Back and neck pain

Back and neck pains are among the most common presentations to a physiotherapy clinic. Acute back pain generally lasts a few days or weeks, and is often mechanical in nature and caused by some form of trauma e.g lifting a heavy object, a fall, sports injury or prolonged activities such as gardening or sitting in front of the computer.

Chronic back pain last for a longer period of time, generally more than 3 months, and may be more degenerative in nature.

Common causes of back pain include:

Ligament or joint sprain and muscle spasm

May be caused by heavy lifting, prolonged bending or sporting injuries. Pain is usually felt in the lower back, sometimes one sided. Movement is often restricted. Physiotherapy treatment for this type of back injury usually gives good results and can reduce recovery time and prevent ongoing problems.

Disc bulge (sometimes called herniated or ruptured disc)

The disc between the vertebrae may become damaged and bulge slightly, causing pressure on the surrounding nerves. This can cause symptoms of back pain, leg pain, pins and needles and possible numbness. Physiotherapy treatment is usually indicated.

Postural back pain

Poor posture can be one of the most common causes of back pain. Sleeping position, work desk set up and standing posture may all be contributing factors. Back pain and injuries are often caused by weak abdominal and back muscles, contributing to poor posture and reduced ‘core strength’. Physiotherapy can assist in retraining muscles to correct inappropriate postures.


Refers to pain originating from pressure or irritation to the sciatic nerve. This nerve exits the spine in the lower back and travels down the leg. Causes of sciatica may include a disc bulge, muscle spasm or poor posture. This condition requires careful assessment and specific Physiotherapy treatment is directed in accordance with symptoms and or neurological deficits.

Degenerative changes

Back pain and stiffness may develop from ‘wear and tear’ to the spinal joints and discs. This can be degenerative in nature, be gradual in onset, and may become chronic. Early morning stiffness and pain with prolonged standing is a common complaint. Physiotherapy treatment can assist in reduction of back stiffness and therefore improve quality of life.

Physiotherapy treatment

A physiotherapy assessment for back pain will allow accurate diagnosis of the problem, and a treatment plan to be formulated. Treatment may involve joint mobilisations, massage, stretches, and exercises.

Physiotherapy rehabilitation for a back injury may involve a graded exercise program to strengthen postural muscles and improve flexibility. Advice on back care, back injury prevention and a strengthening program is a core part of physiotherapy treatment for back pain.


Migraines, depending on the individual, can have varied and multiple triggers.  This can vary from; chocolate, processed meats, hormonal changes etc. Often the cervical spine, although perhaps not the main trigger, when added to the mix can tip the central nervous system into migraine. Treating the upper cervical spine can lead to a significant reduction in incidence and severity of migraine, even when the cervical spine is not the most influential factor.

Colin attended the 3 day Watson Headache Institute level 1, foundation course and the 2 day level 2 consolidation course titled “The role of C1 – C3 Cervical Afferents in Primary Headache”. The courses were held on 9th, 10th & 11th July, 2011 for level 1 and 4th and 5th February, 2012 for level 2, in Sydney Australia and presented by Dean H. Watson, Australian Musculoskeletal Physiotherapist.  For further information go to www.WatsonHeadacheInstitute.Com.  The courses comprised 40 hours and were based on the Watson Headache® Approach, a protocol for the skilled assessment and management of the upper cervical (neck) spine in headache and migraine conditions.  The Watson Headache® Approach is recognized as a scientifically researched method of examination and treatment. The diagnostic accuracy of the Watson Headache® Approach is unparalleled.  It can confirm if disorders in the upper neck are responsible for headache or migraine and determine the exact nature of the disorder as well as which spinal joints are involved.  There is no guesswork and no cracking or manipulation.  Its unique and powerful feature involves temporary reproduction and resolution (easing) of usual head pain.  For further information, go to:

Joint & spinal manipulation & mobilisation

Mobilisation is when a physiotherapist uses a controlled amount of force to move the surfaces of a joint.  A mobilisation should not be confused with manipulation.

How does it work?

Joint mobilisations lubricate the joint and help to relax muscle spasm. Gentle mobilisations are used for pain relief while more forceful, deeper mobilisations are effective for decreasing joint stiffness.

What conditions is it used for?

Mobilisation is a very effective means of treating spinal and joint pain and stiffness, both in the spine and peripheral joints.

Knee Injuries

Physiotherapy is crucial in the rehabilitation of knee injuries, both traumatic and post operative conditions. Focus should be on restoration of range of movement, strength, proprioceptive retraining with conditioning focusing on functional activity and or sport requirements

Medial and Lateral Collateral Ligaments

As with the anterior and posterior cruciates, damage to these ligaments of the knee can put you out of action for some time. It is less likely that surgery will be needed for these ligaments, so strengthening the muscles is imperative to recovery. It is imperative with these injuries that active rehabilitation is carried out quickly and that it is progressed to dynamic stability before return to sport. This way you dramatically reduce the risk of reinjury.

Anterior / Posterior Cruciate Ligaments

Damage to either of these ligaments can see you out of action for many months, so good rehabilitation is crucial. The quadriceps, and more importantly the hamstrings must be strengthened to avoid stressing the ligament, whether it be following a tear or surgical repair. If you are awaiting surgery, the stronger you are beforehand the quicker your recovery will be post surgery. Research is proving more and more that post surgery early movement, controlled strengthening, and proprioception are most beneficial to the healing process. Our protocols are designed to minimise time away from sport and activity, aiming to get people safely back to their sport or work.


There are certain ways to minimise the symptoms of arthritis, including Strength and Nutrition. Arthritis is essentially a deterioration of the joint. This can be slowed down by being strong, fit, active and nutritionally healthy. The strength and control of your leg muscles will determine how much strain your knees take, so the stronger the muscles are and the better the control is, the more the knee becomes protected. Joint replacements can be put off by a significant amount of time if the muscles are strengthened. If a replacement is inevitable then the stronger and fitter you are before hand, the more speedy and successful your recovery will be.

Running Injuries

Running injuries should not be treated in isolation but seen as part of a complex pattern of movement intimately related to running style, posture, individual conformation, muscle strength, length of muscle groups, footwear and running surface. All these things have to be assessed and considered when assessing rehabilitation.

Runners Knee

This injury usually builds up over several weeks of running. The major subjective complaints are pain at the front of the knee (anterior knee pain) during running, stair walking and in particular during prolonged sitting with the knee at a 90 degree angle. There is often pain with sideways movement of the kneecap and occasionally swelling under the kneecap. There is often stiffness of the fibres of the muscle on the outside of the knee as well as biomechanical faults, such as increased ankle rolling, changes of the angle of the knee, increased swayback and general poor muscle control of the lower limbs. The treatment consists of pain relieving techniques release of the tight tissue and retraining of muscles. Foot orthotics may also be used.

Achilles Tendon Irritation

Approximately 10 percent of all runners will at some point experience Achilles tendon problems. This is mainly due to the high impact that is placed on the tendon during running. The athlete usually complains of pain during running and stair walking, but relief while resting. Clinical examination reveals soreness of the tendon during palpation. If the medial part of the tendon is particularly sore, there are likely biomechanical problems as mentioned above. Treatment includes pain relief, decreasing the load on the tendon, and strengthening the calf muscle complex.

Lower Back Pain

As running is continual landing on one or the other leg, there is a high load impact on shock absorbing structures, including the lordosis of the lower back. This may well lead to repeated micro-trauma of the sensitive structures in this area, leading to pain. The treatment will be similar to the treatment of usual lower back pain.

Sports Injuries

Sports injuries are injuries caused by playing sports. The injuries can vary in severity, from a sprained ankle to a dislocated shoulder.

Causes of sports injuries:

  • Overtraining and overuse
  • Under training
  • Poor training practices
  • Wearing incorrect training equipment
  • Not warming up and stretching

Ideally physiotherapists should see injuries while they are in the acute phase (this is the first 24 to 72 hours). Initially sports injuries should be treated with the RICE (Rest, Ice, Compression and Elevation).

The sports injury should then be assessed by a physiotherapist who will accurately diagnose and treat the injury. An injury is a setback and is disruptive to normal training routines, so having your injury looked at immediately is important.

It is important that if you injure yourself playing a sport, stop playing, use the RICE principles mentioned and make an appointment with your Physiotherapist.

Treatment before and after surgery

At Hawkesbury Physiotherapy we believe that it is important to prepare you mentally as well as physically for surgery. Treatment will therefore consist of educating you regarding your up-coming surgery. After surgery the aim is to restore joint movement, muscle strength, limb swelling and improve overall functionality. We try and ensure you are treated by the same physiotherapist pre- and post operatively, implementing the rehabilitation protocols set by your surgeon.

How does it work?

Pre-operative treatment is beneficial because it assists in providing for an optimal recovery post surgery. If you have good muscle strength beforehand it is easier to regain movement and further improve strength afterwards.

Post-operatively, you and your physiotherapist will work on a progressive program of manual therapy and exercise to enable you to return to sport or normal activities as quickly and safely as possible. At Hawkesbury Physiotherapy, exercise rehabilitation is a key component to the effective management of your care. In conjunction with the 1:1 treatment sessions with your physiotherapist, we actively promote the self-management of your condition through home exercise program’s and the independent use of our rehabilitation gym and hydrotherapy facilities.

What conditions is it used for?

Anyone needing help restoring movement, muscle strength and general function following a fracture.

Anyone preparing for, or had any orthopaedic surgery such as:

  • Anterior Cruciate Ligament Reconstruction
  • Knee arthroscopies and meniscal and ligament repairs
  • Total hip or knee replacements
  • Shoulder Surgeries – i.e. rotator cuff repairs
  • Foot and ankle surgeries – i.e. Achilles tendon repairs.
  • Wrist and elbow surgery
  • Neck and Back Surgery