strengthen the achilles tendon and manage the loads it experiences during running. Calf muscles are our major propulsive force during running, contributing 25% more power to the running cycle than our quadriceps muscles. Resting and stretching are NOT the answer for this issue, as this will weaken the calf muscle and achilles tendon. (BUT you still may need to decrease your running for a period of time) Seeing a physiotherapist is vital for the rehabilitation of your tendon. They will provide you with a progressive strengthening program which incorporates the different types of load that a tendon needs (strength, power, endurance, etc). Tendon rehabilitation does take time usually 12 weeks to 6 months. This is due to tendons adapting to change slower than other soft tissues. However, if you stick to a structured and progressive loading protocol your tendon will get better. The good news by increasing the strength of your tendon and calves your Parkrun time should get better as well! If you are experiencing achilles tendon pain contact us for an appointment or come and have a chat the next time you see us at Parkrun.
Posted in Blog, Physio Blog
Mulligan Headache Techniques

Mulligan Headache Techniques

Mulligan Headache Techniques: Mulligan Therapy is a series of techniques designed to treat joint dysfunction. It has a number of different techniques, including some for headaches which can help, depending on the cause of your headaches. Headaches can be caused by many different factors including eye strain, compression, whiplash, and cervicogenic headaches that arise from the neck. Mulligan has a number of different techniques which can help relieve headaches. Some move different joints in the neck forward and others move joints backwards. There are also rotation type techniques which can relieve the headaches. If these techniques work then we can use the foundations of these to develop some home exercises to help continue to relieve the headache and develop a plan so you don't develop them again in the future. It is often better to be able to treat headaches as they start to occur rather than once they have been present for a longer period and are more severe - the more you can do for yourself, the better. The techniques are sustained and as they are sustained you should feel the headache easing. These techniques should cause no pain while they are being performed. Mulligan techniques were developed by trial and error but the underlying principle is that if the joints are repositioned into their correct place then the movements will be pain free.
Posted in Blog, Case Studies, Physio Blog

Pelvic Pain

Prolapse can be one source of pelvic pain. There are lot of women that sit in my office and tell me they experience a dragging sensation low and deep in the abdomen. Some ladies report a sudden onset of severe sharp pain with a heavy lift or push, (eg. the lawn mower through long grass). Why there is pain most likely due to ligamentous strain, just like it might hurt when you sprain your ankle. For a grade 1 or 2 prolapse pelvic floor exercises can be very effective in relieving the symptoms of pain, discomfort and or bulges at the entrance to the vagina. If you have a significant bulge at the entrance to the vagina it best to see a GP who will guide you from there. How does the pelvic floor support the pelvic organs. Imagine your pelvic organs are like boats sitting at dock, the boats are held in place by ropes and supported by the sea. The ropes are like your ligaments and the sea is like your pelvic floor. If the sea dissappears, so does the support fro the boats, your pelvic organs. And a prolapse is a possible outcome.
Posted in Blog, Caroline's Blog - Pelvic Girdle Pain, Physio Blog
ACL Reconstruction

ACL Reconstruction

Often through traumatic instances, an anterior cruciate ligament injury can occur. This is one of four major ligaments involved in providing stability around and inside the knee joint. The ‘ACL’ as its commonly called, prevents the shin bone moving forward in relation to the thigh bone. When this is ruptured, episodes of giving way may occur. Often, surgical intervention is required, when a hamstring tendon is used to graft the new ACL. The length of rehabilitation required varies, pending specialist protocol and what the patient intends to return to. Quite often a full twelve months is required to return to full sporting capacities in the non professional population. Physiotherapy plays a integral role in assisting the patient back to tasks when appropriate and retraining movement patterns to prevent reinjury.  
Posted in Blog, Physio Blog, Uncategorized
The adductor muscles, Adductor Magnus

The adductor muscles, Adductor Magnus

Have a look at this muscle referral pattern. This muscle, Adductor Magnus can refer pain into the vagina, bowel, and lower abdomen.  On the right of the picture, is adductor magnus, the x marks where trigger points are usually located. This is one of the muscles that gets sore when you ride a horse for the first time. Adductor Magnus is a big powerful muscle, hence the name Magnus.   This picture shows where, in your body, you may experience pain if one of these trigger points becomes active. An active trigger point is a focal area of intense muscle activity that does not relax, this then becomes painful, and can refer pain to other locations in the body. Adductor Magnus can be implicated in women that experience pain during intercourse, lower abdominal pain and deep bladder pain. We generally get trigger points in muscles that are weak and then overloaded, however this is not the only cause. Accepted treatments to settle trigger points are either ischemic pressure or dry needling. Beware that there are big important muscles and blood vessels in the upper thigh, and you don’t want these interfered with, so make sure your therapist is well trained. I recommend using a physiotherapist with dry needling training. Remember pain in this area can be due to a number of medical conditions also, do not discount these make sure you are checked by a doctor. It may not be obvious that the muscle is causing the pain, and even when testing the muscle, it may not be obvious.
Posted in Blog, Physio Blog
PD Warrior Parkinsons Disease

PD Warrior Parkinsons Disease

Sean graduated from the University of Newcastle with first class honours in 2015 and currently operates out of the Maitland and Dungog clinics. Sean prides himself on patient education and providing clarity with regards to the rehabilitation process. He has a passion for sport- with particular interest in football and currently plays for Beresfield USSC in the ZPL and has recently finished working with the Maitland Blacks Rugby Club as their club physiotherapist (2016 and 2017). His interests in physiotherapy lay in post-surgical rehabilitation, Parkinson’s disease and sporting injuries. Sean utilises techniques including advanced dry needling and also designs individualised exercise programs in order to suit patient needs. This also includes the Parkinson’s Disease Warrior exercise program- a specialised set of exercises tailored to stem to progression of the neurological disease. Sean also instructs weekly mat based pilates classes out of the Dungog location. Mitchell Physiotherapy has been a stalwart of healthcare in the Hunter region for over 40 years. With over 10,000 success stories, we pride ourselves on patient centred care and strong communication channels. Our dedication to being ‘simply the best’ has seen the clinic grow into more areas of speciality, inclusive of Women’ Health, Hand Therapy and until recently, a specialised neurological service. We have a passion for improving the quality of living for patients particularly with Parkinsons disease. All too often patients are given dated advice on generalised exercise programs. This passion has led to rolling out the PD Warrior program in the Hunter, and enables us to be at the forefront of neurological rehabilitation.
Posted in Blog, Physio Blog
Vertigo

Vertigo

Vertigo is defined as the feeling that you or your surroundings are moving when they are actually still. It is a sensation often described as feeling like you are spinning, swaying, tilting or falling. Vertigo is often associated with nausea, vomiting and sweating. Your balance may also be affected and standing or walking may be challenging, which can lead to increased chance of falls. Vertigo affects your vestibular system. The vestibular system is the sensory system that controls information regarding motion, equilibrium and spatial orientation. Causes Vertigo is most commonly caused by a condition called BPPV or benign paroxysmal positional vertigo. This occurs when tiny calcium particles clump together in the inner ear and become loose, affecting the balance receptors and messages sent to the brain regarding balance. Symptoms are often triggered by lying down, rolling over in bed or tilting the head backwards. BPPV usually affects people older than 50 years. There may be no obvious cause, but in some cases it may develop after a minor head injury, ear surgery, or following a period of prolonged bed rest. Symptoms
  • Loss of co-ordination/un-steadiness
  • Nausea
  • Sweating
  • Blurred vision
  • Ringing on the ears
  • Headaches
 Treatment Treatment depends on the cause. In most cases vertigo goes away without treatment. For instance, vertigo may go away in a few weeks as the brain learns to compensate for an imbalance caused by the inner ear. However, if symptoms persist treatment options are available
  • Vestibular rehabilitation or balance training – this is a type of physical therapy that strengthens the vestibular system and aims to restore a person's sense of balance using other senses​
  • Canalith repositioning procedure – this is useful if the cause is BPPV. The treatment aims at moving these calcium deposits out of the inner ear canal so they can be absorbed by the body
Posted in Blog, Physio Blog

Mulligan Thoracic techniques

These are pain free techniques designed to get the joints in your thoracic spine moving. These include the intervertebral joints, costo vertebral joints (vertebrae and rib joints), and the ribs themselves. They can help people with anterior, lateral or posterior thoracic chest pain. These rely on the movement of the joints into a pain free position. The joints become jammed in the wrong position creating pain, with further movement this jamming is exacerbated and your pain increases because the joint is jammed harder. Mulligan techniques rely on unjamming the joints and then regaining movements. For this reason the techniques need to be pain free when performed because this is what tells us that the joint has been moved into the correct position. Each vertebrae has 2 articulations or joints with the vertebra above and below and with the ribs on either side. The ribs usually have a joint with the transverse process of one vertebra and another joint with the body of the vertebra above. This means each vertebra has 6 joints, 3 on either side. This is why your thoracic spine gets so stiff when it is sore because the joints all start to tighten. Mulligan techniques are designed to unlock these joints and get movement back into your thoracic spine. So if you get chest pain with movements or even coughing (not associated with a respiratory infection), then these techniques could work for you.
Posted in Blog, Physio Blog
Mulligan techniques for the ankle

Mulligan techniques for the ankle

A couple of techniques which Brian Mulligan developed are for regaining ankle dorsiflexion that is pulling your toes towards you, and plantarflexion or pushing them down or away. The first technique uses a movement of the tibia and fibula forwards while pushing the talus and navicular back. The patient is then asked to dorsiflex their ankle while overpressure is applied. It is interesting that the joint is moving in the opposite direction to which you would expect. This is because the joint actually glides as well as moving and getting the glide part right first, gives a much better result.

The second technique for plantarflexion is where the tibia and fibula are moved back and the talus and navicular are moved down while the patient is asked to point their toes and ankle down. Again this relies upon a pain free technique and a glide of the joints before the movement occurs.

These techniques can work very well in stiff ankles.

Posted in Blog, Physio Blog
The problem with Parkinson’s

The problem with Parkinson’s

By Melissa McConaghy The problem with Parkinson’s is not that it slows you down, that it impairs your thinking and can make you depressed. The problem with Parkinson’s is that it takes away your control – your independence, dignity and ability to do the things you want to do. Sometimes it takes away your hope. The medical model that manages Parkinson’s makes this even worse – medications, while an important part, take you further into the sick role. Taking medication is a relatively passive activity where you have minimal control over the outcome. Time and time again I used to meet people like you. I would hear their frustration, their fears of the unknown. What were they going to be like in five years, 10 years? Before, I didn’t really have much to offer. I was only starting to work with people in the moderate stages of their disease when falls and daily life were becoming really bothersome. I was well trained to work on balance, walking and daily skill training – but not much really changed long-term. As a therapist it was not satisfying work and it would have done little to have improved your situation. Now, with PD Warrior – it is very different. Because I know that I can help, that PD Warrior can help. PD Warrior was originally designed just as an exercise program. The physical results were amazing, it was a novel treatment, we were working people harder and more specifically for their Parkinson’s and people were loving it – but there was something even more amazing. People’s levels of confidence and quality of life were improving. Their perspective on how they were going to live with their Parkinson’s was changing. They were making friends with other people who were also working hard to be their best. People were starting to drag their ‘bucket list’ out again. They then started ticking things off. Cycling up the hills of the Tour de France, travelling to Antarctica, returning to playing Tennis, golf, looking after the grandkids. Folding the laundry. Creating their own support network. None of this was insignificant. PD Warrior was giving people hope that there was life after diagnosis. That they could regain the control they thought had been taken away. They were developing a self-belief they didn’t even know they’d lost. And word was spreading fast. PD Warrior has now touched the lives of thousands of people around the world and has challenged both medical and health professionals to reflect on the current model of management. It has created a community of people who want to connect, engage and support each other – through the highs and the lows. PD Warrior remains in direct contrast to traditional management and we now know that taking medication is not enough. We want to see you early, work you hard and help you set up a strategy to keep exercising well, long into the future. So, if you thought PD Warrior was all about the exercise, you’ve missed the most important part. PD Warrior is about helping you have a better life, in spite of and because of your Parkinson’s. PD Warrior has changed lives, and we’d like to change yours too. Join the community and do something your future self will thank you for.   About the author Melissa McConaghy I am the owner and creator of PD Warrior. As a physiotherapist with a special interest in Parkinson's and neurological Rehab I am here to help!  
Posted in Blog, Physio Blog
Opioid Medication

Opioid Medication

This group of drugs include, codene, endone and morphine. They have a direct slowing effect on the bowel. The drug binds with the opioid receptors located along the length of the gut. The end result is decreased peristalsis (muscle action in the gut to move contents along), decreased fluid secretion, vital to keep the stool soft and moist, increased sphincter tone, (the valves become smaller), increase fluid absorption, drying out the stool. This has become such an issue that we now have a label, Narcotic Bowel Syndrome. People with pelvic pain syndrome may well be making themselves worse by taking pain medication that is opioid based. It is important to keep your pain under control but there are other medications and methods that maybe need to be explored.  Many people ask me “should I use ice or heat?”. My answer is always the same, use what ever gives you relief. Ice is intended to help settle inflammatory pain, which it does pretty well in the acute setting. While heat tends to work better where there is muscle or joint pain of a more long term nature. What many people don’t try is placing the heat or ice pack, against the labia, in the Saddle region. Lots of relief can be gained doing this, get 2 pack one down there and one on the tummy. There also stick on heat patches, one use only. These last up to 12 hours and would be great as panty liners. We have these at our practice and they are cheap and effective. I placed one on as a trial. Put it on at 7.00pm wore it all night to bed and was very surprised when it was still emitting a gentle heat the next morning. Great if you have to travel, if at an event, or just going to work. I am not sure about use during plane flight. May not get through security as it relies on a chemical reaction, to make it work.  
Posted in Blog, Physio Blog
Irritable Bowel Syndrome

Irritable Bowel Syndrome

A complete half a day was dedicated to IBS at the International Pelvic Pain Conference. The reason being is that this is a very common illness which can cause pain in the region of the pelvis. If you suffer from IBS you will know that IBS is a cluster of symptoms, including pain, constipation, diarrhoea. It appears that researchers are getting closer to a brain/neurology model of irritability. We are becoming more and more aware as health professionals that the mind and body are intimately linked. There is now work looking at transcutaneously (through the skin) stimulating the vagal nerve, which is leading to reduction in bowel irritability. Obviously there is more work required, but the research is well underway.    
Posted in Blog, Physio Blog

International Pelvic Pain Conference

International Pelvic Pain Conference On the 8th October I will be flying off to Washington DC. I have been invited to present 3 posters on pelvic pain at the International Pelvic Pain Conference. I will be presenting 3 cases that I have successfully treated, that are all due to muscle imbalances around the pelvis. What I am starting to discover by working through and reflecting on theses cases is that there is probably such a thing as abductor syndrome. I haven’t found any references in the literature that such a thing exists. So I will be doing some research into this over the next few years. Surprisingly all 3 cases had pain with intercourse as one of their primary complaints. It is often assumed that this is due to pelvic floor muscle trigger points, but in these cases this was not the primary causative factor.
Posted in Blog, Caroline's Blog - Pelvic Girdle Pain

Mulligan Therapy

Brian Mulligan developed the Mulligan therapy concepts on the basis of his clinical findings with patients. He was able to develop a number of techniques starting from simple finger techniques through to more elaborate techniques. His basic concept for treatment is that the joints are slightly out of alignment. Pushing the joint further out of alignment will create pain but pushing the joint back into correct alignment will reduce pain and allow pain free movements, thus it is very important when using these techniques that the patient understands that they have to inform the therapist if the technique is hurting. A simple explanation of the first technique he developed might explain this. He had a patient with a sore finger that wasn’t responding to normal established physiotherapy techniques. The patient couldn’t bend her finger. He thought he should try something different. He found the sore joint and pushed on the bones either side of the joint. This made the patient sore. He then pushed the joint in the opposite direction and the patient reported that it felt better. He then asked the patient to bend their finger and was amazed to see the finger bend fully without any pain. Since then he has developed techniques for just about every joint in the body. The results from these techniques are amazing to see at times but the critical thing is that they need to be done pain free. The less pain the better the techniques work. They often work really well with other techniques to achieve great results for patients.
Posted in Blog, Physio Blog

Fascia

The deep front line fascial train passes through and surrounds the pelvic floor. This fascia extends from tibialis posterior in the lower leg up to diaphragm and into scalenes in the neck. The fascial network is continuous and very little in known about its functional relationship to muscle tension and less is known about changes that may occur during pelvic floor rehabilitation, (exercises) and surgery. Meyers a well known fascail train expert and myofascial therapist believes that fascia is a highly adaptive structure that can change in response to forces placed through the body. We do know that fascia is made mostly of elastic tissue and has no contractile elements like muscle. We can also demonstrate fascia is able to lengthen or tighten, depending on loads applied. Lets argue that a weak pelvic floor, which is essentially bowl shaped, deepens. This deepening potentially stretches the fascia over time, maybe 1-2 years. Which then leads to less support through the pelvic floor for the pelvic organs. Strengthening the pelvic floor leads to reduced stretch of the pelvic fascia. Therefore we could assume that those that get some relief from their pelvic pain by lying down, especially if the pelvis is higher than the shoulders, may get relief from long term pelvic floor strengthening routines. We could also assume that some of the pelvic pain may be due to altered tension of the pelvic fascia.
Posted in Blog, Caroline's Blog - Pelvic Girdle Pain

SIJ Pain in Pregnancy

Pregnancy should be a wonderful time of planning and bonding with your growing bump. Unfortunately it can also be a time for discomfort as your baby bump grows and your pelvis expands. A hormone is secreted during your pregnancy called relaxin which helps everything expand for your baby to grow. This can affect all joints in the body including your pubic symphasis and  sacroiliac joint or SIJ. Many pregnant women experience pain into their lower back, bottom, groin and down the legs. This could be due to movement in the SIJ, tightening of the gluteal muscles and extra strain on the lower spine due to the changing shape of pregnant women.   Physiotherapy can help make the countdown a little more bearable. We can work on supporting your SIJ with core and pelvic floor strengthening, massage and stretches to relieve your tightening gluteals ( the more you waddle the worse it gets), educate you on things to avoid that can make the SIJ move and we can if you with a sacroiliac belt that may help ease your discomfort. If this sounds like you, or something your midwife has suggested, why not make an appointment to find out more.
Posted in Blog, Physio Blog

Prolapse Rehabilitation

Some women (and men) can develop a pelvic organ prolapse during their life. According to literature about half of all women who have a child will develop some degree of pelvic organ prolapse however only 1/5 will need seek help. It can also develop in people who are overweight, have a chronic respiratory condition, constipated, or due to genetics. Some women will also prolapse after a hysterectomy as the supportive structures holding their organs to their uterus are removed.   Physiotherapy can help with prolapse management by helping reduce the symptoms of your prolapse and educate you further on your prolapse. We help you exercise your pelvic floor muscles, work on proper lifting technique, discuss adequate fibre and fluid input to further help reduce your symptoms and strain on the prolapse. If you have a prolapse why not make an appointment with us today, it’s never too late to start exercising your pelvic floor muscles.
Posted in Blog, Physio Blog

Cervicogenic Headaches

Definition:                                                                                                                                           
  • Refers to a headache of cervical origin
  • The International Headache Association defines cervicogenic headache (CGH) as a pain referred from a source in the neck and perceived in 1 or more regions in the head and/or face
  • May arise from cervical joint, muscle or ligament dysfunction
  • Difficult to diagnose due to multitude of headache types and overlapping characteristics
Signs/Symptoms:
  • Unilateral or bilateral
  • May affect any area of the head
  • Neck pain
  • Muscular trigger points in head or neck
  • Tight band around the head
  • Shooting or stabbing pain behind eyes
  • TMJ pain
  • Dizziness
  • Visual disturbances
  • Vascular or autonomic response mediated symptoms
Treatment:
  • Mobilisation and manipulation are passive movement techniques aimed at restoring normal ROM within a joint
  • Mobilisation refers to a passive movement, rhythmic in nature, which may vary in amplitude
  • Manipulation is defined as a small amplitude, high velocity thrust applied at end of range
  • Either technique may be administered to alleviate a CGH.
  • Commonly physiotherapists will also use soft tissue techniques to release tight musculature which may also be contributing to headaches. This can be done through massage or dry needling
  • Your physiotherapist may also provide you with a home exercise program. Exercises may involve stretching or strengthening to at maximise biomechanics and long-term outcomes.
Posted in Blog, Physio Blog
2017 Charity Ball

2017 Charity Ball

Mitchell Physio is having a Charity Ball on July 1st and we are still looking for sponsors or people to (more…)
Posted in Blog

Latest Blog Posts

Tendinopathies: Surgery vs Physiotherapy

Jul 10, 20190 Comments

There are many uncertainties over the exact pathophysiology of tendinopathies. With the emergence of new treatment modalities making decisions regarding management can be difficult. A systematic review conducted over the past 12 months highlights the benefits that surgery and physio have. Though the study shows very little difference between the two management techniques. The management […]

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Maitland

Maitland Practice

Address: 44 Ken Tubman Drive, Maitland, NSW 2320
Phone: (02) 4933 6895
Fax: (02) 4934 1186

Kurri & Cessnock

Kurri Kurri Practice

Address: 3B, 110A Lang St, Kurri Kurri, NSW 2327
Phone: (02) 4937 5308
Fax: (02) 4934 1186

Dungog

Dungog Practice

Address: 114 Dowling Street, Dungog, NSW 2420
Phone: (02) 4992 1498
Fax: (02) 4934 1186
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