How much exercise do you need to do?

Staying active regularly is essential for good physical and mental health and wellbeing.  

This is true no matter how young or old you are. But the amount of activity varies, depending on your age.

There is also good evidence to support the role in regular physical activity in the management of chronic pain and also in the management of many chronic lifestyle diseases. 

For adults, here are some of the things that regular physical activity can do:

So with the benefits of being physically active now clear, the real question is how much do you need to be doing. 

To start with, before reading these recommendations, it is important to note that anything is better than nothing when it comes to physical activity, so if you are currently not doing any, and these guidelines feel like a lot or too much, then doing some is better than none.  The important thing is just to get started.  

The other important factor from a physiotherapy perspective is that gradual, progressive increases are your best bet to make sure you do not end up with overuse conditions to the tendons or bursas.  I like to use the 10% rule as a good guideline to ensure progress to gradual and gentle on the body.  This means no more than a 10% increase on load and/or volume each week. 

Physical activity recommendations 

Adults should be active most days, preferably every day. Each week, adults should do either:

As your trusted healthcare professionals we are well placed to help you put together a physical activity that will work for you.  Our group programs are also a great option to get your dose of strength work and we are seeing an increasing number of our clients do these programs twice per week to make sure they are getting the recommended amount of strength work done each week. 

We are can help put a program together so book yourself in for a review today

Yours in health

Chris from Out of the Box Physiotherapy 

What you need to know about Rotator Cuff tears

What is the Rotator Cuff?

The rotator cuff is a group of four muscles and their tendons located around the shoulder joint. These muscles—supraspinatus, infraspinatus, teres minor, and subscapularis—work together to stabilise the shoulder joint and facilitate a wide range of motion. The rotator cuff plays a vital role in lifting, rotating, and moving the arm, making it essential for everyday activities and sports performance.

Types of Rotator Cuff Tears

Rotator cuff tears can occur gradually over time due to wear and tear or suddenly as a result of injury. There are two main types of tears:

Causes of Rotator Cuff Injuries

Understanding how the rotator cuff is typically injured is crucial for prevention and effective management. Rotator cuff injuries can result from various factors, including:

Management of Rotator Cuff Tears

The management of rotator cuff tears depends on various factors, including the severity of the tear, the patient's age, activity level, and overall health. Treatment options may include:

How we can help

Numerous studies have demonstrated the effectiveness of physiotherapy in the management of rotator cuff tears. A systematic review published in the Journal of Orthopaedic & Sports Physical Therapy found that conservative treatments, including physiotherapy, were effective in improving pain and function in patients with rotator cuff tears. Physiotherapy interventions, such as progressive strengthening exercises, manual therapy, and therapeutic modalities, have been shown to enhance shoulder strength, mobility, and overall function, leading to improved patient outcomes and satisfaction. For this reason, we alway recommend starting management of your rotator cuff injury with physiotherapy first. We can often achieve a lot over a 6-12 week rehabilitation program. We have saved countless numbers of people from having surgery.

Rotator cuff tears can significantly impact shoulder function and quality of life. While surgical intervention may be necessary in severe cases, physiotherapy remains a cornerstone of conservative management, offering safe, non-invasive interventions to improve pain, function, and overall shoulder health. If you're experiencing shoulder pain or suspect a rotator cuff tear, consult with our physiotherapy team for an accurate diagnosis and personalised treatment plan.  

All about Knee Osteoarthritis

Knee osteoarthritis (OA) is a prevalent joint condition affecting millions of people from all walks of life. This degenerative disease often leads to pain, stiffness, and reduced mobility, significantly impacting one's quality of life.

Knee osteoarthritis can be divided into two types, primary and secondary. Primary osteoarthritis is articular degeneration without any apparent underlying reason. Secondary osteoarthritis is the consequence of either an abnormal concentration of force across the joint as with post-traumatic causes or abnormal articular cartilage, such as rheumatoid arthritis (RA).

The defining feature of osteoarthritis is the breakdown and loss of articular cartilage. In the knee, articular cartilage covers the top of the tibia (shinbone), the bottom of the femur (thigh bone) and the back of the patella (kneecap). Articular cartilage protects the surfaces of these bones where they meet at the joint. During the development of osteoarthritis:

When cartilage is damaged, bones experience more friction and impact. This can cause the bone to undergo changes. For example:

Common signs you can look for

Recognizing the early signs of knee osteoarthritis is crucial for timely intervention and management. Some common symptoms include:

Management Options for Knee Osteoarthritis

While knee osteoarthritis is a progressive condition with no cure, several management strategies can help alleviate symptoms and improve joint function. These include:

Conservative management with your physiotherapist should be the first treatment option for your knee osteoarthritis.  We have seen several patients be able to forgo the immediate need for surgical intervention while being under our care and guidance.  The best strategy is to seek help sooner rather than later, as in some cases that have been left too long, the knee is simply too stiff and too sore to be able to tolerate any physiotherapy intervention.  

If you are over the age of 45 and have a stiff and or painful knee, then having a chat with us could be one of the best things you can do for yourself this year. Action now, might save more drastic action later on.   

Yours in health

Chris and the team from Out of the Box Physiotherapy

Updated Exercise Class Timetable

Please see our updated timetable for our Physio Strong Exercise Programs that came into effect from February 2024. This shows the addition of the new Physio Strong Bones Program on Thursdays at 2pm.

Trying to beat that annoying heel pain? Read on

Heel pain, Plantar fasciopathy or Plantar Fasciitis (it doesn’t really matter too much what we call it), is a prevalent foot condition that we see almost daily in the clinic.  It can range from mild to severe and the functional impacts it has on our lives makes it one of the more annoying conditions for our patients.

Over the course of my almost 20 year career, a lot has changed in the guidelines surrounding best practice management of the condition and thankfully, in my opinion, we are now much better at managing it.  However, time and time again, I continue to see patients who have been elsewhere (even so-called “Foot Doctors”)  miss out on one key component of their rehabilitation.  

This blog will shed some light on what Plantar Fasciopathy is, what we know about some factors that contribute to it occurring and how it is managed, including a key exercise that should be done in the majority of cases.

What is Plantar Fasciitis?

Plantar fasciitis occurs when the plantar fascia, a strong band of tissue that supports the arch of your foot, becomes irritated and inflamed.  This inflammation can lead to heel pain, especially during the first few steps in the morning or after a period of rest or sitting.  Heel pain is the most common area of pain reported but it is not the only place where symptoms can be present.   

So what exactly is the plantar fascia? The plantar fascia runs from the calcaneus to the phalanges. Utilising its inherent tensile strength, it prevents the collapse of the arch of the foot upon vertical load transmission from the weight of the body. 

Who Gets Plantar Fasciitis?

Plantar fasciitis can affect anyone but we have learnt over the course of time that there are some factors that do tend to correlate with presentations of painful heels. Here are the main ones.

How is Plantar Fasciitis Managed?

Effective management of plantar fasciopathy involves a combination of lifestyle modifications (i.e less walking), physiotherapy, and, in some cases, medical interventions.

Key aspects of management include:


In my experience, plantar fasciitis that is going to settle with physiotherapy will usually do so by around 3 months.  This amount of time is usually needed to improve the capacity of the plantar fascia in regards to load and also provides a good amount for 1st toe and ankle mobility to improve. 

Despite good adherence to the treatment plan, then if symptoms persist beyond 6 months I would usually be looking to refer for medical opinion and possible management using shockwave therapy, cortisones and anti-inflammatory medications. 

There is very rarely ever only one thing that contributes to the development of plantar fasciitis.  This means that a comprehensive treatment plan that looks at all variables is put in place.  Physiotherapy is best placed to help you with this and with the right plan and a little patience, you should see improvement.  

If you have been putting up with heel pain that is not going away then come and see us, we can help.  

Yours in health 
Chris from Out of the Box Physiotherapy.

Middle back pain: aka Thoracic Spine Pain

We continue to see lots of patients suffering with pain in the middle section of their back.  These patients have often had worsening pain in the area across days or weeks before they come and see us.  This article will help to explain the role that physiotherapy can play in management of thoracic spine pain.

Anatomy 101:
The thoracic spine, located in the mid-back region, consists of 12 vertebrae (T1-T12) that connect to the ribs, forming the thoracic cage. This part of the spine plays a pivotal role in maintaining stability and supporting our body's movements, acting as a bridge between the cervical and lumbar regions.

Common Sources of Pain:
Poor Posture: Modern lifestyles often involve prolonged sitting, hunching over screens, or slouching. This can lead to poor posture, causing strain on the thoracic spine and surrounding muscles.

Muscle Imbalances: Weakness or tightness in the muscles supporting the thoracic spine can disrupt its natural alignment, contributing to discomfort.

Herniated Discs: Although less common in the thoracic region compared to the cervical or lumbar spine, herniated discs can still occur, leading to localised pain and potential nerve compression.

Overuse or Repetitive Movements: Activities involving frequent rotation or lifting can strain the thoracic spine, leading to pain and dysfunction over time.

How Physiotherapy Helps:
A skilled physiotherapist will conduct a thorough assessment to identify the root cause of your thoracic spine pain. This may include analysing your posture, muscle strength, and range of motion.  Treatment techniques will include:/

Targeted Exercises: Physiotherapy involves tailored exercises to address muscle imbalances, strengthen supportive muscles, and improve posture. These exercises aim to restore proper alignment and alleviate pain.  We love our back balls for this section of the spine as they are a great way to self-mobilise the spine at home between physio visits.  

Manual Therapy: Hands-on techniques, such as massage and joint mobilisation, can help release tension in tight muscles and improve the mobility of the thoracic spine.

Posture Education: Your physiotherapist will provide guidance on maintaining good posture during daily activities and offer ergonomic advice to prevent future issues.

Pain Management: Physiotherapy may include modalities such as heat or ice therapy to manage pain and reduce inflammation in the affected area.

Thoracic spine pain is a condition where traditional physiotherapy techniques remain highly effective.  Manual therapy and soft tissue therapy along with mobility exercises targeting the area will all help.  We love treating this part of the spine as we can generally start to make a big difference in your pain quite quickly.  If you have middle back pain, stop suffering, we are here to help.  

Usually, in a short block of treatment across 2-4 weeks, we can see a significant improvement in your middle back pain.

Cervicogenic Headaches: Your headaches might be coming from your neck

Neck related headaches, often referred to as cervicogenic headaches, are quoted as accounting for up to 20% of all chronic headaches.  There are certain factors that can increase the likelihood of suffering from cervicogenic headaches.  Things such as previous neck injuries and trauma (eg. whiplash), occupational demands, and postural loads are all possible factors.   

What are Cervicogenic Headaches?
Cervicogenic headaches are a distinct type of headache that originates from the neck or cervical spine. Unlike tension headaches or migraines, cervicogenic headaches are specifically linked to dysfunction or abnormalities in the neck. The pain is often felt on one side of the head and may be accompanied by neck pain or stiffness.  The headache might also be triggered by movements of the neck. 

How They Differ from Other Headaches:
Distinguishing cervicogenic headaches from other types is crucial for effective treatment. Tension headaches typically result from stress or muscle tension, while migraines are often associated with neurological factors. Cervicogenic headaches, on the other hand, stem from structural issues in the neck such as muscle imbalances, or joint dysfunction.

How Physiotherapy Helps:
Physiotherapy plays a pivotal role in alleviating cervicogenic headaches by addressing the underlying musculoskeletal causes. Physiotherapists employ a variety of techniques, including:

a. Manual Therapy: Hands-on techniques to manipulate and mobilise the neck joints, reducing pain and improving mobility.

b. Exercise Prescription: Tailored exercises to strengthen and stretch specific muscles, correcting imbalances and improving posture.

c. Posture Education: Educating patients on proper ergonomics and posture to prevent recurring issues.

d. Soft Tissue Mobilisation: Techniques such as massage or myofascial release to address tight or tense muscles in the neck.

How Long Patients Typically Take to Get Relief:
The duration for relief varies from patient to patient, depending on the severity of the condition, adherence to treatment plans, and individual response to therapy. Some patients experience significant improvement after a few sessions, while others may require a more extended period for lasting relief.

How to Prevent Headaches from Returning:
To prevent the recurrence of cervicogenic headaches, patients are encouraged to:

a. Follow Exercise Programs: Consistently engage in prescribed exercises to maintain neck strength and flexibility.

b. Adopt Healthy Habits: Incorporate proper posture and ergonomic practices in daily activities, especially during prolonged periods of sitting or working.

c. Manage Stress: Practise stress-reduction techniques such as meditation, deep breathing, or yoga to minimise tension-related triggers.

d. Regular Physiotherapy Check-ups: Periodic visits to a physiotherapist for assessment and adjustments can help identify and address potential issues before they escalate.

At Out of the Box Physio, we understand the impact cervicogenic headaches can have on your life. Through personalised physiotherapy interventions, we aim to not only relieve your immediate pain but also provide you with the tools to prevent future headaches. Take the first step towards a headache-free life by scheduling a consultation with our experienced physiotherapists. Your journey to lasting relief starts here.

Needling away pain: The art of dry needling in physiotherapy

Dry needling has gained popularity in the world of physiotherapy, offering a unique approach to alleviate pain, improve function, and promote healing.

In this Blog, we will dive deep into what dry needling is, what it's used for, how it differs from acupuncture, and the myriad benefits it can bring to your recovery journey.

What is Dry Needling?
Dry needling is a specialised treatment technique used by physiotherapists to address pain and movement impairments in the body. It involves inserting thin, solid needles directly into specific trigger points or tight bands of muscle tissue. Unlike acupuncture, which is rooted in traditional Chinese medicine and focuses on rebalancing the body's energy flow, dry needling is firmly grounded in Western medicine and neurophysiology.

How is Dry Needling Different from Acupuncture?
While both dry needling and acupuncture use thin needles, they have distinct differences:

Philosophy: As mentioned, dry needling is based on Western medicine and focuses on trigger points and muscular issues. In contrast, acupuncture is rooted in traditional Chinese medicine and is often used to restore the body's energy balance (Qi).

Needle Placement: Dry needling involves targeting specific myofascial trigger points, muscles, or soft tissues responsible for pain and dysfunction. Acupuncture, on the other hand, uses a broader network of meridian points.

Needle Manipulation: In dry needling, the needles may be manipulated to create a local twitch response, helping to release muscle tension. Acupuncture needles are typically inserted and left in place for a longer period.

Training: Dry needling is performed by trained physiotherapists or medical professionals who have a strong understanding of anatomy and pain mechanisms. Acupuncture practitioners follow their own specialized training and techniques.

What is Dry Needling Used For?
Dry needling can be a versatile tool for physiotherapists, with applications in various conditions, including:

Benefits of Dry Needling:
Some of the benefits of dry needling are:

Some Examples of Areas Dry needling can be used:

Low Back Pain: Dry needling can effectively treat chronic low back pain by targeting trigger points in the lower back muscles.

Rotator Cuff Injuries: For shoulder pain and rotator cuff injuries, dry needling can relieve muscle tension and improve joint mobility.

Plantar Fasciitis: Dry needling can be beneficial in alleviating the pain and tension in the foot's plantar fascia.

Dry needling is an effective addition to the toolbox of modern physiotherapy. It offers a Western medicine perspective on pain management, with a focus on musculoskeletal issues and trigger points. By understanding what dry needling is, how it differs from acupuncture, and the many benefits it brings, you're one step closer to making informed decisions about your recovery journey.

Our skilled professionals are ready to guide you towards a pain-free and active lifestyle.

Yours in health

The team from Out of the Box Physiotherapy 

Whiplash: On the Road to Recovery with Physiotherapy

Whiplash is a common injury that can occur in various situations, such as car accidents or sports-related incidents. In this blog, we will explore what whiplash is, the typical timeframe for recovery, and how physiotherapy can be a crucial part of the healing process.

What is Whiplash?
Whiplash is an injury to the neck that occurs when the head is suddenly and forcefully jolted backward and then forward. This rapid motion can strain or damage the neck's soft tissues, including muscles, ligaments, and tendons. While it is commonly associated with car accidents, whiplash can also result from other high-impact incidents, such as falls or contact sports.

Recovery Phases
Whiplash recovery typically unfolds in distinct phases. It's important to note that every individual's experience may vary, but understanding these phases can help you prepare for what to expect.

How Physiotherapy Helps
Physiotherapy is a fundamental component of the whiplash recovery process. Here's how physiotherapy can assist in your journey to healing:

In summary, whiplash is a neck injury that can disrupt your life, but with the right approach, you can overcome it. Physiotherapy is an essential part of the healing process, helping you manage pain, regain mobility, and rebuild strength. If you've recently experienced whiplash or are currently dealing with its aftereffects, don't hesitate to reach out to us at Out of the Box Physiotherapy. Our team of skilled professionals is here to guide you on your journey to recovery.

What exactly is Tendinopathy?

Tendinopathy is a term that may sound complex, but it's a condition that many of us have heard of or even experienced without fully understanding what it entails. Whether you're an athlete dealing with a nagging injury or someone who occasionally experiences tendon pain, it's crucial to have a clear understanding of tendinopathy. In this blog post, we'll break down the concept of tendinopathy, exploring its causes, symptoms, and potential treatments.

What is Tendinopathy?

Tendinopathy is a broad term used to describe conditions that affect tendons, the tough, fibrous tissues that connect muscles to bones. Tendons play a crucial role in facilitating movement by transmitting the force generated by muscles to the bones they're attached to. When tendons become damaged or degenerated, it can lead to pain, reduced mobility, and functional limitations.

Types of Tendinopathy

Tendinopathy is an umbrella term that encompasses several specific conditions, including:

Causes of Tendinopathy

Understanding the causes of tendinopathy is crucial for prevention and management. Common contributing factors include:

Symptoms of Tendinopathy

Tendinopathy can manifest with various symptoms, depending on the type and location of the affected tendon. Common signs include:

Treatment and Management

The treatment of tendinopathy depends on its type and severity. Common approaches include:

Tendinopathy is a common and often painful condition that can affect anyone, from athletes to office workers. Understanding its causes, symptoms, and treatment options is essential for effective management and prevention. In a majority of tendinopathy cases, the best place to start is with a physiotherapist. Whilst the condition can sound generic, the management plan is always best personalised as no two tendinopathies are the same. Remember, early intervention can lead to faster recovery and a return to pain-free movement.

Can you move your neck well?

In today's fast-paced world, where digital devices and sedentary lifestyles have become the norm, neck pain has emerged as a prevalent issue affecting countless individuals. Whether it's due to long hours spent hunched over a computer screen, excessive smartphone use, or poor posture, neck pain has become an unwelcome companion for many. One key factor that often goes overlooked in understanding and managing neck pain is the correlation between neck range of motion and the discomfort experienced. In this blog post, we'll delve into the fascinating connection between neck range of motion and neck pain, shedding light on how helping your neck to move better can help reduce (and remove) your neck pain.

Before we explore the connection, let's clarify what neck range of motion entails. In simple terms, neck range of motion refers to the degree and direction to which an individual can move their neck comfortably. It encompasses movements such as tilting the head forward and backward, turning side to side, and tilting the head from one shoulder to the other.

How Range of Motion Affects Neck Pain
1. Muscular Imbalance: Reduced neck range of motion often stems from muscular imbalances and stiffness. Muscles that are constantly strained due to poor posture or excessive stress tend to become tight and restricted. This limits the ability of the neck to move freely, leading to discomfort and pain.

2. Joint Health: The neck is composed of numerous small joints that enable its various movements. When these joints are not used through their full range, they can become stiff, leading to decreased flexibility and pain. Regular movement maintains joint health and reduces the risk of pain.

3. Postural Alignment: A significant contributor to neck pain is poor posture. When the head is constantly held in a forward position, it places undue stress on the neck muscles and ligaments. This can lead to chronic pain as well as limitations in range of motion.

4. Nerve Irritation: Limited neck mobility can sometimes result in nerve irritation. When nerves are compressed or pinched due to restricted movement, it can lead to radiating pain, tingling, or numbness in the neck and even down the arms.

Addressing the Issue: The Role of Physiotherapy
Through targeted exercises, manual therapy, and education, physiotherapists can guide individuals toward a healthier neck and improved quality of life.

Stretching and Strengthening: Physiotherapists design tailored stretching and strengthening exercises to improve muscle flexibility and balance. This promotes a wider range of motion while reducing muscular tension that contributes to pain.

Manual Therapy: Hands-on techniques like joint mobilization and soft tissue manipulation can help restore normal joint mechanics and alleviate muscular tightness. These therapies can significantly improve neck mobility and comfort.

Posture Education: Physiotherapists educate patients about proper posture during daily activities, whether sitting at a desk, using a smartphone, or lifting objects. These guidelines minimize stress on the neck and prevent pain from recurring.

Pain Management Strategies: Physiotherapists teach pain management techniques such as relaxation exercises, heat or cold therapy, and ergonomic adjustments. These strategies help individuals manage and reduce pain during their recovery.

So if you have neck pain, the good news is that physiotherapy offers effective solutions to address these issues. By working with a skilled physiotherapist and adopting recommended exercises and lifestyle changes, individuals can regain a fuller range of motion, alleviate pain, and prevent future discomfort. Remember, a pain-free neck leads to a more comfortable and productive life.

Unveiling the Connection Between Thoracic Spine Stiffness and Shoulder Pain

If you're a swimmer, cricket, AFL or rugby player (league or union), or someone engaged in employment in heavy industries or construction, you're likely no stranger to shoulder pain. 

This persistent discomfort can hinder your performance and daily activities at home, work and during sporting endeavors. However, what you may not realize is that the biomechanical driver of your shoulder pain could be related to the stiffness in your thoracic spine. In this article, we'll delve into the relationship between thoracic spine stiffness and shoulder pain, shedding light on how addressing one can alleviate the other.

Understanding the Thoracic Spine
The thoracic spine, comprising the twelve vertebrae in the middle part of your back, serves as a crucial link between your upper body and lower back. Its role extends beyond providing stability; it also facilitates optimal movement of the arms, shoulders, and chest. However, prolonged repetitive movements, poor posture, or heavy workloads can lead to thoracic spine stiffness, resulting in shoulder pain.

The Impact of Thoracic Spine Stiffness
When the thoracic spine loses its mobility due to stiffness, it can have significant repercussions on the shoulders. Here's how thoracic spine stiffness can contribute to shoulder pain:

  1. Restricted Range of Motion: Stiffness in the thoracic spine limits the shoulders ability to move into end of range flexion (arms moving in front of the body above head) and abduction (arms moving out from the side of the body above the head). Consequently, your shoulder joints suffer a reduced range of motion in these directions (flexion and abduction) leading to stiffness and impaired muscle activation patterns around the scapula and shoulder joint.
  2. Compromised Shoulder Mechanics: A stiff thoracic spine alters the normal movement patterns of the shoulders. This disruption can cause muscle imbalances and poor biomechanics, leading to shoulder impingement, tendonitis, or rotator cuff issues.
  3. Postural Imbalances: Thoracic spine stiffness often leads to a rounded shoulder posture, where the shoulders roll forward and the chest collapses. This postural imbalance places excessive stress on the shoulder joint, leading to pain, instability, and decreased athletic performance.

Addressing Thoracic Spine Stiffness to Relieve Shoulder Pain
To alleviate shoulder pain caused by thoracic spine stiffness, it's essential to adopt a multifaceted approach that focuses on improving thoracic mobility and optimizing shoulder mechanics. Consider the following strategies:

  1. Thoracic Mobility Exercises: Incorporate exercises that promote thoracic spine mobility, such as thoracic extensions, foam rolling, and cat-cow stretches. These exercises can enhance flexibility and reduce stiffness in the thoracic region.
  2. Corrective Posture Techniques: Pay attention to your posture, both during activities and throughout the day. Avoid slouching or rounding your shoulders forward, and strive to maintain an upright posture. Ergonomic adjustments in your workplace can also play a significant role in supporting proper posture.
  3. Strengthening and Stability Exercises: Engage in exercises that target the muscles supporting the thoracic spine and shoulders, such as rows, scapular retractions, and push ups. Strengthening muscles that perform these movements can help maintain stability, improve shoulder mechanics, and alleviate pain.
  4. Activity Modification and Rest: If your shoulder pain is aggravated by specific activities or sports, consider modifying your technique (in consultation with your physiotherapist and coach) or taking rest periods to allow for proper recovery. Overuse and repetitive motions can exacerbate shoulder pain, so it's crucial to give your shoulders adequate rest when needed.

In a lot of cases, manual therapy is needed to help address thoracic spine stiffness so it is always beneficial to seek the help of a physiotherapist to provide treatment to this area. We do often find that unlocking the stiffness in the thoracic spine assists greatly in the management of shoulder pain conditions. Often across a few visits, we are then able to progress to self-managed exercises at home or the gym to keep your pain and stiffness away.

Yours in health
Chris and the team at Out of the Box Physiotherapy