Triangular Fibrocartilage Complex

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Triangular Fibrocartilage Complex

What is the TFCC?

The TFCC (triangular fibrocartilage complex) is a cartilage structure located on the small finger side of the wrist, it consists of ligaments and tendons. The function of this group of structures is to provide stability and smooth movement of the wrist joint. The TFCC keeps the forearm bones, the radius and ulna, stable when the hand grips objects or when the forearm rotates. An injury or tear to this structure can cause chronic wrist pain.

 

Types of TFCC injuries

There are two types of TFCC injuries:

  • Acute injuries: this is a traumatic tear. This can result from a fall onto the hand or from excessive arm rotation.
  • Chronic injuries: this is a degenerative tear or a tear that has lasted a long time. This can occur due to repetitive loading over a long period.

 

Symptoms

The symptoms of a TFCC tear include:

  • Pain at the base of the pinky side of the wrist
  • Pain worsens as the wrist is bent from side to side, and any activity that requires forearm rotation produces pain. For example: turning a doorknob or a key in the door, or lifting a heavy pan with one hand.
  • Tenderness over the back of the wrist
  • Reduced grip strength
  • Sometimes a clicking in the wrist

 

How is it diagnosed?

TFCC tears are diagnosed through careful assessment of the wrist and forearm. This involves your physiotherapist determining how your pain began, looking at the location of your pain, and how your pain is affecting the movements of your fingers, wrist and forearm. From here your physiotherapist is able to implement a treatment program.

 

How is it treated?

Throughout your assessment your physiotherapist would have determined the likely cause of your pain, which movements are painful and which movements are affected by your injury.

If the wrist is still stable, conservative treatment is taken. This involves beginning to decrease inflammation and pain around the area. You may be given a splint to wear for a short period of time to assist in pain reduction, and activity modifications will be applied to movements which cause pain such as heavy grasping and turning and twisting the wrist. Your physiotherapist will assess how you perform daily tasks, so these activity modifications can be manageable in your every day life.

Once pain and inflammation have been controlled, the focus of treatment will be on strength and mobility of the wrist and hand. Mobility will be addressed by improving the bending and straightening of the wrist, turning the palm up and then turning it back, along with making sure all of your fingers have proper mobility as well. Strength exercises will be prescribed to improve your grip strength, your ability to exert force when twisting the wrist, grabbing items, and bearing weight through the wrist. Additional exercises will be prescribed for you to be able to perform your activities of daily living with no pain.

Through mobility and strength exercises given by your physiotherapist you should be able to return to sport and return to normal activity.

 

If you have any questions regarding your wrist pain, please give us a call at (02) 8411 2050. At Thornleigh Performance Physiotherapy, we can give you an accurate diagnosis and treatment, to help you get back in action as soon as possible. We are conveniently located near Beecroft, Cherrybrook, Hornsby, Normanhurst, Pennant Hills, Waitara, Wahroonga, Westleigh, West Pennant Hills, and West Pymble.

 

Reference

Lubiatowski, P. Romanowski, L. Splawski, R. Manikowski, W. 2006. Treatment of injury of the Triangular Fibrocartilage Complex TFCC. Ortop Traumatol Rehabil. 30:8(3). 256-62.

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Extensor Tendinopathy

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Extensor Tendinopathy

History

A 53 year old female presented with gradual onset of pain to her right elbow localised to the lateral side of elbow and forearm.  She described her pain to worsen with gripping, reaching and lifting tasks, especially when attempting to use scissors at work. What can physiotherapy do to help?

 

Clinical examination

At rest, with her forearm relaxed on a pillow the patient had minimal to no symptoms. During active and passive range of motion examinations, pronation (inward rotation) of her forearm with the elbow extended and flexion of the wrist were the most provocative movements. Resisted extension of her wrist and 3rd finger also reproduced her symptoms and she was tender upon palpation over the lateral side of her right elbow and presented with painful and decreased grip strength. No reproduction of symptoms was evident following a screen of her right shoulder and neck, indicating a non-referral pain diagnosis.

Her mechanism of injury and clinical presentation indicate an extensor tendinopathy or commonly known as “tennis elbow”.

 

Management

A multimodal treatment incorporating education, unloading of the tendon from aggravating factors, pain relief and restoring tissue capacity and control was used to manage her extensor tendinopathy appropriately. Pulsed ultrasound was firstly used to promote the initial healing of soft tissue. She had active trigger point pain along her forearm muscle, that is a common occurrence in the presentation of extensor tendinopathy. The patient responded well with dry needling to her right forearm muscles which assisted in relieving muscle tension and forearm pain. She was provided with education regarding the use of ice as a form of pain management and unloading strategies. Isometric muscle activation exercises and stretches were also prescribed to be completed at home. She was also provided with a counterforce brace to be worn during working hours to assist her in gripping with reduced pain.

Over the next couple of weeks, the main focus was to restore the tissues capacity to withstand loads with minimal to no pain. This is achieved through appropriate rest and unloading of the tendon. Completing a progressive home strengthening exercise program with appropriate loads and tendon stretching. These strategies allowed time for the patient’s tendon to heal appropriately and reduce the symptoms the patient was experiencing. Manual therapy techniques and dry needling were used in conjunction to relieve any associated muscle tension. Following a couple weeks, she was able to return to full work duties with minimal to no issues.

 

If you have any questions regarding elbow pain, and need an assessment, please give us a call at (02) 8411 2050. Here at Thornleigh Performance Physiotherapy, we can give you an accurate diagnosis and treatment, to help you get back in action as soon as possible. We are conveniently located near Beecroft, Cherrybrook, Hornsby, Normanhurst, Pennant Hills, Waitara, Wahroonga, Westleigh, West Pennant Hills, and West Pymble.

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What does your pillow do to you?

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What does your pillow do to you?

With approximately one third of our lives spent sleeping, it is essential to have good quality sleep in order for the body to maintain normal physiological function and biological processes [1,2]. However for many of us, a good night’s rest is interrupted by uncomfortable neck pains that most likely will wake us during the night and persist throughout the day. Studies have shown that problems sleeping and in sufficient time of rest can also be indirectly linked with increased risk of diseases, hormonal changes, sleeping disorders and associated stress [3]. So you may ask, what can be done to ensure you get a more comfortable nights’ rest and reduced neck pain?

Studies have concluded that the proper selection of pillow can significantly reduce neck muscular tension and pain, improving an individual’s overall quality of sleep [1]. Poor neck support increases the work of neck and upper back muscles during sleep, causing increased biomechanical stress and morning pain [2]. Therefore the posture we adopt during a night’s rest can be related to musculoskeletal injuries of the neck and upper back, with muscular tension found to be a contributing factor to constant headaches [2].

 

What can be done?

Muscular tension and neck pain can therefore benefit from an appropriate pillow type as an adjunct management strategy to neck exercise training [1,4]. There are many various pillows on the market designed to help create the most relaxed position for the neck joints and surrounding muscles. How do you know what pillow to choose?

Here are some tips:

  • A pillow that has firm support to cervical lordosis (neck contour) which holds the head and neck region sufficiently in a neutral alignment to the upper back, reducing the biomechanical load to these regions [2] 
  • A neck pillow with the appropriate shape and consistency [5] 
  • A pillow of the correct height that will correctly support the cervical lordosis [5]
  • A one size fits all approach does not exist.

 

What has studies shown?

Studies have found that after 18 months of use of a supportive pillow, 84% of users achieved clinically important relief from neck pain [1] Compared to conventional pillows cervical pillows were shown to be effective in reducing neck pain and discomfort [1]

Another study found that muscle activity was higher in those with shoulder and neck pain, with a change of pillow height to a more suitable height significantly lowering the amount of muscle activity [2]. This study also showed that a pillow height of 10 cm not only had the lowest muscle activity but also resulted in similar muscle activity on both side when in side lying positions. They concluded that the best perception of comfort was associated with better head and shoulder alignment which produced the lowest amount of muscular activation [2]. A study that compared the comfort of certain material types of pillows found that memory foam pillows performed best with reduced waking pain and improved sleep quality, whilst the feather pillow performed the worst [6].

However, changing a pillow may be beneficial in improving a night rest and reduce pain, but for those who experience acute and chronic neck pain clinical treatment is most advantageous in conjunction with a suitable pillow.

 

How can Physiotherapy help?

  • Provide suitable tailored maintenance strategies to decrease muscular tension, pain and headache symptoms
  • Create a personalised exercise and stretching program to increase neck and upper back muscle strength
  • Undertake a postural and movement assessment of neck and upper back and provide recommendations on adjustment of seating posture
  • Help assist you with selecting the correct pillow for you through analysing posture and upper back and neck biomechanics
  • Provide education to encourage self-management strategies.

 

If you have any questions regarding neck pain and sleeping posture please give us a call at (02) 8411 2050. Here at Thornleigh Performance Physiotherapy, we can give you an accurate diagnosis and treatment, to help you get back in action as soon as possible. We are conveniently located near Beecroft, Cherrybrook, Hornsby, Normanhurst, Pennant Hills, Waitara, Wahroonga, Westleigh, West Pennant Hills, and West Pymble.

 

References

  1. Erfania P, Tenzif S, Guerriero RC. Assessing effects of a semi-customized experimental cervical pillow on symptomatic adults with chronic neck pain with and without headache. Journal of the Canadian Chiropractic Association. 2004;48(1):20-28.
  2. Sacco ICN, Pereira ILR, Dinato RC, Silva VC, Friso B, Viterbo SF. The effect of pillow height on muscle activity of the neck and mid-upper back and patient perception of comfort. Journal Of Manipulative And Physiological Therapeutics. 2015;38(6):375-381.
  3. Lavin RA, Pappagallo M, Kuhlemeier KV. Cervical pain: A comparison of three pillows. Archives of Physical Medicine and Rehabilitation. 1997;78(2):193-198.
  4. Helewa A, Goldsmith CH, Smythe HA, Lee P, Obright K, Stitt L. Effect of therapeutic exercise and sleeping neck support on patients with chronic neck pain: a randomized clinical trial. The Journal of Rheumatology. 2007;34(1):151-158.
  5. Persson L, Moritz U. Neck support pillows: a comparative study. Journal Of Manipulative And Physiological Therapeutics. 1998;21(4):237-240.
  6. Gordon SJ, Grimmer-Somers K, Trott P. Pillow use: The behaviour of cervical pain, sleep quality and pillow comfort in side sleepers. Manual Therapy. 2009;14(6):671-678.

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What is Osteoarthritis (OA)?

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What is Osteoarthritis (OA)?

What is osteoarthritis?

Osteoarthritis (OA) is a complex degenerative non-inflammatory joint disease that affects the whole joint including subchondral bone, articular cartilage, ligaments and muscles that surround a synovial joint1 [1]. It is characterised by progressive cartilage loss, subchondral bone remodelling and formation of osteophytes narrowing the joint space [2]. Low-grade local synovial inflammation occurs believed to be a result of release of inflammatory mediators from the degradation of articular cartilage [3]. OA is the most common type of arthritis that leads to a gradual decline in health, physical function and well-being if not managed correctly [1]. Hands, hips, lower back, knees and feet are the areas that are most affected by OA.

OA is commonly referred as a “wear and tear” form of arthritis as it is thought to occur as a part of an aging process, however it has been found that aging is not a predictor of OA [1]. The aetiology of OA is however due to the result of excessive mechanical stress applied in context of susceptibility modifiable and non-modifiable factors such as age, genetics, gender, ethnicity, local mechanical factors, obesity and joint injury [2]. OA is a highly preventable and manageable disease, with 70 per cent of cases within Australia preventable by avoiding excess weight gain and joint injuries [1].

 

How common is OA?

OA currently affects one in 12 Australians and is the leading cause of chronic pain and disability world-wide [1,4]. Although the incidence of OA has been found to increase with age, osteoarthritis can occur at any stage, with more than half of the people being of working age [1 ]. It is estimated that within the next four years, the prevalence of OA will have doubled due to the higher rates of obesity also placing people at a higher risk of death compared to a general population [2].

 

Common Causes and Contributing Factors of OA

The causes of OA are not well understood however it has been shown that several biomechanical, genetic, behavioural and environmental factors contribute [1].

Person-level factors [5]

  • Genetics
  • Excess weight and obesity
  • Gender: Higher prevalence in women, incidence rates increases around menopause.
  • Age: Main risk factor however not an inevitable factor of OA

Joint- level factors

  • Abnormal joint irregularity, joint malalignment, muscle weakness and ligament rupture are some local mechanical contributing factors that increase susceptibility and progression of OA [2]
  • Joint injury and certain repetitive joint loading occupational activities [2]

 

 Common Symptoms of OA [6]:

  • Limited/reduced range of motion
  • Stiffness
  • Clicking or cracking sound
  • Mild swelling around joint
  • Pain- worse at the end of day
  • Tenderness
  • Muscle weakness
  • Mild effusion
  • Joint and limb deformity

 

How can physiotherapy help?

Currently physiotherapy treatment and management of OA is focused on reducing mechanical loads and symptom management [1]. Physiotherapy management includes the use of a variety of low impact exercise programs which has been shown to be effective [7]. Exercise based treatment approaches such as walking programs to water and land based strengthening programs have been proven to be beneficial in managing symptoms of OA [7]

Other management strategies include [4]

  • Electrical based therapy
  • Prescription equipment/aids
  • Taping
  • Weight loss program
  • Manual therapies
  • Education on pain and self-management.

Studies has found that the benefits of exercise in OA in relation to pain and physical function has a similar effect to that gained by analgesic and non-steroidal anti-inflammatory medications with fewer side effects [2] Physiotherapy treatment and management will be tailored to target each individual taking into account specific risk factors and patient characteristics.

If you have any questions regarding managing OA better, please give us a call at (02) 8411 2050. At Thornleigh Performance Physiotherapy, we can give you an accurate diagnosis and treatment, to help you get back in action as soon as possible. We are conveniently located near Beecroft, Cherrybrook, Hornsby, Normanhurst, Pennant Hills, Waitara, Wahroonga, Westleigh, West Pennant Hills, and West Pymble.

 

References:

  1. Arthritis A. Time to Move: Osteoarthrtis. http://www.arthritisaustralia.com.au/index.php/reports/time-to-move-arthritis-reports.html: Arthritis Australia;March 2014.
  2. Hunter DJ. Osteoarthritis. Best Practice & Research Clinical Rheumatology. 2011;25(6):801-814.
  3. Berenbaum F. Osteoarthritis as an inflammatory disease (osteoarthritis is not osteoarthrosis!). Osteoarthritis and Cartilage. 2013;21(1):16-21.
  4. Larmer PJ, Reay ND, Aubert ER, Kersten P. Systematic review of guidelines for the physical management of osteoarthritis. Archives of physical medicine and rehabilitation. 2014;95(2):375-389.
  5. Palazzo C, Nguyen C, Lefevre-Colau M-M, Rannou F, Poiraudeau S. Risk factors and burden of osteoarthritis. Annals of Physical and Rehabilitation Medicine. 2016;59(3):134-138.
  6. Michael JW-P, Schlüter-Brust KU, Eysel P. The epidemiology, etiology, diagnosis, and treatment of osteoarthritis of the knee. Deutsches Arzteblatt International. 2010;107(9):152.
  7. Rosedale R, Rastogi R, May S, et al. Efficacy of exercise intervention as determined by the McKenzie System of Mechanical Diagnosis and Therapy for knee osteoarthritis: a randomized controlled trial. journal of orthopaedic & sports physical therapy. 2014;44(3):173-A176.

 

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Middle back pain and left arm pain

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Middle back pain and left arm pain

Question

A 50 years old female, Mrs L., presents with middle back pain and left arm pain gradually developed over the weekend without clear mechanism of injury. The only potential reason that she could think of was gardening. She had ongoing back stiffness; otherwise she is normally healthy and active. What could be the cause of her problem?

 

Clinical examination

Mrs L’s left arm pain is provoked when she is reaching forward. Her left shoulder range of movement is normal. She has reduced neck and middle back range of movement, specifically cervical retraction and thoracic extension.

In neurological examination, Mrs L’s biceps and triceps jerk reflex are normal. Her strength and sensation were also normal. On palpation, her left mid thoracic area is stiff and her arm pain is also provoked.

It appears that Mrs L’s left arm symptom is related to her left thoracic spine.

 

Management

Mrs L’s left arm symptoms and thoracic spine stiffness are reduced after some thoracic spine joint mobilisation. She was then given some cervical and thoracic mobility exercises to restore her loss of range of movement. Her symptom is almost completely abolished in two weeks.

It is not uncommon that sometimes the arm pain that patient experienced come from a different body part, typically cervical or thoracic spine. A systematic examination procedure will help identifying the source of the symptoms, and aid an appropriate management approach.

 

If you have any questions regarding suspicious arm pain and need and assessment, please give us a call at (02) 8411 2050. At Thornleigh Performance Physiotherapy, we can give you an accurate diagnosis and treatment, to help you get back in action as soon as possible. We are conveniently located near Beecroft, Cherrybrook, Hornsby, Normanhurst, Pennant Hills, Waitara, Wahroonga, Westleigh, West Pennant Hills, and West Pymble.

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Conservative Management of Meniscal Tear

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Conservative Management of Meniscal Tear

History

A 47-year-old male presents with an acute left knee injury from rotational standing up movement from a seated position at lunch. He felt immediate pain in the medial side of his knee and reports a locking sensation when attempting to straighten his knee. What can physiotherapy do to help.

 

Clinical Examination

The patient was unable to weight bear on his left leg as he could not straighten his left knee due to pain and catching sensation. During passive range of motion movements, his knee could be flexed to full range, however was painful at end of range and when moving leg back into extension. Passive patella movement did not reproduce his symptoms, though symptoms reproduced upon palpation of medial border of knee cap and medial knee joint. No swelling was evident at time of review, however this is expected in the acuteness of his injury.

His mechanism of injury and clinical presentation indicate an acute torn flap of his medical meniscus.

 

Management

Small meniscal tears can be managed conservatively if a person’s range of motion is not greatly affected, have minimal swelling and are able weight bear. The first phase of conservative management of an acute meniscal tear includes maintaining knee extension range of motion and providing stability to the knee to reduce any risk of further injury. Small amplitudes of passive accessory movements were undertaken in attempt to normalise joint range of motion. He was provided with education regarding the importance in maintaining knee extension and encouraged to undertake light knee extension stretching techniques to aid in this. Kinesiology tape was used to strap his knee to promote healing, support, reduce swelling and assist in pain reduction. The patient responded well with dry needling to his hamstrings and calf muscles which assisted in off-loading the knee joint from muscle tightness. Following the initial treatment, the patient had a reduction in pain symptoms and ability to weight bear as tolerated through left leg.

Over the next two to three weeks, the focus was to eliminate swelling and achieve full range of motion and focus on hamstring and quadriceps strength. Through the completing all home strengthening and stretching exercise program, this patient improved well and could obtain full range of knee extension with a reduction of pain and an increase of muscle strength. He was provided with full range squats and lunges as a progression to his hamstring and quadriceps strengthening exercises with added endurance training program for his hip external rotators. After another few weeks, he could return to his home-based fitness program and work schedule without any issues.

 

If you have any questions regarding your knees or are interested in seeing if we can help you, please give us a call at (02) 8411 2050. Here at Thornleigh Performance Physiotherapy, we can give you an accurate diagnosis and treatment, to help you get back in action as soon as possible. We are conveniently located near Beecroft, Cherrybrook, Hornsby, Normanhurst, Pennant Hills, Waitara, Wahroonga, Westleigh, West Pennant Hills, and West Pymble.

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Ankle Sprain from Basketball

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Ankle Sprain from Basketball

Question

A 15 years old boy presents with a recent right lateral ankle sprain from landing on someone’s foot and rolled inwards during basketball. What should he do to facilitate return to sports?

 

Clinical examination

In observation, the patient has mild lateral ankle swelling but no bruises. He is able to walk without pain. Symptoms are provoked during eversion and lunging. His anterior talofibular ligament (ATFL) is tender on palpation. Ligament stability tests (anterior and posterior drawer tests) are negative.

The examination findings suggest that he has a low grade right ATFL sprain.

 

Management

A combination of education, RICE (rest, ice, compression and elevation) approach will be appropriate to manage his acute symptoms. In this scenario, his symptoms are able to further reduce with joint mobilisation and strapping. 

Over the next two weeks, he is able to gradually progress his exercises from range of movement exercises to proprioception and strengthening exercises, specifically single leg balance and single leg heel raise. He was able to perform thirty repetitions in single leg heel raise which is clinically indicative for exercise progression and trial return to modified sports. 

It is indicated from research that the reinjuring rate after the first ankle sprain within the first year is remarkably high, up to eighty per cent. It is also suggested that proprioceptive (balance) and ankle strengthening exercises will significantly reduce the risk of recurrence, and the exercises program should at least last up to two months. It is important to be aware that free of symptoms and ‘feeling good’ do not always mean the ankle function is fully recovered.

 

If you have any questions regarding ankle sprain and ankle braces, and need an assessment, please give us a call at (02) 8411 2050. Here at Thornleigh Performance Physiotherapy, we can give you an accurate diagnosis and treatment, to help you get back in action as soon as possible. We are conveniently located near Beecroft, Cherrybrook, Hornsby, Normanhurst, Pennant Hills, Waitara, Wahroonga, Westleigh, West Pennant Hills, and West Pymble.

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ACL Tear

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ACL Tear

History

A 15 years old female Miss K who is a netballer presents with a right ACL reconstruction surgery one week ago. Her surgeon has referred her to do physiotherapy. What does she need to do in rehab?

 

Clinical examination

The patient is walking with two crutches. Her knee is moderately swollen. Her wound is covered by wound dressings. Her knee extension range is -5 degrees (meaning it’s in a slightly bended position) and her flexion range is about 20 degrees, both motions are limited by pain and stiffness.

 

Management

It is expected that ACL reconstruction rehabilitation to be a lengthy process. It generally takes at least six months to twelve months to return to sports. Most surgeons would provide the patient and the physiotherapist a rehabilitation protocol, but it is common to have variations which depend on the graft choice and individual factors.

Initial stage of ACL-recon for Miss K focuses on swelling control and restoring her loss of knee extension range. This is critical as it allows her to walk with normal gait as soon as possible and avoid the development of compensation strategies. Her treatment includes manual therapy, compression therapy, and inner range closed chain quadriceps exercises. 

In six weeks times, Miss K has recovered full knee extension and ninety per cent flexion range of motion.

Depends on the sports type, most patients can return to sports after six to twelve months. In between this six to twelve months, there is a variety of exercises need to be covered to allow successful return to sports. That includes improvement on proprioception, strength, balance, flexibility, agility, functional strength, plyometric ability and sports-specific skills.

As Miss K is very compliance to her rehabilitation program and keen to return to sports. She performs her exercises well and on schedule. She is able to return to low level netball in nine months.

 

If you have any questions regarding your post operative rehabilitation or are interested in seeing if we can help you, please give us a call at (02) 8411 2050. Here at Thornleigh Performance Physiotherapy, we can give you an accurate diagnosis and treatment, to help you get back in action as soon as possible. We are conveniently located near Beecroft, Cherrybrook, Hornsby, Normanhurst, Pennant Hills, Waitara, Wahroonga, Westleigh, West Pennant Hills, and West Pymble.

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Knee Pain whilst Running

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Knee Pain whilst Running

In this episode of our case review, we take a look at a challenging group to treat - runners.  The most important rule of treating them - never tell them NOT to run.

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Low Back Pain in the Office

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Low Back Pain in the Office

In this case review, we take a look at an office worker struggling with back pain.  She was treated efficiently and was back to full function much quicker than she anticipated.  We take pride in utilizing the most effective methods using the least number of sessions to get you back to 100%!

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Shoulder Pain after a Fall

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Shoulder Pain after a Fall

In a new website feature, we take a look at real cases and dissect them for you.  This gives you insight into how the physiotherapists here at Thornleigh Performance Physiotherapy work.  Each case will feature a different injury.  Please keep in mind that each individual is unique and it is short sighted to apply the results and finding to another individual.

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Did you know?

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Did you know?

Good news!  Thornleigh Performance Physiotherapy is now an NDIS approved provider.  If you or someone you know needs to access services via the NDIS you can send them our way or give us their contact details and we can do the rest.  If you are wondering what I am talking about, here is a link to more information on them.

If you have read the link and ready to take the next step towards a better you,  give us a call. Here at Thornleigh Performance Physiotherapy, we can give you an accurate diagnosis and treatment, as well as advice on the best course of action for your condition to get you back in action sooner than you could’ve imagined.  We have an expertise in musculoskeletal physiotherapy and are conveniently located near Beecroft, Cherrybrook, Hornsby, Hornsby Heights, Normanhurst, Pennant Hills, Wahroonga, Waitara, Westleigh, West Pennant Hills, and West Pymble. So give one of our physiotherapists a call on (02) 8411 2050 to get started on a journey to a better you. 

 

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