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cervicogenic headache

Cervicogenic Headaches – What are they and what can cause them?

These types of headaches are classed as secondary headaches. Pain is felt in the head, resembling a headache, however, the source of the pain has developed in the neck.

This can be caused by a number of issues, including tightness and strain in the neck muscles. This tension can lead to restricted movement of the neck and discomfort in the neck and shoulders. Overuse of these muscles can be due to a person’s type of work, for example, driving and long periods working at a computer, sporting activities, lack of sleep, stress and anxiety. These tense muscles in the neck, often result in a headache.

Remedial massage to the neck and shoulder muscles, can have a positive effect on reducing the tightness in the muscles, resulting in an increased range of movement and reduction in pain and discomfort. By working through the muscle adhesions, using various massage techniques, including trigger point therapy, the stiffness in the neck can be reduced and full length of the shortened muscles can be restored.

There are a number of changes that can be implemented, which can help to reduce the build up of muscle tension. For instance:

  • changing your sleeping position
  • ensuring your workstation has the correct ergonomic set up
  • taking regular breaks
  • stretching the muscles
  • correcting poor posture

These changes, together with remedial massage, can be of huge benefit to those overused, tired muscles and in turn can result in reduced cervicogenic headaches.

Tendonitis, tendinosis and tendinopathy? What’s the difference and when will I get better?

There is a lot of misunderstanding when it comes to tendon injuries, with many confusing terms and sometimes contradicting advice on how best to treat them.

What do tendons do and how do they work?

We often think of tendons as merely a connection a muscle has to the bone, to allow it to transfer a pulling force, much like pulling on a string or rope. We have since discovered tendons to be a lot more complex! Their primary role is actually to store and release energy, much like a spring, to allow us to propel ourselves. This is particularly obvious with the Achilles tendon at the ankle when we are sprinting. It is responsible for much of the forward propulsion, and allows us move efficiently with less metabolic energy expenditure.

What happens when a tendon is injured?

A tendon is injured when there is a force exerted on it that exceeds what it is capable of withstanding. What we have found is that when there is damage to tendon tissue, that area of the tendon does not heal. Even when re-scanned long after the injury and once pain has settled and tendon function has restored, the tendon will still look the same on ultrasound.

Tendinopathy  This is a broad term to describe any pathology of a tendon.

Tendonitis Refers to inflammation of the tendon, which is actually a less common cause of tendon pain than you might think! However the term is loosely used out of habit to described any tendon pain or pathology.
Tendinosis This is non-inflammatory degeneration of collagen fibers in the tendon due to repetitive overloading and is a much more common cause of tendinopathy or tendon pain. As a result, they typically don’t respond that well to anti-inflammatories, and are best treated with rehabilitation exercises to strengthen the intact tendon tissue.

How are tendon injuries treated?

Studies have shown scans on individuals with even quite extensive tendon tissue damage, go on to be relative pain-free and high functioning with appropriate non-surgical treatment and rehabilitation. The key is, that even when there has been significant damage to part of the tendon, there is generally still a lot of good quality, functioning tendon tissue around it, and it is this part of the tendon that we are looking at strengthening and conditioning with our exercises, to allow it to operate at capacity.
It is not just a case of ‘stretching it out’ – in fact, in some cases this could actually cause further tissue damage and prolong your road to recovery. We need to use gradual strength and loading exercises to recondition the function of the tendon. Everyone’s injury will be slightly different, and require a tailored approach, so it’s best to see a health professional for proper advice and management.
In the case of a complete tendon rupture, then surgical intervention is required.
Our goal with rehabilitation exercises is to improve the capacity of the tendon to store and release energy, well above the daily demands that will be exerted upon it, thus reducing the risk of re-injury.
We see a lot of tendon injuries through the clinic, most commonly of the shoulder and hip region. A thorough physical examination is often enough for us diagnose the nature and severity of tendon injury, and develop a treatment plan to get you back to full function. In some cases we may decide to get an ultrasound or MRI to further assess the degree of tendon injury and rule out any other pathology. Treatment generally comprises gradual progression through a program of exercises designed to increase the load tolerance of the tendon, in combination with hands-on manual therapy to maintain pain-free range of motion through the region.
Feel free to contact us if you would like more information on tendon injuries, or if you would like to book a consultation, you can use our online bookings or phone on 9581 3331.

Check out the short video below on how tendons work!

frozen shoulder

What is Frozen Shoulder? What is the Best Treatment?

frozen shoulderFrozen shoulder is the commonly used name for ‘Adhesive Capsulitis’, which is a condition that causes the shoulder to become very pain and stiff. This can sometimes occur following minor trauma to the shoulder, but often happens due to no apparent reason, which can be both confusing and frustrating for patients.
It affects 2-5% of the population, typically between 40 to 65 years of age, with certain risk factors such as:

  •  previous shoulder injury
  • diabetes
  • thyroid disease

How Does it Happen?

The shoulder joint, by design, is an incredibly mobile joint with a very large range of motion. The shoulder joint, like other joints in the body, is surrounded by a capsule, that allows this free range of motion. The capsule is also important in  providing stability, sensory feedback, and aiding in lubrication of the joint. Tightening of this capsule due to adhesions, is what causes Adhesive Capsulitis.

The condition follows three distinct phases:
1. The Freezing Stage – This is where the joint gradually starts to stiffen over time. This initial stage is usually characterised by an achy shoulder at rest, very painful with movements, and difficulty sleeping due to the pain.
2. The Frozen Stage – This is the longest stage, and where the joint stiffness plateaus at it’s peak. This period is where people find greatest difficulty with performing daily tasks due to stiffness, but often the pain is less than the initial phase.
3. The Thawing Stage – Where the shoulder starts to gradually recover, and shoulder movement and function is restored.
The good news about frozen shoulder, is that for most people it will generally recover on it’s own over time. This can typically take anywhere from 9 months up to 3 years, with the average being about 18 months. Appropriate therapy is important in managing recovery.

What is the Best Treatment?

Current clinical guidelines for frozen shoulder suggest a combination of the following treatment:

Education – Understanding the nature of your pain, and what to expect in terms of time for recovery, can make managing it a lot easier.
Maintain Normal Activities – It is helpful to continue using the affected shoulder as much as possible. Not using the affected shoulder can further restrict free movement and increase sensitivity of painful structures within the joint.
Manual Therapy and Exercise – Treatment provided by your health practitioner  can assist in speeding up the recovery time, and reducing pain as it naturally recovers. Treatments shown to be effective include specific exercises to improve range of motion and strength at the shoulder joint, and joint mobilisation and manipulation performed by your health practitioner.
Joint Injections – For some people, corticosteroid injections into the joint, can be very helpful, especially when combined with joint mobilisation and manipulation.

shoulder therapy

If you need more information regarding frozen shoulder, do not hesitate to contact us at the clinic on 9581 3331, and book an appointment to discuss what type of treatment is appropriate for you.

“Shoulder Pain and Mobility Deficits: Adhesive Capsulitis,” J Orthop Sports Phys Ther 2013;43(5):A1-A31. doi:10.2519/jospt.2013.0302.

Rethinking Chronic Pain

Chronic pain is a significant problem for many Mandurah residents, and can interrupt your ability to do the things you enjoy. In general terms, chronic pain can be defined as pain that has been present for longer than 3-months. Thankfully, over the past decade, research in the field of pain science has helped us to understand more about chronic pain, and how we can more effectively treat it. Chronic pain is a lot more complex than previously thought, and although we have been good in the past at treating the physical components to pain, the neurological and brain components to chronic pain have not been as well addressed.

What we have learnt about chronic pain is that after a long period of being in pain, our pain system can become over-protective and hypersensitive. This means that we can continue to feel pain signals (perhaps with certain movements), even after the physical component causing the pain has long since resolved. This may explain why some people suffering from chronic pain have normal x-ray/scan results!

So what can we do about it? Well, one of the simplest, and most effective ways to help chronic pain is to better understand what is happening. The short video below titled ‘Tame the Beast’ really helps to explain it well.

There is no single effective treatment for chronic pain, but what we do know, is that people get better with a combination of different types of treatment. This generally includes hands-on manual therapies, exercise and education on pain.

Regular Exercise Prevents Chronic Muscle Pain

We all know exercise is good for you, but it’s nice to have some good quality scientific evidence to prove it! The fact that people who exercise regularly are less likely to experience chronic pain is commonly observed in practice everyday, and by patients first-hand. It is not too far fetched to suggest that exercise keeps our musculoskeletal system strong, and therefore less likely to hurt ourselves, but a recent study has looked into the proposed mechanisms as to how exercise prevents pain, from a neurological perspective.

Without going into too much detail, it is commonly believed that exercise produces its chronic pain-prevention benefits by activating what is known as the central opioid receptors in the nervous system, and this is a key factor in reducing pain sensation.

In brief, the reseachers did a study on mice whereby they were given access to a running wheel prior to induction of chronic muscle hyperalgesia (pain), and compared them to a group of mice without the running wheels. They closely measured and compared the neurochemistry of both groups and found that the wheel running produced analgesia (pain-relief) via central pain inhibitory mechanisms.

If you are keen to get stuck into the full science of it, there full research article can be found here.


What does this mean for us in everyday life?

If you are suffering from chronic pain, it is likely that regular exercise will assist in conjunction with your existing treatment. Exercise doesn’t have to be super-high intensity either – brisk walking is good start! The key is finding exercise that is conducive with any existing injuries of musculoskeletal conditions you may have. It is recommended to consult with your usual health practitioner who can advise you on exercise that is appropriate to you.



Brito, R.G., Rasmussen, L.A., Sluka, K.A., 2017. Regular physical activity prevents development of chronic muscle pain through modulation of supraspinal opioid and serotonergic mechanisms. PAIN Reports 2, e618. doi:10.1097/PR9.0000000000000618

Is My Child’s Schoolbag Too Heavy?

The start of the school year is often when we get an influx of rightfully concerned parents, worried about the weight of their child’s school backpack. Current recommendations suggest that a child’s backpack should not exceed 10% of their body weight.

Although back pain in children is a lot less common than in adults, there are a number things we can do as parents to ensure our children stay pain-free, with happy healthy spines!


Here are some simple hints and tips for correctly selecting and fitting your child’s back pack:

  • Ensure the backpack is the correct size. When the shoulder straps are adjusted, the bottom of the backpack should be above your child’s waist – not hanging over the buttock.
  • Get an adjustable backpack. Every kid is different, so make sure the backpack can be adjusted to suit your child’s frame, and change as they grow!
  • Look for features such as a moulded frame and/or hip strap, so that the weight of the contents can rest against your child’s pelvis instead of their shoulders and spine.
  • Ensure their backpack is fitted correctly. It should be snugly fitted over both shoulders and should comfortably fit the contour of their back. Don’t have the backpack hanging low off their shoulders.
  • Fill their backpack appropriately. Pack the heaviest items closest to their spine, which will help balance the load. Also using the backpacks compartments if you have them, will help stop the load moving around.

I hope you find this information helpful. If you are concerned or just want a spinal check-up for your child, feel free to contact us at the clinic to book a chiropractic appointment.

3 Exercises to Improve Your Hip Strength and Mobility

Perhaps second only to shoulder rotator cuff issues, persistent pain and stiffness at the hip joints is one of the most common non-spinal complaints we treat in the clinic. Patients often describe stubbornly tight and painful hips that don’t respond to standard hip stretches. Due to the inherently stable nature of the ball-and-socket joint, months of intense ‘static stretching’ will often provide little benefit, and instead exercises that improve correct muscle contraction and movement patterns are the key to improving functional hip range of motion.

There are many underlying conditions that can account for poor mobility and flexibility, but for the majority of people, a program of home exercises in conjunction with your chiropractic treatment, can go a long way towards improving your hip range of motion, strength and overall function.

As always, it is advisable to first see your health practitioner before commencing any exercises described in these blogs. Some conditions can be aggravated with certain exercises, especially if performed incorrectly.

1. Reverse Active Straight Leg Raise

This exercise is fantastic for improving hip flexion in combination with hamstring flexibility, which is important for correct hip biomechanics. Start by  lying flat on your back with both legs elevated at 90 degrees. Be sure to activate your core muscles, ensuring your lower back stays flat against the floor. With a resistance band or rope around one leg, slowly lower the opposite leg down to ground level. Alternate between both legs, aiming to perform 2 x 10 reps.

2. Single Leg Hip Lift

This exercise is another that is excellent for those with tight hip flexors, and again combines flexibility with strengthening, to improve mobility. Start by lying on your back, with one hip pulled tight up against your chest. The knee is bent 90 degrees with the foot flat on the floor. Next, lift your hips up as high as possible, without arching the lower back. You should feel your glutes (buttock muscles) activating with this movement. Hold the position for 5 seconds, alternating between legs to do 2 x 10 reps.

3. The Psoas March

This is a great exercise to improve lumbopelvic control and hip flexibility. Lying on your back, raise both your legs with your hips and knees both bent at a 90/90 position. Be sure to keep your lower back flat against the ground by activating your core muscles. Slowly kick one leg out straight, whilst keeping your other leg stationary, and maintaining your lower back position. You can alternate from leg to leg, aiming to complete 2 x 10 reps. As you progress, you can add resistance band between both your feet to increase difficulty.


5 Easy Shoulder Mobility Exercises You Can Do With a Broomstick!

Shoulder ‘stiffness’ is a common complaint from patients, and can be attributed to a number of underlying conditions. The good news is, that most shoulder complaints will benefit from some mobility exercises to improve pain-free range of motion. Here are 5 shoulder mobility exercises I find helpful for my patients, and the only equipment you need is a broomstick (or rake, mop, PVC pipe etc).

1. Shoulder Flexion

Hold the stick in both hands with your knuckles facing forwards. Gradually raise both arms up whilst keep the elbows straight. You can use your good arm to assist in elevating the injured/painful shoulder. Hold for 5 seconds and repeat 10 times.

2. Shoulder Extension

Hold the stick behind your back, again with your knuckles facing forwards. Slowly elevate the stick away from your back and hold this position for 5 seconds. Repeat 10 times.

3. Shoulder Abduction/Adduction

Hold the stick in both hands with your palms facing fowards. Keeping your elbows straight, use your good arm to elevate your injured shoulder up past 90 degrees if possible. Hold this position for 5 seconds and repeat 10 times.

4. Shoulder Internal Rotation

Hold the stick with both hands behind your back, with your uninjured shoulder behind your head, and your injured shoulder behind your back at waist-level. Move the stick up and down by bending at the elbows, with your uninjured arm (at the top) assisting the injured shoulder through gradual movements. Hold the elevated position for 5 seconds, repeating 10 times.

5. Shoulder External Rotation

This exercise is easiest performed lying on your back. Hold the stick in both hands with your palms facing upwards, and your elbows bent at 90 degrees. Ensure the back of your upper arms are resting against the floor. Use your good arm to swing your injured arm away from your body, whilst keeping the elbow of the injured arm by your side. Hold the stretch for 5 seconds and repeat 10 times.

These exercises are meant only as a guide, and should not replace proper consultation with your health practitioner. For some people, these exercises may not be appropriate, and could cause further irritation if performed incorrectly. If you are unsure as to the appropriate course of treatment for your shoulder pain, feel free to contact the clinic to book a chiropractic consultation with me.

I Have a Disc Herniation – What Does it Mean? How is it Treated?

he discs in the lower back play an important role in acting as shock absorbers between the vertebra, while at the same time allowing us to perform a wide range of motion with our spine. The discs are made up of a strong outer ring called the annulus fibrosis,  consisting of overlapping fibers, that helps to protect the inner gel liquid, called the nucleus pulposis.

Over time, the discs will naturally degenerate, and can cause lower back symptoms.

Lumbar disc herniations are very common, and in fact research has shown that even people without low back pain, are likely to have a few disc hernations. A research article from 2015 published in the American Journal of Neuroradiology (available here) found that over 50% of 30-39 year-olds with no low back pain, did in fact have signs of disc degeneration, as seen on MRI scans. The important take-home message, is that although degenerative changes do occur in all of our spines, this does not always have to equal pain.

How does a disc bulge?

If there is excessive load or stress placed on the spine, either from repetitive actions or a single trauma, the fibers of the outer annulus can tear, forming a point of weakness in the disc. The pressure from the inner nucleus can form a bulging or protrusion in the shape of the disc at this area, causing a bulge, that can put mechanical pressure on one of the nearby spinal nerve roots.

Material from within the disc, can also cause an inflammatory response at the area, and irritate the nerve. Both of these can result in sciatica, which is leg pain arising from irritation/compression of one of the these nerves that form the sciatic nerve, which runs down the back of the leg.

Progression of Disc Herniations:

There are a few different types of disc herniations as detailed in the following diagram.

If there has been tearing of the annular fibers but the ring is intact, this will cause just a bulge. As the fibers of the annulus tear further, the bulge can become more pronounced. If there is complete rupture of the annular fibers, disc material can leak though the tear, causing a chemical inflammatory irritation to the nerve. Free fragments of disc material can break off into the spinal canal, and can often be reabsorbed.

How long will the pain last?

Often patients will report initial pain with a disc injury, that settles as the associated inflammatory response reduces. Research has shown that about 90% of people with a disc hernation, will be pain-free at 6-weeks, even without any form of treatment. Current thinking is that the body sees the protruding disc material as a foreign body and breaks it down, resulting in less inflammatory material near the spinal nerves. Also, it is believed that the body reabsorbs some of the water from within the disc itself, causing it to shrink in size.

In some cases, where the herniation is severely compressing one of the spinal nerves, symptoms may persist longer. This is where further investigation and treatment may be warranted.

Do I need a scan?

In most cases, a diagnosis can be made without the need for scans. However, if symptoms are severe, if there are neurological symptoms such as foot-drop or other leg weakness, then imaging will be performed to assess the degree of hernation and nerve impingement. MRI is the ‘gold standard’ for imaging the discs and nerves of the lumbar spine, and will be needed in cases where surgery is being considered.

What are the treatment options for disc herniations?

For the vast majoirty of uncomplicated disc herniations, conservative non-surgical treatment should be the first option. Depending on the nature of the disc herniation, the treatment commonly provided by a chiropractor will include a combination of hands-on manual therapy to improve pain-free range of motion and alleviate pain, along with exercises to help reduce any nerve irritation, unload the disc, and also to strengthen the core stabiliser muscles. The aim of non-surgical treatment is to reduce the recovery time, and recondition the spine to avoid recurrence.


There will be cases where surgery is considered. This will often be if there is a very large disc herniation that is putting significant pressure on the spinal nerves and/or spinal cord. This is a whole topic of it’s own, that we might look at later in another blog!


  1. Schroeder GD, Guyre C, Vaccaro A. The epidemiology and pathophysiology of lumbar disc herniations. Seminars in Spine Surgery. Volume 28, Issue 1, March 2016, Pages 2-7. Lumbar Disc Herniation. doi:10.1053/j.semss.2015.08.003.

  2. Brinjikji W, Luetmer PH, Comstock B, et al. Systematic Literature Review of Imaging Features of Spinal Degeneration in Asymptomatic Populations. AJNR American journal of neuroradiology. 2015;36(4):811-816. doi:10.3174/ajnr.A4173.

  3. Abraham P, Rennert RC, Martin JR, et al. The role of surgery for treatment of low back pain: insights from the randomized controlled Spine Patient Outcomes Research Trials. Surgical Neurology International. 2016;7:38. doi:10.4103/2152-7806.180297.

  4. Kreiner, D. S., Hwang, S. W., Easa, J. E., Resnick, D. K., Baisden, J. L., Bess, S., … Toton, J. F. (2014). An evidence-based clinical guideline for the diagnosis and treatment of lumbar disc herniation with radiculopathy. The Spine Journal : Official Journal of the North American Spine Society, 14(1), 180–191.

2 Simple Exercises to Keep Your Shoulders Strong and Pain-Free

Following on from our blog last week on subacromial bursitis and shoulder impingement, I thought it would be useful to provide some information on two exercises I have found to be very helpful for my patients with various forms of shoulder pain.

Stretches are beneficial to keep soft tissue structures flexible, but strengthening is really the key to enabling the shoulder to move correctly and be stabilised. Strengthening increases the capacity of the muscles to perform the tasks we demand of them, in a pain-free manner.


1. Resisted External Rotation

This is an excellent and very popular exercise to strengthen the rotator cuff muscles, and will generally form part of the initial rehabilitation phase in most clinics.

With your elbows by your side at 90 degrees, hold a length or resistance band between both hands. Keep one arm still as an anchor point, and slowly rotate the opposite arm away from your body. Alternatively, you can tie the band onto a pole or hook. It is important to keep your elbow up tight against your body with the movement, to ensure the rotator cuff muscles are doing the work and not the torso trying to help out. Also ensure that the wrist stays straight, as it too can try to compensate for a weakness in the rotator cuff. The body will look for ways to cheat and avoid using the shoulder if it is painful, so keep an eye on your form!

2. Seated Rows

This exercise helps to strengthen the muscles of the upper back that help support the scapula(shoulder blade). The scapula forms the base of support from which the upper limb operates, so it important that we have a strong, stable foundation here. Issues with scapular control and stability, can often have a significant flow-on effect down the chain.

It is best to start with this exercises in a seated position, with your arms slightly elevated out to your sides. With the resistance band in each hand, have it looped around a pole or a hook in front of you. Focus on squeezing the shoulder blades together in the middle of your back, without shrugging your shoulders. Try to focus most of the strength and movement at the shoulder blades, and not the arms/elbows. Also, be careful not to jut the neck/chin forward!


These exercises are meant as a guide only. It is recommended that you consult with your usual healthcare practitioner prior to commencing exercises, to rule out any contraindications or underlying pathology that may need to be addressed.