Frequently Asked Questions

Our team of physiotherapists and podiatrists can assist you and your family with a wide range of problems including postural issues, sports injuries and rehabilitation support. You don’t need a referral to visit. Paddington Physio provides HICAPS facilities to claim your private health insurance on the spot, so usually you will only need to pay the gap. We help family members of all ages, active weekend warriors, and athletes need serious sports physio to keep them at their peak. Please do not hesitate to contact us if you are unsure if physiotherapy or podiatry is for you! You don’t need a referral to visit.

The short answer is that we offer both physiotherapy and podiatry treatments! We understand how these two practices support each other and can provide you with a strong and effective integrated service. We provide a contemporary and professional service with thorough assessments and comprehensive management of your condition. All of our appointments are individual consultations in private rooms, which means we won’t be treating other clients at the same time or just leave you hooked up to a machine! Physio doesn’t have to be expensive; a couple of targeted treatments can often make all the difference.

Paddington Physiotherapy & Podiatry is independently owned and operated. All our clinical staff are university educated, some with postgraduate degrees. We have extended opening hours 7am to 7pm Monday to Friday as well as Saturday mornings, and endeavour to provide you with Same Day Appointments if required. We are located close to the Brisbane CBD with the entrance on Princess Street in Paddington with two hour free street parking or you can use our free on-site parking underneath.

Your Physiotherapist will talk with you about your symptoms (pain, pins and needles, numbness, weakness, giving way, locking, dizziness, headaches, stiffness etc.), how they affect you, what activities make them worse, when they first occurred, what (if any) treatment you have had prior to your appointment here. They will also discuss your goals and expectations, your normal leisure activities, sports and the physical demands of your occupation, your workstation/desk setup. You will also be asked about your general health and any medication you are taking.

Your physiotherapist will then examine your movements and do some physical tests to see what aggravates your symptoms. They may look at your scans or reports from your scans if you have any.

After determining what is causing your symptoms and the contributing factors your physiotherapist will treat the main areas of concern. Your Physiotherapist will work with you to determine whether there are some changes that you can make to reduce the pain. Your Physio will have a discussion with you about what habits need to be changed or techniques or movement patterns need to change, your workplace changes of habits and the work environment and your posture. Sometimes just a small tweak to your daily routine can make a huge difference. Something as simple as using a lumbar support to help your back while sitting at a desk or adjusting the height of the computer screen might stop you from aggravating your condition.

While you are getting better it can be beneficial to reduce the movements that are causing the pain. The Physiotherapist can help you with some practical guidance on ways to prevent further injury. For example if you are the parent of a small child and have developed back pain, it is unlikely that you will be able to just stop lifting your child altogether, but the physiotherapist will work with you to determine ways that you can reduce the strain on your back when lifting the child. The lifestyle changes might be simple for example using a small step when getting your child out of the cot.

If you are having difficulty lifting, we can teach you better ways to lift which will mean that you will be less likely to do further damage.

You will be given some exercises to do at home to maintain changes and make further improvements to range of movement, strength and balance. Our physios don’t just do quick fixes we are dedicated to assisting you to achieve long-term solutions. We work with you to help you regain your normal lifestyle as soon as possible.

We work with our patients to help them achieve the best possible outcome and therefore follow up with our patients to ensure they are maintaining improvements and continuing the necessary exercises. We are able to help you with decisions surrounding any required surgery and help you understand other choices and your likely recovery process after surgery.

Good physiotherapists will assess and analyse your movement patterns to identify factors that are contributing to your problem. We will look at how much movement you have, the quality of your movement and assess your strength. From the assessment we can then make a diagnosis and provide treatment that is appropriate for your needs.

A physiotherapist can:

Podiatrists focus on evaluation and management of injuries and diseases of the foot and caused by the foot. We will assess the function and structure of your feet, and we will note any specific problem or pain you are experiencing. When commencing the diagnosis process we aim to identify any underlying causes of the issue and advise on treatment. We will need to ask questions about your shoes, work, mobility, sporting activities and your general foot health. At Paddington Podiatry we strive to incorporate good footwear advice with your work and fashion requirements.

At Paddington Physiotherapy we see a lot of lower limb injuries (hip, buttocks, hamstrings, quads, knee, calf, shin splints, heel pain and foot injuries). We can help with stopping bunions from progressing and can improve your function and strength in the lower limb. We endeavour to fit your exercise regime into your lifestyle as much as possible. If you don’t like Pilates we will not force you into Pilates classes you can get core stability in other ways. If you want to run, we will help you return to running. If walking is your chosen exercise regime we will assist you into a walking programme.

Joint replacements are generally thought to last about ten years prior to needing revision surgery. You cannot have multiple joint replacements on the same joint so it is most often beneficial to delay surgery. If you have a hip replacement you need to allow an extended period of time off work and spend time doing your rehabilitation so sometimes one of the benefits of delaying surgery is to fit it in when it is most convenient with your lifestyle and work commitments. Our physios can help you manage pain, regain some range of movement and strengthen up your hip area. Many of our patients have been able to put off having a hip replacement for over ten years without any increased levels of pain and with much better function.

It is a difficult position to be in when you need to exercise to help with weight maintenance or loss but cannot because of knee osteoarthritis or degeneration especially if a joint replacement is required but the risks are too high when overweight or obese. Our physios have helped many patients manage their knee condition so that they can return to exercise. Sometimes in losing the weight and doing the prehabilitation they have found that they no longer need the joint replacement. A programme of treatment with our physios can make your joint replacement surgery safer and sometimes gives you the choice to delay it indefinitely.

The current research suggests that degenerative knees and degenerative cartilage symptoms in the knee do not benefit substantially from arthroscopic surgery but are more likely to benefit from physio management. Acute locking episodes and traumatic tears of the meniscus, however especially in younger patients, do still get better outcomes with surgery. Your physio can help you with the diagnosis of your knee injury and discussing your prognosis.

There are a number of headache types that physio can assist in resolving they include;

• Cervicogenic headaches, which are caused by the joints and muscles of the neck. These headaches will regularly refer to the eye socket and can often feel like someone is poking a pencil in your eye.
• Tension headaches, which are caused by the muscles of the neck pulling on the muscles of the scalp.
• Pre Migraine. A neck headache can be a trigger for developing into a true Migraine so often if you manage the neck headache early you can prevent it from progressing. Improvements in neck range and function may be able to help you reduce the number of migraine episodes you experience.
• Post Migraine, many people experience a residual neck headache and restriction of neck range of movement after a migraine. This will respond quite well to physio management and can help faster recovery and help reduce further episodes of migraines.

It has been fairly difficult for researchers to definitively prove that posture has an effect on the development of injury, this is likely to be because some people just manage to get away with bad posture without injury and thus skew the research results. However, there have been plenty of studies that suggest that posture can affect mood and can affect the way other people perceive you. You can also easily demonstrate that your posture affects the amount of range that you have available for certain joints to work in e.g.: sit in a very slumped, C-curve position and try lifting both your arms straight up in front of you, you come to a stop. Then try sitting up tall with your head on top of your neck and lift both arms and you will find that you can easily make full shoulder range.

Clinically, we find that patients get much better, much more quickly if they are able to spend more time in a good position than in a bad position. Our spines have curves in them to increase the structural strength if we maintain those curves well we take the weight of our very heavy heads more easily.

Another obvious example of posture affecting your movement is at the shoulder. The scapula or shoulder blade is mainly held in place by muscles, which essentially means that you decide where you are going to put your shoulder blade. If you elevate it as you slump, it will not be able to move as well as you lift your shoulder and it will block the movement.

If you have had a gradual build-up of symptoms it is often most convenient to see the physio as a private patient. If you have had an incident where you have injured yourself at work (or on the way to or from work) you should report it to your employer, see your GP for a medical certificate and a referral to physio and then lodge a claim with Workcover. We are able to assist most workers back to work having missed very few days. You may be able to go back to restricted duties, shorter hours or modified duties. If you seek physio treatment early you can usually resume your normal lifestyle faster.

There’s a lot of evidence emerging that prehabilitation, which is rehabilitation before surgery rather than afterwards, is beneficial in better, faster outcomes following surgery for a lot of different conditions. Some of the surgeries where it can be useful to see a physio beforehand include anterior cruciate reconstruction, total knee replacement, total hip replacement, rotator cuff surgery and ankle reconstruction.

Our Physios adapt their management according to your abilities, general health and your goals of treatment. Your age is taken into consideration but the abilities and goals of people the same age are vastly different. We have clients whose physical activity matches that of people 20 years younger than their chronological age so we match their capabilities. You are given exercises that you are capable of getting done without much hassle. Irrespective of your age, your range of movement and pain is likely to be improved with physiotherapy and just a small amount of targeted intervention could have a huge impact on your quality of life.

You do not need a referral to see a physio as a private patient. Your physio can refer you for most investigations you might need and can write you a medical certificate for the workplace or school. If required, we also liaise with your regular GP. You might need a referral if you are under DVA, Workcover or if you are covered under the Medicare EPC (Enhanced Primary Care programme) with a Careplan in place, or after a motor vehicle accident (although your referral might also come from your lawyer).

The rotator cuff is a group of four muscles that stabilise the shoulder and help keep the ball in the socket joint. They are prone to injury when you lift a weight out to the side like lifting your handbag off the passenger seat or when you reach behind you to put the seatbelt on or put on a heavy coat. Often you will do these movements and not really notice that you have injured yourself until the pain appears later. This is quite a common presentation. Your Physio will test the rotator cuff and other structures around the shoulder to determine what you have done and help you treat the pain, strengthen up and avoid aggravating movements in the future.

A break or a fracture means the same thing and there is no difference in severity. If you have broken a bone it will be managed according to which bone it is and the severity and position of the fracture. The primary management may be a cast, a bandage, a brace, crutches, a sling or surgery. In the early stages a physio appointment may help you learn how to manage the fracture during the period of immobilisation. Some examples might be;

• If you have fractured your shoulder you may need physio treatment of your neck for pain from the fall or from being in a sling. You will also need to be given exercises to prevent a frozen shoulder and to prevent wrist and elbow complications, as well as taught positions of comfort and what to do with the sling.
• If you have fractured your ankle you may need to be taught how to use your crutches, what other muscles you can exercise during your time in a cast and you may need treatment for other areas that might have been injured at the same time for example your low back.
• Some fractures you won’t be immobilised for and should commence Physio treatment immediately such as some avulsion fractures where a chip of bone is pulled off by a muscle.
• After you come out of immobilisation you are very likely to require physio treatment to regain your range of movement and strengthen up. Stiffness and weakness after immobilisation need to be addressed.

Low back pain can respond really well to Physio treatment. Your Physio will help you settle the immediate pain and give you exercises for pain relief and to help you strengthen up. When you get low back pain, even for a short period of time, some of your core muscles can get inhibited. Your physio can help you to activate them properly and teach you positions of comfort and ways of avoiding back pain. Low back pain is common but it is not normal. It may have a recurrence rate of over 90% but the trick is to reduce recurrences and make future episodes less debilitating.

The word chronic is used as a measure of time not severity. Chronic means that the condition has been present for a period of greater than three months. Having chronic pain does not mean that you cannot get rid of it and resume your normal lifestyle. We see lots of patients with chronic pain, sometimes it is simply because they have not previously sort treatment. One of our patients was 21 years old and had an eight-year history of low back pain. She presented to Paddington Physiotherapy after going to a party where the conversation led to her finding out that not all people had back pain. She had thought that it was normal and there was nothing she could do about it. She responded well to treatment and was able to get rid of her back pain.

TENS machines are designed to give you an electrical impulse to distract the nerve from giving the sensation of pain. They will work while they are attached and have some residual affect after they are removed but they do not fix the condition causing the pain. TENS machines are not recommended for new (acute) pain or intermittent pain that is brought on by specific activities. For example if you get back pain every time you stand up from sitting that would not be something you would use TENS for, you would benefit more from physio treatment. If you had long-term (chronic) pain that was present all the time then that would be a situation where adding TENS to your management might be beneficial.

When you sprain your ankle you usually lose range in a movement called dorsiflexion. This will not spontaneously correct itself, it is best regained through Physio treatment. A loss of dorsiflexion has been shown to contribute to the onset of many other problems including shin splints, hamstring strains, hip/groin pain, knee injury, foot injuries, stress fractures, Achilles tendinopathy, recurrent ankle sprains, arch pain, heel pain…. So it is very important to get your ankle back to full range. You also need to strengthen your ankle correctly and learn how to improve your proprioception or balance.

This is a really common question and the answer is to seek treatment as soon as you can. Your Physio will help you determine if you need X-rays as you may have fractured a bone in your ankle. You will be assessed to determine if you require crutches so you are not making the injury worse and you will have the swelling treated so your movement becomes normal earlier and so that your pain reduces. You will be given exercises and you may be bandaged, taped, casted or braced to protect the injured ankle.

Hamstring injuries are very common and they are very prone to becoming recurrent. Some of the risk factors for recurrent hamstring injury are unfortunately non-modifiable like your age, but many are modifiable. Your Physio at Paddington can assess you to determine what risk factors you have and help you address the modifiable ones.

There are four major types of hamstring injury:

• The common hamstring injuries occur during sprinting and change of direction just before footstrike.
• Long distance runners will often get a tendinopathy along the musculotendinous junction, which will act like a recurrent muscle strain.
• Upper hamstring ruptures can happen at end of range either slowly or quickly for example in soccer players kicking above their head or slowly such as in ballet, yoga, gymnastics.
• Upper hamstring tendinopathies are common and give you a pain in the lower buttock. These can happen commonly in sports where you bend down to get the ball like AFL, touch football, rugby…

If you injure your hamstring try to make your appointment as soon as possible.

Tendinitis means inflammation of the tendon and whilst there are conditions that have inflammation, research has found that many painful tendons do not have any inflammation present so we generally call tendon injuries Tendinopathy, although it may be called Tendinosis on your Ultrasound or MRI. Often there is delayed pain after exercise that can warmup but as the condition worsens it starts to affect normal lifestyle activities and becomes present at rest.

Tendinopathies can often be quite troublesome to patients and difficult to resolve. Common tendinopathies include:

• The lateral hip (and Trochanteric bursa) – responsible for extreme tenderness on the outside of the hip making it difficult to sleep on your side
• Achilles tendon or plantar fascia – producing heel pain
• Hamstring – at the back of the knee or up at the buttock
• Patellar tendinopathy – below the kneecap
• Tennis elbow (although there are other cause of tennis elbow as well)
• Rotator cuff in the shoulder

Our physios help you determine how the tendinopathy has developed and what lifestyle factors you need to change as well as treating the contributing risk factors and assisting you with your strengthening programme to resolve the condition.

Our physios can get you ready to use a personal trainer if you have not exercised much in the past – we can get you fit to Get Fit! We are always happy to work in collaboration with other medical, health and exercise practitioners to ensure the best results for our clients.

It is common for people to blame a lack of flexibility for injuries however research shows that flexibility is rarely a cause of injuries. Maintaining adequate strength, control and proprioception, which is like balance, have been found to be the most effective ways of preventing injury. Stretching immediately before running can impair performance. Read more about this in our client information.

People will often say I am waiting for the swelling to go down before I see the physio or I am waiting for the pain to settle before I see the physio. The injury needs to be diagnosed you may be doing the wrong thing for the injury. Physio treatment can help from the beginning in reducing swelling and reducing pain and making it so you don’t end up with more problems from compensatory movements or slowing down your recovery due to not addressing the muscles that get inhibited right from when the injury occurs.

There are some injuries that put you at risk if they are not diagnosed early some examples are if you have calf pain that is caused by a clot (DVT), or a calf injury which is actually ruptured and needs immediate attention, a cartilage injury that needs appropriate time non-weight bearing. So the answer to when should I see a physio is ASAP. If you ring up our receptionists will endeavour to book you in with a physio as soon as possible.

It is rare for our sports physios to prescribe complete rest. Usually we will suggest as much exercise as you can manage without putting your injury or condition at risk of getting worse. There are some injuries in particular to the Tendon that respond poorly to complete rest as it deloads the structure so often we will keep you running through your management. We may give you a strict prescription of what you can do in terms of distance, hills, speed, footwear type, etc.

Running has not been found to cause knee degeneration, studies have shown that runners who are consistent in their training loads are less likely to have hip and knee problems than non-runners. It has also been shown that people with degenerative knees do not get worse if they take up running.

For children and teenagers, it is important that “growing pains” are correctly assessed and treated. Active children often experience pain that can be explained as growing pains, however this may not be the case for every child. It is paramount that children are fitted with the right type of shoes to support their growing bones. This reduces the risk of future malalignment and reduces the risk of permanent damage occurring. Furthermore, active children, heavy children and children with hypermobility or structural issues may require orthotic therapy for extra support for their feet. There are at least 26 bones in our feet and some people may have more if they have accessory bones. Growth plates in each bone found in our feet fuse at different times as well. This is also why it is important growing pains should not be ignored. The risk of long term issues is too great to ignore your concern – most times a little intervention early can prevent a life-time of problems.

When you see a registered Podiatrist you can relax in the knowledge that all of the instruments they use are safe and sterilized according to a strict protocol. You will not be sharing a foot fungus from the person before you. Your Podiatrist is qualified and has precision skills that can help you with more than a surface treatment of your feet – a more heavy-duty pedicure! Unlike a beautician, the Podiatrist will assess your feet and ensure that there isn’t an underlying concern. Your Podiatrist will give you the advice of a qualified professional.

There are a number of conditions of the feet, toes and toenails that can look unappealing for which a Podiatrist can assist. After playing a sport that may lead to regular hits to the toes such as football or hockey, the toenail may become thickened and look ugly. Your Podiatrist can work on the nail to shave it down gradually to a normal size.

Wearing ill-fitting shoes may have resulted in calluses, blistering, and deformities of the toes. Your Podiatrist can assist with general skin and nail care, footwear advice and additions or changes to your existing footwear.

Fungal infections are a common cause of ugly toenails – your podiatrist can diagnose the condition and give you options to manage the infection and stop it from returning.

Calluses can often look unsightly, as can cracked heels. Your Podiatrist can both treat the skin condition and help you learn how to prevent it.

Plantar warts can be difficult to get rid of as the wart may reach deep below the surface of the skin. There are many different ways for the Podiatrist to address Plantar warts and they will discuss with you the method that will suit you and your condition best. Some of the treatment options include carefully removing the top layers of skin and applying medication to the area enclosed within a dressing for a few days. After removal of the dressing, pharmaceutical treatments can be used on the wart as home therapy. You will need to see a podiatrist to reassess the wart(s). Treating warts can take weeks to months depending on how deep the wart has penetrated. This type of treatment is virtually painless. Other methods of wart treatment include freezing the wart and cauterisation.

You will need to discuss this with your Podiatrist as it will differ according to the extent of the surgery, sometimes you won’t need removal of the whole nail. Your time off work will vary depending on your work duties and the amount that you have to stand as well as the dress code if it determines the type of footwear required. Closed in safety boots will be more difficult to do an early return to work. You may be able to time your nail surgery to the end of the week so that you have the weekend to recover and you can minimize your time off work. Your Podiatrist can write you a medical certificate for the surgical recovery if required.

Do not pop the blisters as this will expose you to a risk of infection. Your Podiatrist can debride the blisters and apply any necessary dressings. You may need the black toenails removed to assist with healing or the Podiatrist may need to release some of the blood from under the toenail to limit damage to the nail bed. Your Podiatrists can give you tips on how to prevent damage from endurance events.

Diabetes affects many areas of the body including your eyesight and your feet due to changes in circulation. Diabetics are prone to peripheral neuropathies where they can lose the feeling and function in their feet. This has a number of consequences including poor healing and inability to feel an injury; both of which (when combined with the poor circulation) can result in ulcers that do not heal and may require amputation if the condition worsens. So diabetics should have regular foot checks by a Podiatrist and have general maintenance foot-care by the Podiatrist if severe. You may need only one check a year but if more severe you will need your feet checked regularly. If you have Diabetes you may be able to talk to your GP about a Care Plan and a Medicare EPC referral to the Podiatrist.

During your consultation, your Podiatrist will determine if you need X-Rays. The Podiatrist will be able to refer you directly to a Radiology clinic for X-Rays. Crutches can be organised and immobilisation if necessary. If X-Rays confirm a fracture the Podiatrist will determine if you need to be referred to a Surgeon and if not, manage your continuing care.

The types of orthotics prescribed at Paddington Podiatry vary from custom orthoses to semi-custom orthoses. Materials used to fabricate the orthotic devices also vary from rigid to semi-rigid plastics. Slimline custom orthotic devices are a popular choice to wear inside dress shoes to accommodate your needs.

At Paddington Podiatry, we perform a biomechanical assessment before deciding if you need orthotic devices. Adjunct therapies such as Trigger Point Dry Needling may be just what you need instead of orthotic devices. A biomechanical assessment will give us information about what is happening with the hips, knees and feet to address your problems. If needed, our podiatrist may do a tape therapy test where you have your foot taped for a few days. This shows us whether there is a change to your symptoms when taped, or an improvement the way you walk. You might even have a trial of padding in your shoe prior to deciding to make the more permanent orthotics. We strive for informed decision making and will work with you according to what you need.

You do not necessarily need to buy special shoes to fit the Orthotic device. Many styles of shoes allow you to remove the original insole from the shoe so that you can slip your orthotic devices into the shoe easily. On rare occasions you may need to purchase a shoe that is a half size bigger. Alternatively, your orthotic devices can be designed and made to fit your current shoes. Slimline Custom devices might be a good option for RM Williams style boots or dress shoes or heels.

Orthotic devices are made differently depending what type you need. Custom orthotic devices require a 3D image of your feet. To achieve this, a negative plaster cast is taken to ensure an excellent fit and comfort. Custom orthotic devices are made to fit your feet only, and no one else.

Using plaster casting is the traditional method for getting an accurate 3D image of your feet. At Paddington Podiatry, the casts are sent to a professional orthotic laboratory with specific instructions on the prescription. The instructions are deduced from the information collected during your biomechanical assessment.

Information our Podiatrist needs to consider before writing your orthoses prescription include:

• Your shoes, activities you do regularly and work environment
• The level of stability you need from your orthotic device will influence the material, and thickness of the material chosen. It also affects the width of your orthotic device and the depth of the heel cup in which your heel sits in.
• Medical conditions that you may have. Difference paddings and covers are available to accommodate to your needs.
• Shape of your toes

As a cast is made specific to your foot, we know that it will be a correct and comfortable fit. A 3D computer image is not always able to pick up the nuances that might be present in your individual foot structure.

When running a customised EVA device is often more comfortable than a rigid custom device. We favour using the customised EVA device for running and to play sport as they are usually more comfortable and there is less chance of blisters.

Your Podiatrist will help you work out why you have pain with shoe wearing. Feel welcome to bring a large selection of your footwear for the Podiatrist to assess. It may be the structural shape of your foot. You may have a high arch that requires some more support or alternatively it might be that your arch doesn’t function well and you are more comfortable in Orthotics. You may have been told before that your foot is over-pronated or has prolonged pronation or that you have a supinated foot. Your Podiatrist can help you assess the joint range of movement as you may have stiff joints that prevent normal movement. The Podiatrist may determine that your choice of footwear might be the reason for you not being at all comfortable in any shoes or you might be spending too much time in the one type of shoe. Your Podiatrist will be able make recommendations on other types of shoes that may be more comfortable for your needs.