Vestibular Rehabilitation & Physiotherapy

Your vestibular system consists of parts of the inner ear and brain that are responsible for maintaining balance. Damage or irritation from infection and other causes can result in imbalance, vertigo or dizziness.

• Imbalance refers to difficulty in physically maintaining your balance in activities of daily living, for example, if you suffer from frequent falls or near falls. Imbalance may be accompanied by sensations such as vertigo or dizziness.

• Vertigo is a sensation of spinning, dizziness, false sense of movement or swaying even when the person is stationary. It may be associated with nausea, vomiting, sweating or imbalance.

• Dizziness is an impairment in spatial perception and stability. The term dizziness is imprecise and can refer to a wide range of feelings such as light headedness, difficulty concentrating or a ‘foggy’ feeling.

Benign Paroxysmal Positional Vertigo (BPPV)

BPPV is the most common cause of vertigo. In BPPV, small bone-like crystals in one part of the inner ear, called the otolith, make their way into the wrong part of the ear, called the semi-circular canals. This can happen to anyone, but is more likely as we age or after suffering a blow to the head.

BPPV causes very intense vertigo lasting from a few seconds to a couple of minutes, most commonly when looking up or down or when getting in and out of bed. It is sometimes accompanied by a constant feeling of less intense dizziness or light-headedness.

At the time of writing, BPPV is the easiest type of vertigo to treat with 80% of people getting better after one treatment and over 90% getting better with two treatments.

Unfortunately, once someone has had BPPV, there is a 60% likelihood that it will happen again in the future.

Rarely, chronic dizziness will occur after BPPV. This is treatable by Vestibular Rehabilitation.

BPPV is treated by moving your head and body through a specific set of movements that physically guide the crystals out of the semicircular canals. 

In cases of BPPV and vestibular problems causing chronic dizziness, vestibular rehabilitation has been shown to be more effective at treating these symptoms than commonly prescribed anti-dizziness medications.

What Causes Imbalance, Vertigo & Dizziness?

Vestibular hypofunction describes the condition of one or both of the inner ears being damaged, and is the underlying problem in many cases of chronic dizziness. When the messages from your ears to your brain become imbalanced, the brain can have difficulty processing the information. The result can be the sensation of dizziness. This can happen as part of the natural ageing process, as a side effect of medication, or as a result of one of the three diseases listed below.

• Labyrinthitis and Vestibular Neuronitis are two different kinds of infections of the inner ear. In severe cases, symptoms may begin with constant intense vertigo lasting for more than a day.

• Meniere’s Disease causes fluid pressure in the inner ear to increase leading to acute episodes of constant intense vertigo often lasting for many hours. 

• Acoustic Neuromas are benign tumours on the nerve that communicates from the ear to the brain. Vestibular rehabilitation will not fight the infectious cause of labyrinthitis, nor stop the attacks from Meniere’s and it will not cure a tumour. It does not repair damage to the inner ear, but it is very effective at decreasing or eliminating the long-term symptoms caused by the brain’s response to that damage.

Other conditions that can be treated include:

• Central Vestibular Dysfunction: Dizziness or vertigo caused by damage to the brain, for example, stroke or a disease of the nervous system. 

• Post-Concussion Syndrome: Dizziness or vertigo lasting more than several weeks after a concussion.

• Cervicogenic Dizziness: Dizziness caused by musculoskeletal dysfunction.

• Migraine Related Vertigo: Some attacks of vertigo even without a headache can be caused by migraines. 

• Chronic Subjective Dizziness: idiopathic (unknown cause) dizziness is often effectively treated with vestibular rehabilitation.

• Anxiety-Related Dizziness and Dizziness-Related Anxiety: When dizziness has been interfering with someone’s life for a long time it is not uncommon for anxiety about the dizziness to accompany, and even contribute to the problem. Some people who suffer with an anxiety disorder become “hypersensitive” to sensations from their vestibular systems and experience dizziness even though nothing is wrong with their ears or their brain. 

This does not mean that the problem is “all in your head” and it does not mean that there is nothing that can help. Many people with anxiety associated with dizziness and vertigo benefit from vestibular rehabilitation.

Vestibular Rehabilitation incorporates physiotherapy prescription of exercise and manual therapy to treat symptoms of imbalance, vertigo and dizziness.

If you would like to book an appointment with our Vestibular Rehabilitation Physiotherapist Nathan Bridgeman, please request this when making your booking.

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What Causes Lymphedema?

Infection or physical trauma to the lymph nodes can damage the system leading to Lymphedema. Some people are born with a lymphatic system that is not working properly resulting in Lymphedema that can start early in life, or well into adulthood.

People have a higher chance of developing Lymphedema when they have experienced the following:

• Cancer treatment including radiation & chemotherapy

• Removal of lymph nodes

• Radiation therapy

• Being overweight or obesity

• Acquiring an infection in region of the at-risk body part

• Trauma to the at-risk body part

Surgery, Radiation & Lymphedema

Surgical removal or radiation treatment to the lymph nodes increases the risk of developing Lymphedema.

The Sentinel Node Biopsy procedure is minimally invasive but does not eliminate the risk of Lymphedema entirely. 

How is Lymphedema treated?

Physiotherapy is used to address Lymphedema by applying Complete Decongestive Therapy (CDT).

Treatment using CDT has four components: 

• Manual Lymphatic Drainage (MLD): A light massage-like skin stretching technique that stimulates the lymphatic system.

• Compression: Compression therapy physically resists the internal forces which produce lymph fluid. Well-padded bandaging is initially used to reduce edema. At a later stage, expertly fitted medical compression garments manage Lymphedema for the long term.

• Exercise: Whilst wearing your compression garments or bandaging, specifically prescribed exercises that utilise your muscles’ pumping action will be performed to assist in moving the fluid out of the Lymphedematous area.

• Skin Care: Keeping the skin clean and moisturised will help to prevent skin damage and infections that often occur with Lymphedema.

Nathan Bridgeman is an expert in this field and is Hong Kong's only Physiotherapist and fully certified practitioner in CDT.

What Conditions Require Lymphedema Management?

Patients who would most benefit from Lymphedema management and have a higher chance of developing Lymphedema include the following: 

• Those who have undergone cancer treatment such as radiation therapy or removal of lymph nodes, 

• Overweight or obese patients

• Those have an acquired infection or trauma in the at-risk body part 

If you are uncertain whether you suffer from Lymphedema, contact us to see if you would benefit from PhysioMotion's specialised services.

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Examples of Chronic Overuse Injuries Include:

To treat these injuries, we apply our integrated care model to using strong Diagnostic assessment skills and Treatment & Prevention Strategies.

Diagnostics: 

• Our Physiotherapists will perform a comprehensive assessment to diagnose the the injury and the primary cause of the dysfunction

• To encourage optimal healing and prevent further injury, we will perform an individualised whole body biomechanical assessment looking at your strength and control. We will observe any areas where your body might be overloading in one area to compensate for dysfunction in another area.

• A sport-specific analysis will also be conducted, which often includes a running assessment.

Treatment & Prevention:

• We will also discuss other factors that may contribute to your injury such as your exercise program, training regimes, general health and nutrition.

• We know behavioural changes can be essential to optimise healing and recovery, so we will take time with you to explain in depth about your specific issues.

• We also draw on our wide network of health professionals to provide you with the latest research for best possible outcomes.

• A personalised and progressive treatment approach will allow a faster recovery because we take the time to fully assess your problems to establish the root causes. 

• Treatment and exercises will target the cause of your issues. In some cases, you’ll be surprised to see that treatment is not necessarily targeted at where symptoms or pain appear.

• Early intervention is important to prevent further injury and to discourage your body from compensating in other regions of the body.

Our team of therapists will ensure that you have optimal care throughout your treatment and support you in returning to full physical health.

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Our sports injury prevention and treatment programs are designed to expedite a patient's return to full fitness through focused attention to your exercise regime, skillful manual therapy, and target-oriented exercise prescription.

Our team of experienced therapists includes former Hong Kong Team Physiotherapists at the Olympics, Hong Kong Rugby, Hong Kong Swim Team and many other international sporting tournaments. Our therapists are also athletes themselves having represented Hong Kong in netball and other sporting pursuits.

We offer treatment for a range of injuries, including:

• ACL/PCL reconstruction rehabilitation

• Chronic and acute shoulder injuries

• Core stability retraining

• Joint sprains

• Tennis and golfer's elbow

• Spinal pain

• Pelvic girdle dysfunction

Our Programs

The same principles apply to programs for elite athletic training, weight management, post-natal care or post-surgery. 

Our aim is to be progressive, innovative and results-driven.

Our team of therapists will ensure that you have optimal care throughout your treatment and support you in returning to full physical health.

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Essential FAQ’s About Joint Issues

• What causes joint pain?

  Many musculoskeletal aches arise from joint pain and stiffness that often occurs when there are inefficient loading mechanisms through the body. That is, the body is not moving well and causing wear and tear on joint surfaces. This leads to inflammation or degenerative changes in the underlying bone and cartilage within joints.

• What are the long term effects of joint pain?

  If left untreated, it may lead to osteoarthritis (OA) that can range from mild to severe and will impact your ultimate health and quality of life.

  Some will suffer significant joint pain from OA, whilst others will have mild symptoms. Research shows that x-rays and other investigations often do not correlate well with symptoms so having a treatment plan that is patient-specific and targeted at your underlying causes is crucial in symptom relief and long term preservation of the joint.

• What parts of the body are commonly affected by OA?

  The most common joints affected by osteoarthritis are fingers, hips and knees. It is estimated by the Centre for Disease Control and Prevention in the USA that 50% of the population will suffer symptomatic knee OA.

• What are the other types of arthritis?

  Other types of arthritis include rheumatoid arthritis, psoriatic arthritis, gout and fibromyalgia. These types of arthritis need medical advice for drug therapy, but will rely on expert physiotherapy care to help reduce further damage and relieve symptoms.

We Recommend Early Treatment for Prevention of Joint Pain

At PhysioMotion, we will help you alleviate your symptoms, prevent further damage and return you to optimal fitness including nutritional counselling. 
To treat these injuries, we apply our integrated care model to using strong Diagnostic assessment skills and Treatment & Prevention Strategies

Diagnostics: 

• Our Physiotherapists will perform a comprehensive assessment to diagnose the the injury and the primary cause of the dysfunction

• To encourage optimal healing and prevent further injury, we will perform an individualised whole body biomechanical assessment looking at your strength and control. We will observe any areas where your body might be overloading in one area to compensate for dysfunction in another area.

• A sport-specific analysis will also be conducted, which often includes a running assessment.

Treatment & Prevention: 

• A personalised and progressive treatment approach will allow a faster recovery because we take the time to fully assess your problems to establish the root causes. 

• Treatment and exercises will target the cause of your issues. In some cases, you’ll be surprised to see that treatment is not necessarily targeted at where symptoms or pain appear.

• Early intervention is important to prevent further injury and to discourage your body from compensating in other regions of the body.

• We will also discuss other factors that may contribute to your injury such as your exercise program, training regimes, general health and nutrition.

• We know behavioural changes can be essential to optimise healing and recovery, so we will take time with you to explain in depth about your specific issues.

• We also draw on our wide network of health professionals to provide you with the latest research for best possible outcomes.

Our team of therapists will ensure that you have optimal care throughout your treatment and support you in returning to full physical health.

Book an Appointment Today

Neck & Back Pain

At PhysioMotion, we treat the following spinal dysfunctions:

• Scoliosis management, correction & exercise therapy

• Prolapsed intervertebral discs (‘slipped discs’)

• Acute wry neck (torticollis)

• Chronic stiff thoracic spine (upper back) and neck

• Sacroiliac joint pain & pelvic pain

• Lower back pain

• Post-surgical spinal procedures

Neck and low back pain are some of the most common conditions managed by our Physiotherapists. 

Treatments are based on the most up to date research and evidence based techniques. As with other conditions, an extensive analysis using a whole-body approach will be used including a thorough physical assessment of your biomechanics (the way your body moves), muscles and joints will be performed to find the root cause of your problem.

Once a definitive diagnosis is made (which we believe is the foundation of effective rehabilitation), manual therapy techniques are then employed by our Therapists.

These include: 

• Joint mobilisations

• Soft tissue massage

• Customised and specific exercise prescription such as core stability retraining (Pilates)

• Acupuncture

• Postural advice and

• Ergonomic workstation assessments

Lower Back & Pelvic Girdle Pain

Lower back and pelvic girdle dysfunctions include:

• Scoliosis management, correction & exercise therapy

• Prolapsed intervertebral discs (‘slipped discs’)

• Chronic stiff thoracic spine (upper back) and neck

• Sacroiliac joint pain & pelvic girdle pain

• Lower back pain

• Post-surgical spinal procedures

Many chronic and acute lower back pain; sacroiliac joint dysfunction; recurrent muscle strains (hamstring, groin and calf muscles); chronic headaches and pregnancy related discomfort (pubic symphysis and sacroiliac joint pain) are related to the lumbo-pelvic area.

At PhysioMotion we are able to ascertain whether the biomechanics of the lumbar spine (lower back) in relation to the pelvic girdle are optimal and how they are being affected by all other regions of the body. This holistic approach will aim to relieve acute pain within these specific areas, whilst also addressing other loads contributing to their dysfunction. 

Ultrasonography can also assess imbalances and weaknesses in any of your core stabilising muscles. The proper use of these muscles (transversus abdominus, multifidis, pelvic floor, thoracic and hip stabilisers) and how they coordinate with other ‘global’ muscles will allow long term management of this condition.

Headaches & Migraines

Neck driven headaches include:

• Migraines

• Tension headaches

• Ice pick headaches (acute pain in the eye region)

• Cluster headaches

• Hormonal headaches 

Hormonal headaches and migraines are caused by elevated levels in progesterone and low oestrogen levels during your pre-menstrual cycles. These changes in your hormones make the mechanoreceptors (joint sensors that give your brain information) extra sensitive – highlighting to your brain that the joints are non-optimal.

If you suffer from headaches or migraines that have been investigated by a medical doctor and there is no known cause, then the cause may be musculoskeletal – the headaches and migraines are likely coming from your neck.

Non-optimal biomechanics specifically in the upper neck and base of the cranium (skull), known as the sub-occipital joints (C1/C2/C3) are often the pain ‘generator’. This is because the sensory nerve supply to the skin and other areas of your head comes from these joints. When there is dysfunction in these areas, your brain is unable to distinguish the difference between a headache as opposed to problems in the neck.
This is similar to ‘sciatica’ where the pain is perceived in the leg when it is actually caused by problems in the lower back.

More specifically, these upper neck joints may be hypo mobile (stiff), hypermobile (excessive movement) or have poor movement patterns. This will be associated with spasm of the suboccipital and other muscles that attach from the shoulder girdle, thorax and head to the neck. 
Other factors that increase tension in this upper neck region may also significantly contribute to neck driven headaches such as physical and emotional stress, fatigue, dehydration and poor postures. Any other regions in the body that are contributing to the poor loading in the neck joints will also be related to the headaches and migraines, for example, a scoliosis in the thoracic spine. 

Scoliosis, Thoracic Spine & Rib Dysfunction​

At PhysioMotion we address the following scoliosis, thoracic & rib cage dysfunctions:

• Scoliosis from moderate to severe cases pre & post-surgical rehabilitation

• Scoliosis management through our unique integrated care model using manual therapy & exercise approach

• Stiffness & pain in the upper back, neck and shoulder region

• Chest pain & breathing difficulties of musculoskeletal in origin

• Poor posture

• Digestive issues such as reflux, indigestion and heartburn

• Shoulder pain related to the thorax and rib cage

• Weak abdominal core muscles

Scoliosis is an abnormal lateral curvature of the spine involving mostly the thoracic and lumbar spine, costo-vertebral joints (spine and rib joints), but also affects the cervical spine (neck) and sacral (bottom of the spine) complex. It is usually diagnosed in adolescence and the causes can be congenital or neuromuscular.

Depending on its severity, treatment options include corrective surgery or conservative management with braces, exercise and physiotherapy. 

The thoracic spine and rib cage can be a source of pain in regions such as the spine, chest, shoulders, neck, and lower back whilst also can cause referred pain anywhere in the arms and torso. It can be the source of poor posture, spinal scoliosis, inefficient loading mechanisms, digestive issues (such as reflux, indigestion and heartburn) and poor nerve supply to the abdominal musculature leading to ‘weak core’ muscles.

The thorax and rib cage can also be responsible for non-optimal loading through the pelvis, lumbar spine and hips causing various osteoarthritic conditions in the lower limbs.

Research shows that neck and back pain have a high recurrence rate. 

Given the high recurrence rate of back pain, we will take the time in prescribing, explaining and getting you to feel how your program creates healthy movement in your body. Equally, we will advise exactly what aspects of your lifestyle need modifying, or sporting pursuits are contributing to the cause of any spinal condition to optimise your chances of a healthy spine. We want to empower you to lead a lifestyle free of back pain.

Our team of therapists will ensure that you have optimal care throughout your treatment and support you in returning to full physical health.

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Our therapists are experienced in using techniques to treat conditions that require expert knowledge in the lumbar spine and the pelvic girdle, including the sacroiliac joint (SIJ), pubic symphysis (PS), and pelvic girdle pain (PGP).

Conditions We Treat:

• Pregnancy-related SIJ, PS, and PGP

• Chronic muscle strains and hip pain due to lower back-pelvic disorders

• Leg length discrepancies related to asymmetry scoliosis and pelvic girdle dysfunction

• Scoliosis – functional and structural

• Prolapsed intervertebral discs ("slipped discs")

• Lower back pain

• Post-surgical spinal procedures

• Urological disorders including incontinence, sexual health and prostate health

Many chronic and acute lower back pain, sacroiliac joint dysfunction, recurrent muscle strains (such as hamstring, groin and calf muscles), chronic headaches and pregnancy-related discomfort (such as pubic symphysis and sacroiliac joint pain) are commonly related to the lumbo-pelvic area.

Our Approach

We take a holistic approach to treatment and aim to ascertain whether the biomechanics of the lumbar spine in relation to the pelvic girdle are optimal, and how they are being affected by other regions of the body. This approach aims to relieve acute pain within these specific areas while also addressing other contributing loads to their dysfunction.

Our therapists use a variety of techniques including manual therapy, exercise prescription and education to help patients achieve optimal recovery from their conditions. We work closely with our patients to develop personalised treatment plans that take into account their specific needs and goals.

Using our real-time ultrasound imaging equipment, we are able to assess and treat imbalances and weaknesses in any of your core stabilising muscles. The proper use of these muscles (diaphragm, transversus abdominus, multifidis, pelvic floor, thoracic and hip stabilisers) and how they coordinate with other ‘global’ muscles are important to the long-term management of any chronic condition. The dynamic stability of these muscles will be trained and be integrated into sport specific goals.

If you are experiencing any lower back or pelvic-related discomfort, our therapists at PhysioMotion are here to help. Contact us today to learn more about our services and how we can help you achieve optimal recovery.

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UI is currently the second reason behind dementia as the reason why the elderly are placed in assisted living facilities in the USA. It is a significant issue that can be effectively addressed with the right approach.

In fact, one-third of men and two-thirds of women will experience urinary incontinence in their lifetime, with 55% of women over 65 years old living with leakage. Although common, urinary incontinence is not a normal part of aging and can be treated effectively with expert help.

Types of Urinary Incontinence:

• Stress incontinence from physical stress such as coughing or jumping.

• Urge incontinence from the sensation or actual need to urinate before the bladder is full.

• Mixed incontinence – a mixture of both stress and urge incontinence.

• Neurogenic incontinence due to disturbance of the nervous system.

Causes and Symptoms of UI:

• Life events such as pregnancy, childbirth and menopause may contribute to urinary incontinence in women.

• Contributory factors to UI and fecal incontinence include weak bladder or pelvic floor muscles, asymmetry in weakness and tightness in the pelvic floor muscles, overactive bladder muscles, nerve damage from pregnancy, childbirth, spinal dysfunction, or post-surgical procedures such as prostatectomy, imbalance in intra-abdominal pressure caused by musculoskeletal issues in other regions of the body, and constipation caused by increased pressure on the pelvic floor muscles during bowel movements.

• In healthy women, normal recruitment of the pelvic floor muscles (PFM) and abdominal muscles is often lost in women with UI. This imbalance causes excessive pressure onto their pelvic floor muscles due to insufficiency in the abdominal and trunk muscles while also preventing optimal neuromuscular recruitment patterns of the pelvic girdle muscles.

• Symptoms of UI and fecal incontinence include urgency, frequency, and leakage of urine or fecal matter. These conditions can have a significant impact on quality of life, leading to social isolation, depression, and decreased activity levels.

• Urge frequency often has a neural drive (nerve input) associated with other regions in the body e.g., spine and pelvis that are contributing to the overactive bladder and excessive urge to urinate.

At PhysioMotion, our skilled therapists take a holistic approach to treating all types of incontinence and urge frequency. 

We conduct a full body assessment to determine any contributory musculoskeletal factors, perform a thorough examination of the pelvic floor muscles, including an internal vaginal or rectal examination conducted by a specifically trained and qualified women’s / men’s pelvic health Physiotherapist if required.

We use real-time ultrasound-guided imaging to assess the pelvic floor and abdominal muscles. Our treatment approach combines pelvic floor muscle exercises with the treatment of other musculoskeletal dysfunction for successful management of incontinence.

Take the first step toward effective treatment by contacting PhysioMotion. 

Our team of expert therapists will work with you on this sensitive topic to develop a personalised treatment plan tailored to your specific needs and goals. 

For more information on our incontinence and urge frequency services, refer to Women’s Health or Men’s Health.

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Either or both of these factors can cause sagging and a downward bulge of any or all of the pelvic organs into the vagina. Childbirth is often the cause of a prolapse affecting 50% of parous (child bearing) women. It is also common to suffer incontinence associated with a POP. However, non-parous women may also suffer a POP if they have some of the risk factors below.

Symptoms of a POP may include: 

• Heaviness or pain in the vagina & perineum (area between the genitals and anus)

• Sensations of something “coming down” or a lump bulging out of the vagina

• Pain or decreased sensation with intercourse

• Recurrent urinary tract infections

• Difficulty emptying your bowel & bladder

• A slow urine stream during voiding

Risk factors include:

• Pregnancy & vaginal delivery especially requiring forceps assistance

• Increased risk with multiple pregnancies

• Poor posture leading to increased intra-abdominal pressure & altered breathing patterns

• Other musculoskeletal issues causing increased abdominal pressure & weakness of the pelvic floor muscles (PFM)

• Surgical intervention causing a disruption to the ligamentous & muscular support in the pelvic girdle

• Obesity

• Chronic cough

• Constipation

How can POP be addressed? 

Medical research confirms that pelvic floor muscle training is the most effective treatment option in addressing both urinary incontinence and pelvic organ prolapse. This is supported by the high recurrence rate of POP after surgical repair indicating the original cause of the loss of pelvic organ support was not addressed – including exercise programs with excessive abdominal pressure.

The combination of pelvic floor muscle exercises and treatment of other musculoskeletal dysfunction is the key to successful management of POP & incontinence.

At your postpartum 6 week check up with your obstetrician, you can request to check for any signs of POP as many are not symptomatic. Early detection will prevent the POP from further progressing and becoming a problem. In addition, the loss of pelvic support poses challenges for other regions of the body and can be related to other issues such as lower back pain.

At PhysioMotion, our Women’s Health Physiotherapists and team effectively treat POP & incontinence.

Our services include:

• An intra-vaginal or rectal examination and ultrasonography assessment to assess if you have a POP & pelvic floor muscle (PFM) function 

• A PFM rehabilitation program: PFM exercises, biofeedback intravaginal electrical stimulation  & bladder training

• Abdominal retraining exercises including functional training progressing to full strength based exercises

• Investigation into any other factors that are contributing to increased intra-abdominal pressures and excessive load on the pelvic floor. Treatment in this regard may require the expertise of other team members at PhysioMotion.

For more information regarding our services for a pelvic organ prolapse or incontinence, refer to Women’s Health or Men’s Health in our Services section.

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A rectus abdominus diastasis (abdominal muscle separation) occurs when there is a separation, stretching or thinning in the linea alba (fascial portion of the rectus abdominus) of the rectus abdominus muscle commonly known as the “six-pack”. It occurs more commonly in women than men due to pregnancy, but its role in the cause of lower back pain in men is under-reported.

Cause of Rectus Diastasis

It frequently occurs during pregnancy when the linea alba softens due to hormones (relaxin) and the mechanical stretch resulting from the accommodation of the growing fetus. As pregnancy progresses, there is more pressure on the abdominal wall with the highest incidence of a rectus abdominus diastasis occurring in the third trimester. Although undesirable, it is a natural process of pregnancy that allows optimal growth for the fetus.

The diastasis can vary from a superficial tear that is minimal to a deep tear extending from the chest to the pubic bone. If abdominal contents ‘bulges’ through this separation, it is known as an abdominal hernia. Our team will put into perspective the significance of your diastasis and how it relates to your issues or goals.

Studies indicate that 66% of women with a diastasis will also have one other support related pelvic floor dysfunction such as incontinence or a pelvic organ prolapse due to the change in neuro-muscular control in the abdominal wall and pelvic floor muscles (PFM). There is also a high likelihood of lower back pain and pelvic girdle pain. 

A rectus abdominus diastasis as a multi-factorial (has many causes) issue requiring consideration of the whole musculoskeletal system. We have found that retraining of the abdominal & pelvic floor muscles and treatment of other dysfunctional regions is most effective. Simply doing ‘core work’ is often insufficient because the core abdominal muscles may not be working properly due to other issues in the body. For optimal recovery from a rectus diastasis, a detailed assessment of whether your abdominal core muscles are activating through ultrasonography and a whole body assessment is the best treatment option.

Physiotherapists at PhysioMotion treat rectus abdominus diastasis’ and related issues. Our services include:

• A detailed assessment using ultrasound guided imaging, skilled palpation and functional tests to determine the extent, depth and severity of the rectus diastasis

• Determining the functional relevance of assessment findings to advise specifically on how to optimise healing, appropriate types & intensity of exercise, and when it is safe to return to sport

• Expert advice & counselling regarding the factors to be considered or functional need for a surgical repair

• An individualised progressive treatment plan from retraining activation patterns in the abdominal wall & pelvic floor muscles to integrating these strategies to full athletic performance

• Management & exercise strategies to maintain optimal abdominal muscle function for subsequent pregnancies

• Considerations for men suffering this condition will be made specific to their needs

At PhysioMotion, all our staff are trained to conduct real time ultrasound assessments for a rectus abdominus diastasis, pelvic floor and abdominal muscle function.

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Modern medicine has vastly improved survival rates, but the effects of treatment can have negative impacts on a patient's emotional and physical health.

Treatment for breast cancer involves a combination of surgery (lumpectomy or mastectomy), radiation, chemotherapy, hormonal therapy and medication.

Although lifesaving, post breast cancer treatment, patient’s may experience any of the following impairments:

• Decreased strength of the upper extremity

• Decreased shoulder mobility

• Scar tightness (breast and/or axilla)  

• Upper extremity ache 

• Lymphedema of the upper extremity

• Neuropathic pain

• Musculoskeletal pain (breast, axilla, and/or neck-shoulder)

At PhysioMotion our experienced team of therapists will aim to return you to full health with our services:

• Motion exercises to improve tissue extensibility and facilitate normal movement patterns

• Myofascial release for mobility and enhance tissue extensibility 

• Manual therapy for joint mobilisation, neurodynamic & soft tissue release

• Exercise programs to return to physical health progressing towards a more advanced cardio-respiratory and strength regime

Breast Cancer Related Lymphedema (BCRL)

Breast cancer – related lymphedema (BCRL) is a potentially debilitating and often irreversible complication of breast cancer treatment. Risk of BCRL is proportional to the extent of axillary surgery and radiation. Unfortunately, one in five people will develop BCRL and there is no curative treatment at present, but early diagnosis and management leads to best outcomes.

The implications of treatment for breast cancer for BRCL are:

• Surgery: Removal of lymph nodes affects lymph fluid drainage from one side of the upper body (chest, ribcage, arm and hand) to the axillary nodes. The more lymph nodes and vessels removed, the higher chance of BCRL.

• Radiation: Forms scar tissue in the soft tissue that presses on or narrows remaining lymph vessels and nodes interfering with the lymph flow from the body to the axillary nodes.

• Chemotherapy: Ese of docetaxel can be a risk factor for BCRL

At PhysioMotion, our Lymphedema Physiotherapist can help treat this condition with the internationally recognised standard of care Complete Decongestive Therapy (CDT). 

Treatment & management will consist of:

• Quality patient education that begins early in the post-operative period and is followed by evidence-based physiotherapy 

• Manual lymphatic drainage (MLD), a type of manual therapy, is frequently used for BCRL and often as part of complex decongestive therapy (CDT).

• CDT is a fourfold conservative treatment which includes MLD, compression therapy (consisting of compression garments), skin care, and lymph-reducing exercises (LREs)

We will support and encourage you to return to full activities. 

Research has shown that no activity level, occupation or hobby is related to developing lymphedema. Resistance training has been shown to be safe and may assist in preventing lymphedema. 

Our team at PhysioMotion are here to help you recover your full health from breast cancer.

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Testosterone also drops albeit at a slower rate. Menopause can have various effects on women’s overall health. 

These effects include: 

• Temporary changes in cognitive function

• Mood swings, depression and anxiety

• Urological conditions

• Sexual health

• Sleep disturbances

• Hot flashes

• Joint aches

• Changes in body composition

• Overall changes in physical health and fitness.

During menopause, physical health and fitness declines. Below are some of the changes that occur:

Changes in body composition
Menopause can be associated with changes in body composition including an increase in abdominal fat and a decrease in muscle mass. These changes can affect body weight, body fat percentage and overall body shape.

Joint and muscle discomfort
Some women may experience joint and muscle discomfort during menopause. Hormonal changes can contribute to joint stiffness, aches and muscle soreness. 

Impact on cardiovascular health
Oestrogen has a significant protective effect on cardiovascular health and its decline during menopause can increase the risk of heart disease.

Bone density changes
Oestrogen plays a vital role in maintaining bone health by regulating bone metabolism to make new bone cells.

Peak bone density occurs at approximately 25-30 years old. It is also the age when your body cannot deposit as much bone tissue and you must rely on sufficient dietary intake and oestrogen to maintain bone tissue health. 

The decline in oestrogen levels during menopause can lead to decreased bone density and elasticity - the latter is what increases the risk of osteoporosis. 

On average, women can lose up to 10% of their bone mass within the first five years after menopause and fractures are more common among women with osteoporosis.

Reduced muscle mass and strength: With declining oestrogen levels, women may experience a gradual loss of muscle mass and strength. This loss of muscle can impact overall physical fitness and functional abilities. 

Diagnosing Osteoporosis

Diagnosis employs a specialised X-ray technique called dual energy X-ray absorptiometry (DXA). This measures bone density usually in the spine and hip. Ask us if a DXA scan would be appropriate for you.

• How can bone health be managed?

  For individuals suffering from osteopenia or osteoporosis from perimenopause through to post-menopause, we recommend Strength and Conditioning to manage long term health risks, whilst simultaneously alleviating any immediate symptoms. We are very pro-active in the management of bone health, in particular as it relates to hormonal dysregulation and will review your overall medical approach aiming to halt or reverse sub-optimal bone health.

• How can exercise help to manage the effects of menopause?

  Engaging in regular resistance training exercises can help mitigate muscle loss, promote muscle strength and improve overall physical performance.

  Regular aerobic exercises, such as brisk walking, jogging, cycling or swimming can help maintain cardiovascular fitness, improve heart health, and reduce the risk of heart disease.

  Stretching exercises and low-impact activities (e.g., swimming, cycling), and appropriate warm-ups and cool-downs, can help alleviate discomfort and promote joint flexibility. Having more muscle mass also reduces loads on joints to reduce discomfort.

• What do our tailored exercises focus on?

  • Customised Approach: Our Physiotherapists develop individualised plans considering medical history, fitness level and your specific needs, ensuring an effective training experience. We work closely with our Nutrition team and medical doctors to ensure that all factors relating to bone health are considered to optimise your training program - a very direct and targeted approach.

  • Bone Health: We incorporate weight-bearing resistance and appropriate levels of high intensity interval exercises that stimulate bone growth, elasticity and density to reduce the risk of fractures.

  • Muscle Support and Joint Health: Our program strengthens muscles and bones providing vital support to the skeletal system and promoting joint stability.

  • Balance and Fall Prevention: With exercises targeting balance and stability, we help prevent falls that are a common concern in reducing the risk of fractures.

  • Hormonal Balance and Overall Well-Being: Our strength training can contribute to hormonal balance helping manage symptoms associated with perimenopause and all stages of menopause, whilst also enhancing overall mental well-being due to the hormonal effects on the brain as a result of exercise.

• How can physiotherapy help?

  As Physiotherapists, we focus on the urological conditions, joint aches, body composition, physical and sexual health. We work closely with medical practitioners to tailor a holistic approach to help alleviate the symptoms of menopause. We strongly recommend you to consult a medical professional who specialises in hormone replacement therapy (HRT) to discuss whether you are a suitable candidate.

• Are there risks associated with HRT?

  You may have heard concerns with HRT, as reported by the Women’s Health Initiative study in 2003. These risks have now been re-evaluated. For the vast majority of women, HRT is safe when administered by an appropriate medical professional and is very effective in alleviating the symptoms of menopause.

Our team of therapists will ensure that you have optimal care throughout your treatment and support you in returning to full physical health.

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What is Mastalgia and Mastitis?

Mastalgia is the name for breast pain often experienced by breastfeeding mothers. Mastitis is the inflammation or infection of breast tissue. The symptoms associated with mastalgia are similar to mastitis and usually include: pain, swelling, palpable lumps in the breast, redness with fever and general malaise with mastitis.

Mastitis is a main reason why mothers prematurely wean. It is experienced by up to 33% of breastfeeding mothers in the first six-weeks postpartum, usually in the first two to three weeks.

It is very important to seek help urgently if you think you are suffering from mastitis. Early detection and intervention of breastfeeding problems resulting from lactating pain can prevent the use of antibiotic medicines, particularly if the problem can be practically managed through drainage and clearance of the blocked ducts with Physiotherapy. This will allow mothers to return to breastfeeding.

How can I recognise mastitis? 

It often presents as local breast pain, erythema (rashes), swelling, systemic fever and malaise (lethargy) associated with hard lumps in the breast tissue or the areola (nipple). The discomfort can also present in the axilla (underarm) or near the sternum (chest bone).

What causes the condition? 

The causes are not yet well understood why some women suffer this and others do not. The hard lumps are usually blocked milk ducts caused by inflammation of the surrounding breast tissue. Careful assessment by a suitably qualified Physiotherapist who is specially trained in treating lactating breast pain is needed to help alleviate and manage the condition.

How can Physiotherapy address breast pain and mastitis?

Our Lactation Pain Physiotherapist is able to provide practical treatment to assist in successful breastfeeding by managing inflammatory breast conditions, including mastitis.

Our protocol includes:

• Assessment of your breastfeeding history, symptoms and breast tissue

• Breast feeding issues between mother and baby related to breast pain

• Education on how to minimise risk factors for breast pain & mastitis

• Advice and explanation of self-administered techniques to maintain well-being & prevent mastitis / mastalgia

• Treatment to reduce inflammation

• Use of therapeutic ultrasound

• Manual therapy and taping techniques to improve lymphatic drainage

• Liaison with your midwife to ensure optimal breast-feeding regimes

Our aim is to allow you to return to breastfeeding

There is compelling research that indicates the health benefits of breastfeeding for mothers including the prevention of illnesses such as diabetes, cardiovascular disease, obesity, osteoporosis and various cancers.

The health benefits for infants range from reduced incidences of respiratory tract and gastrointestinal infections, diabetes, asthma, cardiovascular disease, obesity to sudden infant death syndrome. 

Our Lactation Pain Physiotherapist has an important role in both assisting breastfeeding and general well-being for mother and baby.

For issues relating to breastfeeding, request to see our Lactation Pain Physiotherapist when you are making an appointment.

Our team of therapists will ensure that you have optimal care throughout your treatment and support you in returning to full physical health.

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Erectile Dysfunction

Erectile dysfunction (ED), also known as impotence, refers to the consistent or recurrent inability to achieve or maintain an erection that is sufficient for satisfactory sexual performance. It is a common condition that affects men of all ages, but becomes more prevalent as men get older. ED can have a significant impact on a man's self-esteem, intimate relationships and overall quality of life.

How Is ED Diagnosed?

The diagnosis of ED is typically made when the problem persists for at least three months. It is important to note that occasional episodes of difficulty with erections are normal and do not necessarily indicate ED. However, if the problem becomes persistent or recurrent, it may warrant medical attention.

Causes of Erectile Dysfunction are Both Mental and Physical

ED can have both physical and psychological causes and often, a combination of factors contributes to its development. Physical causes can include cardiovascular diseases, diabetes, hormonal imbalances, neurological disorders, pelvic surgery or trauma, medication side effects and substance abuse. Psychological causes can involve stress, anxiety, depression, relationship issues and body image concerns. See below for more detail on the causes.

Treatments Will Change According to the Diagnosis and Causes

Treatment options for ED depend on the underlying causes and may include lifestyle modifications, counselling or therapy, medication (such as phosphodiesterase type 5 inhibitors), vacuum erection devices, penile injections, or in some cases, surgical interventions. It is important to consult with a healthcare professional for proper diagnosis and guidance regarding the most appropriate treatment approach for individual circumstances.

Physiotherapy Assists with Neural and Physical Causes

It's important to note that while Men's Pelvic Health Physiotherapists can be effective in the treatment of ED, their role may vary depending on the underlying causes and individual circumstances. It's always recommended to consult with a qualified healthcare professional for a proper diagnosis and personalised treatment approach.

How can Physiotherapy Help?

An appropriately trained Men’s Pelvic Health Physiotherapist who has experience and expertise in dealing with men’s sexual health will assess and treat using methods below:

• Comprehensive Assessment: Men's Pelvic Health Physiotherapists conduct a thorough whole body assessment to identify any pelvic floor muscle imbalances, weaknesses, tension or dysfunctions that may be affecting erectile function. They evaluate muscle tone, strength and coordination, as well as any signs of tension or trigger points within the pelvic floor muscles.

• Pelvic Floor Muscle Training: Based on the assessment findings, Physiotherapists develop personalised treatment plans that often include pelvic floor muscle training. These exercises aim to strengthen and reduce tension in the pelvic floor muscles, which can enhance blood flow to the penis, improve erectile function and alleviate symptoms of ED.

• Manual Therapy Techniques: Men's Pelvic Health Physiotherapists may employ various manual therapy techniques to release muscle tension, reduce trigger points and improve overall muscle function within the pelvic floor. These techniques can include myofascial release, trigger point therapy, and soft tissue mobilisation, dry needling – all of which aim to optimise the function of the pelvic floor muscles. 
  
  Such treatment strategies are often applied to other regions of the body if they have been found to be impacting the pelvic floor muscle’s ability to function optimally. For example, issues in the lower back or pelvic region can affect both the nerve supply and synergy of muscle function. In such cases, these areas would also require treatment to improve pelvic floor muscles for symptoms of ED.

• Education and Lifestyle Modifications: Physiotherapists provide education about the pelvic floor and its role in erectile function that are related to your specific case. They will advise on proper posture, breathing techniques and lifestyle modifications that will promote more positive pelvic floor health and reduce symptoms of ED. This can include recommendations related to exercise, nutrition, stress management and healthy habits.

• Collaboration with Other Healthcare Professionals: Men's Pelvic Health Physiotherapists often collaborate with other healthcare providers involved in the management of ED such as urologists, psychologists and sex therapists. They work together to develop a holistic treatment plan that addresses both the physical and psychological aspects of the condition, ensuring comprehensive care for the individual.

• Follow-up and Progress Monitoring: Throughout the treatment process, Men's Pelvic Health Physiotherapists regularly monitor the individual's progress and make necessary adjustments to the treatment plan. They provide ongoing support, guidance and encouragement to ensure compliance with exercises and lifestyle modifications, which can lead to improved erectile function over time.

Erectile dysfunction (ED) can have various causes including both physical and psychological factors.

Common Physical Causes of Erectile Dysfunction

• Cardiovascular Issues: Conditions that affect blood flow such as atherosclerosis (hardening of the arteries), high blood pressure or heart disease can restrict blood flow to the penis, making it difficult to achieve or maintain an erection.

• Diabetes: High blood sugar levels associated with diabetes can damage blood vessels and nerves leading to ED.

• Hormonal Imbalances: Low levels of testosterone, the primary male sex hormone, can contribute to erectile problems.

• Neurological Disorders: Conditions such as multiple sclerosis, Parkinson's disease or spinal cord injuries can disrupt the nerve signals involved in achieving an erection. Less obvious neurological issues that can contribute to ED are musculoskeletal disorders that affect the nervous system and have an impact on ED.

• Pelvic Surgery or Trauma: Surgeries or injuries that affect the pelvic area including the prostate, bladder or genital region can cause nerve damage or impair blood flow resulting in ED.

• Medications: Certain medications including those used to treat high blood pressure, depression, anxiety and prostate conditions can have side effects that contribute to ED.

• Substance Abuse: Excessive alcohol consumption, tobacco use and illicit drug use can all impact erectile function.

Common Psychological Causes of Erectile Dysfunction

• Stress and Anxiety: High levels of stress, anxiety or performance-related pressure can interfere with sexual arousal and contribute to ED.

• Depression: Persistent feelings of sadness, hopelessness, or a loss of interest in activities can affect sexual desire and lead to ED.

• Relationship Issues: Problems within a relationship, communication difficulties or unresolved conflicts can contribute to sexual difficulties including ED.

• Body Image Concerns: Negative body image or low self-esteem can affect sexual confidence and contribute to ED.

It's important to note that ED can often be multifactorial, meaning that several causes may contribute to its development.

If you're experiencing erectile dysfunction, it's recommended to consult with a healthcare professional who can assess your specific situation, identify the underlying causes, and provide appropriate treatment options.

At PhysioMotion, we are here to help with your sexual health with utmost sensitivity and privacy.

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Men's pelvic health physiotherapists play a crucial role in assisting men who are dealing with non-bacterial prostatitis (inflammation or swelling of the prostate gland) and recovering from prostate surgery. 

Understanding Prostatitis

Prostatitis can cause discomfort and pain in the pelvic region. The most common type is chronic prostatitis (CP) / Chronic Pelvic Pain Syndrome (CPPS). CP and CPPS are clinical syndromes in males defined by pain or discomfort in the pelvic region, often accompanied by urologic symptoms or sexual dysfunction. 

CPPS is the most common type of prostatitis, accounting for the majority of cases. It is characterised by long-lasting pelvic pain or discomfort, often accompanied by urinary symptoms such as frequent urination, pain or burning during urination and pain or discomfort in the genitals or lower back. 

The exact cause of CP/CPPS is unknown, but it is believed to involve a combination of factors including inflammation, muscle tension and nerve abnormalities.

After Prostate Surgery

Prostate surgery, like a prostatectomy for prostate cancer involves the removal of part or all of the prostate gland and surrounding tissues, which can lead to post-surgical side effects. These side effects range from incontinence, urge frequency, erectile dysfunction and bowel dysfunction.

Our approach is practical and effective

Men's Pelvic Health Physiotherapists are very effective in addressing the specific needs of male patients with CPPS or recovering from prostate surgery by providing specialised care and guidance throughout their journey. 

They are able to often alleviate the symptoms of CPPS and side effects of prostate surgery through their in-depth knowledge of the male pelvic anatomy, including the muscles, nerves, and surrounding structures, enabling them to offer targeted interventions and support.

Here are ways in which Men's Pelvic Health Physiotherapists assist men with prostatitis and the side effects of prostate surgery:

• Pain Management: Prostatitis can cause pelvic pain, discomfort and sometimes referred pain in the lower back, testicles or groin area. We employ various techniques such as manual therapy, myofascial release and trigger point therapy to alleviate pain and reduce muscle tension in the pelvic region.

• Pelvic Floor Muscle Training: The pelvic floor muscles play a vital role in maintaining urinary and sexual function. Specific exercises are taught to strengthen, release when there is tension, and coordinate the pelvic floor muscles with other muscular systems. Coordinated muscle balance assists in managing symptoms related to prostatitis and aids in the recovery process after prostate surgery.

• Bladder Training: Prostatitis and prostate surgery can impact bladder function leading to issues such as urinary urgency, frequency or incontinence. Patients learn about bladder training techniques, including timed voiding and urge control strategies to improve bladder control and reduce urinary symptoms.

• Bowel Management: Prostate surgery may affect bowel function resulting in changes in bowel habits or constipation. Guidance on bowel management techniques includes dietary modifications, bowel retraining and proper toileting positions to promote regularity and alleviate any associated discomfort.

• Scar Tissue Management: Following prostate surgery, the formation of scar tissue is common. Scar tissue mobilisation techniques enhance tissue flexibility, minimise adhesions and improve overall mobility in the surgical area.

• Education and Lifestyle Modifications: We offer valuable education regarding lifestyle modifications such as ergonomic advice, proper sitting posture, and strategies to improve overall pelvic health. Concerns or questions you may have about sexual function or activity after prostate surgery are also welcome.

Men's Pelvic Health Physiotherapists play a vital role in helping men manage prostatitis and recover from prostate surgery. At PhysioMotion, we are here to help alleviate symptoms and support you through your health journey.

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