https://maximisephysio.com/physio-blog daily 0.75 2023-08-04 https://maximisephysio.com/physio-blog/running-injury-basics monthly 0.5 2023-07-19 https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/f5f8d02e-0510-4008-8576-b70f3e5d1ec5/Running+1.jpg Blog - Running Injury Basics If you think about it running is a very complex movement. Multiple joints in both the upper and lower body must work together to continue to propel us forwards in a repetitive manner. Every step that we take whilst running places around 3 times our bodyweight through each limb. So if you weigh 80 kilos that is 240 kilos going through EACH LEG with EVERY STEP. The patella tendon (in the front of the knee) and achilles tendon (at the back of the ankle) must absorb the energy that this bodyweight produces, momentarily store it and quickly send it back to propel us forwards. Whilst the bones in our feet, ankle, shins, knees, thigh and hip must both transfer the load along and tolerate the muscles pulling on them over and over to continue to produce movement. https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/6a08212d-5d1c-499d-bca0-6a457459e426/Running+2.jpg Blog - Running Injury Basics Because of all this complex and energy intensive movement, running using A LOT of energy. This makes it a fantastic choice to improve the efficiency of our cardiovascular system (make us fitter) and improve the endurance of our muscles (how long they can work for without getting tired). Running doesn’t commonly cause injuries to muscles. Muscle strains tend to occur when a muscle has to contract more forcefully than it is capable of doing or is stretched beyond tolerance. Running is lots of lower level contractions within unstretched positions. Sprinting is a completely different story and not what we are talking about here. Both the cardiovascular system and muscles have the ability to adapt very quickly, this is great because it means we can quickly run longer and faster. Unfortunately tendons and bones take much, much longer to adapt. In novice runners who are getting fitter at a rapid rate, this can quickly lead to overload and injury. https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/d78c4910-87e5-470b-b7f5-c3aa7f65b8e5/Running+Preso.jpg Blog - Running Injury Basics As you can see on the graph, as load (the amount of stress placed onto tissues) exceeds capacity (the amount of load that can be tolerated) there is risk of acute injury. If this situation continues there is an ongoing risk of chronic injury. Running itself will produce adaptations to tendons and bone. For example the achilles tendons of experienced distance runners tend to be thicker, stiffer and more elastic than those who don’t run. This enables to tendons to better absorb, store and transfer back load. https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/e9e15562-34dd-45b2-b941-04363cafa731/Load+Capacity+2.jpg Blog - Running Injury Basics However, waiting for running to do the job isn’t the best way to reduce the risk of injury. We can increase our capacity much more quickly with the right training. Strengthening can improve the efficiency of joint movement and increase the muscles ability so absorb some of the impact of running. Strengthening also encourages tendons to become thicker more quickly than running and can help to increase bone density. https://maximisephysio.com/physio-blog/why-are-injury-rates-in-womens-sport-rising-so-quickly monthly 0.5 2023-07-06 https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/fb1b3e97-b262-44ba-be41-a116e7bf2356/Women+RUgby.png Blog - Why are Injury Rates in Women’s Sport Rising So Quickly? - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/081c0458-ac62-4196-9d83-b5261343f4ca/Women+Football.png Blog - Why are Injury Rates in Women’s Sport Rising So Quickly? - 1) Disparities In Developmental Environment Female participation in sport is increasing. However there is still a large disparity between male and female participation rates. In sports that are/were traditionally male dominated this gap in participation rates can over 50% Lower participation rates make it more likely that these sports receive less access funding, high quality facilities or equipment . Additionally, it can be very difficult to recruit higher level coaches. These factors all equate to a poor developmental environment, especially when compared with male counterparts who may receive access to all of these things. Unfortunately this increases risk of injury. This is a chicken and egg conundrum. With lower participation and less funding feeding each other. https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/88cbf30e-9e12-49e6-b943-3925c4a99c51/Female+Rugby.png Blog - Why are Injury Rates in Women’s Sport Rising So Quickly? - 2) Lower Training Age Lower levels of participation mean less teams and a reduced number of leagues. For example in Cairns we have 8 mens soccer clubs with 4 different leagues (Premier, Reserves, Division 2 and Division 3). In contrast the female league consists of 5 teams with 2 leagues (Premier and Reserves). This is by no means the fault of the clubs, it is simply due to a lower number of players. Females who do show potential in a particular sport are therefore fast tracked to higher levels of competition with a lower training age than male counterparts. https://maximisephysio.com/physio-blog/the-rotator-cuff monthly 0.5 2023-07-04 https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/e22f161e-e8f9-4485-86bf-2d41aaa312cd/Rotator+Cuff.png Blog - The Rotator Cuff - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/5d2bd3d2-c23a-4a57-b225-0c6fbe667e26/Shoudler+Pain+.png Blog - The Rotator Cuff Many of the theories used by physiotherapists and other heath professionals regarding rotator cuff related shoulder pain are actually derived from research by an Orthopaedic Surgeon called Charles Neer, over 50 years ago! Amongst Dr Neers beliefs was the theory that because the rotator cuff tendons run through a very small gap between the humerus and part of the scapula called the acromion, they could become impinged, especially when lifting the arm overhead. He believed that continual impingement over time leads to degeneration and eventually tears of the rotator cuff tendons. https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/9567801f-50f8-4a6f-bce2-bdcf9b546833/Pic+1.png Blog - The Rotator Cuff In regards to atraumatic shoulder pain, as stupid as it may sound, being totally honest, in many cases……. WE DON’T ACTUALLY KNOW WHICH EXACT TISSUE IS CAUSING THE PROBLEM!!!! We used to think that there were a number of special tests we could do to work out which exact tissue was causing the problem. However, we now know that these tests are nowhere near as accurate as we thought they once were. Whilst there are definitely exceptions that a competent physiotherapist will be able to pick up on, it is more useful to think of MOST atraumatic shoulder problems as fitting into 3 broad categories. https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/09f22066-c6dd-471a-b58a-a2c58c69fd87/Shoulder+Press.png Blog - The Rotator Cuff Identifying the contributing factors allows us to come up with strategies to reduce your pain. Once pain is under control we then use these same factors to come up with a plan to build you up again. Either to reduce the chances of pain coming back, or to better manage any ongoing symptoms. By treating you as an INDIVIDUAL and not as a scan or body part it means that physiotherapy rehabilitation is tailored to your individual needs. https://maximisephysio.com/physio-blog/a-guide-to-quadricep-injuries monthly 0.5 2023-07-04 https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/244a8989-4320-4ef1-8c80-3a307505c0d5/Quad+Muscles+1.png Blog - Quadricep Strain, Not As Simple As You Would Think…. The quadricep muscles are a group of 4 muscles which sit on the anterior (front) of the thigh. These muscles are called the rectus femoris, vastus medialis, vastus intermedius and vastus lateralis. The quadricep muscles is a very important muscle group which has a number of complex functions. All 4 of the quadricep muscles contribute to extending (straightening) the knee. Are the main stabilising muscle at the knee when the foot contacts the ground from walking, running, hopping and jumping activities They function to keep us standing Contract eccentrically to lower us into squatting and landing positions Unlike the other 3 quadricep muscles, the rectus femoris originates at two sites at the hip joint, and so plays a role in both flexing the hip (bringing knee towards chest) and stabilising the hip joint. https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/2a1ceee4-f827-4109-a893-dce2b49888a2/Quadricep+Muscle+Strains.png Blog - Quadricep Strain, Not As Simple As You Would Think…. This article covers indirect quadricep injuries which are muscle or tendon strain or in severe cases, rupture. Almost all strains occur to the upper or lower rectus femoris muscle. The rectus femoris is a large, complex muscle. Keeping it as simple as possible, its tendons originate on two sites at the hip and it connects to the quadricep tendon at the knee. The muscle also has a “central tendon” which extends down its body. Most injuries to the rectus femoris occur to the upper part of the muscle in two different locations. Either close the the origin site at the hip, or close to the “central tendon” approximately 1/3rd of the way down the muscle. The usual mechanisms for injury as forceful kicking as the rectus femoris has to contract hard whilst being put onto a large stretch, this is more likely to cause an injury close to the central tendon. Injuries sustained whilst running are more likely to occur close to the tendon origin at the hip, or around the junction between the muscle and tendon at the knee. https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/5b01a28b-09fd-42c6-97f5-4e3111367cb5/quad+2.png Blog - Quadricep Strain, Not As Simple As You Would Think…. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://maximisephysio.com/physio-blog/not-all-calf-strains-are-the-same monthly 0.5 2023-07-04 https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/b0f1732d-8353-4b85-ae82-ab77e218971c/1438px-Triceps_surae.svg.png Blog - Not all calf strains are the same…. - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/7a287918-e607-45bc-863d-217379fec5a3/Calf+Strain+1.png Blog - Not all calf strains are the same…. Injuries to the gastrocnemius commonly occur when the knee is straight and the ankle begins to move from a toes up to toes pointed downwards position rapidly. This mechanism places the muscle into a stretched position under load. This injury commonly occurs from maximal sprinting or acceleration and will have a sudden onset. The individual may hear an audible popping noise. With higher grade injuries there will be an immediate weakness and pain with pointing the toes down. Walking may be difficult or impossible. Strains of the gastrocnemius normally occur at to either inside head of the muscle or at the junction between the muscle and tendon (musculotendinous junction). Strains of the gastrocnemius share an identical mechanism to tears of the achilles tendon (which require an immediate diagnosis and appropriate management for good outcomes). https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/05710add-8c92-4eb2-a33f-23a8d5538a1d/Calf+Strain+2.png Blog - Not all calf strains are the same…. Soleus strains are more likely to occur from repetitive movement of the toes towards the knee with the knee bent. This puts the muscle into a repetitive stretched position. This injury commonly occurs from distance running, especially if lots of inclines are involved. Because these are a repetitive injury they rarely come on suddenly, being much more likely to have a gradual onset. An affected person may feel a gradual onset of tightness and aching. There may not be any associated muscle weakness. Strains to the soleus can be difficult to pick up, as these symptoms can be present in other conditions such as sciatica, general muscle tightness or even DVT’s (blood clots) in the calf region. https://maximisephysio.com/physio-blog/acl-ruptures-an-australian-epidemic monthly 0.5 2023-06-09 https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/90b4bd65-6b4f-4ff7-b9f8-ef22617028f7/ACL.png Blog - ACL Ruptures, An Australian Epidemic The Anterior Cruciate Ligament (ACL) is a connection that runs from the back of the thigh bone, to the front of the shin bone. The ACL prevents the shin bone from moving forwards or rotation inwards in relation to the thigh bone. However it function is not JUST to provide mechanical stability to the knee joint THE ACL has a very important role in sending information to the brain related to joint position. the brain uses this information to adjust how we move and position ourself. This function provides not only protection but performance! allowing us to quickly twist, turn, change direction, jump, hop and land. All the things that make us good at sports! https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/6d901a43-4b6f-474d-a1e4-f1bccfe4503a/Football+1.png Blog - ACL Ruptures, An Australian Epidemic ACL ruptures have always been considered a relatively serious injury. Until recently we used think that they only really caused a reduction in mechanical stability of the joint. We now know that the effects are far more widespread. Physical changes have been observed within the surrounding muscles, the muscles of the opposite leg, the spinal cord and brain. This leads to a knee joint which isnt only mechanically unstable but also other symptoms such as:Reduced strength particularly of the quadricep muscles Reduced co-ordination, balance and control Reduced joint position sense (proprioception) Altered movement patterns, jumping and landing mechanics Reduced power output https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/e0df079d-d723-4f69-8759-b376d674d6e5/Knee+Injury.png Blog - ACL Ruptures, An Australian Epidemic - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/5b0a9dfb-fa34-4e24-9a3d-5ba423f36955/Football+3.png Blog - ACL Ruptures, An Australian Epidemic There are 2 main reasons that have been proposed 1) We are seeing increased participation in sport, especially in females 2) Our kids are specialising in a single sport at a younger age. As they become more skilled this leads to longer more intense training sessions, more games, greater levels of competition and inadequate downtime/rest 3) In those that are older we are seeing more weekend warrior or those returning to sport wishing to relive past glories! Inadequate training and return to high levels of competition in a risk factor https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/8ce2c57e-cd07-4adc-a9ea-9d850a6d900f/Plyometrics.png Blog - ACL Ruptures, An Australian Epidemic These are things that WE CAN CHANGE! 1) Neuromuscular Control Neuromuscular refers to the ability of your neurological and muscular systems to control a specific joint and control complex movement e.g hopping or landing from a jump. Many non-contact ACL injuries occur due to poor movement strategies or lack of control in the way we move. 2) Muscle Strength The evidence regarding muscle strength and ACL injuries is mixed! However the general consensus is that weakness of the glutes, hamstring and quadriceps can all increase risk of ACL rupture. As can an asymmetry between hamstring and quad strength in the same leg. As quadricep strength differences between legs. https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/c36330c4-ecc2-43ed-9d2e-95f07b3dc61f/Poster-of-the-11-Freely-available-at-extranetfifacom-medical.png Blog - ACL Ruptures, An Australian Epidemic - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://maximisephysio.com/physio-blog/management-of-knee-meniscus-injuries monthly 0.5 2023-07-04 https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/2c55e28e-f2f2-4d00-8ac9-41646c6429eb/640px-Gray349.png Blog - Knee Meniscus Injuries The knee meniscus is a series of two semi-circular structures which sit on top of the shin bone (tibia). It is an extremely important structure within the knee joint (the connection between the thigh and shin bones). The meniscus has 3 main functions. 1) Increases conformity between the thigh and shin bone 2) Acts as a shock absorber to reduce the amount of load transferred through the bones 3) Provides stability to the knee by limiting extreme ranges of motion and aiding in joint proprioception Tears of the meniscus are very common and are generally grouped into two categories, degenerative or traumatic. https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/488483f4-e008-4379-bd33-c9102c3f34cf/meniscus+1.png Blog - Knee Meniscus Injuries - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/8743634d-3590-4155-8896-3e08b4fe864e/knee+1.png Blog - Knee Meniscus Injuries Well… it depends and the answer is complex, multi-factorial and unique to each individual! All meniscal tears and all knees are not the same. More complex tears can cause not only pain, but instability, locking, catching, giving way, restricted range of motion and pain. However the exact same tear in somebody else, may be symptom free! It therefore really does depend on the individual. If someone is getting persistent symptoms as mentioned above, surgery may be indicated. Partial meniscectomy (removal of the torn portion of the meniscus) is one of the most commonly performed surgical procedures in the world! https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/ae1f5b80-ca07-4647-b79b-6c326c496790/knee+2.png Blog - Knee Meniscus Injuries One other potential option is meniscal repair. The benefit of a repair is that the knee meniscus in retained rather than removed. It has been shown that repairs lead to better outcomes than removal and may half the risk of developing knee OA. However, it is still associated with greater overall risk of developing OA than no surgery. A repair of the meniscus is commonly used in younger patients who have sustained a traumatic meniscal injury. Age was commonly considered the biggest roadblock as it was thought that those over the age of 40 would suffer from a significantly increased risk of surgical failure. Whilst the evidence is limited, recent studies actually show no significant differences in failure rates dependent upon age. https://maximisephysio.com/physio-blog/chronic-ankle-instability monthly 0.5 2023-05-24 https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/89d671d3-e094-4bd9-a017-148d0791b801/Ankle+2.png Blog - Chronic Ankle Instability Ankle sprains account for approximately 10-30% of all injuries in sport, they are most prevalent in multi-directional sports such as basketball, netball and soccer. Ankle sprains are thought of as a minor injury that will get better with some rest. Whilst evidence suggests that 50% of those who sustain an ankle sprain will seek medical attention, less than 7% of individual receive physiotherapy treatment. Persistent symptoms after ankle sprain are very common, research heavily supports the effectiveness of physiotherapy in reducing the chances of these symptoms occurring. https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/ca3ce252-83dd-444a-a98b-5ff83c93da19/Ankle+Sprain.png Blog - Chronic Ankle Instability As with most things in physiotherapy it is not a simple answer…. the ligaments on the outside of the ankle do have the capacity to heal relatively well, though almost everyone who sprains their ankle will be left with ligaments that are a little more lax (looser) than before. However not every single person who sprains their ankle develops CAI. So we can’t attribute its development to JUST the ligaments. The overarching answer is that the factors that contribute towards the development of CAI are going to be different for everyone. It is our job as physiotherapists to break this all down. To assist in this process in 2019 a framework was proposed, which outlined all the potential contributing factors https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/b624b49f-17c6-4deb-82dc-61e6effd8c22/Ankle+4.png Blog - Chronic Ankle Instability Other injuries In many cases an ankle sprain does not just involve an injury to the ligaments. There can be simultaneous injury to the muscles and/or tendons on the outside of the leg (peroneals), damage to the ankle or shin bones or ligaments elsewhere in the ankle, namely the high ankle or medial ankle ligament complex. These additional impairments lead to an ankle that is more mechanically unstable and increases the risk of CAI. Joint Restriction It is commonplace following an ankle injury to have ongoing restriction in movement. This occurs for 2 main reasons. 1) Reduced movement of the ankle joint 2) Soft tissue restriction from the calf muscles https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/79774f2e-893d-4e19-8d32-4b57d5f19057/Ankle+Proprioception.jpeg Blog - Chronic Ankle Instability Functional Impairments Functional impairments refer to a personals ability to control their ankle. This goes well beyond just muscle strength. Reduced Reflexes We have a natural reflex to protect against our ankles suddenly being turned outwards. The stability muscles in the ankle will quickly switch on, in an effort to prevent injury to the ankle occurring. Research has identified that this reflex is delayed in those with CAI. Muscle Inhibition Muscles require a signal from a nerve in order to contract. It has been found that these signals are altered in those with CAI. This process does not just affect the muscles in the ankle, but also the quadricep on the injured side, the hamstring muscle ON BOTH SIDES! and even some of the muscles of the core! https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/d10cd224-a0f0-410e-adac-1825e15f5fa9/DSC00142.jpeg Blog - Chronic Ankle Instability It is a physiotherapists job to identify and acknowledge all these factors to construct a treatment and management plan. The contributing factors will be different for everyone and so treatment and management should be individualised to take this into account! If your physiotherapist is providing you with generic exercise sheets or is not conducting an in depth assessment of your ankle they are simply NOT doing their job correctly! The evidence strongly supports the use of a comprehensive rehabilitation program in the management of ankle sprains. A rehabilitation program is most effective when utilised following the primary injury (first ankle sprain), though even those who suffer from long term ankle problems can improve significantly with the proper program. https://maximisephysio.com/physio-blog/what-is-a-tendinopathy monthly 0.5 2023-05-14 https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/a5c4ac9f-6c80-4300-bd6b-edb65ed4bd9b/325rfr.png Blog - What is a Tendinopathy? A tendinopathy is a reactive or degenerative process affecting a tendon. A tendon is a connection between muscles and bone, we have around 4000 tendons within the human body which assist us in a variety of different ways. 1) Provide passive joint stability along with other connective tissues such as ligaments 2) Providing a muscle with an anchor point at one end, and an insertion point at the other. The connection formed allows the muscle to contract (shorten), pulling on the insertion point to produce movement about a joint. https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/ebcaee11-ff79-40d8-a29a-81d12c233bbf/Tendon.png Blog - What is a Tendinopathy? Healthy Tendons Tendons are comprised of the fibres which transmit load, and the supporting fluid and cells termed the extra cellular matrix. Once our bodies reach maturity, healthy tendon fibres don’t significantly change in their makeup. It is the job of the cells and fluid of the extra cellular matrix to maintain the health of the tendon fibres and protect them against the stresses of everyday life (this process is termed homeostasis) Whilst tendons can adapt to changes in their everyday stress (be that increases or decreases), they do so slowly. https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/30dcfd37-19e4-4796-8e73-06ca8f3edc8b/Degenerative+Tendon.png Blog - What is a Tendinopathy? - Degenerative Changes If a tendon is in a reactive state for a sustained period of time, the changes that are occurring with the fibres start to become more permanent in nature. A number of factors can contribute towards a reactive tendinopathy progressing to a degenerative tendinopathy. These factors include excessive loads over sustained periods of time, too little load over a sustained period of time, genetics, age, weight, diabetes, smoking, rapid changes in activity levels and poor movement patterns. Whilst we don’t entirely understand why tendons become painful it has been observed that as tendons become more severely degenerated abnormal blood vessel and sensory nerve growth starts to occur. https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/ba28f064-b0b7-4892-a20c-6f9d3ba6ce4c/Dougnut+Theory.png Blog - What is a Tendinopathy? Doughnut Theory We used to think that we could stimulate tendons to heal through physiotherapy treatments such as tendon specific exercise, dry needling and shockwave. However, more recent research indicates that once a tendon fibre is degenerative significant repair is very unlikely. It is thought that a degenerative tendon fibre is no longer able to transmit load. Fortunately, the healthy tendon fibres are able to take up the slack, and transmit load around the degenerative fibres. We term this the doughnut theory! Unfortunately as these tendon fibres are having to do more work, they are susceptible to tendinopathy themselves. This point will be important in a few paragraphs time. https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/f0f3db20-703a-4cbb-a6fb-0259e8cad873/DSC00142.jpeg Blog - What is a Tendinopathy? More recently we have started to look at the affected tendon too….. Whilst the degenerated fibres have no capacity for healing, the healthy fibres retain capacity to adapt, becoming stiffer (a good thing) and increasing their ability and tolerance to transmit load. As mentioned above, normally tendon adaptations take long periods of time. However, the latest research studies have suggested that specific types of exercise that focus upon the tendon itself, can be used to speed this process up dramatically. Significant changes in tendon make up have been seen in as little as 12 weeks! https://maximisephysio.com/physio-blog/what-is-blood-flow-restriction-training monthly 0.5 2023-05-14 https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/c2246a0d-abdc-4fa8-9bb9-ca892808e4f3/Smith+Machine+.jpeg Blog - What is Blood Flow Restriction Training? Strengthening…. a lot of the time it is one of the main goals of physiotherapy, no matter who the patient is. From the professional AFL player recovering from a knee reconstruction, to the elderly man struggling to stand from sitting ,there are a huge number of our patients who need to get stronger, quickly. There are lots of things that can contribute to how strong you are. To keep it simple the most important factors are….. 1) How skilled you are at performing a movement - the better you are at performing a movement the more efficient you are 2) How big your muscle is - a larger muscle has more microscopic contractile elements 3) How many messages are sent from the brain to the muscle group(s) performing a movement - all to do with the brain, spinal cord and nerves that run to the muscle In order to increase our strength all of these must improve. https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/d996091c-aaa0-4de2-bb3b-c3bbde5d9577/45+degree+hyper.jpeg Blog - What is Blood Flow Restriction Training? 2) Bigger Muscles Muscles becoming bigger is called hypertrophy. Very simply, for hypertrophy to occur the amount of proteins being formed (protein synthesis), needs to be greater than the amount being broken down (protein degradation). We can encourage more muscle protein synthesis by putting muscles under lots of mechanical tension and by the accumulation of lots of waste products (metabolic accumulation). Aside from taking lots of anabolic steroids, the only way to meaningfully increase muscle protein synthesis is through exercise! STILL FOLLOWING US…… Now for exercise to cause high amounts of mechanical tension and build up of waste products we need to be using relatively heavy loads and be working very hard… these factors will be important in a minute! https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/5be37f05-3930-4e6b-8f46-25548b9f0864/Barbell+bicep+curl.jpg Blog - What is Blood Flow Restriction Training? Lets use the arm and a heavy bicep curl for an example. As you do a heavy bicep curl the muscle has to work hard to perform the movement, this directly causes large amounts of mechanical tension Muscles working hard also require lots of energy immediately. Energy is is most efficently produced in the presence of oxygen, but this process takes time. Because this process takes too long the required energy is produced much less efficiently and many waste products are produced. If we are lifting very light loads the the muscle doesn’t have to work hard, and the body is able to supply the muscle with sufficient oxygen so very few waste products are produced. https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/a7e93afb-25a0-4e3f-9939-eb7ca274fafc/Blood+flow+restriction+knee.jpeg Blog - What is Blood Flow Restriction Training? Blood flow restriction training is using a device to limit blood flow to a target muscle….. Take the same bicep curl but this time with a light weight. If blood flow is restricted the muscle cannot continue to rely on oxygen for energy. This makes it’s energy production inefficient and large amounts of waste products are produced. It also causes the muscle to fatigue rapidly and start to work hard, this mean lots of signals being sent to the muscle to contact AND lots of mechanical tension SO WE CAN USE RESTRICTION OF BLOOD FLOW TO A TARGET MUSCLE TO CAUSE HIGH AMOUNTS OF MECHANICAL TENSION AND WASTE PRODUCTS, AND LARGE AMOUNTS OF NEUROLOGICAL ADAPTATION. SIGNIFICANT STRENGTHENING USING LIGHT LOADS!!!!! This has huge potential for all the patient mentioned above that can’t use heavy loading. https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/5fae4178-8732-4f9c-bc10-4f3be0a44972/Blood+Flow+Restriction+Training.jpeg Blog - What is Blood Flow Restriction Training? Here at Maximise we have the latest generation of blood flow restriction cuffs. They essentially function as tourniquets around a limb which tighten up to reduce blood flow. These cuffs are able to calibrate to each individual and we are able to set custom amounts of pressure based upon the calibration. Normally prescribed exercises are then performed using lighter loads, with short rest breaks in between sets. Whilst there are a few specific repetition and set schemes that have been recommended (the most popular being 4 sets of 30, 15 ,15 15 with 30 second rest breaks) the best rep and set scheme using BFR training has yet to be ascertained. Blood flow restriction training isn’t new. A form of it called Kaatsu training has actually been around since the 1980s. It started to be studied quite intensively in the exercise science world over the last decade. But it’s use specifically within physiotherapy evidence and treatment has only really started to take off in the last 5 years or so. https://maximisephysio.com/physio-blog/lifting-with-a-bent-spine-is-not-bad-for-you monthly 0.5 2023-05-14 https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/f919ba5e-41b4-46bf-a486-80c5f4f0cbfe/Jefferson+Curl.jpg Blog - Lifting with a Bent Spine Is NOT Bad For You Our spines bend 2000 - 4000 times per DAY… NOT A TYPO! Flexion of the spine is a normal movement which occurs naturally during activities in our daily lives. Getting out of bed, standing from sitting, tying your shoelaces and yes LIFTING FROM THE GROUND all require some degree of spinal flexion! Our backs are incredibly resilient and designed to cope with the stresses that we place upon them everyday. We have big strong vertebral bodies, robust facet joints either side, thick strong supporting ligaments, a huge number of supporting muscles and discs which act a shock absorbers! Whilst injuries to the spine can occur, our backs also have the ability to heal! In fact studies seem the show that for the discs of the lower back, the larger the degree of injury the more potential for healing. In addition, research has proven that most of the time, there is no correlation between changes found on scans such as MRI’s and lower back pain. In fact, over 90% of lower back pain has no specific cause. Before we go any further it is important to note that “no specific cause” does not mean simple. In fact its the complete opposite….. Lower back pain is so complex that in most cases blaming one single structure shows a LACK of understanding. https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/bb7c04e1-50ac-469a-88e8-71f62709cd5e/Factors+Contributing+to+Lower+Back+Pain.png Blog - Lifting with a Bent Spine Is NOT Bad For You - So What Does This All Have To Do With Bending Forwards? We have been told for years that we must lift by bending our knees and keeping our backs straight. As physio’s we have preached strengthening and improving control within the neutral zone. However, more and more evidence is emerging that shows us that we were actually wrong the whole time! Numerous studies have shown us that stooped lifting is NOT a risk factor for developing lower back pain. It also doesn’t prolonging the duration of painful episodes or increase the risk of reoccurrence. In fact stooped lifting has many benefits. Including being quicker, using less energy, placing less demand on the heart and lungs and a lot of the time being more convenient. Given that we bend our spines thousands of times per day, we should be aiming to improve our ability to do so, not try and avoid it. https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/54c01a5f-1b3a-4083-b396-f98446230f5b/Load+Capacity+Model.png Blog - Lifting with a Bent Spine Is NOT Bad For You - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/dc58ed32-f15f-47a0-9b07-b4b2af4e66ab/Side+Flexion+45+degree+hyper.PNG Blog - Lifting with a Bent Spine Is NOT Bad For You - The Answer We have 2 options here. We can either 1) Treat our spines like the amazing, strong, adaptable structures that they are. Building our capacity and tolerances to all kinds of different positions over time, leading to a stronger, more resilient and more capable back. or 2) Stick our heads in the sand, run away from the problem, avoid bending forwards as much as possible and continue in the cycle of injury-recovery-injury. Here at Maximise all our physiotherapists are very experienced at rehabilitating all kinds of lower back pain and presentations. We understand that lower back pain is complex, different for everybody and requires an individualised approach. Speak to the team today for a comprehensive approach to your treatment and management! https://maximisephysio.com/physio-blog/osteoarthritis-is-not-wear-and-tear monthly 0.5 2023-05-14 https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/a46027dc-5181-4d51-bd43-24849f112587/DSC00383.jpeg Blog - Osteoarthritis is NOT wear and tear “Your Joints Have Wear and Tear” “Normal part of ageing” “ Your joints are worn out” “ It’s bone on bone” These are all common phases used by both physios and doctors when referring to Osteoarthritis (O.A). But we are here to tell you today that this information is untrue, outdated and unhelpful! Firstly, it important to distinguish between "radiographic OA” and “symptomatic OA”. Just because someone has OA on a scan it doesn’t mean that this is what is causing them pain! We see people in the clinic all the time with a body part which may display very advanced osteoarthritic changes who are absolutely pain free! Now, before we can go any further we must have a basic understanding of what O.A actually is….. https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/05e0e5b7-3d42-4a07-8746-e944f196eafd/Blood+flow+restriction+knee.jpeg Blog - Osteoarthritis is NOT wear and tear - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://maximisephysio.com/physio-blog/tag/exercisescience monthly 0.5 https://maximisephysio.com/physio-blog/tag/rehab monthly 0.5 https://maximisephysio.com/physio-blog/tag/cairns+local+business monthly 0.5 https://maximisephysio.com/physio-blog/tag/strength monthly 0.5 https://maximisephysio.com/physio-blog/tag/hip+osteoarthritis monthly 0.5 https://maximisephysio.com/physio-blog/tag/physiotherapy monthly 0.5 https://maximisephysio.com/physio-blog/tag/cairns+physio monthly 0.5 https://maximisephysio.com/physio-blog/tag/physio monthly 0.5 https://maximisephysio.com/physio-blog/tag/lower+back+pain monthly 0.5 https://maximisephysio.com/physio-blog/tag/acl monthly 0.5 https://maximisephysio.com/physio-blog/tag/blood+flow+restriction+training monthly 0.5 https://maximisephysio.com/physio-blog/tag/strength+and+condititioning monthly 0.5 https://maximisephysio.com/physio-blog/tag/knee+rehab monthly 0.5 https://maximisephysio.com/physio-blog/tag/shoulder+osteoarthritis monthly 0.5 https://maximisephysio.com/physio-blog/tag/rehabilitation monthly 0.5 https://maximisephysio.com/physio-blog/tag/physiotreatment monthly 0.5 https://maximisephysio.com/physio-blog/tag/cairns+physiotherapy monthly 0.5 https://maximisephysio.com/physio-blog/tag/cairns monthly 0.5 https://maximisephysio.com/physio-blog/tag/knee+osteoarthritis monthly 0.5 https://maximisephysio.com/physio-blog/tag/cairnsphysio monthly 0.5 https://maximisephysio.com/physio-blog/tag/physio+rehab monthly 0.5 https://maximisephysio.com/physio-blog/tag/shoulder+rehab monthly 0.5 https://maximisephysio.com/home2 daily 0.75 2025-06-25 https://maximisephysio.com/cairns daily 0.75 2026-02-24 https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/48260e5b-5b6a-4ae8-af04-02b394167575/Hands+on+physiotherapy.png Cairns https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/70e202b6-7c9b-46de-83ad-b4137489ed3d/Gym+Rehab.png Cairns https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/56773386-5daa-4918-8b49-5ab6e026cd38/Patient+education.png Cairns https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/072df891-fdf6-4877-a016-6e7f81896a09/Cairns+Physio+Reception.jpeg Cairns https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/b3b981ac-908d-401e-a0ec-908c588df6e2/Ankle.jpg Cairns https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/fee6983a-64ff-4d1e-a372-2ad6f2862005/Ben+scott+2.png Cairns https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/e0a18aef-ffa0-447c-9954-637cd1e51ec3/Ben+Scott+Lumbar+Spine.png https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/f1c31916-692b-4da1-88c5-94d41f48fa7a/Cairns+Homepage+Background.png https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/2627c63b-bc3b-4af7-addc-ce95ed8355c0/Ben+Scott+Hands+on+Treatment.png https://maximisephysio.com/physiotherapy daily 0.75 2024-12-07 https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/e04e5b79-abfe-45d3-965e-3c322a36a013/Lower+Back+Joint+Mobilisation.png Physiotherapy https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/61fa4238-9eef-447d-9123-94b3e598048e/Workcover+Physio.png Physiotherapy https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/e30afbdf-a57d-423b-af79-df562faf7b36/Touch+Rugby.jpg Physiotherapy https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/15841f83-f337-465d-887c-acdf885bd327/Whiplash+Injury.png Physiotherapy https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/84aa27ff-be66-4532-91c8-9405b54a30b3/Chronic+Lower+Back+Pain.png Physiotherapy https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/d53126ff-d734-4909-b7b4-b296d64c5202/Department+of+Veteran+Affairs.png Physiotherapy https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/3bcff08f-9408-4824-ac0d-74143d82c677/Womens+Health+Diagnostic+Ultrasound.jpg Physiotherapy https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/800acea6-c804-4985-9fe3-65ffcb899c1d/Physio+Hydro.png Physiotherapy https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/158dfcdc-f86d-40ce-9f0b-7f6941e4fbf6/Paediatric+Physiotherapy.JPG Physiotherapy https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/9d1fec69-0c1c-4a66-8e9e-f14a8a5e5e08/Elderly+Physio.png Physiotherapy https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/57b90c08-724c-44ca-8311-2eb5c278a4da/Registered+NDIS+Service+Provider1.png Physiotherapy https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/a31e1e96-b887-426d-966d-b7efc7bb3227/tempImageoZgxLF.jpg Physiotherapy https://maximisephysio.com/northernterritory daily 0.75 2025-08-29 https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/5c432758-b870-449b-8889-26973fee526c/tempImageuXHgyO.jpg https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/bb4d6d16-3374-4993-856e-e96fec5f1387/Paul+Foster+Physio+Teaching.jpg https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/9136779e-af61-4084-ad35-1de2c427065d/Palmertson+Logo+V3.png https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/1ea2983d-a305-41c0-bbe0-6765ead29fae/Ankle+Rehab.jpg https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/3f49565e-2ccf-4350-a0a2-9ddf37ee3530/HD+V2.png https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/1ea2983d-a305-41c0-bbe0-6765ead29fae/Ankle+Rehab.jpg https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/a5c06d4d-7543-40a5-8410-b7318f3a328f/Cas+v2.png https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/1ea2983d-a305-41c0-bbe0-6765ead29fae/Ankle+Rehab.jpg https://maximisephysio.com/contact daily 0.75 2024-03-13 https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/1df0e346-c216-4ede-a253-03b04d5111d9/Maximise+Physiotherapy+Cairns+Logo+White.png https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/4974bb95-02e8-4ac3-af32-c14004da36cb/Maximise+Physiotherapy+Palmerston+Logo+White.png https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/863cc284-77e8-4462-aee6-15a056af1fde/Maximise+Physiotherapy+Humpty+Doo+Logo+White.png https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/44b360eb-2991-4355-b64d-b56cba89462d/Maximise+Physiotherapy+Casuarina+Logo+White.png https://maximisephysio.com/sport daily 0.75 2024-12-12 https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/906a05f5-3bfc-45b3-ba9e-127bcc1c8d00/Sports+Injury+Management+Desktop.png https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/62175612-f72a-4b64-8d24-343c41db2807/Prevention+Desktop+5.png https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/08625715-9893-44ff-a424-b9fb5227c6fb/Concussion+Management+Desktop.png https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/3414b624-f8ca-4491-a6be-2d86ac47e9cc/Sports+Performance.png https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/65a2d655-4871-4919-ad42-a4aff42a9eb5/Sport+Education+Desktop.png https://maximisephysio.com/aaron-gandecha daily 0.75 2026-01-07 https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/cb9fe699-7ea3-464b-b7fb-f140091a3e8b/DSC00383.jpeg https://maximisephysio.com/stratfordconcussion daily 0.75 2025-03-19 https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/c97ba903-14fc-4b68-af91-2aaec0243cb4/1.jpg Stratford Medical Concussion Presentation https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/21ee6f32-425c-48e0-a3e9-3aa81b30590d/2.jpg Stratford Medical Concussion Presentation https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/cd321284-b911-4a3e-ae25-4969c0af8d18/3.jpg Stratford Medical Concussion Presentation https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/596a77ee-be3f-4b0f-baf9-2f4ecf46397c/4.jpg Stratford Medical Concussion Presentation https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/36b433bc-8402-4dc5-8e15-cb44e2d1ca74/5.jpg Stratford Medical Concussion Presentation https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/2c731de7-52d7-4f2a-abd9-bf1e22fc9204/6.jpg Stratford Medical Concussion Presentation https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/5dfc4044-b236-4d38-8f7d-1c2765353301/7.jpg Stratford Medical Concussion Presentation https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/50c1691c-d659-4fea-8c2e-78ea075e6261/8.jpg Stratford Medical Concussion Presentation https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/e4d78473-a4db-49fd-8d28-18f489949ccf/9.jpg Stratford Medical Concussion Presentation https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/4007406e-e82f-47bf-b198-ba1bb59bad91/10.jpg Stratford Medical Concussion Presentation https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/b6325f21-ddcf-450e-ae6f-78c4f2404edd/11.jpg Stratford Medical Concussion Presentation https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/bf15746d-c1ed-475f-ae65-b65865a61494/12.jpg Stratford Medical Concussion Presentation https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/45b7cd5f-1e89-4c62-b6af-562f484eb460/13.jpg Stratford Medical Concussion Presentation https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/302f0d35-30aa-4889-aff1-6e865a7903e9/14.jpg Stratford Medical Concussion Presentation https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/aecb76ab-9fc9-49e1-a412-53dce0734f95/15.jpg Stratford Medical Concussion Presentation https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/3c56b8cd-89cd-46f8-a2c9-aee65eb53919/16.jpg Stratford Medical Concussion Presentation https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/54d71770-a256-4437-813c-69494f139eb5/17.jpg Stratford Medical Concussion Presentation https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/a73f9cfe-476e-45b8-a596-d8bd53284c54/18.jpg Stratford Medical Concussion Presentation https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/2bd49fa5-0b96-46dc-9e5c-e4520ffca55e/19.jpg Stratford Medical Concussion Presentation https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/19189e0d-f4bb-4cf0-ae48-b9dcc4f413e0/20.jpg Stratford Medical Concussion Presentation https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/626185d2-f3c8-4d4d-b1de-e854daba1b03/21.jpg Stratford Medical Concussion Presentation https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/76d8b2e9-8c26-4217-9d0c-ab8500a99547/22.jpg Stratford Medical Concussion Presentation https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/24219bf8-16ab-4903-b43e-989884619eca/23.jpg Stratford Medical Concussion Presentation https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/099d7617-b78e-4b54-93d9-126804dff960/24.jpg Stratford Medical Concussion Presentation https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/12d64e29-55b0-4922-bd34-26fb68e3843b/25.jpg Stratford Medical Concussion Presentation https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/26a167fc-f142-452d-ba05-ecb256e0c227/26.jpg Stratford Medical Concussion Presentation https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/c5065b8c-d027-44d5-945f-dd604d1ccbce/27.jpg Stratford Medical Concussion Presentation https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/89fefb2a-bbbc-492f-8d49-6cd809dfb01d/28.jpg Stratford Medical Concussion Presentation https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/fb63ad63-52b1-462f-9f66-7d95dca014ae/29.jpg Stratford Medical Concussion Presentation https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/5d2892fd-fe50-4e46-8f94-f91f14abe559/30.jpg Stratford Medical Concussion Presentation https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/95274618-255e-4cd7-bfeb-46fdcfd0aa0c/31.jpg Stratford Medical Concussion Presentation https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/38765931-bd6f-4916-a0ad-b3ee288dac06/32.jpg Stratford Medical Concussion Presentation https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/d7f7ddb8-4341-47f8-8ba8-112e40b11550/33.jpg Stratford Medical Concussion Presentation https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/3d82ce6f-6084-4a93-9656-471c7d70027c/34.jpg Stratford Medical Concussion Presentation https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/a5867f3d-869e-4a36-af34-d1540c093ce9/35.jpg Stratford Medical Concussion Presentation https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/150b1dc4-1cd4-42ef-952c-f7290863675a/36.jpg Stratford Medical Concussion Presentation https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/1ca2da4c-40fa-48b0-b946-df5f9e5097cf/37.jpg Stratford Medical Concussion Presentation https://maximisephysio.com/neurologicalphysio daily 0.75 2024-12-18 https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/dab45d89-b501-4336-9510-278aeb33e4f4/tempImageC2wsiR.jpg https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/e5604d08-abf0-4828-b016-faf8cacec034/tempImage34U0Ku.jpg https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/ff9580f6-4c7f-4762-adfc-2e27c79ed2b3/tempImageglFUQM.jpg https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/52ce71f7-4b67-4407-a139-dfad2705d222/Lauren+Hill+Meet+the+team.png https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/1532be75-ce35-408e-9eb3-d0a688232b30/Lauren%2BHill%2BPhysiotherapist.jpeg https://maximisephysio.com/sportsinjurymanagement daily 0.75 2024-12-12 https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/d049c6e3-962c-48dc-8f66-0c9eeeab62c3/Injury.png https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/77d13364-7ff7-4109-8adb-09ba078b1f13/Palmerston+Clinic+Gym.jpg https://maximisephysio.com/sportsinjuryprevention daily 0.75 2024-12-12 https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/088af16f-9c0a-4439-bfa1-8d8682179d31/Injury+photo.png https://maximisephysio.com/concussion daily 0.75 2024-12-12 https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/fcb77de4-1a66-4c9b-b04d-65e8f8f3184e/AFL+Tackle.png https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/0f5013bc-845d-4a40-85c6-3840f9bb604f/Concussion+1.png https://maximisephysio.com/sportperformance daily 0.75 2024-12-12 https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/c50c6ec1-fbad-49aa-9bb5-da883c5c5465/Sprint+3.png https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/cf03843b-3884-4fc4-aa1b-4eb8d6686ce1/tempImageuREh4M.jpg https://maximisephysio.com/cairns-1 daily 0.75 2025-02-27 https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/2145766f-0461-4105-b121-10dd24dac4dc/Hamstring+Stretch+Physio.jpeg https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/f244e1b1-7420-4c2f-af11-fda3f2b348a3/Cairns+Physio+Gym.jpeg https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/33c70360-cdbb-462d-8cbd-74f23bfe1aea/DSC00357.jpeg https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/29f5b04c-3c75-4c66-8528-77e6242f2bf0/Cairns+Physio+Reception.jpeg https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/8319718f-1dc4-4073-a39a-4cf6eb6390a8/Shoulder+Physio+Massage.jpeg https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/b3b981ac-908d-401e-a0ec-908c588df6e2/Ankle.jpg https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/a919d73d-93c0-4e0c-ab0f-760ad0a38dfd/Shoulder+Physio+Massage.jpeg https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/9d04911d-dcf4-44e6-b04d-5cf32c36a269/Aaron+Gandecha+1.png https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/ef1c131d-25f8-43ae-a4ce-ef7c6b23db95/Aaron%2BGandecha%2BPhysiotherapist.png https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/78dccdf6-ee71-418a-89aa-6e07d1780f63/20230505_191038.jpg https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/6a6f5d34-ebd3-405c-935f-b20ed1ab529e/tempImage5jAbm1.jpg https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/1f89cd57-cef3-4599-ad79-2467a8a66fcd/Ben+Scott+Physio.png https://maximisephysio.com/concussion-1 daily 0.75 2025-03-19 https://maximisephysio.com/home daily 1.0 2025-11-11 https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/84f5abbc-29cb-4361-9d77-8122614311a7/Hands+on+treatment+1.png+.png https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/778df00a-653e-4032-bd98-fb4069bb1f9d/logo+11111.png https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/778df00a-653e-4032-bd98-fb4069bb1f9d/logo+11111.png https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/778df00a-653e-4032-bd98-fb4069bb1f9d/logo+11111.png https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/778df00a-653e-4032-bd98-fb4069bb1f9d/logo+11111.png https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/a9bd353a-127b-4ea4-bf07-ec643c56a21a/Patient+centred+1.png https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/770c0e82-7bb5-429e-91f3-8d0ddaea9bd3/treatment+spec+2.png https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/84f5abbc-29cb-4361-9d77-8122614311a7/Hands+on+treatment+1.png+.png https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/aa3d5dc9-3edf-4a75-8a27-703ca044759f/Rehab+Gyms.png https://maximisephysio.com/private-physiotherapy daily 0.75 2025-06-28 https://maximisephysio.com/onlinebooking1 daily 0.75 2025-11-11 https://maximisephysio.com/home-1 daily 0.75 2025-06-28 https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/3af4efeb-0be0-4d07-b4bf-2872d7908a5e/Physio+Joint+Manipulation.jpeg https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/4673f591-a458-42bb-9928-770d3b73b66a/Spine1.png https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/ea6934a2-8ee4-4a0c-869b-d1c28faf1734/Physio+1.png https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/d8dc9064-5d29-4610-91ed-dfcfe3b5a7c7/Dumbbell.png https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/bce09892-f86c-4b5d-a561-5e7b47fcb456/Hands+on.png https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/c789d246-fa13-483f-9294-50a31cc76e41/Neurological+Physiotherapy+.png https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/8f8012be-140f-4bbf-8c20-d53951d1dbd2/Chronic+Pain.png https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/27767edb-64d2-40eb-bb0f-3dc3aca47669/Paeds.png https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/db60ce75-756e-429c-be06-28cdd634a0b5/Womens+health.png https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/e6a0cc9f-4fe0-4c97-9748-f8a286c37156/Insurance+Claims.png https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/7cf88c2c-cab4-446f-809b-fbb18dce14ed/Private+Physiotherapy.png https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/5688701a-6601-4552-a91b-4c357253d3ce/Sports+Injury.png https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/31d4a7c2-e327-42a6-a26d-5867dadc4bd5/NDIS.+.png https://maximisephysio.com/cairnslightbar daily 0.75 2025-06-29 https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/48405ff3-e68d-4369-bc6f-bf35bf03a57f/DSC00357.jpeg https://maximisephysio.com/meet-the-team daily 0.75 2026-01-22 https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/3841795c-8f3e-4554-aa1b-e91a19abed1b/Damon+Sala+.png https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/05b99021-694f-428c-9da5-91841b4b5ba1/Paul+Foster.png https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/0ec788ca-a979-48ac-9df3-df5ec7759b5a/Aaron%2BGandecha%2BPhysio.png https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/6846f75a-0eec-455d-85c9-6a8bb59154fc/Samson+Leung+photo.png https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/791a6e47-a433-4729-8345-17196045d066/Lauren+Hill.png https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/5edd65a0-1382-4f7d-bd43-314fa9de2d09/Sriharan+Manogharan.png https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/44dd8cb8-3cfa-4be0-b1f5-e119c1a34af0/Ryan+Himing.png https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/b1d5d0ea-1048-4e2f-9843-0a06e2a55fca/Michael+Ninneman+photo.png https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/09df997a-f9d4-4b4c-b913-32fb3fcf8ac5/Thomas+Ng+Photo.png https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/1e6f3bfb-ea59-46f4-95f7-0c99f6a3c63d/Kadir+Sungkar+Photo.png https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/6a6f5d34-ebd3-405c-935f-b20ed1ab529e/tempImage5jAbm1.jpg https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/29dfc186-6956-404b-810e-bcbf455622e9/Aminda+Shakoor.jpg https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/9b75c0c4-1c36-4f9f-97c3-c271d8ca646c/Macey+Collet.png https://maximisephysio.com/michaelninneman daily 0.75 2025-07-22 https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/f47f6b1f-8f17-4d25-b3af-401c8b44fb48/MN+.png https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/ef0acd89-a2de-4e15-a726-8ae08449033b/MN+3+.png https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/d58cb965-d290-4e78-b672-39263f197d49/MN+2.png https://maximisephysio.com/kanna daily 0.75 2025-08-31 https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/5edd65a0-1382-4f7d-bd43-314fa9de2d09/Sriharan+Manogharan.png https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/5d244e53-5507-4a07-9f93-90b164916b39/Kanna+2.png https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/637579d8-3feb-490b-a783-9c678f72a5c3/Kanna+3.png https://maximisephysio.com/aarongandecha daily 0.75 2025-07-22 https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/775fafb0-b982-41ec-885b-82b10a4773cb/Aaron+Gandecha+Physiotherapist.png https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/78dccdf6-ee71-418a-89aa-6e07d1780f63/20230505_191038.jpg https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/77a1f05e-bdf4-41a2-b326-9c6af30cbc08/Physio+Joint+Manipulation.jpeg https://maximisephysio.com/thomasng daily 0.75 2025-08-13 https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/4bd5fa62-7711-4fd6-9e90-33787d6d2c4a/Thomas+NG+2.png https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/afe8b0f6-2f70-40a7-9d8d-caf14bc3a0a4/Tom+NG+1.png https://maximisephysio.com/nthomepage daily 0.75 2025-08-31 https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/e6211166-c853-4cd3-bfb0-9d98e183698c/MRI+Photo.png https://maximisephysio.com/palmerston daily 0.75 2025-11-11 https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/a83bfff0-36ed-40cd-9857-97970e43d8b3/Thomas+NG+1.png https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/ba849032-603d-4f42-9c56-8d2a12090e24/Hands+on+treatment1.png https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/b8026344-daa8-41f0-b1f4-691ecd45fd5c/rehab.png https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/6cf8d01f-5bf4-42e6-ae5c-ea4187c6d061/Ryan12.png https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/5bef8448-48b6-4a6b-bda6-90e2c15eeb3f/Lauren+homepage+1.png https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/ba849032-603d-4f42-9c56-8d2a12090e24/Hands+on+treatment1.png https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/ba849032-603d-4f42-9c56-8d2a12090e24/Hands+on+treatment1.png https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/5d54915a-d602-4cad-8351-425e504d69d7/ChatGPT+Image+Aug+30%2C+2025+at+11_05_27+AM.png https://maximisephysio.com/humptydoo daily 0.75 2025-11-11 https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/8eafd49e-a88c-4e3c-898a-65494d011336/Jack.png https://maximisephysio.com/casuarina daily 0.75 2025-11-11 https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/9d667bc8-5c82-44f4-86cd-e2d48559c58d/Amina.png https://maximisephysio.com/ryanhiming daily 0.75 2025-08-31 https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/468dc100-eee3-4d85-b6b4-01987238235f/Ryan+Himing+1.png https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/aa5e774e-04d4-4545-8dd8-c4ba9f291607/Ryan+Himing+2.png https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/90129a62-5896-4c69-b46a-8b3635ce57ec/Ryan+Himing+3.png https://maximisephysio.com/laurenhiming daily 0.75 2025-10-03 https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/ea8bb6b9-5934-4ff3-bdb7-087b1331edbe/Lauren+Himing+1.png https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/985ce455-d850-453e-9b34-1040f86dc268/Lauren+Himing+3.png https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/9bbf537a-5c18-4ad4-a4f8-bf4988ff5a74/Lauren+Himing+2.png https://maximisephysio.com/maceycollet daily 0.75 2025-10-22 https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/ff023807-e4a9-4c96-9a5e-56ba6ed9a91e/macey+collet+1.png https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/8b45f59f-ebcb-4a62-8838-11f332c7fa2e/macey+collet+2.png https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/e5f4051b-2c25-42d2-b013-fd505b4c1ceb/macey+collet+3.png https://maximisephysio.com/aminashakoor daily 0.75 2026-01-21 https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/785420c6-0c2c-4604-b472-97b973e91099/Amina+Shakoor+1.png https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/1887cfff-d5f3-4f68-acad-2326ad96f370/Amina+Shakoor+2.png https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/9d667bc8-5c82-44f4-86cd-e2d48559c58d/Amina.png https://maximisephysio.com/careers daily 0.75 2026-01-22 https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/d291c616-df9d-4843-ba7c-6a379c0439ab/Humpty+Doo+Homepage.png Careers https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/031bc146-b274-4648-b331-607841500aef/Damo+CPD.png Careers https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/b8026344-daa8-41f0-b1f4-691ecd45fd5c/rehab.png Careers https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/1887cfff-d5f3-4f68-acad-2326ad96f370/Amina+Shakoor+2.png Careers https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/027360f7-c5ec-4e55-895f-c2c82e4c4088/Lauren+Himing+4.png https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/ff023807-e4a9-4c96-9a5e-56ba6ed9a91e/macey+collet+1.png https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/1ce58def-a543-48c3-b5b8-18acc0fb903a/Shoulder.png https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/2e32c8da-0493-41af-95f9-f42c4fae088b/Box+Jump.png https://maximisephysio.com/cairns-3 daily 0.75 2026-01-21 https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/fee6983a-64ff-4d1e-a372-2ad6f2862005/Ben+scott+2.png Cairns (Copy) https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/48260e5b-5b6a-4ae8-af04-02b394167575/Hands+on+physiotherapy.png Cairns (Copy) https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/072df891-fdf6-4877-a016-6e7f81896a09/Cairns+Physio+Reception.jpeg Cairns (Copy) https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/56773386-5daa-4918-8b49-5ab6e026cd38/Patient+education.png Cairns (Copy) https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/70e202b6-7c9b-46de-83ad-b4137489ed3d/Gym+Rehab.png Cairns (Copy) https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/b3b981ac-908d-401e-a0ec-908c588df6e2/Ankle.jpg Cairns (Copy) https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/e0a18aef-ffa0-447c-9954-637cd1e51ec3/Ben+Scott+Lumbar+Spine.png https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/f1c31916-692b-4da1-88c5-94d41f48fa7a/Cairns+Homepage+Background.png https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/2627c63b-bc3b-4af7-addc-ce95ed8355c0/Ben+Scott+Hands+on+Treatment.png https://maximisephysio.com/kadirsungkar daily 0.75 2026-01-22 https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/c0be59d4-8a99-4979-b753-a54ec3c73a42/Kadir+Sungkar+1.png https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/d078d8a7-b6b7-4079-991c-93cb5a74d4a0/Kadir+Sungkar+3.png https://images.squarespace-cdn.com/content/v1/6453131a96b34e7331d729ad/50c49912-ee00-4b78-bd01-61434ade8e4b/Kadir+Sungkar+5.png