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Call us now at: 02 9922 6806

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Opening times : Monday - Friday, 7.30 - 6.30

 

How we'll help put you "Back in Business!"

We aim to reduce pain and recurrences by improving your understanding of your condition. A thorough assessment is used to assess movement dysfunction.  This includes examination of movement patterns, muscle length & strength, as well as quality of muscle activation. Palpation of soft tissue is used to reveal the precise nature of any tightness. Further, diagnostic procedures include assessment of joint function.   

Through my formative years as a physiotherapist to elite athletes in Switzerland, I learned the importance of taking a broader perspective.   Therefore, if for example we were treating low back pain, I would assess the pelvic girdle, lower limbs, ribcage and shoulders. Similarly, if we were treating the shoulder, I would examine the neck, rib cage and low back-pelvic girdle.  Hereby an holistic approach is taken.

Exercise regimes are designed to treat the specific pathology, but are also used as a self assessment tool for you to manage your pain as well as attain your performance goals.

Standard consultations are 40 minute sessions and we strive to have you back in business within 3 - 6  treatments.

On the initial consultation you can expect

 
    • a thorough evaluation , including history taking and movement assessment
    • a work or sport specific evaluation where possible
    • a diagnosis
    • some treatment
    • a management plan of exercises and an expectation of duration and cost of treatment
    • an immediate result
    • reassurance with our 'money-back guarantee'.

Our 6 ethical principles are to

  • act in the best interest of our patients
  • practice in accordance with acceptable professional standards
  • apply principles of best practice of physiotherapy to our professional activities
  • respect the rights and dignity of all individuals
  • comply with all legislation that governs and impacts upon the practice of, and research in the field of physiotherapy
  • accept the responsibility to uphold the integrity of the profession

History of this website

First of all I would like to thank all my teachers, future, past and present, as this website represents a homage to them, my mentors and my source of inspiration. This website was initially started in 1998, to provide information to physiotherapist whom I had the pleasure of teaching, in various locations, around the world. At that time it was primarily directed at countries who had limited access (eg Zimbabwe and Chile) to continuing education or whose traditional emphasis in physiotherapy wasn't musculoskeletal (eg Japan and Brazil). Through vigorous interest in the early versions of the website, it expanded to include information directed not only at physiotherapists, but also other health professionals such as personal trainers, etc. When, I stopped teaching in the late 1990's, I decided to place all the teaching content that I owned onto this website for free public dissemination. The site now contains over 130 pages, packed full of information. There have been 3 reincarnations of this site, which unfortunately have lead to losses of 'important google back links'. Hence, if you like this site or at least appreciate the work and effort put in, then tell your friends. If you don't like what you read or see then please tell me.

Since the establishment of this website in 1998, it has grown to contain over 130 pages of inter-related material. Some of the material was written during research carried out as far back as 1986. In fact, the section on the shoulder was written in 1986, the section on hormones was originally conceived in 1992, the area on the neurophysiological aspects of pain was written in 1995, along with the section on Mechanical Traction. Knee rehabilitation using a 'motor control' and biomechanical approach of hip, back and foot synergies was devised during my time at the Rennbahn Klinik (Basel, Switzerland) from 1992-1993, as was the area on Achilles Tendonosis. More recently, the information on the immune system, muscle mass, sarcopenia was researched (2003-4), written and finally presented in Rome in 2005. In 2010, I was the principal author of the first ever book written in Whole Body Vibration Therapy.

Naturally enough, another purpose of this website is to provide details on Musculoskeletal Physiotherapy to prospective clients, current and previous clients. Importantly, this site is not meant to be an exercise in narcism, but instead it should illustrate how I have tried to stay ahead of the pack and continue to stay abreast of the latest knowledge. This has been achieved by maintaining a process of clinical reasoning whereby great clinical results are a used as a stimulus to question why they work. Either through clinical research or literature reviews and dissertations I have tried to make sense of the phenomoenology. This in turn led me to use the content of that new knowledge for the purposes of teaching internationally. Hence, this site promotes community health across several languages and cultures. By describing in detail the broad scope of the clinical reasoning process, this site wishes to enhance the knowledge base of all physiotherapists and clients alike.

By understanding the timeline of this website, it is possible to ascertain that the knowledge contained within, has been constructed over a period of time and represents 'avant-guard' thinking. All the information, which has been presented here, forms the basis of my treatment methodology, as well as reflects the dissemination of this knowledge through my international teaching experiences from 1993 - 2000. Reflection of thought, learning and striving for excellence are an ever evolving experience. Currently, I am adding references from research, which add further relevancy to thoughts and ideas, which at the time of writing, may merely have been an hypothesis based on abstract ideas, limited research and clinical reflection. Interestingly, three sections stand out, as having withstood the test of time. These are those on hormones, motor control and the neurophysiology of pain and inflammation. The section on immunology was written almost a decade before a plethora of research into the influence of this area on musculoskeletal conditions became apparent. The hormonal, immune and motor control sections were borne out of problems I encountered when treating elite and professional athletes. Whereas, the sections on biomechanics and neurophysiology of pain were a result of the inadequate explanations as to some of the stunning effects which our treatments techniques could achieve. The section on sarcopenia was written as a direct result of a question from a patient which I couldn't answer. Whilst the book on Whole Body Vibration was written to help out a friend. The clinical sections are somewhat extensive, and should be read in conjunction with the section on instructional design - clinical reasoning to fully understand why the various conditions are presented. Knowledge is forever evolving, and as such I hope that this website will continue to serve as a catalyst to, my own and my colleagues, clinical excellence.

Martin Krause 2012

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Funding, Advertising and Linking Policy

This site is set up as a free of charge service to the community. Back in Business Physiotherapy pays for all aspects of this website and does not endorse any paid advertising on this site. Back in Business Physiotherapy does have an affiliate program with Lunar pages who host this website. Additionally, the links to Human Kinetics and Amazon may result in Back in Business Physiotherapy receiving a small commission for precisely those books if purchased on those sites. Links to other sites are based on the relevance of that sites information to the principles of this websites desire to enhance the standards of Physiotherapy. Unless I am the author of the content of a linked site, these links are not based on reciprocal agreements. No banner adds or pop-ups should appear on your browser as a result of browsing this website. However, if you leave this website to a related one, Back in Business Physiotherapy cannot accept responsibility for neither changes in their contents nor their advertising or privacy policies.



 

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  • Thu 22 Dec 2016

    Ehlers Danlos Syndrome

    Is your child suffering Ehlers Danlos Syndrome? Hypermobile joints, frequent bruising, recurrent sprains and pains? Although a difficult manifestation to treat, physiotherapy can help. Joint Hypermobility Syndrome (JHS) When joint hypermobility coexists with arthralgias in >4 joints or other signs of connective tissue disorder (CTD), it is termed Joint Hypermobility Syndrome (JHS). This includes conditions such as Marfan's Syndrome and Ehlers-Danlos Syndrome and Osteogenesis imperfecta. These people are thought to have a higher proportion of type III to type I collagen, where type I collagen exhibits highly organised fibres resulting in high tensile strength, whereas type III collagen fibres are much more extensible, disorganised and occurring primarily in organs such as the gut, skin and blood vessels. The predominant presenting complaint is widespread pain lasting from a day to decades. Additional symptoms associated with joints, such as stiffness, 'feeling like a 90 year old', clicking, clunking, popping, subluxations, dislocations, instability, feeling that the joints are vulnerable, as well as symptoms affecting other tissue such as paraesthesia, tiredness, faintness, feeling unwell and suffering flu-like symptoms. Autonomic nervous system dysfunction in the form of 'dysautonomia' frequently occur. Broad paper like scars appear in the skin where wounds have healed. Other extra-articular manifestations include ocular ptosis, varicose veins, Raynauds phenomenon, neuropathies, tarsal and carpal tunnel syndrome, alterations in neuromuscular reflex action, development motor co-ordination delay (DCD), fibromyalgia, low bone density, anxiety and panic states and depression. Age, sex and gender play a role in presentaton as it appears more common in African and Asian females with a prevalence rate of between 5% and 25% . Despite this relatively high prevalence, JHS continues to be under-recognised, poorly understood and inadequately managed (Simmonds & Kerr, Manual Therapy, 2007, 12, 298-309). In my clinical experience, these people tend to move fast, rely on inertia for stability, have long muscles creating large degrees of freedom and potential kinetic energy, resembling ballistic 'floppies', and are either highly co-ordinated or clumsy. Stabilisation strategies consist of fast movements using large muscle groups. They tend to activities such as swimming, yoga, gymnastics, sprinting, strikers at soccer. Treatment has consisted of soft tissue techniques similar to those used in fibromyalgia, including but not limited to, dry needling, myofascial release and trigger point massage, kinesiotape, strapping for stability in sporting endeavours, pressure garment use such as SKINS, BSc, 2XU, venous stockings. Effectiveness of massage has been shown to be usefull in people suffering from chronic fatigue syndrome (Njjs et al 2006, Man Ther, 11, 187-91), a condition displaying several clinical similarities to people suffering from EDS-HT. Specific exercise regimes more attuned to co-ordination and stability (proprioception) than to excessive non-stabilising stretching. A multi-modal approach including muscle energy techniques, dry needling, mobilisations with movement (Mulligans), thoracic ring relocations (especially good with autonomic symptoms), hydrotherapy, herbal supplementaion such as Devils Claw, Cats Claw, Curcumin and Green Tee can all be useful in the management of this condition. Additionally, Arnica cream can also be used for bruising. Encouragment of non-weight bearing endurance activities such as swimming, and cycling to stimulate the endurance red muscle fibres over the ballistic white muscles fibres, since the latter are preferably used in this movement population. End of range movements are either avoided or done with care where stability is emphasized over mobility. People frequently complain of subluxation and dislocating knee caps and shoulders whilst undertaking a spectrum of activities from sleeping to sporting endeavours. A good friend of mine, Brazilian Physiotherapist and Researcher, Dr Abrahao Baptista, has used muscle electrical stimulation on knees and shoulders to retrain the brain to enhance muscular cortical representation which reduce the incidence of subluxations and dislocations. Abrahao wrote : "my daughter has a mild EDS III and used to dislocate her shoulder many times during sleeping.  I tried many alternatives with her, including strenghtening exercises and education to prevent bad postures before sleeping (e.g. positioning her arm over her head).  What we found to really help her was electrostimulation of the supraspinatus and posterior deltoid.  I followed the ideas of some works from Michael Ridding and others (Clinical Neurophysiology, 112, 1461-1469, 2001; Exp Brain Research, 143, 342-349 ,2002), which show that 30Hz electrostim, provoking mild muscle contractions for 45' leads to increased excitability of the muscle representation in the brain (at the primary motor cortex).  Stimulation of the supraspinatus and deltoid is an old technique to hemiplegic painful shoulder, but used with a little different parameters.  Previous studies showed that this type of stimulation increases brain excitability for 3 days, and so we used two times a week, for two weeks.  After that, her discolcations improved a lot.  It is important to note that, during stimulation, you have to clearly see the humerus head going up to the glenoid fossa" Surgery : The effect of surgical intervention has been shown to be favourable in only a limited percentage of patients (33.9% Rombaut et al 2011, Arch Phys Med Rehab, 92, 1106-1112). Three basic problems arise. First, tissues are less robust; Second, blood vessel fragility can cause technical problems in wound closure; Third, healing is often delayed and may remain incomplete.  Voluntary Posterior Shoulder Subluxation : Clinical Presentation A 27 year old male presented with a history of posterior shoulder weakness, characterised by severe fatigue and heaviness when 'working out' at the gym. His usual routine was one which involved sets of 15 repetitions, hence endurance oriented rather than power oriented. He described major problems when trying to execute bench presses and Japanese style push ups.  https://youtu.be/4rj-4TWogFU In a comprehensive review of 300 articles on shoulder instability, Heller et al. (Heller, K. D., J. Forst, R. Forst, and B. Cohen. Posterior dislocation of the shoulder: recommendations for a classification. Arch. Orthop. Trauma Surg. 113:228-231, 1994) concluded that posterior dislocation constitutes only 2.1% of all shoulder dislocations. The differential diagnosis in patients with posterior instability of the shoulder includes traumatic posterior instability, atraumatic posterior instability, voluntary posterior instability, and posterior instability associated with multidirectional instability. Laxity testing was performed with a posterior draw sign. The laxity was graded with a modified Hawkins scale : grade I, humeral head displacement that locks out beyond the glenoid rim; grade II, humeral displacement that is over the glenoid rim but is easily reducable; and grade III, humeral head displacement that locks out beyond the glenoid rim. This client had grade III laxity in both shoulders. A sulcus sign test was performed on both shoulders and graded to commonly accepted grading scales: grade I, a depression <1cm: grade 2, between 1.5 and 2cm; and grade 3, a depression > 2cm. The client had a grade 3 sulcus sign bilaterally regardless if the arm was in neutral or external rotation. The client met the criteria of Carter and Wilkinson for generalized liagmentous laxity by exhibiting hyperextension of both elbows > 10o, genu recurvatum of both knees > 19o, and the ability to touch his thumbto his forearm Headaches Jacome (1999, Cephalagia, 19, 791-796) reported that migraine headaches occured in 11/18 patients with EDS. Hakim et al (2004, Rheumatology, 43, 1194-1195) found 40% of 170 patients with EDS-HT/JHS had previously been diagnosed with migraine compared with 20% of the control population. in addition, the frequency of migraine attacks was 1.7 times increased and the headache related disability was 3.0 times greater in migraineurs with EDS-HT/JHS as compared to controls with migraine (Bendick et al 2011, Cephalgia, 31, 603-613). People suffering from soft tissue hypermobility, connective tissue disorder, Marfans Syndrome, and Ehler Danlos syndrome may be predisposed to upper cervical spine instability. Dural laxity, vascular irregularities and ligamentous laxity with or without Arnold Chiari Malformations may be accompanied by symptoms of intracranial hypotension, POTS (postural orthostatic tachycardia syndrome), dysautonomia, suboccipital "Coat Hanger" headaches (Martin & Neilson 2014 Headaches, September, 1403-1411). Scoliosis and spondylolisthesis occurs in 63% and 6-15% of patients with Marfans syndrome repsectively (Sponseller et al 1995, JBJS Am, 77, 867-876). These manifestations need to be borne in mind as not all upper cervical spine instabilities are the result of trauma. Clinically, serious neurological complications can arise in the presence of upper cervical spine instability, including a stroke or even death. Additionally, vertebral artery and even carotid artery dissections have been reported during and after chiropractic manipulation. Added caution may be needed after Whiplash type injuries. The clinician needs to be aware of this possibility in the presence of these symptoms, assess upper cervical joint hypermobility with manual therapy techniques and treat appropriately, including exercises to improve the control of musculature around the cervical and thoracic spine. Atlantoaxial instability can be diagnosed by flexion/extension X-rays or MRI's, but is best evaluated by using rotational 3D CT scanning. Surgical intervention is sometimes necessary. Temperomandibular Joint (TMJ) Disorders The prevelence of TMJ disorders have been reported to be as high as 80% in people with JHD (Kavucu et al 2006, Rheum Int., 26, 257-260). Joint clicking of the TMJ was 1.7 times more likely in JHD than in controls (Hirsch et al 2008, Eur J Oral Sci, 116, 525-539). Headaches associated with TMJ disorders tend to be in the temporal/masseter (side of head) region. TMJ issues increase in prevelence in the presence of both migraine and chronic daily headache (Goncalves et al 2011, Clin J Pain, 27, 611-615). I've treated a colleague who spontaneously dislocated her jaw whilst yawning at work one morning. stressful for me and her! Generally, people with JHD have increased jaw opening (>40mm from upper to lower incisors). Updated 18 May 2017  Read More
  • Fri 09 Dec 2016

    Physiotherapy with Sharna Hinchliff

    Physiotherapy with Sharna Hinchliff    Martin is pleased to welcome the very experienced physiotherapist Sharna Hinchliff to Back in Business Physiotherapy for one on one physiotherapy sessions with clients in 2017.  Sharna is a passionate triathelete and mother and has had several years experience working locally and internationally (New York and London) in the field of physiotherapy. Originally from Western Australia, Sharna graduated from the world renowned Masters of Manipulative Physiotherapy at Curtin University. read more Read More
  • Mon 07 Nov 2016

    Pilates – with Brunna Cardoso

    Pilates – with Brunna Cardoso Martin is pleased to welcome the bubbly Brunna Cardoso to Back in Business Physiotherapy for Pilates Classes in February 2017.  Brunno is an experienced pilates instructor and has had several years experience training with pilates instructors in Brazil. Read more Read More

Using Whole body Vibration in Physical Therapy and Sport


Funding, Advertising and Linking Policy

This site is set up as a free of charge service to the community. Back in Business Physiotherapy pays for all aspects of this website and does not endorse any paid advertising on this site. Back in Business Physiotherapy does have an affiliate program with Lunar pages who host this website. Additionally, the links to Human Kinetics and Amazon may result in Back in Business Physiotherapy receiving a small commission for precisely those books if purchased on those sites. Links to other sites are based on the relevance of that sites information to the principles of this websites desire to enhance the standards of Physiotherapy. Unless I am the author of the content of a linked site, these links are not based on reciprocal agreements. No banner adds or pop-ups should appear on your browser as a result of browsing this website. However, if you leave this website to a related one, Back in Business Physiotherapy cannot accept responsibility for neither changes in their contents nor their advertising or privacy policies.

image removed

Updated : 10 May 2014

No responsibility is assumed by Back in Business Physiotherapy for any injury and/or damage to persons or property as a matter of product liability, negligence, or from any use of any methods, products, instruction, or ideas contained in the material in this and it's related websites. Because of rapid advances in the medical sciences, the author recommends that there should be independent verification of diagnoses and exercise prescription. The information provided on Back in Business Physiotherapy is designed to support, not replace, the relationship that exists between a patient/site visitor and their treating health professional.

Copyright Martin Krause 1999 - material is presented as a free educational resource however all intellectual property rights should be acknowledged and respected