Dry Needling

Dry Needling

Straight to the point! 

You know that sore spot or trigger point that all us physios talk about?  What about that tight band of muscle that you just can’t roll out or target with your massage ball? Dry needling is your man.  It’ll get straight in there and clear that pain, tight point or band right up. 

What are trigger points anyways?  A muscle is made up of hundreds of filaments that contract and relax every time we shorten and subsequently lengthen our muscles.  Through sustained postures like sitting at computers, carrying children, handbags or repetitive movements at work muscles can become tight, weak or both. Similarly, with injury or times of inactivity, we can develop so called ‘trigger points’, where those contractile filaments get locked, tighten parts of the affected muscle and cause pain. These have also been referred to as ‘knots’.  Trigger points not only cause pain and restriction at the centre of them, but can refer severe pain away from themselves and restrict normal movement of the whole limb or area. 

So what is Dry needling? We use small needles that are only .25-.3mm thick and when tapped into the muscle aim to stimulate the trigger point and release it. When we hit the spot and get a full release of those particular filaments, the muscle will elicit what we call a twitch response.   This may feel odd or even a little painful, but can be very beneficial in the end because these twitches are the muscle fibres unlocking and returning back to normal working length.  

After dry needing you can expect increased movement and pain reduction.  However, in the first 24 hours it is normal to feel a heavy and achy feeling, especially with higher grade treatment or with certain muscle groups (e.g. upper traps). Your physiotherapist can grade your treatments to see how you react after the first session and then adjust the treatment accordingly. This is because we have created an inflammatory response in your muscle by breaking the skins surface and micro damaging the muscle fibres. In response, the body increases blood flow to the area, bringing with it histamine and other goodies to start the healing process. Histamine is our body’s natural relaxant and will continue to relax the area and increase blood flow to the muscle for the next three days! It is recommended to drink lots of fluids for the next 2 days after treatment and not to take ibuprofen or any anti-inflammatories, since we have just created a good inflammatory response and need the body to do its thing. 

What conditions may benefit from dry needling? 

Almost any injury or condition. Some of these may sound familiar to you:

  • Tight quads, patello-femoral pain or knee dysfunction. 
  • Tennis of golfers elbow
  • Neck pain and headaches 
  • Acute and chronic neck pain
  • Sciatic pain
  • Plantar fasciitis
  • Shin splints 
  • Gluteal issues and hip bursitis
  • Shoulder impingement and pain
  • And the list goes on…

So come on in and ask one of our great Physios on the benefits of Dry Needling and how it can help you. Book online or give us a call at (02) 9810-2839.

Returning to Sport – but hold up, not so fast! 

Returning to Sport – but hold up, not so fast! 

Read to the bottom to claim your gap free or 50% off return to sport appointment

As restrictions are easing we all seem to be spotting the light at the end of the tunnel and wanting to just sprint towards it, but hold up! While I understand the excitement and share it with you all, we must remember that COVID has changed the many people’s routines. For some of us, this includes more time spent in the typical ’T-rex crouching in front of a laptop’-position, for others it may have been the lack of walking to work, running for a bus or taking the stairs to the place of work. Little activities like getting a coffee or going for lunch required little or large walks that would break up our day and give us some form of exercise. You may not think it’s a lot but little activities can accumulate and before you know it the 5 minutes of movement x4 daily can quickly amount to more than 2 hours of extra movement each week. Now consider that many gym-goers lacked the equipment to match their pre-COVID training intensity and group sporters lacked the legality of training with their teammates.


Fast forward to today and the light at the end of the tunnel, all I ask of you is to take it slowly and pace yourself. As I will shortly explain, pacing can be the difference between you going on your merry way to return to your sport of choice and injuring yourself just to add several weeks or months of rehab to your program.


How do I pace myself? 

To successfully pace yourself, you need to lower your expectations of the intensity and volume of your workouts for the first few weeks. Even with home workouts, I advise against picking up where you left off. Take this time to clean up your technique, practice low impact skills, and build mobility. Mobility refers to the ability to support all ranges of movement available to you. In other words, slow down your training for now and build it back up to match your strength to your flexibility.


There is more…

Now that we know what pacing is, I want to address another modification to your training: Assess what you spend most of your day doing. It can be sitting at a laptop, standing for long periods, or looking down/ bending over a lot. Include an exercise that counters the movement you do all day. If it’s sitting, you may want to add hip extension (straightening) exercises like deadlifts or bridges to your program, while a person constantly standing may want to add squats and core exercises, and a person bending over a lot may want to focus on back extensor exercises.


How do I Prehab? 

Get your warm-up right and focus on ‘activating’ all your stabilisers. For your shoulders that would be the rotator cuff, for your hips, this may be various hip muscles like e.g. the gluteus medius.


Lastly, you know where we are. Should you need a prehab program where we assess what to focus on, or want to know more about your return-to-sport, book-online or give us a call at (02)98102839.

When should I see a Physio?

When should I see a Physio?

A lot of people don’t know when to see a physio. They might ask a friend or family member, google their condition (don’t do it!) or just stick it out hoping for it to get better.
Here are five tips to determine whether you should come in for an appointment:
1. I’ve sustained an acute injury
If you have hurt yourself, it’s good to come in and let your physio assess the extent of your injury and give you tips on initial management. Some injuries might seem worse than they are, and others might masquerade as harmless. Either way, it’s good to get peace of mind and prevent unnecessary worry or further harm.
2. I’ve had this pain for a while
Pain in one area can create a cascade of compensatory behavior. Come in early, because the longer you stick it out, the more factors can contribute to your problem and make finding the original cause a lot murkier.
3. Limitations without pain
You don’t need to be in pain to see a physio. Especially if something is limiting you during your daily activities, training or work it’s worth consulting as physio and finding a solution.
4. Past injuries or conditions
If a past injury is bothering you or you are thinking of starting a new activity or sport, you could get a general assessment. This is because, with changes in behavior and activities, something that was previously harmless may become problematic. This applies to anything from previous fractures, musculoskeletal injuries and/or acquired and hereditary conditions.
5. Is this physio related? 
Many people presenting with vertigo or headache benefit greatly from seeing a physio. If you are experiencing dizziness, nausea, incontinence and/or night pain we may refer you on to see a doctor as a precaution to rule out any more serious causes of pain, discomfort or dysfunction.
Besides this, you can always just call up and have a chat with us!
If you have tried different treatments before, communicate this to your physio and they will find something that works for you.
How Long Will it Take to Get Better??

How Long Will it Take to Get Better??

How long will it take to get better Phys?

This is a question we get asked multiple times a day, every day.

Firstly, every injury is different, as is every patient. It is not one size fits all or one magic potion. In saying that though, most injuries have similar patterns of recovery and rehabilitation.

The first stage of physiotherapy is usually to decrease pain and inflammation and address any neuromotor deficits (like balance or coordination). This will be followed by regaining range of motion and increasing neural mobility if a deficit was present. This may take 1-2 weeks. Or even longer in severe and complex cases. I can assure you, you will feel great and even forget about the injury once the pain has eased. But wait!, not too fast there. Rehab is not over and re-injury is common without ticking the next few boxes.

This is the fun and hopefully pain free part of physio and sometimes the more important part. This is where you learn to stop re-injury and take home a tool box of techniques that will allow you to recognise and strengthen before the same pain arises again…..which it may if tissues are not strong enough. Pain may even sneak back at times in a lesser way in your rehabilitation journey. This is completely normal.

We will correct biomechanics and increase stability with specific muscle activation and lengthening techniques. Yes you guessed it, stretching and exercises. Exercises are so so SO important. It is at this stage that recovery times are lengthened from slacking off, and weakened structures are compromised.

Last and probably the most fun is regaining proprioception – regaining balance and joint awareness and including sport specific function into rehab if that is what you need for a full recovery.

So how long is recovery? Well soft tissue averages at 6 weeks to heal. Ligaments take on average 3 months. That’s not including the second stage of rehab. So some rehab will average from 6 weeks to 3 months depending on some injuries and others take up to 12 whole months.

Physiotherapy Treatment of Migraine and Headache

Physiotherapy Treatment of Migraine and Headache

Migraine and headaches can have a significant impact on the quality of life for those who suffer from them.

Overcoming headaches and migraine relies on an accurate diagnosis of the cause of the problem. While significant research exists about the role the neck can play in headache and migraines, the neck is sometimes ignored as a possible cause of headaches and migraine.

Physiotherapists at Rozelle Physio have undertaken special training in the Watson Headache Approach to provide effective management of headaches and migraines that are caused due to issues in the neck.

The Watson Headache approach relies on taking thorough history of the headaches and migraines from the patients, followed by a careful physical examination of the neck and surrounding structures. The aim is to be able to not only re-produce the headache or migraine pain, but to also relieve it with a sustained technique.

Physiotherapists who train in the Watson Headache Approach know how to:

  • Identify the relevancy of symptoms arising from the C1-C3 upper cervical spine levels
  • Apply a scientifically validated series of techniques in a systematic way to identify if the upper cervical segments are responsible for headache or migraine
  • Reproduce and resolve headache with demonstrated de-sensitisation of a sensitised brain-stem
  • Correct musculoskeletal problems that are causing symptoms to arise for the affected cervical levels

If you would like to book a consultation with a physiotherapist who has trained in the Watson Headache Approach, please use the form below.


Running Retraining for Exercise and Performance

Running Retraining for Exercise and Performance

(Read to the end of the article if you have a running injury and would like to have a free initial consultation with a physiotherapist)
Running is good for you. It boosts immune cells, heart and lung function, decreases insulin resistance and has been shown to decrease the rate of knee osteoarthritis. It has also been proven to decrease chronic systemic inflammation, not to mention preventing at least 25 other chronic conditions.

It’s no wonder then that lots of people run – but as physiotherapists we often see people who have injured themselves when they run the wrong way.
So what are the main things that runners do that lead to injury, and how do you avoid them? Here are the top three.

1. Technique
Most runners display one or two minor issues with their running technique that unchecked can lead to major issues, such as over- stride, excessive foot pronation or landing on a suboptimal part oftheir foot. Small technical problems can turn into big headaches when running over long distances or at a suboptimal pace. For example, runners who overstride often land on their heel, which can lead to injuries such as plantar fasciitis, patellofemoral pain and shin splints. Ouch!
An expert such as a physiotherapist can assess your running technique and give you the tips and advice you need to make small changes to your running technique that will make a big difference when it comes to potential injuries. Even something as simple as shortening your stride can help to reduce the ground reaction forces that ultimately lead to avoidable pain.

2. Match Fitness
As they say, you have to walk before you can run. Intrinsic factors in individual runners such as lack of flexibility or lack of strength in key stabilising and global muscles can decrease your capacity to employ proper running technique. If you’re just starting your running journey, chances are you will experience one or more of those issues.

For example, runners with tight anterior hip muscles which are the hallmarks of having a desk job and weak glutei (i.e. booty muscles) that simply aren’t worked enough frequently experience lower back
pain, hip impingement, patellofemoral pain and Achilles tendinopathy after running. Physiotherapists can assess your key “running muscles” and work out exactly what you need to do to improve your underlying capacity to ‘run, Forest, run!’ Just increasing your glutei and calf power by 10% can seriously increase your ease of propulsion and muscle power.

3. Power Load
Load management is key when running because all runners need to manage their training load to ensure they have capacity to handle the big forces being exerted on the muscles and bones in their legs. If these things aren’t managed well, it leads to avoidable pain. When you run with pain you inevitably adopt maladaptive (bad) behaviours leading to both physical and non-physical changes such as increased stress and decreased running capacity. It really is a vicious cycle.

A physiotherapist can assess and educate you on the best way to manage your training loads. Something as simple as adjusting your gait through specific, targeted exercise prescription can seriously improve muscle capacity and have you running better.
Book an appointment today with our specialist and passionate physios at Rozelle Physio and receive a gait analysis, muscle testing and a personalised exercise prescription to improve your running today.


What are the Deep Hip Muscles and Why are They Important for Hip Pain?

What are the Deep Hip Muscles and Why are They Important for Hip Pain?

What are the deep hip muscles and why are they important?

Many of us would have heard about the “core” muscles and how important they are for people with back pain, or about the “rotator cuff” muscles and their role in protecting the shoulder. But very few people, even those with hip pain, would have heard about the deep hip muscles and their role in protecting the hip joint.

A group of Australian physiotherapists and leading researches have proposed that the deep hip muscles (glute med, glute min, piriformis, illiacus, illiocapsularis, gemelli and obturator internus) play an important role in stabilising the hip joint. That is because these muscles are situated in a position very close to the hip joint and have a high proportion of type 1, slow twitch muscle fibres. This is the ideal combination for producing a stabilising force around a joint. EMG studies, also show that these muscles activate at times that could only serve to stabilise the hip joint.

So why is this important?

Many of the common hip injuries such as osteoarthritis, trochanteric bursitis, femoracetabular impingment (FAI) and labral tears can be the result of excessive movement or laxity in and around the hip joint. At the same time, research has shown that when we have pain in a joint, the muscles that stabilise that joint often stop working properly, they switch on too late or atrophy. So identifying these muscles in the hip joint gives options for rehabilitating these important muscles. If these muscles do play an important role in stability, then making sure they are strong and functioning well could help prevent hip problems.

How Can we Assess and Rehabilitate the Deep Hip Muscles?

Because the deep hip stabilisers are quite small and quite deep, we use real time ultrasound to identify these muscles in physiotherapy and check if they are functioning well. We can also prescribe exercises to target these muscles, again using real time ultrasound to check the exercises are being performed well. Once the patient is able to recruit and switch on these deep muscles well, we then move on to more functional exercises that recruit larger muscle groups too.


Heel Pain and Plantar Fasciitis Treatment

Heel Pain and Plantar Fasciitis Treatment

(Read to the end of the article if you have heel pain and would like to have a free initial consultation with a physiotherapist)

Heel pain caused by plantar fasciitis is a condition we commonly treat at Rozelle Physiotherapy.
The plantar fascia is a band of connective tissue that runs from the base of the heel to the toes. The plantar fascia supports the arch of the foot and acts like a spring during normal walking.

What Causes Plantar Fasciitis?

When there is too much load placed on the plantar fascia, such as an increase in exercise, walking on hard surfaces, poor footwear, abnormal biomechanics or an increase in body weight, then the plantar fascia can become painful. The pain is usually worst on the bottom of the heel and can be most severe with the first few steps in the morning or after spending a long time on your feet.

How Do Physios Treat Plantar Fasciitis?

Early treatment usually involves correcting the contributing factors by modifying load, improving the biomechanics of the foot and ankle, stretching tight muscles and improving the range of movement of the foot and ankle. We may also use soft tissue massage to improve the mobility of the calf muscles and plantar fascia, or dry needling of the plantar fascia.

Chronic Plantar Fasciitis and Shockwave Therapy

If the problem has been occurring for a long time, it can be particularly stubborn and difficult to treat. So as well as the above treatment, Rozelle Physiotherapy has recently started using extracorporeal shockwave therapy (ESWT) at the practice to help treat chronic plantar fasciitis. ESWT uses pressure waves to treat musculoskeletal conditions such as plantar fasciitis and tendinopathies. It is particularly useful when the condition is chronic.

Studies show that ESWT is safe and effective for reducing pain in chronic plantar fasciitis. Recent research comparing ESWT to corticosteroid injection for chronic plantar fasciitis found that ESWT had greater reduction in pain after 12 weeks compared to the corticosteroid injection group.
At Rozelle Physio we have also been finding that patients are having a good response to treatment with ESWT. Pain relief is often immediate after the session.
Usually treatment involves 1 session per week of 2000-3000 pulses for 4 weeks. At Rozelle Physio there is no additional charge for ESWT as part of physiotherapy treatment.

If you have had long term plantar fascia or tendon pain and would like to assess if Shockwave Treatment may be appropriate for you, use this link to click for a free initial consultation:


“That’s Tight Y’all”

“That’s Tight Y’all”

“I feel really tight…..it’s nice” – Said no one ever

I have lost count of the times I have had patients come in complaining that their muscles feel “tight” or that they feel “stiff”. This feeling may or may not be accompanied by pain and is generally a fairly constant thing that increases or decreases without rhyme or reason. Additionally, these people often tried everything under the sun; from stretching to heat to supplements, all to no avail. People will resort to “adjustments” from chiros, releases from massage therapist or hours on end of hot yoga, all to try to alleviate this tightness. I feel your pain (Tightness, as the case may be), I can fully empathize with this sensation of feeling stiff and tight. I can’t even remember a time when my hammies and upper traps haven’t felt tight. Let us try to delineate some of the possible causes for this annoying phenomenon.

We must first separate something important from the get-go. THIS IS NOT TO DO WITH YOUR MUSCLES LENGTH. Tightness/stiffness is very rarely a range of motion issue unless you have certain conditions e.g. Parkinson’s or brain injury. Interesting fact to prove my point – In a poll of hyper-mobile people 80% reported that they felt MORE stiff than the average person. The polar opposite being true as well – people with crappy range or flexibility can feel perfectly fine. So don’t assume that just because you feel tight that you are literally tight or shortened in those muscles.

“Normal” range doesn’t even truly exist anyway. Sure, we have averages out there for what we are generally looking for but what is “normal” is dependent purely the individual and what they need that joint or muscles to be able to do in their daily life. Case in point, swimmers and baseball throwers require huge ranges of shoulder motion that would be considered abnormal by any relevant measure. Although a cool trick to bring out at parties, being able to do the splits has no bearing on well, anything really.

Inflammation, a big word that gets thrown around a lot. Tissue inflammation can definitely cause tissue irritation and thus stiffness & tightness. “Inflammaging” ( I promise that’s a real term that I didn’t just make up right at this moment) is a combo of inflammation and aging. Put simply, it means is that as we age we get more inflamed and therefore a feeling of more stiffness. Just like with Arthritis, some people get it worse than others – blame the genetic lottery folks. However, this doesn’t answer the question of why many young people feel stiff. There are many possible causes but the most likely explanation is our good old friend muscle knots/trigger points.

Trigger points are super common pressure-sensitive soft patches of the muscle that may be active (acutely painful) or latent (hurts with pressure applied). Think of them as mini-cramps in the muscle giving that sensation that the muscle is “tight”. This explains why there is often not an actual tissue extensibility problem. Although we don’t know exactly why they appear, we do at least know what they respond to and they can be treated relatively well if the therapist knows what they are doing. I like to think we here at Rozelle Physio know what we are doing when treating these pesky spots 😉

Finally, we come to psychogenic stiffness. Those stressed at work know all too well this feeling of stress-induced “tightness” (the neck often feeling it worst). Amazingly, the mere fact that you believing you are stiff could result in feeling that way. A self perpetuating stiffness you might say. There may then, therefore, be some credence then in freeing up the mind to free the body. State of mind equals state of body – possibly……… can’t hurt to try think loose thought!

Key points:
– Your muscles are not chronically short
– Aging and inflammation have a role to play in the tight sensation
– Trigger points are also a biggie – Thankfully they can be treated!!
– Think loose thoughts 🙂

No more RICE, call the POLICE!!

No more RICE, call the POLICE!!

Physios love our acronyms, from ACL to VBI and every letter in between (unfortunately no acronyms begin with ‘Z’) we have acronyms for everything. The most well known of these is one thrown around in every sporting field in the country…..RICE. ). It’s easy,  every coach, player or parents knows; Rest, get the ICE, COMPRESS the area, and ELEVATE! That’s the correct thing to do right? RIGHT?  As soon as someone goes down with a sprain or strain “QUICK, get the ice” (as though ice has magical healing properties I was not aware of).  Alas, while ice can help numb the pain it does not speed up recovery (may actually hinder in some cases but that’s for another blog). With what the evidence tells us, it may be time for an update to this outdated practice.

We see soft tissues injuries from sports all the time in the clinic; whether it be muscular strains (Commonly hamstring) or ligament strain (ankle). It’s frustrating from a physio standpoint to see these relatively simple, common injuries managed so poorly in the acute stage. The blame lies primarily with ‘old school’ practitioners avoiding change to traditional methods that have been in place for decades. As the adage goes ‘you can’t teach an old dog new tricks’.

Fear not though, here comes the POLICE to the rescue. Another acronym I know ( I told you we love them) but one that actually aids the healing progress from minute one. You will notice that the ‘ICE’ remains the same…. ‘Phew I don’t need to remember 5 new words’.  The ‘P” = protect which is really just the same as the ‘R’ but it wouldn’t be right if our acronym didn’t form a cool word, ROLICE doesn’t have quite the same ring to it.

The critical point of difference here is the ‘OL’. Which lead us to this term of “Optimal load” which you may have heard if any of you have been to see us before in clinic. Sounds good, but what does this fancy term actually mean? Ahhhh you see, this is where you’re friendly neighbourhood physio comes in to guide you.

I call this the ‘Goldilocks principle’. Just like Goldilocks, we want to find Kellogg’s ‘Just Right’ (I may not have been paying attention in fairy tale class). That is, the adequate amount of load on the injured tissue that will aid tissue healing and recovery. Instead of playing a guessing game like goldilocks did, your physio can help guide you with finding that sweet spot. However if you decide to brave it alone, a good rule of thumb is to let pain guide you. *Unpopular pinion time – Pain is awesome (acute pain) because without it we don’t know when things hurt (duh).It’s surprisingly critical for our survival (ask anyone who can’t feel pain how day to day life feels). We use this important sense to determine what is a safe amount to ‘load’ things up. Think safe as anything that stays within 1-3/10. You WILL NOT damage to the tissues with this amount of pain. Pain DOES NOT equal damage.

So next time you go down with an injury optimally load that baby

Key points:

– No more RICE (stick to potatoes or pasta for your starchy carbs)

–  Call the POLICE (not literally, maybe call us instead)

–  Optimally load that injury (get into the clinic Goldilocks)