Acute Lower Back Pain: Top Tips For Recovery

Most adults will suffer from an episode of back pain at least once in their lifetime. Back pain can be frustrating, incapacitating, and frightening – especially if you haven’t had it before! Thankfully, most back pain is not serious and will resolve within a few weeks. Resting from aggravating activity can help but it’s important to keep moving too! Walking at an easy pace for 5-15 minutes a few times a day, along with pain relief medication and some gentle exercise goes a long way to helping you make those first steps in your recovery. See the top tips below for starting your recovery from acute lower back pain.

1. Don’t stress – over 80% of back pain is not serious will settle within a few weeks.

2. Take pain relief medication – take some pain-relieving medication and try using a hot or cold pack on the area for 10-15 minutes, 2-3 times per day to help reduce muscle tightness and spasm.

3. Take some deep breaths – muscle spasm can be very painful in the early stages of back pain. Remember to breathe through it. Taking some relaxed, deep breaths every hour can help. Try to relax your shoulders while sitting or lying in a comfortable position (this may be with a pillow under/ between your knees). Take long, slow breaths in through your nose and out through your mouth for 5-6 breaths. Return to your normal breathing pattern for 1-2 minutes, then perform another set of deeper breaths.

4. Perform gentle movements – gentle movement in a way that feels comfortable and right for you will help to further reduce muscle spasm. You can try the exercises below to get started – remember to keep your movements slow and to move within the range that you can manage without adding to your pain or discomfort.
– Knee rolls side-to-side.
– Crook pelvic tilts.
– Cat/cow.
– Mini child’s pose.
– Crook marching.

5. Get some advice – if you are not getting better or you are concerned , arrange an assessment with a physiotherapist to get it checked.

*If you notice any changes to your bladder and/or bowel function, have changes to the feeling around your genital area, and/or have symptoms in both legs – you should go to your closest
emergency department immediately.

*If you have osteoporosis or have risk factors for osteoporosis, you should get any sudden-onset back pain checked

Crick In The Neck: Top Tips For Recovery

Neck pain is uncomfortable and debilitating. It can negatively impact your mood and stop you from doing the activities you enjoy if left untreated. Most of us have woken up with a crick in the neck before. It’s a strain injury that’s usually due to muscle spasm, sleeping in a poor position, and often occurs because the neck muscles are tight and deconditioned. It presents as discomfort, pain, or a pulling sensation on one side that affects the back/side of the neck, upper shoulder, and sometimes reaches down to the shoulder blade. It can range in severity from mild to severe and requires some attention to enable recovery. See the top tips below for starting your recovery from a crick in the neck!

1. Don’t stress – most neck pain is muscular and will be eased with relaxation and treatment.

2. Take pain relief medication – take some pain relieving medication and try using a hot or cold pack on the area for 10-15 minutes, 2-3 times per day to help reduce muscle tightness and spasm.

3. Gently move your neck- it’s important to keep moving your neck to avoid stiffness and further spasm. Doing some gentle movements within your comfortable movement range 3-5 times per day will really help. Doing these movements after you’ve used some heat and taken pain killers will help. Movements include looking up and down, turning your head from side-to-side to look over your shoulders, and bringing your ear towards your shoulder on each side. *Remember to move slowly, and avoid fast or jerking movements.

4. Move your arms – when it comes to muscle issues, the neck and shoulders are closely related. It’s helpful to gently roll your shoulders backwards and forwards in large circles 3-5 times per day, and use your arms normally for daily activities.

5. When to get it checked – if your pain is not improving within a few days, is getting worse, or if you are concerned, book an appointment with a physiotherapist to get it checked.

If you have face, arm, or head symptoms, or a history of circulation or blood pressure problems, get it checked immediately.

Golfer’s Elbow (Medial Epicondylitis)

Golfer’s elbow is defined as chronic degeneration of the tendon on the inside of the elbow, usually due to overuse. As its name implies, it is a condition common in golfers. However, as with all sporting injuries, this condition can affect anyone. Golfer’s elbow is similar to tennis elbow, occurring on the inside of the elbow rather than the outside.

What are the symptoms?

Typically, someone suffering from this condition will experience pain on the inside of the elbow, forearm and possibly extending down to the hand. The pain will be worst with activities that require gripping of the hand and movements of the wrist. Less common is the experience of pins and needles in the hand.

How does it happen?

The exact cause of this condition is unknown, however it is generally thought to occur when the forces transmitted through the tendon become too great. This can be due to increased demands on the tendon or reduced quality of the tendon tissues. As the tendon is attached to muscles that bend the wrist and provide grip strength, activities such as golf, rock climbing or manual work that involve gripping objects can easily create forces that damage the tendon. Conversely, factors such as poor blood supply or simply the normal processes of aging can reduce the quality of the tendon. If the tissue is not functioning well, then even simple but repetitive movements in an office job can cause Golfer’s elbow. There are a few other known contributing factors for Golfer’s elbow, such as poor posture, neck dysfunction, a recent change in activity and a history of trauma, such as a fall onto an outstretched hand.

What is the treatment?

Golfer’s elbow usually develops slowly, and healing can be a long process. The first step to effective treatment is accurate diagnosis, as many other conditions have similar symptoms and need to be excluded first by a medical professional. Once a diagnosis of golfer’s elbow has been confirmed, treatment is aimed at allowing tissues to heal and regenerate. This will require a certain level of rest, and changes to the forces affecting the tissues, sometimes through bracing or taping. Specific exercises have been shown to assist tissues in coping with and responding to load; these are called “eccentric” exercises. Other treatments include increasing blood flow to the area to promote healing. In chronic and severe cases, injections of corticosteroids are used, and in severe cases surgery may be undertaken.

The information in this newsletter is not a replacement for proper medical advice. Always see a medical professional for assessment of your individual condition.

Shoulder Dislocations

The shoulder is an amazing joint with incredible flexibility. It doesn’t attach directly to the spine, like the hip joint; instead, it is held to the body through a complicated system of musculature and
indirectly by the collarbone (clavicle) to the front of the rib cage. Many other joints in the body are extremely stable, thanks to the structure of the bones and ligaments surrounding them. However, the shoulder has so much movement that some stability is sacrificed. It is for this reason that shoulder dislocations are a relatively common occurrence.

What is a dislocation and how does it happen?

As the name suggests, a dislocated shoulder is where the head of the upper arm is moved out of its normal anatomical position to sit outside of the shoulder socket joint. Some people have more flexible Joints than others and will unfortunately have joints that slip out of position easily without much cause. Other people might never have a dislocated shoulder except for a traumatic injury that forces it out of position. The shoulder can dislocate in many different directions, the most common being anterior. This occurs when the arm is raised and forced backwards in a ‘stop sign’ position, which can occur in many situations.

What to do if this happens

The first time a shoulder dislocates is usually the most serious. If the shoulder doesn’t just go back in by itself (spontaneous relocation), then someone will need to help to put it back in. This needs to be done by a professional as they must be able to assess what type of dislocation has occurred, and often an X-ray needs to be taken before the relocation happens. A small fracture can actually occur as the shoulder is being put into place, which is why it is so important to have a professional perform the procedure.

How can physiotherapy help?

Following dislocation, your physiotherapist can advise on how to allow the best healing for the shoulder. It is important to keep the shoulder protected for a period to allow any damaged structures to heal as well as they can. After this, a muscle-strengthening and stabilization program can begin. This is aimed at helping the muscles around the shoulder to provide further stability and prevent future dislocations.

This information is not a replacement for proper medical advice. Always see a medical professional for assessment of your individual condition.

Gluteal Tendinopathy

What is Gluteal Tendinopathy?

When tendons are repeatedly placed under more tension than they can deal with, they can have a failed healing response. This can cause changes to the structure of the tendon and is known as a
tendinopathy. When this occurs in the tendons of the gluteal muscles it is referred to as gluteal tendinopathy. The gluteal muscles are three large muscles located at the back of the pelvis that provide most of the muscle bulk of buttock region. These muscles work together to keep your pelvis level when standing and are responsible for many movements of the hip. They play an important role in standing, walking and running. The two deepest gluteal muscles, gluteus medius and gluteus minimus, attach from the center of the pelvis (the sacrum) and insert into the bony
outer region of the upper thigh, called the greater trochanter via the gluteal tendons.

What causes tendons to develop tendinopathy?

Tendons, like muscles, skin and bones are living tissues and their strength and elasticity is influenced by a variety of factors, including hormones, age, how often and how much they are used. Rapid changes in activity levels or simply performing the same tasks too often can place a tendon under more stress than it can tolerate and it begins to break town. Recently it has been shown that
tendon health is also negatively affected by compressive forces, which can occur from blunt trauma or even habits such as crossing you legs, or sleeping on your side on a hard mattress.

What are the symptoms of Gluteal Tendinopathy?

When gluteal tendons are affected by tendinopathy, a typical pattern of sharp pain at the outside of the hip with specific movements is present. The pain is usually worse with walking, going up and down stairs and running. The pain can become quite severe, and eventually can impact day-to-day activities.

How can physiotherapy help?

A thorough assessment is required for an accurate diagnosis and once gluteal tendinopathy is confirmed, your physiotherapist will be able to identify which factors have contributed to your condition and help to address these. It has been shown that specific loading exercises and muscular retraining can stimulate the tendon to heal and remodel the collagen fibres into a more organized pattern again. Your physiotherapist can investigate any postural habits or activities are contributing and address these as required.

This information is not a replacement for proper medical advice. Always see a medical professional for advice on your individual injury.

LCL Tears

What is the LCL?

The knee is one of the largest joints in the body and has only one plane of movement. This means it bends and straightens but does not twist (much) or move from side to side. To keep the knee from moving in other directions, the knee is supported by many strong ligaments, with two of these being found on either side of the knee. The inside ligament is the ‘Medial Collateral Ligament’ (MCL) and the outside one is the ‘Lateral Collateral Ligament’ (LCL). The primary role of the LCL is to prevent the lower leg from moving too far towards the midline in relation to the upper leg.  Both the LCL and MCL are extremely strong ligaments and provide lots of support to the knee during movement however, they are still vulnerable to injury.

How do tears happen?

The LCL is injured less often than the MCL, however tears do still occur. The most common way the ligament is damaged is through a force causing the knee to move inwards in relation to the upper leg, or a twisting of the knee. This can be seen in sports that involve changing directions or with a direct force, such as a rugby tackle. This injury can also occur from a simple fall and as with all sporting injuries, it is not only athletes who can be affected, anyone can tear their LCL in the right circumstances.

What are the symptoms?

Following an injury to the LCL, common signs and symptoms are a ‘popping’ sound at the time of injury, immediate pain with weight bearing and swelling and a feeling instability. The severity of the injury will impact how much each of these symptoms are felt and LCL tears are classified as either Grade I, II or III, which helps to direct treatment. A grade I tear is where a few fibers of the ligament are stretched and damaged, a grade II is where this a partial rupture of the ligament with some instability of the knee and Grade III is a complete tear.

How are LCL tears diagnosed?

Your physiotherapist is able to perform clinical tests to evaluate if there is any instability of the knee from an LCL tear. An MRI can confirm this diagnosis and an Xray may be required to rule out any associated fracture. It is possible for nerve damage to occur at the same time as an LCL Tear, which will result in weakness and loss of sensation in the lower leg. Severe injuries are more likely to involve injury to other parts of the knee and your physiotherapist will make a full evaluation of all your injuries on assessment. Most LCL tears are managed well with just physiotherapy and support of the joint, however severe tears and associated nerve damage may require surgery. Your physiotherapist and medical team will work together to help determine the best course of action for each individual injury

How can physiotherapy help?

For tears that don’t require surgery, your therapist will advise you on how to best support and protect the injured joint. In the first 48 hours, RICE protocol (Rest, ice, compression, and elevation) is applied to reduce any pain, swelling, and inflammation. Following this period, you will be advised on how best to mobilise the joint whilst preventing any further damage. Return to sport will be dictated by healing times with a full recovery expected by 6-12 weeks. Following ligament damage, balance, strength, and proprioception are often impacted and your physiotherapist will develop a program to address this, which is an important part of preventing further injury. Tears that are repaired surgically will require a longer program of rehabilitation and close liaison with the medical team.

This information is not a replacement for proper medical advice. Always see a medical professional for advice on your individual injury.

Snow Sport Injuries

Snow sports are exhilarating and fun, but as we know only too well, they come with a safety warning: injuries can happen. A recent study titled New Zealand Snow Sports Injury Trends Over Five Winter Seasons 2010–2014 found that over a five-year period, more than 18,000 skiers and snowboarders suffered injuries on the slopes. Falls accounted for 74.3% of all injuries, followed by collisions (9.6%), jumps (7.3%), man-made terrain features (5.3%) and lifts (2%). The most common injuries were to the knee (36%), followed by the back (18%), wrist (14%), head (11.2%), shoulder (11%), lower leg (6.4%), and collar bone (3.4%).

At Queenstown Physio we see hundreds of knee injuries every season, mostly from skiing.  They are typically ligament injuries, most commonly MCLs. They tend to be twisting-type injuries where the knee becomes the pivot point. Skiers can also have more serious knee injuries such as ACLs, and again, that’s when a person’s ski doesn’t release from their boot. Another injury specific to skiers is “skier’s thumb” – when skiers fall and the pole forces their thumb backwards injuring the ligament.

Snowboarders, on the other hand, come to our clinic with mostly upper limb injuries because both their feet are attached to the board, so they don’t have the same twisting force to the lower limbs. Snowboarding injuries are commonly fractured wrists or collarbones, or shoulder and elbow dislocations. However, snowboarders can also rupture their ACL following a “big air, flat landing”, where they overshoot a jump and miss the angled slope, and land on the flat with their quad muscles absorbing the full force of the landing. Then there is “snowboarder’s ankle” or a talus fracture, also from landing hard after a jump. This injury has become more common since snowboarding increased in popularity.

Injuries are usually the result of the force of a fall, but sometimes it is purely bad luck and the way the person happens to fall. However, clients often blame fatigue. Our physio Deborah’s advice?
“We always say, don’t call last run.” As the name implies, “last run” is the last run before heading to lunch or home for the day, and this can often be when an injury occurs. She says that “weekend
warriors” like herself are most at risk from fatigue-related injuries. These are people who work Monday to Friday and go to the mountain only on weekends. “We’re likely to think we’ve only got the weekend, and then we go too hard and too fast.” Another common cause of injury is people exceeding their technical ability. People go too fast for their skill level, use the chairlift before
they can get off safely, or progress to the more challenging slopes or the terrain park – where the jumps and other man-made obstacles are – before they are ready. There are other factors that can play a part, such as poor gear setup, particularly if the boot binding is too tight and doesn’t release; and icy conditions, which make falling injuries more severe. That’s when we see whiplash and concussion, which we see in both skiers and snowboarders. Or it can be breaks and fractures.

There are ways to mitigate the risk of injury, and Deborah’s advice to clients is simple and easy to follow: “Obviously the stronger and fitter you are, the less likely fatigue will play a part in any injury. But I always tell my clients to walk from the car park and not to take the shuttle, because the walk is a nice, gentle warmup, especially for lower limbs. And then to ease into it on the
slopes, start gently.” Deborah recommends protective gear, including helmets for everyone and wrist guards for snowboarders, particularly for beginners and those progressing to the terrain park where there’s further to fall and, therefore, more force in the landing. After a day on the slopes, Deborah would encourage stretching, particularly the lower limbs – quads, hamstring, glutes and hips. For pre-season preparation, Deborah prescribes squats, particularly done on an uneven surface to challenge balance as well as build strength.

The most common question Deborah gets asked is: “When can I get back on the snow?” For clients on holiday from Australia, the question becomes more loaded. “In the more serious injuries,
that’s really easy to answer: they won’t be back. But in a grade one sprain in any ligament – and the majority is knees – it can be a bit more challenging because they’ve got a limited time and a small injury, and they don’t want it to affect their whole holiday.” Deborah stresses the need to respect healing timeframes, but knows that this can fall on deaf ears. “Often, I recommend that they don’t ski, but I know that a lot of them will. I explain to my patients that they won’t ski to their full ability if they’ve got a little niggle, and that puts them at risk of
other injuries.” When assessing whether a client is fit for return to the ski field, Deborah uses a checklist to assess strength, ability and balance. For an injured knee, she will get clients to hop, jump and lunge. “With a hop, I’m looking more at their power up. When they’re jumping, I’d look at how they land comparing left and right. And with skiers, you need that sideways agility so that’s the lunging or jumping out on one leg to the side.”

In Deborah’s opinion, the risk of injury is small and shouldn’t stop people enjoying the snow. She has worked in a first aid clinic on Coronet Peak and says the statistics tell the story: “On a busy day, we might see 30 patients, but there would be 3,000 or 4,000 people up the mountain. Obviously, some come straight down the mountain, but overall injuries are a very small proportion of the number of people up there having a great time.”

Common Running Injuries

Running is a great way to stay in shape, manage stress and increase your overall wellbeing, however it’s not without it’s drawbacks. While being a low risk activity, there are a few injuries that commonly affect runners. As running is a repetitive impact activity, most running injuries develop slowly and can be difficult to treat. Here are three of the most common conditions faced by

Runners Knee

Runners knee is a persistent pain on the inside of the knee caused by the dysfunctional movement of the kneecap during movement. The kneecap ideally sits in the centre of the knee and glides
smoothly up and down as the knee bends and straightens, in a process described as tracking. If something causes the kneecap to track abnormally, the surface underneath can become worn, irritated and painful. The pain might be small to start with, however left untreated, runner’s knee can make running too painful to continue.

Shin Splints

Shin splints is a common condition characterised by a recurring pain at the inside of the shin. While the cause of this condition is not always clear, it is usually due to repeated stress where the calf
muscles attach to the tibia (shin bone). Why this becomes painful is likely due to a combination of factors that can be identified by your physiotherapist to help you get back on track as soon as

Achilles Tendonitis

The Achilles tendon is the thick tendon at the back of the ankle that attaches to the calf muscles. The amount of force that this tendon can absorb is impressive and is vital in providing the propulsive force needed for running. If the stresses placed on the tendon exceed its strength, the tendon begins to breakdown and become painful.

The information in this newsletter is not a replacement for proper medical advice. Always see a medical professional for assessment of your individual condition.

ACL Tears

What is an “ACL tear” and how does it occur?

The ACL, or anterior cruciate ligament, is a strong piece of connective tissue which attaches the thigh bone (femur) to your leg bone (tibia). The ACL is referred to as a “crucial” ligament due to the stability it provides to the knee joint. The ACL’s job is to prevent the tibia from sliding forward relative to the femur.

This ligament is injured in athletes more often than other populations, however injury to the ligament may occur in other ways. Injuries tend to occur when landing awkwardly from a jump, twisting the knee, or suddenly stopping from running. The ACL may also be injured during knee hyper-extension, or when hit from the outside. Many times, other tissues surrounding the knee are also damaged, including the medial collateral ligament, meniscus, joint cartilage, and bone marrow.

A musculoskeletal practitioner can formally grade the severity of ACL injuries. A grade I injury occurs when there is minimal damage to the ligament and the joint remains stable on testing. Grade II injuries occur when the ligament is partially torn. The joint becomes loose on testing, but still provides a degree of stability. Grade III constitutes a full tear or rupture of the ligament. There will be no stability provided to the joint on testing.

What are the signs and symptoms of an ACL tear?

Many people will report hearing a “pop” in the knee associated with pain at the time of injury. Within a few minutes to hours of injury, there is likely to be significant joint swelling. Decreased range of movement of the knee is common, and the injured knee is typically unable to take full weight upon standing or walking. It may also feel unstable at times, such as a “giving way” sensation. Poor balance and coordination may also be experienced.


Non-surgical management of the injured ACL is taken when there is a grade I to grade II injury. Surgical management typically occurs for grade III injuries, and occasionally grade II injuries to the ACL. Your doctor or physiotherapist can help you decide whether non-surgical or surgical management is best for you. Regardless of surgical or non-surgical management, your physiotherapist will assist you with improving your knee’s range of movement, lower limb strength, balance, stability and coordination. You will re-learn the tasks of walking, using stairs, and negotiating obstacles. Early in rehabilitation, the RICE protocol (rest, ice, compress, elevation) is used in conjunction with static resistance type exercises to improve muscle contraction in the leg and increase blood flow in the area. Throughout your rehabilitation program, you will progress through a variety of strength and mobility exercises targeted towards your individual needs, with goals of returning to your favourite sport or hobby as soon and as safely as possible.

This information is not a replacement for proper medical advice. Always see a medical professional for advice on your individual injury.

Optimising Injury Healing – Stress

Healing from injury or surgery is an important process. Poor healing of muscle, ligaments, tendons and bones can delay your recovery and your return to the things you like doing. If you have had surgery or have open wounds, poor healing can increase wound infections or complications.

Healing from a wound or injury requires you to be in good physical condition. Some things can delay healing such as diabetes, smoking and immunological conditions. You may not realize psychological factors also play a part. Stress, which is a normal and natural reaction, is one factor which has been shown to delay healing of wounds/tissue damage.

Unfortunately, chronic stress promotes habits that can negatively impact on health and healing. These habits include smoking, alcohol and drug abuse, reduced level of exercise, poor diet choice and poor sleep.   This sounds like Queenstown!

How stress affects your body:

Many functions in your body are controlled by your autonomic nervous system, there are two parts to this system; the sympathetic nervous system (SNS) and the parasympathetic nervous system (PNS).

The SNS kicks in when your body perceives it is in danger (such as jumping out of the way of a wayward car). It is the fight/flight response. The SNS is also activated when we are under physical stress, such as an injury or a heavy exercise session. Emotional or psychological stress can cause the SNS to work for long periods, which is detrimental to regular body function and can cause clinically relevant delays in healing.

The SNS functions are related to ‘survival’. When activated it helps increase blood flow to your muscles (so you can run away), by reducing the blood flow to your internal organs. If the SNS stays activated for long periods (such as stress), it can have detrimental effects on the functions of your organs such as digestion, fertility and growth (healing).

It is normal for both the SNS and PNS to work together daily, the PNS should be dominant while resting/sleeping to encourage the ‘rest and digest’ functions. The SNS should be more dominant when you are more active, to increase blood to muscles and your breathing and heart rates. Between spikes of SNS activity you should return to a more relaxed/PNS state.