Tennis Elbow presents with pain in the outside of the elbow and spreading to the forearm. I rarely see it associated with playing tennis! Preserving jars, computer work and milking are some of the more common onsets I have seen this year.
Pain is typically aggravated by gripping and lifting and gets worse with more activity. Pain is generated from the bony attachment, the tendon or the muscle which extends the fingers. Localised heat, ice, arnica or Voltaren gel and stretches may all help. It is vital to address the daily tasks which aggravate the pain and try to change them to be less provocative.
Additional physio modalities are ultrasound, laser, bracing or taping, massage, acupuncture and various exercises to load the tendon and strengthen the muscle. It is also important to exclude contributing factors referring from the neck and shoulder.
CASE STUDY
A busy 52 year old farmer had a six month history of increasing forearm pain. It improved a bit with rest but recurred as soon as he was active. It was limiting most upper limb activity- driving, managing the animals, fencing and opening a beer!
On assessment he had positive nerve tests, reduced upper limb distal pulses, elbow joint stiffness and pain and pain on the common extensor tendon of the elbow. Rest was not an option. Eccentric exercises increased his pain to an intolerable level.
We used neck mobilisations, release through the neck and chest muscles, elbow mobilisations, ultrasound, taping, massage and trigger points to reduce the pain severity and progressed to slowly introducing eccentric strengthening. It has taken a couple of months but he is finally back to work, cycling AND opening his beer!

METHVEN CLASSES
Start from Monday 29th Jan – 4th Apr 10 weeks
Mon
day
Krissy
5-6pm
BEGINNERS & LEVEL 1
Wishing
to start Pilates as a core strengthening,
balancing programme and no specific condition limiting
your movement and for people to continue onto level 1 at steady
pace
Krissy 6-7pm BLOKES LEVEL 1& 2 Continue Pilates for core strength and flexibility.
Venue : Elim Church Rooms, above the cinema on Main St
Price: Early Bird Rate of $150 - payable to confirm your place by Wednesday 24 th January .
After this, classes will be $180 for the term
STAVELEY CLASS
Wednesday Tania 9-10 am LEVEL 2 For those with Pilates experience who wish a more challenging session
Tania 1015-1115am LEVEL 1 continue Pilates as a core strengthening, balancing programme and no specific condition
limiting your movement
Venue: Staveley Hall
Price: Early Bird Rate of $150 - payable to confirm your place by Wednesday 24 th January .
After this, classes will be $180 for the term
Payment for Methven & Staveley classes :
Can be made at the clinic Mon - Fri with cash, eftpost or cheque or via direct credit to the
Westpac bank, Tancred St, Ashburton, 03 0835 0400010 03 .
Use name and Pilates as a reference. Places are confirmed on payment and email confirmation only. Classes subject to minimum numbers to run. Contact: phone 03 3028 205, email amy@contactphysio.co.nz
ASHBURTON CLASSES
Start from 30th Jan – 3rd Apr 10 weeks
Tuesday Nina 530-630pm LEVEL 1&2 continue Pilates as a core strengthening, balancing programme and no specific condition limiting your
movement.
Venue: St Pauls Room, 65 Oxford Street Ashburton
Price: Early Bird Rate of $150 - payable to confirm your place by Wednesday 24 th January.
After this classes will be $180 for the term
Payment for Ashburton classses :
Can be made at the clinic with cash, eftpost or cheque or via direct credit to the Westpac bank, Tancred St, Ashburton 03 0835 0400010 00.
Use name and Pilates as a reference. Places are confirmed on payment and email confirmation only. Classes subject to minimum numbers to run.
Contact: phone 03 302 8205 to Methven clinic or email to amy@contactphysio.co.nz

Are you stuck with an idea for Xmas present? Looking for something different? Please see below items we have on offer!
You can purchase some of these items on our online store as well so please visit the store !
Pilates voucher 10 weeks class $150
Pilates mat 15mm $75
Spikey massage ball $15
Strapping tape $20
Wheat Bags $20
Lumbar Roll $25
Deer Velvet $65- varieties for joints, athletes, dogs !
Vouchers for complimentary therapies 45mins session- $90
Craniosacral
Reiki
Somalink
Acupuncture
Visceral Mobilisation

I love this study! You can google a short summary under FIDELITY- the Finnish Degenerative Meniscal Lesion Study.
Signs of cartilage or meniscal degeneration in the knee are joint line pain with squatting or twisting with or without locking where the knee feels stuck.
I cannot imagine any other Ethics Committee authorising “pretend†surgery but that is what happened in this Finnish research. They compared two groups-  keyhole knee surgery removing degenerative cartilage in the knee to keyhole surgery NOT removing the cartilage. Yes, they had the anaesthetic and the incision but no actual surgery was performed in the control group.
In short the outcomes were pretty amazing. At two year follow up patients without knee arthritis but with symptoms of a degenerative medial meniscus tear were no different whether they had had the actual surgery or not. That means that their condition could have been just as well managed with no surgery.
CASE STUDY
I had an interesting example of this last year. A 32 year old woman had tweaked her knee squatting to lift a heavy pot out of a low cupboard. She showed all the clinical signs of a tear in her cartilage so we arranged a specialist appointment and had a few sessions of physiotherapy working on strength, range of motion and pain management. The specialist confirmed the diagnosis but in the interim the mother of one had conceived again and was unable to proceed for MRI or surgery.
We continued with occasional physio visits and exercise and I was thrilled to see her and her beautiful baby pop in to the clinic at the beginning of the year with a fully functioning pain free knee.
I am sure she would have proceeded for surgery had she not become pregnant. It was a great learning experience for me and a relief for her and her family!
Reference:
Sihvonen R, Paavola M, Malmivaara A , et al
Arthroscopic partial meniscectomy versus placebo surgery for a degenerative meniscus tear: a 2-year follow-up of the randomised controlled trial
Annals of the Rheumatic Diseases Published Online First: 18 May 2017. doi:10.1136/annrheumdis-2017-211172

METHVEN CLASSES
Start from Mon 2nd Oct - 5th Dec for 10 weeks
Monday
Krissy
5-6pm
ADVANCED
LEVEL 1&2
Continuing
from level 1 at steady pace
Krissy 6-7pm BLOKES LEVEL 1& 2 Continue Pilates for core strength and flexibility.
Tuesday Isabel 6-7pm BEGINNERS Wishing to start Pilates as a core strengthening, balancing programme and
no specific condition limiting your movement.
Venue: Elim Church Rooms, above the cinema on Main St
Price: Early Bird Rate of $150 - payable to confirm your place by Wednesday 20 th September .
After this, classes will be $180 for the term
STAVELEY CLASS
Wednesday Tania 9-10 am LEVEL 2 For those with Pilates experience who wish a more challenging session
Tania 1015-1115am LEVEL 1 continue Pilates as a core strengthening, balancing programme and
no specific condition limiting your movement
Venue: Staveley Hall
Price: Early Bird Rate of $150 - payable to confirm your place by Wednesday 20 th September 2017 .
After this, classes will be $180 for the term
Payment for Methven & Staveley classes :
Can be made at the clinic Mon - Fri with cash, eftpost or cheque or via direct credit to the
Westpac bank, Tancred St, Ashburton, 03 0835 0400010 03 .
Use name and Pilates as a reference. Places are confirmed on payment and email confirmation only. Classes subject to minimum numbers to run. Contact: phone 03 3028 205, email amy@contactphysio.co.nz
ASHBURTON CLASSES
Start from 3rd Oct - 5th Dec 10 weeks
Tuesday Nina 530-630pm LEVEL 1&2 continue Pilates as a core strengthening, balancing programme and
no specific condition limiting your movement.
Classes subject to minimum numbers to run. Payment required to secure place.
Venue: St Pauls Room, 65 Oxford Street Ashburton
Price: Early Bird Rate of $150 - payable to confirm your place by Wednesday 20 th September 2017 .
After this classes will be $180 for the term
Payment for Ashburton classses :
Can be made at the clinic with cash, eftpost or cheque or via direct credit to the Westpac bank, Tancred St, Ashburton 03 0835 0400010 00.
Use name and Pilates as a reference. Places are confirmed on payment and email confirmation only. Classes subject to minimum numbers to run.
Contact: phone 03 302 8205 to Methven clinic or email to amy@contactphysio.co.nz

When netball and Rugby seasons was in full swing we saw a lot of ankle sprains coming through.
It can be so tempting during a game to have a tweak and play on- clinically I often see this preceding a much more significant sprain and resulting in time off sport and work. So rule number one is even for a small sprain- stop and RICE rest ice, compress and elevate. Elevate above the level of the hip. Take the time to evaluate before returning to play.
An ankle x-ray should be considered if there is pain around the malleoli – the bumps on either side of the ankle, bony tenderness along the bottom 6cm of the posterior edge of the tibia and fibula- either the inside or outside ankle bones, or an inability to weight bear for four steps- both immediately and once at the medical centre (Ottowa ankle rules).
It is recommended to RICE for 48-72 hours and then progress to movement. This can be a good time to consider physiotherapy support to help manage pain, swelling, joint stiffness and gait re-education. Choosing the appropriate time to progress weight bearing and exercises can be very helpful to optimise recovery time and return to play.
Taping and bracing are often used in the treatment and prevention of recurrent ankle sprains. Studies have shown both to have a preventative effect while having minimal detrimental effect on sports performance. There is no research evidence soundly supporting one more than the other.
Bracing and taping are not replacements for rehabilitation to regain full range of motion, strength and balance. Recurrent sprains can occur off the sports field too!
Try assessing your ankle stability by using tape to mark the above shapes. 6 feet long and at 45 degree angles. Stand in the centre and reach the non weight bearing leg in each direction as far as possible. Reach should be equal on both sides. Reduction in reach all directions and specifically in direction 4 has been found to accurately predict people with chronic ankle instability.

Neck pain is a common condition and affects most of us at one time or another. It can be acute and last a few days or be a recurrent life time problem. Gradual onset is common associated with posture, driving or computer work. Whiplash, sports injury or concussion can be involved. It can also include a headache from the neck, arm pain, pins and needles, numbness and or weakness.
Clients almost always benefit from a review of posture and provoking activities. Altering driving position, work station or even getting large mirrors for a vehicle can all make a huge difference to function. We spend a lot of time in the same position or doing similar activities. Spending some recreational time stretching or doing yoga or pilates can be very beneficial.
Physiotherapy studies have identified joint mobilisation of the neck and upper back to be beneficial in the short to medium term. Specific strengthening exercises have also been found to be beneficial. Interestingly there was not evidence found in favour of manipulation- a more vigorous mobilisation of the joint outside of normal range of motion. There is convincing evidence for specific exercises for chronic neck pain and headache.
In the clinic we assess each client individually and consider their joints, muscle length and strength and nerves in relation to their symptoms and daily activities. Our goal is to have both a treatment which eases symptoms and a longer term plan for the client to ease symptoms and prevent future recurrence. This way we are striving to build a future filled with doing the things you love without pain limiting you.
CASE STUDY
A 60 year old grandmother was having neck and shoulder pain causing her problems at work, preventing her lifting her grandchild and most importantly preventing her bowling.
We provided a work station assessment; massage, joint mobilisations, acupuncture and taping to get her bowling again and in the longer term a programme of upper back stretches and shoulder neck strengthening exercises so she would be able to keep up with her ever growing grandchild!
She is anticipating a championship win at bowling in the coming season!

Osteoporosis means porous bones and is a condition in which bones lose their strength. We reach our optimal bone density by about 18 years old and from then it is a case of slowing bone loss. 1 in 2 women and 1 in 5 men over the age of 50 will break a bone because of osteoporosis. This is not only relevant because of pain and loss of function but can also lead to long term disability and loss of independence.
Adults over 50, who use steroids, have a history of falls or have had previous fractures with low level trauma are considered higher risk.
The best way to address osteoporosis is prevention- high impact and strengthening exercise, plenty of calcium and vitamin D from the sun and reducing intake of alcohol and smoking are all critical. Starting as children and continuing all the way through life.
A daily calcium intake if 700-1200mg a day is recommended (National Osteoporosis Guidelines UK 2017)- possibly higher in post-menopausal men and women. Supplements or prescribed medication should be considered for those at high risk. Consider your diet and calcium uptake. Foods high in calcium are milk or yogurt, kale, sardines, broccoli, water cress and tahini.
Take a walk in the sun for 15 minutes a day. Try early in the morning so you can have the vitamin D benefits without the harsh UV rays.
Numerous studies have found that bone density can be optimised at any age with exercise. Elderly hospitalized patients could improve theirs doing arm exercises with 0.5kg weights by the side of their bed.
Physiotherapists can help provide an appropriate exercise programme. Your GP can consider the need for supplementing your calcium. Take action to maintain your bone density- it is so easy!

Tennis Elbow presents with pain in the outside of the elbow and spreading to the forearm. I rarely see it associated with playing tennis! Preserving jars, computer work and milking are some of the more common onsets I have seen this year.
Pain is typically aggravated by gripping and lifting and gets worse with more activity. Pain is generated from the bony attachment, the tendon or the muscle which extends the fingers. Localised heat, ice, arnica or Voltaren gel and stretches may all help. It is vital to address the daily tasks which aggravate the pain and try to change them to be less provocative.
Additional physio modalities are ultrasound, laser, bracing or taping, massage, acupuncture and various exercises to load the tendon and strengthen the muscle. It is also important to exclude contributing factors referring from the neck and shoulder.
CASE STUDY
A busy 52 year old farmer had a six month history of increasing forearm pain. It improved a bit with rest but recurred as soon as he was active. It was limiting most upper limb activity- driving, managing the animals, fencing and opening a beer!
On assessment he had positive nerve tests, reduced upper limb distal pulses, elbow joint stiffness and pain and pain on the common extensor tendon of the elbow. Rest was not an option. Eccentric exercises increased his pain to an intolerable level.
We used neck mobilisations, release through the neck and chest muscles, elbow mobilisations, ultrasound, taping, massage and trigger points to reduce the pain severity and progressed to slowly introducing eccentric strengthening. It has taken a couple of months but he is finally back to work, cycling AND opening his beer!

