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Get the latest and most reliable information on pain relief & physiotherapy treatments at Macquarie Street Physiotherapy Clinic blog.

Surf Ski Paddling on Sydney Harbour

Admini Si - Friday, March 15, 2019


Two years ago my personal trainer, Luke, decided to turn his own passion for surf ski paddling into a business, offering it as a new sport for his clients.  So with some trepidation, myself and some of my fellow training friends bit the bullet and found ourselves venturing onto the Harbour waters at Rose Bay.  Those first few sessions were hard, much of the time being spent in the water not on it!  Whilst sitting in the ski I often felt like jelly, but with practise and good instruction my stability improved.

I also had not appreciated as a sport you have to use every part of your body - arms for pulling the paddle, legs to drive against the foot plate, trunk to power the pull as you rotate, and of course the core for stability.

Luke has pushed me out of my comfort zone many times, from crossing the Harbour avoiding ferries and navy ships to paddling on the Hawkesbury to Palm Beach.  It is amazing what you can achieve with a positive mindset.

I now paddle at least twice a week.  Each session is always different and includes interval training.  Over time, my fitness and strength has improved.

I have to pinch myself sometimes realising how lucky I am to have a sport I love, on the most beautiful Harbour in the world and sharing it with some wonderful new friends.  A sport I can highly recommend to water loving people of all ages who love a bit of adventure and a challenge.

Posture Tips for Travel

Admini Si - Friday, March 15, 2019

Posture tips for travel

The adventure begins and finally you are heading off on your journey!  You can already sense the relaxation of having a break from work and a change of scenery…

The next step is one that physios often get involved in - treating the back strain from lifting the suitcase from the taxi or the rotator cuff tear from taking luggage from the carousel. It’s enough to ruin your holiday!

When you are going away there is often a lot going on, distractions and everything is rushed.  Your body is quite good lifting and carrying if you give it plenty of preparation and warning.  Of course, ideally, preparation started months before with some strength and conditioning at the gym or a sport.

Here are some tips to help avoid pain/injury whilst travelling:

  • Preferably start with a wheelie suitcase.
  • Have your suitcase up off the floor for packing (and stand upright now and then whilst packing it).
  • Know the weight of any suitcase you are about to lift - injuries can occur even when lifting a suitcase lighter than expected!
  • Take a moment to prepare by engaging your core and shoulder muscles before lifting bags in and out of a taxi, onto weighing belt, and off a carousel. Particularly with taking a bag from a carousel, set your shoulder blades back.
  • When lifting try to keep the case close to you, and avoid your torso being in a side-bent or rotated position.
  • If you have shoulder or neck problems ask for help with overhead lockers
  • Whether you are in a plane, train or automobile take a moment to adjust the seat. A lumbar roll behind the small of your back, even one fashioned from a jumper or towel, can assist with lower back and neck pain.
  • Take breaks from sitting to move around, and do exercises such as calf raises, glute squeezes and shoulder rolling whenever possible.

Good luck and happy, pain free travels!

Hydrotherapy for Women

Admini Si - Friday, March 15, 2019

Hydrotherapy for Women

Macquarie Street Physiotherapy is pleased to announce we are commencing hydrotherapy classes for women. We have access to the women’s-only hydrotherapy pool at City Tattersalls Club in Pitt Street, just south of the Mall. We are offering small group classes with a maximum of 5 per class. Classes run for 45 mins. Additionally, 1:1 sessions which run for 30 mins are also available. If you have extras on your private health insurance, you may qualify for a rebate for hydrotherapy run by a physiotherapist. Alternatively, your GP may refer you through the EPC Medicare scheme, which partially funds 5 sessions of 1:1 Physiotherapy (land or pool based) per year.

Why Hydrotherapy?

Hydrotherapy provides an excellent medium to exercise in, for a variety of conditions that may be better suited to water than land. Warm water promotes joint fluid viscosity, muscle and ligament flexibility and pain relief. This can allow movement that might otherwise have been painful. Buoyancy reduces bone and joint stress, and provides resistance to facilitate strength. The compressive force of immersion aides in swelling reduction.

Hydrotherapy is particularly helpful for swollen sore joints, such as hips and knees.  It is the ideal exercise for pre-surgical and post-surgical total hip and knee joint replacement. Osteoarthritic joints will enjoy the heat, buoyancy and resistance of the water especially so for those with higher BMI’s, reducing the pressure on those sore joints.

Strengthening of balance muscles and postural muscles will also help those with osteoporosis.

The benefit of hydrotherapy over aqua aerobic classes is that you are individually assessed by a physiotherapist, and your exercises in class will focus on your specific needs. Once you are proficient and confident with your specific programme we may encourage you to do independent pool exercises and, if capable, progress to an aqua aerobic class.

If you would like any further information about hydrotherapy, feel free to contact Macquarie Street Physiotherapy on 9221 1604

Hamstring Strains Prevention and Rehabilitation

Admini Si - Friday, March 15, 2019

Hamstring Strains - Prevention and Rehabilitation

There is a variety of hamstring-related injuries that can occur in the athlete.  Of these, hamstring strains are the most prevalent. Approximately one-third of hamstring strains will recur, with the highest injury recurrence being within the first two weeks of return to sport.  This high recurrence rate is suggestive of an inadequate rehabilitation program, a premature return to sport of a combination of both.

There is an increased risk for acute hamstring strains in sports that involve sprinting, kicking or high-speed skilled movements such as football, soccer, rugby and track. These strains are more common in competition than in practice and more common in preseason than regular season and post season.

I have compiled some information to best assist in assessing the readiness of an athlete to return to sport after a hamstring strain and may also be helpful in hamstring injury prevention during preseason and throughout the season.

When should I start preseason training?

The literature suggests that preseason training should start 10 weeks prior to commencement of the sports season.

What should my training include?


First and foremost having enough strength in your hamstring is a priority. In a study by C.Askling et al., eccentric strengthening exercises have been shown to reduce hamstring strains among male soccer players.  Eccentric strengthening means that the muscle we are strengthening lengthens as it contracts. Here are two examples:

Single Leg Hamstring Curl on Exercise Ball                                      


Nordic Hamstring Curl

Both exercises work the hamstring eccentrically. As a guide, 10-12 repetitions by 3 sets of both 3-5 times/week is a good starting point.

Nordic hamstring curls are getting a lot of attention in the literature over the last couple of years.  The exercise has been added to the FIFA-11 warm-up protocol. This is a very popular protocol used by many amateur and youth soccer coaches throughout the world.


Flexibility is another important element to include in your training regime. Studies show that including 3 stretching sessions/day can significantly increase flexibility and in turn lower the risk of hamstring strain. One stretching session consists of 2-3 different hamstring stretches, each held for 30 seconds and repeated 5 times.  Here are two examples:

 Hamstring stretch in standing                                    


Hamstring stretch with strap


Agility training programs are designed to allow the athlete to adapt to quick changes in directions, acceleration and deceleration, and cutting activities.

Sport-specific activities can include running, lateral running and backward running, shuttle runs, explosive starts and agility drills (figure-of eight running, running with quick changes in directions, cutting activities, and ball catching, throwing, passing, and kicking)

Some research suggested improvements in lower extremity control following agility training and a potential contribution to injury prevention.

Progressive shuttle runs/sprints                                             


How do I know I’m fit for return to sport or fit for the season ahead?

An athlete’s ability to return to sport may also be predicted by certain functional testing, such as the ability to perform a single leg hamstring bridge.

In one study that was carried out, Australian Rules football players who demonstrated low hamstring strength, via a singe leg bridge hamstring test, were at increased risk for hamstring injury.

A score less than 20 repetitions is considered poor, 25 repetitions is considered average and greater than 30 repetitions is considered good.

Functional ability testing should also incorporate sport-related movements specific to the athlete, with intensity near maximum

Single leg hamstring bridge

If you suffer acute or chronic hamstring strains or just want some advice on avoiding injuries during the season come and see one of our Macquarie Street Physios in Sydney’s CBD.


  1. Darryl G. Thelan et al. (2006) ‘Neuromusculoskeletal Models Provide Insights into the Mechanisms and Rehabilitation of Hamstring Strains
  2. Carl M. Askling et al. (2014) ‘Acute Hamstring injuries in Swedish elite sprinters and jumpers: a prospective RCT comparing two rehabilitation protocols
  3. Carl M. Askling et al (2002) ‘Hamstring injury occurrence in elite soccer players after preseason strength training with eccentric overload
  4. Lauren N.Erickson et al (2017) ‘ Rehabilitation and return to sport after hamstring strain’
  5. J Petersen, P Holmich (2005) ‘Evidence based prevention of hamstring injuries in sport’


Admini Si - Friday, March 08, 2019

Vertigo is the false sensation of motion causing you to experience the feeling of spinning , dizziness, light headedness and being unsteady. You may also feel nauseous. It is as a result of problems with the balance mechanisms in your inner ear known as the vestibular labyrinth.  Within this there are 3 semicircular canals at right angles to each other. As you move your head this causes fluid in the canals to move which in turn causes tiny hairs to move, triggering the firing off of nerve messages to the brain. This gives the brain information about what position the head is in and of movement. This is reinforced by nerve input from the eyes, joints and muscles of the body.

There are a number of different causes of vertigo one of the most common is Benign Paroxysmal Positional Vertigo [BPPV].



Minute calcium carbonate crystals can be dislodged from their normal location in the inner ear and either float in the semicircular canal or get stuck in the canal where they are not suppose to be. This causes the brain to think you are moving. However your eyes and body provide your brain with different information causing a mismatch of input resulting in the sensation of dizziness.


  • Sudden onset of spinning sensation.
  • May have woken up with it or noticed it when turned in bed
  • Can occur when bending forward or looking up
  • May feel nauseous
  • Terrible feeling whilst spinning occurs but settles within seconds
Stemetil and Sec settle nausea but do not change dizziness


A simple test called the Dix Hallpike is used to determine which ear and canal are affected.

If this is positive there is a sensation of dizziness with involuntary movement of the eyes called nystagmus.


The vertigo resulting from BPPV can be dramatically relieved by specialist techniques performed by physiotherapists skilled in this area. This involves moving the head through a series of positions in order to reposition the crystals back where they will no longer cause any problems. This is known as a canal repositioning manoeuvre or Epley.

80% of people will respond to one treatment. If symptoms persist a second treatment may be required one week later.

Some people may need to perform positioning exercises at home.


  • Cervical Vertigo – caused by change in input from the joints of the neck.
  • Menieres – episodes of vertigo with fullness of the ear, some hearing loss and tinnitus.
  • Vestibular neuritis – Viral infection causing inflammation of the vestibular nerve with sudden onset of severe dizziness, vomiting and tinnitus.
  • Vestibular labyrinthitis – Viral infection causing inflammation of the labyrinth with sudden onset of dizziness and unilateral hearing loss.
  • Acoustic neuroma – a slow growing tumour causing a feeling of imbalance, unilateral hearing loss and tinnitus.
  • Vestibular migraines - a feeling of motion sickness that can last a few hours to days with or without a headache and other migraine symptoms. Psycho Physiological Dizziness Syndrome – dizziness brought on by conditions such as anxiety, depression and panic attacks. 

Vestibular Rehabilitation can help with some but not all of these. It involves specific exercises of the head and body including the eyes to try to recalibrate the balance and reduce the dizziness.

If you are currently experiencing vertigo feel free to book an appointment to see our Specialist Physiotherapists at Macquarie Street Physiotherapy and they will assess you to see if they are able to help your particular type of vertigo.

Do I need an MRI for my back?

Admini Si - Tuesday, December 04, 2018

As physiotherapists, we are often asked this question by clients who come to see us with back pain. 

There is a misconception among the public that MRI scans hold the key in finding out why they are experiencing back pain. 

A systematic literature review was undertaken in 2013, to review the imaging findings of individuals who did not report or experience any back pain. 

Interestingly, the review found that degeneration, disc bulges and protrusions were present in a high proportion of asymptomatic individuals and that these findings increased with age.

A summary of the results of the review are found on the table below:

Based on these results, it is worth taking into consideration that many imaging-based findings may be part of normal aging and not related to back pain.

MRI scans definitely have a place in confirming diagnoses but the imaging findings must correlate with symptoms and be interpreted in the context of the individual’s condition. 

If you wish to discuss your MRI scans or have any questions relating to your back pain feel free to contact Macquarie Street Physiotherapy to book an appointment.  

A full version of the systematic review is available via this link:

Posture Tips - Standing Desk

Admini Si - Wednesday, September 05, 2018

Standing Desks

You might think that a standing desk is the answer to all your back or neck issues at work.

However, did you realize it is possible to slouch at a standing desk?  And that your back or neck issues may continue as a result!

Standing slouching looks a little different to sitting slouching:

1)     Hanging on one hip
2)     Hips forward of the rib cage
3)     Pelvis tilted forward
4)     Leaning on the desk
5)     Craning to view the screen


Actually the last two points also can happen sitting, but it’s important to realize that standing helps only if you get it right!

Best standing posture:

-        Even weight on both legs (or have one foot on a small step)

-        Hips under rib cage, pelvis “neutral”

-        Chin tucked in

-        Stay on the move – you don’t have to stand stock still!

Remember, you can alternate between sitting and standing throughout the day.  At first it is recommended that you only stand for 30% of the day.

Understanding your experience of pain

Admini Si - Tuesday, August 28, 2018

Research into pain has increased significantly over the past decade.  We are gaining a greater understanding of, in particular, longstanding (chronic) pain and what might perpetuate it. 

We know that pain is about protecting us, but we are learning that it is not an accurate measure of tissue damage.  If our brain registers injury/threat, pain will result in a change in behaviour to protect our tissues (e.g., muscle, joint).   This is a very appropriate response when we have acute (immediate) pain, as it allows us to rest while tissues heal.  However, sometimes an adequate amount of time has elapsed for healing to take place, but the pain does not reduce. 

Why does the pain remain?

Pain scientists have identified a host of factors which might contribute to pain continuing long after the threat of tissue damage has ceased.  These include social life, family, stress, and a feeling of anxiety or depression relating to the injury.  Other contributors include poor sleep, prolonged opiate (pain killer) use and negative expectations.  Sometimes the language around pain promotes negative feelings about recovery; rather than talking about the body being strong and resilient, people may use ‘weak’, ‘broken’, etc.  Although pain can cause fear and anxiety, it is not helpful to use labels which suggest it will never pass. 

Being fearful can lead to protective strategies such as breath-holding and “gripping” muscles.  Rather than loading and strengthening tissues, avoidance can lead to weakness, disuse and further problems.  Sitting or standing “stock still” in order to avoid movement, is likely to increase stiffness and over-reliance on certain muscle groups.

What is the answer?

Time and again, the answer to chronic pain comes back to movement and exercise.  This, along with continuing to be occupied and maintain a positive outlook, have direct effect on our experience of pain. 

How do I exercise in the presence of pain?

1)     Exercise around the painful part:  The experience of grumbly knee pain is common to many – once we have knee pain, we often limp, avoid stairs, and accept a level of inactivity.  The knee joint, however loves to be strong and supported by surrounding muscles.  Here are a few examples of exercises which allow us to maintain good function around the knee and limb – calf raises, hamstring curls, core exercises, gluteal exercises such as donkey kicks all exercise nearby muscles.  Wall squats and straight leg raises exercise quadriceps (thigh) muscles without the repetitive movement which may aggravate a knee joint. 


2)     Isometric exercises: The last example of exercises are called isometric exercises – they involve muscle activation without joint movement.  These allow us to exercise the muscles around any joint in a (usually) painfree way.  The shoulder is another very good example of a joint which responds well to these exercises, where the muscles act against resistance without elevating the arm. Once there is better activation of muscles around a joint, exercises involving movement can be started.


3)     Keep moving!: Being on the move if you have chronic pain is always preferable to prolonged static positioning.  Movement might include walking, cycling or swimming as alternatives to more demanding exercise, until you are ready to progress. 

Good Help and Support:

It is important that you feel you can trust your health care professionals to guide you regarding appropriate exercise and movement, and it also helps to have the support of family and friends.  It might be that some strategies can be taught with the help of a psychologist, as well as your GP/physician and physio.  If you attend a gym or play sport, having the coach/trainer on board is also worthwhile.  And for workers with chronic pain, it is helpful to have the support of your employer.  There are also pain management courses and specialists to assist which you could consider. 

Trip to Cradle Mountain – Justine Trethewey

Admini Si - Wednesday, March 28, 2018

Trip to Cradle Mountain – Justine Trethewey

The unusually good weather made a recent walking trip at Cradle Mountain, Tasmania all the more enjoyable for me last month.  Having met up with my walking pal in Hobart, we drove north and stayed nearby, taking day walks through the beautiful alpine country.

The first morning was cold!

But it soon warmed up as we ascended:

I was happy to have spent the past month working on glutes and quads strength, as parts of the walk were quite steep and tricky.  It helped to have some tape for my right patella and good sturdy boots as well. Along with this, plenty of breaks to take in the spectacular views, along with snacks and good company made the whole trip a real success.  

Well recommended for walkers of various levels!  

Cradle Mountain is also where the 7 day Overland track commences for those who really like a challenge!  

Maybe next time!

Are you using two screens?

Admini Si - Wednesday, March 28, 2018

Posture tips

Many of our clients are using 2 or more screens which can have benefits for organising and segregating work.

It is important to GET IT RIGHT in terms of set-up, to avoid neck strain, arm pain and headache.

Follow these simple ergonomic set-up guidelines for using dual monitors:

Set-up will depend on the amount of time you use each monitor:

1. If one is the primary monitor, position it directly in front of you.  The secondary monitor should be either side at about 30° to the first.  This is generally the preferred set-up, to minimise prolonged rotation of the neck.

two screen setup

2. If both monitors are used an equal amount of time, set the monitors next to each other, as below: 

two monitor setup

The same principals apply if there are more than two monitors.  Keeping the neck in a neutral position is ideal, of course, better in a gently tall sitting or standing position.  Sustained rotation or extension (looking up) of the neck is best avoided.  Remember to stretch and take regular breaks to avoid neck and back strain and headaches.

Macquarie Street Physio