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FAQ - Frequently Asked Patient Questions

1.    Do I need a scan / X-Ray ?

A scan, in it's self, will not improve anyone's condition. The purpose of a scan is to gain more information about the pathology. Sometimes this information may be supurfaleous to the management of a patient's condition. For example, if you knocked your elbow on a door frame and suffered a bruise, which was already beginning to resolve, an ultrasound scan may show some minor soft tissue damage, but that was already obvious by the fact of the bruise, and the information gained from the scan has not helped nor changed the management of the bruise. Therefore, the main reason for getting a scan would be because there is concern that the presence of certain pathologies may lead to a change in the medical management. For example, sometimes a rolled ankle can be more than sprained ligaments, and may require surgey or immobilisation in a boot. If the therapists suspects this might be the case, then they will recommend or refer for a scan (probably an X-Ray) to check the integrity of the bones (especially the fibular and talar dome), because if there is no boney damage then the patient can be managed conservatively with taping, exercises, ultrasound, massage, joint mobilisations etc. However, if there is boney damage, for example, then it might be necessary for the ankle to be immobilised in a boot for six weeks, for example. This dramatically different medical management depends on the results of a scan, and it is therefore worth doing.

In summary, sometimes it is worthwhile getting a scan, because the information gained from that scan will determined the type of medical management that is employed. However, at other times, the scan may be unneccessary, because the information may be surpurfacelous or not lead to a change in medical management. You will be able to make this decision on the advice of your health care professional. On rare occasions it can actually be detrimental to get a scan done, because some patients can become overly obbessed with the medical terms used to describe their scan results, and that then can become the major focus of the patient, rather than their symptoms and functional abilities. For example, many people have  lumbar buldging discs yet have no symptoms, yet sometimes when these patients have an MRI or CT scan, they can develop symtoms because they think they should have pain if the scan says so! It is very important that the patient's symptoms are managed appropriately, and not added to by the additional, sometimes confusing, information supplied by a scan.

2.    My friend / relative had the same low back problem, am I going to end up like them?

There are many variables between patients, and each patient should be treated differently depending on their individual presentation. There are many structures within the lumbar spine, including discs, joints, nerves, muscles, tendons, fascia, other connective tissues and much more. Even if it is the same structure, for example a lunbar discs, there are several different discs which can give somewhat different symtoms, and there are different pathologies that can occur to discs, such as a broadbased disc buldge, a focal hernia, a disc buldge causing nerve root impingement or formaninal narrowing etc. Then there is the obvious difference in the severity of the pathology and symptoms.  Even if it is the same structure and the same pathology and with the same severity, which would be extremely unlikely, but possible there are other variables such as the muscular length and strength of the sorrounding and supporting structure, which plays a massive role in the patient's symptoms. Then there are the more obvious differences between patients, such as age, gender (which is important because of the anatomical differences between the male and female pelvis), history of previous low back pain, posture, weight, other medical issues (some chronic systemic conditions affect healing rates), fitness, previous medical treatments (for example past prolonged steroid use can affect healing rates, or past chemotherapy or radiotherapy can affect healing rates). Hopefully by now, you can see that every patient's presentation is as unique as people are different. It is impossible that one person's experience of low back pain will be the same as another's. There may be similarities, but it is much more likely that there will be more differences than similarities. Your physiotherapist will be able to assess most of these issues, and perscribe a treatment program to addesss these issues specific to each patient. For example some patients with low back pain may benefit from joint mobilisation and lumbar rotation stretches, whilst others may be better having a sacro-iliac brace and glut strengthening exercises. Sometimes the symtoms for these two very different conditions can appear superficially to be very similar, yet your physiotherapist will be able to differentiate and determine the most evidenced-based treatments that will get the best outcome for you.

3.    Are flexible muscles weak? Or are tight muscles strong?

Muscle length and muscle strength are two separate variables. If a muscle is strong, it may be flexible or not. If a muscle it tight, it may be weak or strong. The two factors are pretty well independent.

In fact, a muscle can be strong in one position, but not in another. For example, the rotator cuff muscles might be fully functional and strong with the arm by the side, what we call the neutral position, but then if the arm is above the head, then those same muscles might not be as strong. This specific muscle testing in different positions is essential to perscribe the best possible exercsies for each patient indiidually. Another common example, is after a rolled ankle many patients are given ankle strengthening exercises where the patient moves the ankle sideways with a elastic band around the toes. This is a great strengthening exercise, but it is almost irrelevant to how the ankle normally functions, because in normal daily life the foot is on the ground and the patient is moving on top of a fixed foot (eg when walking or climbing stairs or jumping etc), however this exercise has the patient fixed and the foot moving freely. To properly rehabiliate an rolled ankle the exercises need to be progressed to doing some work with the foot fixed on the ground and the patient moving on top of the foot against some resistance. There are many creative and functional ways to do this, and your physiotherapist can show you how.

Alternatively, sometimes different parts of one muscle can be tight, but not the whole muscle, Sometimes this can be within a muscle where most of the fibres are running in different directions, such as the glut max, where the lowest muscle fibres are running at right angle to the most upper muscle fibres within the same muscle. Here it is obvious why one portion of the muscle can get tight, whilst another portion has maintained it's flexibility, because the different fibres have slightly different functions, and therefore can be affected differently by different activities, pathologies or demands placed on the muscles. Sometimes, there are muscles where the fibres are running in almost identical directions, such as the supraspinatus muscle, but along the length of the muscle there can be a tight band, whilst the rest of the muscle remains flexible. Sometimes patients called these tight bands, trigger points or knots or spasms or lumps or tightness. In each of the above cases different treatment techniques are required. Sometimes, for example, someone might be stretching their gluts, but to no good effect, but by simply making a small adjustment to the angle they are stretching or the position they are stretching in, then you can target different muscle fibres and gain a more effective stretch, and your physiotherapist will be able to show you how to do this.

4.    I have been stretching my hamstrings for years, but I still can't touch my toes. Why not?

There could be many different reasons for this, and it is most likely to be a combination of these reasons. Firstly, it may simply be because your stretching technique is insufficient to poduce the results you are after, with the most common mistakes being dossage issues, such as not holding the stretch for long enough or not performing the stretch frequently enough. Another common mistake is the stretching technique it's self, where the patient may not even be getting their hamstrings on stretch, despite feeling a lot of 'pulling' in the posterior leg. It may be that the patient is actually stretching their sciatic nerve, rather than their hamstring muscle, and sometimes this can be very difficult to differentiate between, but your physiotherapist will be able to differentiate out which is happening and what action should be taken to address this isssue. Secondly, it may not be the hamstring muscle which is limiting your flexibility, for example the gastrocnemius muscle might be restricting the amount of knee extension, or more likely the gluts might be limited the amount of hip flexion you can get. Alternatively, it might not be a muscle at all, and perhaps the lumbar or thoracic spine is stiff and restricting how far you can bend forwards. However, the most likely reason for patients to complain of posterior thigh tightness, which cannot be relieved by hamstring stretching is actually because of neural tension. The sciatic nerve runs alongside of the hamstring muscle, and some portions of the sciatic nerve actually insert into the hamstring muscle. It is highly unlikely that the sciatic nerve can change it's length in a fully grown adult, but it is definitely possible for the nerve to improve it's mobility, and therefore change your flexibility. The way to do this is with neural mobilisation exercises, and again, your physiotherapist can advise you on the best of many different ways to do this, that is specific to your functional limitations. This is particularly important for those people who require flexible hamstrings, such as AFL footballers, rowers and ballet dancers.

5. Basic similarities and differences between Physiotherapy, Chiropractic and Osteopathy

Therapy for the back or spine comes in various forms, shapes and sizes with many different advocates giving advice deciding between a Physiotherapy, Osteopathy, or Chiropractor. Frequently as a physiotherapist we are asked what osteopaths and chiropractors do. As all three hold important differences related to how practitioners devise treatment plans it may be worth summarising the basic similarities and differences.

Chiropractors and Osteopaths can be considered similar in the sense that both have a primary treatment strategy involving joint manipulations. However, there are some differences in their levels of training and the core ideas that revolve around how diagnosis is made for each individual patient. Chiropractors are influenced mainly by the body’s nervous system, while Osteopaths focus on organs, muscles and connective tissues. The chiropractic profession evolved out of the east coast of the USA, whereas osteopathy continued to be developed in the UK.

Both Chiropractors and Osteopaths have a unique perspective on how the spine performs and are known for successfully treating back issues. Chiropractors are generally licenced to use X-rays for one’s initial consultation and will likely start with an assessment, then massage by a masseur and finally an adjustment by a manipulation of the spine as a part of treatment. They aim is to correct the peripheral nervous system through the correction of spinal alignment which allows the improvement in how one moves and responds to sensations. Much like Osteopathy and Physiotherapy, a Chiropractic doctor will remind patients of how important nutrition and exercise is for keeping the back healthy and to reduce pain that may be problematic in the future. Chiropractic doctors are known as the least holistic of the three, but many have been known to offer lifestyle suggestions and have taken on naturopathic qualifications.

A Physiotherapist is likely to start with how one may heal back injuries with modifications to an unhealthy lifestyle. Physiotherapists restore joint movement and help patients with recovery following surgery with fewer amounts of hands on therapy than that of a Chiropractor. Emphasis on exercise therapy is likely with a Physiotherapist as their main focus is on self managed movement strategies to prevent recurrences and chronicity of the condition. Some APA titled musculoskeletal physiotherapists manipulate. However, generally, the Physiotherapeutic process makes use of manual therapy in the form of joint mobilisations (derived from osteopathic techniques) as well as massage, dry needling, muscle energy techniques, taping and motor control strategies educating the client on how the muscles and joints work together. Moreover, in the presence of disc pathology and nerve irritation and compression, the use of spinal manipulation is contra-indicated in the physiotherapy world. Additionally, many physiotherapists don’t manipulate the upper cervical spine, due to the inherent danger to the vertebral artery, which if damaged could result in stroke or even death.

The aim across all professions is to reduce muscle spasms, which reduces joint and disc compression, however the physiotherapist aims to restore the activity in the muscles that act as slings across the joint. Some of these muscle slings are considered mobilizers whilst others are considered stabilisers. Another consideration in physiotherapy is whether the client falls into a category of ‘stiffy’ (hypomobility) or ‘floppy’ (hypermobility). Floppies tend to have ballistic muscle functionality, whereas stiffies tend to be slow twitch endurance type characters. It’s typical for a Physiotherapist to help the patient heal by focusing on the balance of the muscles, core strength, the patients’ strength and overall stability. Physiotherapy has a holistic viewpoint and uses a variety of drug free techniques to aid in the relief and prevention of chronic pain.
Osteopathy is similar to Physiotherapy in the way that both practitioners have been considered to take a gentler approach than that of a traditional Chiropractor. Osteopathy places a lot of emphasis on internal organ function. Some spinal adjustments may be used during treatment, but only with the most careful and precise movements of one’s joints. Osteopaths have a reputation for treating back, neck and shoulder pain and often utilize a range of alternative healing techniques. Osteopaths have a belief that the body has natural healing abilities and it’s vital for one to live a lifestyle that promotes optimum health. Osteopathy encourages treatment in a holistic manner for the client to return to proper function. The Osteopath seeks to provide symptomatic relief, but also addresses whatever the underlying cause of pain may be. Osteopaths use gentle and effective techniques such as stretching, joint mobilisation, massage and manipulation to skillfully address the significant biomechanical dysfunctions in your body that relate to your complaint.

Chiropractors, Physiotherapists, and Osteopaths all believe that the integrity of the spine is important for optimal health, with the main differences, of the three, lying in the reasoning and professional knowledge which defines the specific style of treatment for each and every patient. Finally, both chiropractors and osteopaths treat neonates and very young children with spinal adjustments whereas physiotherapists generally do not.

6. Preferred provider agreements

BUPA and its subsidiaries which include HBA, Mutual Community and MBF have for a long time referred to practitioners who have agreed to their fee structure of remuneration as 'preferred providers'. This is misleading, as the term appears to confer some special skills, knowledge, expertise to these 'preferred providers' which in most cases isn't so. In fact, with practitioners agreeing to a lesser form of remuneration they are not only undermining the value of their treatment, they are also potentially involved in price fixing and collusion, which probably could be seen as an anti-competitive act which, may come under the auspices of the ACCC. Each individual practice has different operating costs and should be allowed to charge accordingly. Additionally, the health fund rebate is based on 20 minute consultations, which, in a practice like ours, with 40 minute consults, makes the entering into an agreement, an impossible one. Never-the-less, it should be noted, just because we aren't 'preferred providers' doesn't mean that you won't get a rebate on our services. In fact, these health funds rebate anywhere from $22.- up to $112.- for our services. You should contact your health fund directly to ascertain your precise level of cover.

Updated : 31 December 2013

alt Cost : Initial consultations with Martin $135.00, whereas with Jo it is $125.00; with follow-up appointments costing $95.00. All standard consultation times are approximately 40 minutes. Seniors and Full-Time students receive a very generous discount. If you are a member of a health fund you can claim your rebate immediately using our ISoft - IBA Health rebate system. Rebates will vary depending on your health fund and level of coverage. If you have an Enhanced Primary Health Care referral from your GP you will be eligible for a medicare rebate, which we can process at the time of consultation.

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OUR PHYSIOTHERAPISTS HAVE HIGHLY REGARDED POST-GRADUATE QUALIFICATIONS
AND WORK AT THE CUTTING EDGE OF MUSCULOSKELETAL SERVICES.

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Corner of Mount and Walker streets. Suite 201, 107, Walker Street,
North Sydney 2060. Phone: 9922 6806

5 minutes walk from North Sydney station at the heart of the CBD.

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Treatment, Prevention, Education

 

 


 

Trending @ Back in B Physio

  • 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

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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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